Micro congenital and neonatal infections

Question 1

what are the congenital infections?

Answer 1

rubella, CMV, HIV, toxoplasma, treponema, parvovirus B19, HSV, VZV

Question 2

what are the manifestations of congenital infections?

Answer 2

growth retardation (low birth weight), congenital malformations, stillbirths

Question 3

what are the perinatal infections?

Answer 3

neisseria gonorrhoeae, chlamydia, HSV, strep B, e coli, listeria

Question 4

what are the manifestations of perinatal infections?

Answer 4

maningitis, septicemia, pneumonia, preterm labor

Question 5

what are the postnatal infections?

Answer 5

from breast milk: HIV, CMV, HBV
umbilicus: staph aureus, tetanus
person to person: group B strep, listeria, e coli

Question 6

what are the postnatal infections manifestations?

Answer 6

minigitis, septicemia, conjunctivitis, pneumonitis

Question 7

what are the signs of congenital infection?

Answer 7

growth retardation, congential defects, abnormal head size, rash, intracranial calcifications, eye abnormalities, hearing loss, inflammation of CSF, hepatosplenomegaly, hematologic abnormalities, bone lesions

Question 8

how is definitive diagnosis of congenital infection made?

Answer 8

isolate pathogen from infant!!

Question 9

what are the congenital infections

Answer 9

TORCH
Toxoplasmosis
Other (syphilis, hep B, VZV, parvovirus B19, HIV, HTLV-1
Rubella
CMV
HSV

Question 10

toxoplasma gondii classic triad

Answer 10

chorioretinitis (can result in vision loss), hydrocephalus, intracranial calcifications

Question 11

diagnosis of toxoplasmosis

Answer 11

IgM+ in infant is diagnostic

Question 12

toxoplasma treatment

Answer 12

pyrimethamine + sulfadiazine + folinic acid for one year

Question 13

congenital syphilis manifestations

Answer 13

by 3 months:

large puffy placenta, hepatomegaly, rhinitis (snuffles!), rash, lymphadenopathy

Question 14

test for t. pallidum

Answer 14

VDRL (venereal disease research lab), darkfield microscopic exam

Question 15

t. pallidum treatment

Answer 15

penicillin G

Question 16

rubella symptoms

Answer 16

hearing loss!

microcephaly, PDA (patent ductus arteriosis), cataracts

Question 17

risk factors for congenital CMV

Answer 17

no prior infection, pregnancy at younger age, first pregnancy, new sex partner during pregnancy, frequent contact with babies/toddlers
-especially PRIMARY infection

Question 18

CMV symptoms

Answer 18

most asymptomatic - 10% with symptoms
small size, hepatosplenomegaly, rash, jaundice, chorioretinitis, neuro involvement (microcephaly, seizures, abnormal neuro, feeding difficulties)

Question 19

congenital CMV diagnosis and treatment

Answer 19

diagnose: PCR on urine or blood
treat: ganciclovir IV or valganciclovie PO

Question 20

congenital herpes simplex infections - what is worst situation for baby

Answer 20

HSV-2; primary infection ; visible lesions; intrauterine; disseminated infection (causes severe mental impairment)

Question 21

treatment of HSV

Answer 21

C-section birth, antiviral prophylaxis, acyclovir for infant

Question 22

congenital varicella syndrome

Answer 22

primary infection in mother damages fetus - limbs and brain development are impaired

Question 23

congenital varicella treatment and prevention

Answer 23

acyclovir - prevent with vaccination of all seronegative women who reach childbearing age

Question 24

parvovirus B19 presentation

Answer 24

febrile illness without rash precedes followed by “slapped cheek” rash on face and erythematous maculopapular rash, arthralgia, arthritis

Question 25

what are the most common causes of neonatal sepsis

Answer 25

group B strep and e coli

Question 26

risk for chronic infection with HBV

Answer 26

90%

Question 27

what treatment is used for women with HIV

Answer 27

3 part zidovudine (ZDV) regimen - reduces transmission rate to 2%
-avoid agents with tertogenic effects (efavirenz)

Question 28

group B strep

Answer 28

encapsulated gram-positive diplococcus - 25% women asymptomatic carriers

Question 29

what are risk factors for early-onset GBS (group B strep) disease

Answer 29

previous baby with GBS, GBS in urine, fever during labor, heavy maternal colonization, delivery before 37 weeks, premature or prolonged rupture of membranes

Question 30

what reduces risk of group B strep in babies

Answer 30

IAP intrapartum antibiotic prophylaxis

Question 31

what are symptoms of GBS infection

Answer 31

1. early onset: respiratory tachypnea, grunting, hypoxia, appears ill, temperature instability, hypotension, shock
2. late onset: sepsis (fever, irritability, lethargy, poor feeding, tachypnea, gruniting apnea), meningitis (bulging fontanel, nuchal rigidity, focal neurologic findings
3. late onset GBS: sepsis with foci in CNS, soft tissues, bones, joints

Question 32

GBS diagnosis and management

Answer 32

culture bacteria from normally steril site (CNS)

sensitive to penicillin (IAP)