Neonatal Infections

Question 1

Perinatal infections include those acquired when

Answer 1

Before, during, or shortly after birth

Question 2

TORCH

Answer 2

Toxoplasmosis
Other
Rubella
CMV
HIV, Herpes, Hep B

Question 3

What organism causes syphillis

Answer 3

Treponema Pallidum

Question 4

What kind of microscopy shpould be used to detect syphillis

Answer 4

Dark-field

Question 5

Transmission of syphillis to the neonate

Answer 5

• Transplacental (symptoms present at 5 months)

- At birth

Question 6

Newborns don’t have primary syhillis signs

Answer 6

They go straight to secondary

Question 7

The placenta in a mother with syphillis is….

Answer 7

• Paler, thicker, larger than normal
• Endovascular and Perivascular proliferation
• Treponema may be identified with silver stain

Question 8

Clinical features of neonatal syphillis

Answer 8

ASYMPTOMATIC AT BIRTH

• Within 2 years they will show multi-organ involvement, hepatosplenomegaly, bone involvement, cartilage involvement, pneumonia, coper rash

Question 9

Copper brown rash on SOLES

Answer 9

Syphillis!!!!!!

Question 10

Late congenital syphillis

Answer 10

Notched inciscisors
Eight nerve deafness
Neuro involvement

Question 11

Moth Eaten appearance at upper end of tibia?

Answer 11

Wimberger’s sign—– congenital syphillis

WIDESPREAD BONE INVOLVEMENT

May also see late cortical thickening

Question 12

HIV and syphillis in the mother

Answer 12

Greater chance the baby gets syphillis as well as HIV

Question 13

Mother’s serological status must be determined if syphillis present in newborn. Also want to know if mother was treated

Answer 13

ok

Question 14

syphilis can still be treated with penicillin

Answer 14

ok

Question 15

Congenital HIV is preventable, maternal screening is the key

Answer 15

k

Question 16

If the mother’s viral load of HIV is undetectable at the time of delivery, what is the risk for HIV transmission to the child?

Answer 16

Less than 1%….that’s why it is important to get the mother treated

Question 17

Infants of HIV+ Mothers are asymptomatic at birth, but placed on AZT until proven negative by two PCR tests six weeks apart

Answer 17

ok

Question 18

Congenital rubella is rare, but what does it look like in a kid?

Answer 18

Mental retardation, microcephaly, cataracts, deafness

Question 19

Congenital toxoplasmosis

Answer 19

under recognized in the US….transmission more common in late pregnancy

Question 20

Best way to diagnose congenital toxoplasmosis

Answer 20

Serology….negative serology in both the mother and the baby excludes the diagnosis

Question 21

CMV infections are probably most common

Answer 21

Can be occured prenatally, natally, or postnatally (up to 21%)

Question 22

If the mother has had CMV prior to becoming pregnant, the chances of her transferring it to the fetus are relatively low (1-2%). However, if she falls victim to a primary CMV infection during the pregnancy….

Answer 22

Much high chance (30-50%) of passing it on

Question 23

Most common and most severe sequelae of CMV infection?

Answer 23

Neurologic Sequelae….Over 90% of the kids that are symptomatic at birth have neuro sequelae…..5-17% of newborns with ASYMPTOMATIC CMV infection develop neuro sequelae.

Question 24

Head CT in baby with CMV that may have neuro sequelae.

Answer 24

Periventricular calcifications and dilated ventricles

Question 25

Not good treatment for CMV…What is the only thing that is used

Answer 25

Gancivlovir

Question 26

Most HSV is transmitted when?

Answer 26

At the time of birth,,,,fetal transmission is rare

Question 27

Know that the fetus is more at risk during a primary HSV infection in the mother since she doesn’t have any antibodies to pass along. Viral shedding is much lower in recurrent infection

Answer 27

ok…..30-50% passage rate in primary lesion mom compared to 3% passage rate in recurrent lesion mom

Question 28

Three manifestations of HSV at birth

Answer 28

1) SEM—Skin eye mouth
2) Diseminated disease with or without neuro involvement
3) Encephalitis alone—–usually presents later than the other two

Question 29

WOW…herpes is bad:

Answer 29

SEM disease will lead to viscera or brain in 70% of cases without therapy and even 25% with

80% mortality with disseminated dz if untreated

MUST CONSIDER DIAGNOSIS IN ANY NEONATE WITH MENINGITIS OR ENCEPHALITIS

Question 30

How do we know mom can transmit Hb

Answer 30

if she is HBsAg positive

Question 31

Hep B acquired in childhood has a greater chance of progressing to fulminant liver failure and Hepatocellular carcinoma

Answer 31

ok