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Pediatrics > Lecture 4: Congenital Infections > Flashcards

Lecture 4: Congenital Infections Flashcards

1
Q

What characterizes a congenital infection?

A
  • Growth retardation
  • Congenital malformation
  • Fetal loss
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2
Q

What are the ToRCHeS VP infections?

A
  • TOxoplasmosis
  • Rubella
  • CMV
  • HIV
  • HErpes
  • Syphilis
  • Varicella
  • Parvo

Hep

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3
Q

What kind of pathogen is toxoplasmosis?

A

Protozoan, toxoplasma gondii

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4
Q

When is toxoplasmosis screening indicated?

A
  • High index of suspicion + significant cervical LAN and high fever
  • US of fetus shows calcifications or effusions
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5
Q

What risk factors are associated with toxoplasmosis transmission for maternal to fetal?

A
  • Maternal infection at advanced gestational age
  • High parasite load
  • Cat feces more infective than meat
  • Maternal immunocompromised
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6
Q

What are the S/S of congenital toxoplasmosis infection?

A
  1. Cataracts/chorioretinitis
  2. Calcifications in brain
  3. Hearing loss
  4. Anemia
  5. Seizures
  6. Hydrocephalus
  7. Microcephaly
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7
Q

What is the typical lesion seen in congenital toxoplasmosis?

A

Focal necrotizing retinitis

Cataracts/chorioretinitis is the primary sign of congenital toxo

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8
Q

How is congenital toxoplasmosis diagnosed?

A
  • ELISA
  • CT/XRAY showing diffuse cortical calcifications
  • IgM will appear within 1 week
  • IgG Ab will appear after 2 weeks and persist.
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9
Q

How is congenital toxoplasmosis treated?

A
  • < 14wks gestation = spiramycin
  • > 14wks gestation = pyrimethamine + Sulfadiazine + folic acid

TREAT MOTHER

Young SPYro the dragon
PYRo and SULFur are FOUL

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10
Q

If a infant is diagnosed with congenital toxoplasmosis prenatally, what is the postnatal tx?

A
  • Pyrimethamine + sulfadiazine + folinic acid for 1 yr
  • Must treat even if mother was not treated
  • Eye exams every 3 months until 18 months.

Same as mom’s tx after 14wk gest

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11
Q

How do we prevent toxoplasmosis?

A
  • No raw meat or exposure
  • Avoid cat litter
  • Wash stuff
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12
Q

What is rubella also known as?

A

German measles

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13
Q

What is the main concern with congenital rubella infection?

A

High risk of fetal death or preemie stillborn

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14
Q

What are the two main infections that lead to miscarriage?

A
  • Toxoplasmosis
  • Rubella
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15
Q

What are the findings associated with congenital rubella?

A
  • Blueberry muffin syndrome (bluish hue with purpura
  • Ophthalmologic (Cataracts)
  • Cardiac (PDA and pulm artery stenosis)
  • Hearing loss (sensorineural)
  • Mental retardation
  • Microcephaly

Eye Heart Ruby Earrings

I heart Ruby Earrings

Eye, heart, rubella, hearing!

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16
Q

How is rubella diagnosed?

A

Antibody tests

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17
Q

How does plt count present in a newborn?

A

Low, seen with petechiae and purpura

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18
Q

What kind of virus is CMV and how is it transmitted?

A
  • Doublestranded DNA Herpes Virus
  • Intimate contact (blood, saliva)
  • Transmissible through breast milk
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19
Q

How common is CMV and when is exposure the most risky?

A
  • MC congenital infection!
  • Occurs worse if first trimester

Rarely symptomatic, but if it is, it is severe

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20
Q

What is the leading cause of non-hereditary sensorineural hearing loss?

A

CMV

All congenital infections seem to affect hearing ):

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21
Q

Image of baby with congenital CMV

A

Reminds me of dave bautista

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22
Q

How is CMV diagnosed?

A
  • Elevated LFTs
  • Thrombocytopenia
  • Elevated bilirubin
  • Urine/Saliva within first 3 weeks of life
  • CT showing periventricular lesions
  • If found within first 3 weeks, congenital. If after, perinatal
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23
Q

How is congenital CMV treated?

A
  • Ganciclovir and Valganciclovir for symptoms.
  • Must request approval for tx for severe symptoms.
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24
Q

Which HSV is the primary cause of congenital herpes?

A

HSV2

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25
Q

What combination in reference to herpes is the highest risk of infecting a baby?

