Infectious Disease Flashcards
CMV
Clinical symptoms
DS DNA herpes virus
Mono like syndrome with fever, chills, myalgias, malaise, abnormal liver function tests, lymphadenopathy
Clinical findings of congenital CMV
Chorioretinitis Microcephaly IUGR Mental retardation Abdominal , liver, Cerebral calcifications
** most common congenital infection**
What is the typical sequelae of secondary CMV infection
Congenital hearing loss
What is parvovirus B 19
What are clinical manifestations?
SS DNA virus that replicates in bone marrow
Children may have facial rash, slapped cheek, fever, body rash, joint pain
In adults, reticular rash on trunk, peripheral arthropathy, aplastic crisis. Most are asx
Fetal effects of Parvovirus
SAB HYDROPS* (most often from aplastic anemia but can result from heart failure, chronic fetal hepatitis) Periventricular calcifications STILLBIRTH MYOCARDITIS
Increased risk of Neurodevelopmental impairment in fetuses with hydrops
Need weekly US for 2 mo after exposure
US findings of congenital CMV
Abdominal and liver calcifications HSM Bowel or kidneys, echogenic Ascites Intracranial calcifications Microcephaly Cerebral ventriculomegaly
What are the signs of congenital varicella
When is the risk highest
Skin scarring
Limb hypoplasia
Chorioretinitis
Microcephaly
Second trimester, 2%
Ultrasound findings suggestive of congenital varicella
Hydrops, cardiac malformation, microcephaly, growth restriction
Limb deformities
What is the greatest Maternal threat with varicella
Up to 20% of pregnant patients with varicella develop varicella pneumonia which has a 40% mortality rate
Manifestations of congenital rubella syndrome
Eyes- Cataracs, retinopathy Heart- PDA Deafness Microcephaly Neurologic, Behavioral disorders and mental disability
Risk of infection is highest if exposure is less than 11 weeks
Treatment for Toxo
Pregnant women: spiramycin
Fetus: pyrimethamine, sulfadiazine, folinic acid
When is risk of CMV transmission highest?
Most severe?
Third tri
More serious sequelae after 1st tri infection
What is Toxo?
Sxs?
Intercellular parasite
Asx cervical LAD, Fever, malaise, night sweats, HSM
Neonatal sequelae of Toxo
Chorioretinitis
Hearing loss
Developmental delay
Visual impairment
HIV-status unknown presenting in labor
Rapid testing Negative result is not definitive If positive, treat without waiting for confirmatory testing Deliver for CD if SROM HAS NOT occurred Postpone breastfeeding until confirmed
Route of delivery for HIV
VL >1000 CD 38w
<1000 vag del
No need to admin Zidovudine if VL consistently <1000 in third tri AND pt is taking cART
VL unknown and SROM has not occurred CD
Classic triad for Toxo
Chorioretinitis
Hydrocephalus
Intracranial calcifications
Diagnostic criteria for intra-amniotic infection
Treatment
38-38.9
Plus fetal tachy for 10 min
Leukocytosis 15K
Purulent cervical d/c
OR
fever 39 C
Amp/gent
Mild PCN al: an ancef//gent
SEVERE: Gent /clinda or Vanc
Alt: unasyn zosyn
Administer one additional dose of antibiotics after cesarean plus Clinda or metronidazole to cover anaerobes
Maternal treatment for varicella
Fetal treatment
Acyclovir oral
Varicella zoster Immunoglobulin should be given to infants of women who develop varicella 5 days before to 2 days after delivery
If sxs, treat with IV acyclovir
Pre-exposure prophylaxis for HIV
Tenofovir
Emtricitabine
Intrapartum antiretroviral therapy
Zidovudine 2mg/kg 3 hours before CD then 1 mg/kg/h
Not necessary if VL less than 50
Mortality rate for hepatitis D
25%
Hepatic failure
Co-infection with Hep B
What is the leading cause of chronic liver disease in the United States
Worldwide?
Hepatitis C
Hepatitis B
Is breast-feeding contraindicated and women chronically infected with hepatitis B
Not as long as the infant received HBIG and vaccine
Not contraindicated with Hep C
Treatment for hepatitis B
Tenofovir preferred
Lamivudine
Treatment for Hep C
Ribavirin
Contra-indicated in pregnancy
Treatment for newborns of Hep B pt
HBIG
and hepatitis B vaccine within 12 hours of birth
Characteristics of early congenital syphilis
Less than two years of age
HSM, desquamating skin rash, osteochondritis, anemia, thrombocytopenia
Characteristics of late congenital syphilis
> 2 yrs of age
Hutchinson’s triad: notched teeth, deafness, interstitial keratitis
Developmental delay, seizures, nerve palsy’s also may occur
Treatment for congenital syphilis
Aqueous PCN G 18-24 million u/d IV For 10-14d
Characteristics of primary syphilis
Three weeks after infection
Painless chancre, lymphadenopathy
Clinical manifestations of secondary syphilis
4-10w after appearance of chancre
Maculopapular skin rash, Mucosal lesions, genital condyloma, generalized LAD
Malaise, arthralgia, fever
Treatment for primary and secondary and latent syphilis
2.4 million units IM PCN G
Two weekly doses for primary and secondary
Three weekly doses for latent
Placenta manifestations of syphilis
And gross examination, large, pale, hydropic
Micro examination, enlarged terminal villi, chronic villitis, Hofbauer cells
Direct and indirect diagnostic test for syphilis
Direct detection
Darkfield microscopy
PCR
OR
Serological tests
Nontreponemal
RPR
VDRL
TREPONEMAL
fluorescent treponemal antibody
Absorption
T. Palladium particle agglutination
Adverse pregnancy outcomes of congenital syphilis
Stillbirth Preterm birth IUGR HYDROPS polyhydramnios Neonatal mortality
Treatment after exposure to syphilis
Treatment for a presumed early syphilis is recommended for women exposed to a partner with primary, secondary or early late and syphilis in the past 90 days
Jarisch-Herxheimer reaction
Acute febrile reaction characterized by myalgia, fever, headache, possible preterm labor and fetal heart rate tracing abnormalities
Definition of adequate treatment response to syphilis
Fourfold decline in non-treponemal titers within 6 to 12 months after therapy
When should re-infection but I suspect
RPR titer 1:8 or greater
