infections of newborns

Question 1

how do you tx congenital toxoplasmosis?

Answer 1

requires year of pyrimethamine and **sulfadiazine **

Question 2

best way to make congenital toxoplasmosis dx?

Answer 2

serology

Question 3

what is the most common perinatal infection?

Answer 3

cytomegalovirus

Question 4

5-17% of newborns with asympomatic congenital CMV infection develop _______?

Answer 4

neurological sequelae (esp hearling loss)

Question 5

should you order TORCH titers in the diagnosis of perinatal HSV?

Answer 5

NO. they are of no vaule

Question 6

intracranial calficications (2 bugs)

Answer 6

toxo

CMV

Question 7

cataracts (2 bugs)

Answer 7

rubella, HSV

Question 8

chorioretinitis (2 bugs)

Answer 8

Toxo, CMV

Question 9

bone lesions (2 bugs)

Answer 9

syphillis, rubella

Question 10

congenital heart disease

Answer 10

rubella

Question 11

microcephaly

Answer 11

CMV

Question 12

hydrocephalus(which bug?)

Answer 12

toxo

Question 13

vesicles associated with which 3 bugs

Answer 13

HSV, VZV, syphillis

Question 14

how do you detect sphyllis?

Answer 14

dark field microscopy

Question 15

describes what? Paler, thicker and larger than normal

Focal villositis with endovascular and perivascular proliferation

Answer 15

placenta of sphyllis

Question 16

Dermatologic changes – copper rash associated with which disease?

Answer 16

congenital syphyllis -early manifestation

Question 17

these are examples of:

Notched IncisorsTeeth
Eighth nerve deafness
Interstitial keratitis
Rhagades
Neurologic involvement
Clutton’s joints and sabre shins

Answer 17

late features of congenital sphyllis

Question 18

radiologic features of syphillis

wide spread bony invovlement

Answer 18

metaphysitis

periostits

pathologic features

cortica thickening

Question 19

what is wimberg’s sign?

Answer 19

x-ray changes, moth eaten appearance at the upper end of the tibia

Question 20

characterized by mental retardation, microcephaly, cataracts, deafness, intrademral erythropoiesis(blueberry muffin apperance)

Answer 20

congenital rubella

Question 21

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?

Answer 21

congenital toxoplasmosis

chorioretinitis, hydrocephalus, intracranial calcifications

Question 22

negative serology in mom +/- baby essentially excludes what?

what should mothers avoid?

Answer 22

dx of congenital toxoplasmosis

cat litter exsposure, undercooked beef

Question 23

all are examples of :

Multiorgan involvement
Non-immune hydrops
Hepatosplenomegaly
Bone involvement - periostitis
Cartilage involvement - snuffles
Pneumonia
Dermatologic changes – copper rash

Answer 23

clinical features of early syphillis

Question 24

t/f. infants with syphyliss are asymptomatic at birth?

Answer 24

true

Question 25

pathologic fractures associated with which neonatal infection?

Answer 25

congenital syphillis

Question 26

Late cortical thickening

Answer 26

syphyllis

Question 27

why does Concurrent maternal infection of T. pallidum and HIV lead to higher rate of fetal syphilis infection?

Answer 27

cellular immune dysfunction may permit higher treponemal proliferation HIV-infected women may not respond well to recommended therapy

Question 28

Untreated syphilis during pregnancy complicated by HIV infection causes higher rates of\_\_\_\_\_\_\_\_\_

Answer 28

Untreated syphilis during pregnancy complicated by HIV infection causes higher rates of **_fetal HIV infection_**

Question 29

Tests to detect antibodies to cardiolipin(2)

Answer 29

Venereal disease research laboratory (VDRL) Rapid Plasma Reagin (RPR)

Question 30

Mother’s serological status has to be determined prior to discharge for which condition?

Answer 30

syphyllis

Question 31

what are Tests to detect antibody to T. Pallidum?

Answer 31

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

Question 32

prenatal management of syphyllis how often do you screen? which populations?

Answer 32

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

Question 33

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

Answer 33

prenatal management of congenital syphyllis

Question 34

how do you treat infant with penicillin?

Answer 34

**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

Question 35

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

Answer 35

The risk of transmission is \<1% if mother’s viral load is undetectable at the time of delivery

Question 36

in congenital HIV infection: how do you dx? what is the value of serolog?

Answer 36

The risk of transmission is \<1% if mother’s viral load is undetectable at the time of delivery serology is of little value

Question 37

Infants of HIV+ mothers are asymptomatic at birth but placed on AZT until proven negative by ______ DNA PCR tests, done\_\_\_\_\_ weeks apart

Answer 37

Infants of HIV+ mothers are asymptomatic at birth but placed on AZT until proven negative by **two** DNA PCR tests, done **6** weeks apart

Question 38

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)

Answer 38

congenital toxoplasmosis I

Question 39

what is the best way to make dx of congenitan toxoplasmosis?

Answer 39

**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)

Question 40

what % of CMV infections contracted congenitally? natally? postnatally?

Answer 40

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: **congenita**l: 0.6-2.4% live births **natal:** 2-6% neonates **postnatal:** up to 14-21% of neonates!!

Question 41

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)

Answer 41

congenital CMV infections

Question 42

symptoms of congenital infection? Jaundice (62%) Petechiae (58%) Hepatosplenomegaly (50%) IUGR (33%); Preterm (25%) Microcephaly (21%) Chorioretinitis (12%) Fatal outcome (4%)

Answer 42

Symptomatic Congenital CMV Infection

Question 43

which symptoms do infants with CMV have?

Answer 43

\>90% of newborns with symptomatic congenital CMV infection have visual, audiologic and/or other neurological sequelae

Question 44

- 5-17% of newborns with asymptomatic congenital CMV infection develop \_\_\_\_\_\_\_\_

Answer 44

- 5-17% of newborns with asymptomatic congenital CMV infection develop **_neurological sequelae (esp. hearing loss) _**