A

Primary genital herpes + vaginal birth

25-50%

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26
Q

What is more common: neonatal or congenital?

A

Neonatal

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27
Q

What is unique about up to 75% of all infants with acquired HSV infections?

A

Mothers had no previous hx or clinical findings.

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28
Q

Who should we consider disseminated HSV infection in?

A
  • Sepsis
  • Liver dysfunction
  • Negative bacteriologic cultures
  • Fever
  • Abnormal CSF
  • Irritability

HSV is often very severe.

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29
Q

What is the triad of congenital herpes?

A
  1. Skin vesicles
  2. Ulcerations
  3. Scarring eye damage

Herpes is SUS

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30
Q

How is congenital HSV diagnosed?

A
  • Specimen cultures (practically anything amniotic fluid touched)
  • PCR for blood/urine/CSF detection
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31
Q

What is the TOC for congenital HSV?

A

IV Acyclovir (60mg/kg/d) for 2-3 weeks

Give to any infant that is suspected to have it.

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32
Q

What is the primary intervention for a mother if she has active genital lesions?

A

C-section!

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33
Q

When does an infant MC get VZV infections?

A

Mother infected between weeks 8-20.

Perinatal transmission is severe and disseminated.

Perinatal VZV = 5 days prior or 2 days post delivery.

34
Q

How does congenital varicella present?

A
  • Cicatricial skin lesions (zig zag lesion + limb atrophy)
  • Cataracts, retinitis
  • Hydrocephalus, microcephaly, seizures, mental retardation
  • High death rate if Mother develops VZV 5-7 days postpartum.

Congenital VZV looks BAD

35
Q

How is congenital varicella diagnosed?

A
  • Characteristic skin lesion
  • PCR of vesicle base
36
Q

How is congenital varicella treated?

A
  • Prophylaxis: VariZIG given to infants younger than 28wks gest following postnatal exposure
  • Active tx: Acyclovir 30mg/kd/d TID
  • Breastfeeding encouraged!

BFeeding has antibodies in it i think to help

37
Q

What are the alternative names to Parvo B19?

A
  • Human Parvovirus B19
  • Fifth’s disease
  • Erythema infectiosum

Hand slap

38
Q

Who is infection rate highest in for parvo B19?

A
  • Teachers
  • Daycare workers
39
Q

What % of women are usually immune to parvovirus B19?

A

1/2

40
Q

What are the S/S of Congenital Parvo B19?

A
  • Fetal anemia (aplastic)
  • Myocarditis
  • Hydrops fetalis
  • Rash (slapped cheeks)
  • Arthropathy

a plastic parvo

Hydrops fetalis = abnormal accumulation of fluid in 2+ fetal compartments

41
Q

How is Parvo B19 diagnosed?

A
  • Serology
  • Percutaneous umbilical cord blood sample
42
Q

If a mother is diagnosed with Parvo B19, how is the fetus monitored?

A

US weekly for signs of hydrop fetalis

Drop the Parv

43
Q

What causes syphilis?

A

Spirochetes, treponema pallidum

44
Q

How is syphilis MC transmitted congenitally and what does it usually result in?

A

Transplacental infection, resulting in a 40% chance of spontaneous abortion

45
Q

How do most infants present with congenital syphilis?

A

Asymptomatic at birth.

46
Q

If congenital syphilis appears prior to age 2, how does it usually present?

A
  1. Nasal Snuffles (persistent, white)
  2. Rash
  3. Hepatomegaly
  4. Generalized LAN
  5. Skeletal abnormalities
47
Q

If congenital syphilis appears after age 2, how does it usually appear?

A
  • CNS Abnormalities
  • Teeth abnormalities
48
Q

What are the late S/S of congenital syphilis?

A
  • Hutchinson’s triad: interstitial keratitis, 8th CN deafness, hutchinson’s teeth
  • Rhagades
  • Bowing shins
  • Saddle nose
  • Mulberry molars
  • Clutton joints
49
Q

How is syphilis diagnosed?

A

Direct visualization via dark field exam of bodily fluids

50
Q

What is the treatment for congenital syphilis?

A
  • IV Pen G for 10 days
  • Procaine Pen G for 10 days
  • Repeat antibody titers at 3/6/12 months to make sure its falling
51
Q

What is the MCC of sexually transmitted genital infections in the US?

A

Chlamydia

Chlamydia is Common

52
Q

How does congenital chlamydia usually present?

A
  • Conjunctivitis (bilateral)
  • Pneumonia

The main reason for erythromycin ointment at birth

53
Q

How is chlamydia diagnosed?

