Infections in Early Life

Question 1

Important congenital infections (TORCHES):

Answer 1

Toxoplasmosis
Other (VZV)
Rubella
Cytomegalovirus
Herpes simplex, Hepatitis B/C, HIV
Enteroviruses
Syphilis

Question 2

Congenital rubella syndrome (CRS):

Answer 2

Presents as: Blotchy rash, retinal damage

May lead to: hearing impairment, heart defects, PDA, microcephaly, cataracts, low birth weight

Question 3

Mother-to-child HIV infection:

Answer 3

Breastfeeding (35-40% of cases)
Labor and Delivery (35-40% of cases)
Pregnancy (10-25% of cases)
Risk to fetus during pregnancy/labor/delivery: 25%
Risk to fetus during breastfeeding: 20-25%

Question 4

Neonatal HSV disease:

Answer 4

Presents as: disseminated disease (sepsis-like, jaundice, coagulopathy, pneumonia, VERY HIGH MORTALITY), CNS disease (seizures, lethargy, fever), skin-eye-mouth disease (vesicles in skin, mouth, or conjunctivitis/keratitis), or congenital (vesicles, scaring of skin, brain damage, microcephaly, VERY SEVERE MORBIDITY).

Question 5

Neonatal respiratory infections:

Answer 5

Respiratory syncitial virus (RSV), parainfluenza virus, influenza, human metapneumovirus

Question 6

SECRETORY otitis vs. acute SUPPURATIVE otitis:

Answer 6

Secretory otitis - transudate with negative pressure in middle ear
Acute suppurative otitis - purulent exudate with positive pressure in middle ear (bulging of the tympanic membrane). Almost always BACTERIAL.

Question 7

Etiology of acute suppurative otitis:

Answer 7

Streptococcus pneumoniae
Hemophilus influenza
Moraxella catarrhalis

Question 8

Treatment of acute suppurative otitis:

Answer 8

First-line: Amoxicillin
For resistant Strep pneumo: Amoxicillin/clavulanate
Penicillin allergy: Clindamycin or azithromycin
Otitis media is the most common reason for antibiotic therapy for young children in the US. Most common in first two years of life.

Question 9

Most common cause of sensorineural hearing loss in infancy:

Answer 9

CMV infection (although 90% of infections are asymptomatic)

Question 10

Treatment for neonatal HSV:

Answer 10

All cases of presumptive neonatal HSV should be treated with IV acyclovir. Suppressive acyclovir also reduces the frequency of lesions in the mother, but there is no data to suggest that it reduces the risk of neonatal herpes.

Question 11

Group B streptococcus in infants:

Answer 11

Frequently colonizes maternal genital tract. SCREENING for GBS at 35-37 weeks gestation.
Early onset (<7 days after birth): pneumonia, sepsis, meningitis
Late onset (7-89 days of life): sepsis, meningitis

Question 12

Causes of obstructed eustachian tube:

Answer 12

1) viral URI
2) allergy
3) hypertrophied tonsils or adenoids
4) cleft palate

Question 13

Complications of CHRONIC SUPPURATIVE OTITIS MEDIA:

Answer 13

Facial nerve paralysis
Mastoiditis (brain abscess)
Osteomyelitis of petrous ridge of temporal bone (petrositis)
Venous sinus thrombosis

Question 14

Classification of otitis media:

Answer 14

Otitis media with effusion/secretory otitis media (OME)
Persistent secretory otitis media
Acute suppurative otitis media (AOM)
Chronic suppurative otitis media