infections of newborns Flashcards
how do you tx congenital toxoplasmosis?
requires year of pyrimethamine and **sulfadiazine **
best way to make congenital toxoplasmosis dx?
serology
what is the most common perinatal infection?
cytomegalovirus
5-17% of newborns with asympomatic congenital CMV infection develop _______?
neurological sequelae (esp hearling loss)
should you order TORCH titers in the diagnosis of perinatal HSV?
NO. they are of no vaule
intracranial calficications (2 bugs)
toxo
CMV
cataracts (2 bugs)
rubella, HSV
chorioretinitis (2 bugs)
Toxo, CMV
bone lesions (2 bugs)
syphillis, rubella
congenital heart disease
rubella
microcephaly
CMV
hydrocephalus(which bug?)
toxo
vesicles associated with which 3 bugs
HSV, VZV, syphillis
how do you detect sphyllis?
dark field microscopy
describes what? Paler, thicker and larger than normal
Focal villositis with endovascular and perivascular proliferation
placenta of sphyllis
Dermatologic changes – copper rash associated with which disease?
congenital syphyllis -early manifestation
these are examples of:
Notched IncisorsTeeth
Eighth nerve deafness
Interstitial keratitis
Rhagades
Neurologic involvement
Clutton’s joints and sabre shins
late features of congenital sphyllis
radiologic features of syphillis
wide spread bony invovlement
metaphysitis
periostits
pathologic features
cortica thickening
what is wimberg’s sign?
x-ray changes, moth eaten appearance at the upper end of the tibia
characterized by mental retardation, microcephaly, cataracts, deafness, intrademral erythropoiesis(blueberry muffin apperance)
congenital rubella
more severe disease associated with transmission in 1st semester disease(v. last trimester)
cases often associated with: hydrocephalus, chorioretinitis, juandice, splenomegaly, intracranial calcifications(diffuse)
what is the classic triad of this condition?
congenital toxoplasmosis
chorioretinitis, hydrocephalus, intracranial calcifications
negative serology in mom +/- baby essentially excludes what?
what should mothers avoid?
dx of congenital toxoplasmosis
cat litter exsposure, undercooked beef
all are examples of :
Multiorgan involvement
Non-immune hydrops
Hepatosplenomegaly
Bone involvement - periostitis
Cartilage involvement - snuffles
Pneumonia
Dermatologic changes – copper rash
clinical features of early syphillis
t/f. infants with syphyliss are asymptomatic at birth?
true
pathologic fractures associated with which neonatal infection?
congenital syphillis
Late cortical thickening
syphyllis
why does Concurrent maternal infection of T. pallidum and HIV lead to higher rate of fetal syphilis infection?
cellular immune dysfunction may permit higher treponemal proliferation
HIV-infected women may not respond well to recommended therapy
Untreated syphilis during pregnancy complicated by HIV infection causes higher rates of_________
Untreated syphilis during pregnancy complicated by HIV infection causes higher rates of fetal HIV infection
Tests to detect antibodies to cardiolipin(2)
Venereal disease research laboratory (VDRL)
Rapid Plasma Reagin (RPR)
Mother’s serological status has to be determined prior to discharge for which condition?
syphyllis
what are Tests to detect antibody to T. Pallidum?
TPI- T. pallidum immobilizing test
FTA-ABS – flurosecent treponemal antibody
TP-PA- particle agglutination test
MHA-TP- microhemagglutination test
ELISA – IgG and IgM antibody tests
prenatal management of syphyllis
how often do you screen?
which populations?
Mandatory screening during pregnancy by serum RPR at least once
Should be done twice especially in high risk population
Drug use
HIV positive
Poor socio-economic status
Teenage pregnancy
Other STDs
High prevalence areas
describes which disease?
Single dose of benzathine penicillin
Repeat doses weekly x 2 for HIV +
Follow titers during pregnancy and document four-fold drop in titers
Re-treatment anytime there is a four fold increase
Treatment of the partner
prenatal management of congenital syphyllis
how do you treat infant with penicillin?
Procaine Penicillin 50,000 u/kg, IM for 10 days
Aqueous Penicillin 50,000u/kg, IV every 12 hours for 10 days
Benzathine Penicillin single dose IM
Only if guaranteed follow-up because inadequate CNS treatment
Congenital HIV infection is a preventable disease–maternal screening is the key
The risk of transmission is ______if mother’s viral load is undetectable at the time of delivery
The risk of transmission is <1% if mother’s viral load is undetectable at the time of delivery
in congenital HIV infection:
how do you dx?
what is the value of serolog?
The risk of transmission is <1% if mother’s viral load is undetectable at the time of delivery
serology is of little value
Infants of HIV+ mothers are asymptomatic at birth but placed on AZT until proven negative by ______ DNA PCR tests, done_____ weeks apart
Infants of HIV+ mothers are asymptomatic at birth but placed on AZT until proven negative by two DNA PCR tests, done 6 weeks apart
which condition?
Under-recognized in U.S.–especially milder cases (which are the majority)
Transmission more common late in pregnancy, but more severe disease associated with 1st trimester transmission
Severe cases often with hydrocephalus, chorioretinitis, jaundice, splenomegaly, intracranial calcifications (diffuse)
congenital toxoplasmosis I
what is the best way to make dx of congenitan toxoplasmosis?
Serology is currently the best way to make the diagnosis, BUT commercially available assays not reliable
note: Negative serology in mom and/or baby essentially excludes the Dx
Positive titers require confirmation by reference lab (Palo Alto, CA)
what % of CMV infections contracted congenitally? natally? postnatally?
CMV infections are highly prevalent in neonates, and are probably more common than all other perinatal infections combined
CMV infections can be acquired in utero, natally, or postnatally–and frequently are:
congenital: 0.6-2.4% live births
natal: 2-6% neonates
postnatal: up to 14-21% of neonates!!
which condition?
Most (>90%) asymptomatic
Primary maternal infection leads to fetal infection in 30-50% of cases–10-15% of these have overt clinical disease
Secondary maternal infection less likely to lead to fetal infection (1-2% ) but can do so and may lead to severe disease (Boppana et al, NEJM 2001, 344: 1366)
congenital CMV infections
symptoms of congenital infection?
Jaundice (62%)
Petechiae (58%)
Hepatosplenomegaly (50%)
IUGR (33%); Preterm (25%)
Microcephaly (21%)
Chorioretinitis (12%)
Fatal outcome (4%)
Symptomatic Congenital CMV Infection
which symptoms do infants with CMV have?
>90% of newborns with symptomatic congenital CMV infection have visual, audiologic and/or other neurological sequelae
- 5-17% of newborns with asymptomatic congenital CMV infection develop ________
- 5-17% of newborns with asymptomatic congenital CMV infection develop _neurological sequelae (esp. hearing loss) _