A
  • Suspected in any infant under 1 month with conjunctivitis
  • Gold standard: Culture of conjunctival and NP
54
Q

How is chlamydia treated in an infant?

A
  • Oral erythromycin QID x2wk
  • Screen all pregnant women at first visit

Cannot use topical if they are born with it?

55
Q

What kind of organism is gonorrhea?

A

G- diplococci

56
Q

How does congenital gonorrhea present?

A
  • Bilateral purulent conjunctivitis
  • Profuse exudate
57
Q

Who is at increased risk for gonorrhea?

A
  • Previous STD
  • Multiple partners
  • Inconsistent condom use
  • Sex workers
  • Drug use
  • High endemic area
58
Q

What is the prophylaxis for congenital gonorrhea?

A

Erythromycin ointment

Prevention of conjunctivitis

59
Q

How is congenital gonorrhea diagnosed?

A

Gram stain of conjunctival exudate

60
Q

How is congenital gonorrhea treated?

A

Single dose of Rocephin

Also treat asymptomatic infants if mother is untreated

GR

61
Q

How is HIV transmitted to a baby?

A

Transplacental or breastfeeding

62
Q

How is congenital HIV diagnosed?

A

HIV DNA PCR

63
Q

How is congenital HIV treated?

A

Antiviral prophylaxis (Zidovudine) for 6 weeks

64
Q

How is Congenital Hep C transmitted primarily?

A

Vertical

Breastfeeding is not CI.

65
Q

How is congenital Hep C diagnosed?

A

Anti-HCV present in blood at 18 months of age, confirmed with HCV RNA, then HCV genotyping.

66
Q

What are the primary treatment options for congenital Hep C and what determines it?

A

Interferon and ribavirin, determined by GI.

67
Q

How does congenital HPV present?

A

Hoarseness (airway)

68
Q

What kind of virus is zika virus and how is it transmitted?

A

Arthropod flavivirus from mosquitoes, with placental transmission.

69
Q

How does congenital zika present?

A
  • FGR
  • Fetal demise
  • Ventriculomegaly
  • Microcephaly
  • Ocular scarring
  • Sensorineural deafness
  • Arthrogryposis (weird limb formation)
  • ASD/VSD/PFO
  • Hypertonia/Spasticity/Hyperreflexia/seizures
  • SGA
70
Q

How is congenital zika evaluated?

A
  • H&P (head circumference and development)
  • Labs
  • Cranial US (anterior fontanelle is still open)
  • Hearing assessment
71
Q

What two labs being negative make zika very unlikely?

A
  • Serum Zika IgM
  • CSF for RNA and IgM
72
Q

What lab combination is definite for congenital zika?

A

Serum + Urine for Zika RNA via PCR

Both positive = definite

73
Q

What is the primary imaging screening tool for congenital zika?

A

Cranial US

74
Q

What referrals are indicated for congenital zika?

A
  • Ophthalmology
  • Hearing screen (ABR)
  • Neurology, ID, genetics, development

ABR = auditory brainstem response test

75
Q

What is the definition of a newborn/neonate?

A

First 28d of life

76
Q

What are the 3 major routes of perinatal infection?

A
  1. Bloodborne transplacental (CMV)
  2. Ascending due to disruption of amniotic barrier
  3. Infection via birth canal (HSV, HIV, GBS)
77
Q

What is the MC pathogen to cause bacterial sepsis in a newborn?

A

Group B strep

78
Q

How does early-onset newborn sepsis present?

A
  1. Respiratory distress
  2. Hypotension
  3. Acidemia
  4. Neutropenia
  5. Temperature instability
  6. Poor feeding
  7. Irritability
  8. Lethargy

Within 24 hrs

79
Q

What temperature is considered suspicious for newborn sepsis and requires full W/u?

A

Rectal temp of 100.4 for any infant younger than 60d = full workup.

Anything under 90d is just newborn sepsis.

80
Q

What is in a newborn sepsis workup?

A
  • CBC/BMP
  • Urine cath and culture
  • CXR
  • CRP and procalcitonin
  • Blood cultures
  • NP swab
  • LP cultures
81
Q

What is the empiric prophylaxic ABX therapy for newborn sepsis?

A
  1. Ampicillin + cefotaxmine
  2. Ampicillin + gentamicin
  3. Acyclovir +/-

amp and tax the neonate

82
Q

Summary of ToRCHeS VP

A

Pediatrics (41 decks)

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