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sepsis > Neonatal Infections > Flashcards

Neonatal Infections Flashcards

1
Q

What is GBS?

A

gram positive cocci in pairs or chains

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2
Q

what is enterococcus?

A

gram positive cocci in chains

  • nosocomial
  • present as bacteremia, meningitis, and UTI
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3
Q

what is staphylococcus?

A

gram positive cocci in clusters

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4
Q

what is staph coag positive?

A

staph aureus

-scalded skin syndrome, MRSA

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5
Q

what is staph coag negative?

A

staph epi

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6
Q

what is e. coli?

A

gram negative rod

-associated with chorio

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7
Q

what are the space bugs that need double coverage?

A 
Serratia
Pseudomonas
Acinetobacter
Citrobacter
E. coli
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8
Q

what is klebsiella?

A

gram negative rod (second most common)

  • frequent cause of pneumonia especially w/ventilator
  • can produce extended spectrum beta-lactamases which are resistant to penicillins, cephalosporins, and some ahminoglycosides
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9
Q

most common types of candida

A

albicans and parapsilosis

-malassezia furfur requires special plating

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10
Q

congenital candida sepsis

A
  • related to ascending infection in utero
  • presents shortly after birth
  • full term is generalized rash
  • preterm has rash, pustules, vesicles, invasive pulmonary disease
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11
Q

systemic candida

A
  • if infant is deteriorating and not responding to treatment, consider antibiotic change or fungal source!
  • renal involvement is common (do US)
  • thrombocytopenia
  • hyperglycemia
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12
Q

herpes simplex mode of transmission

A
  • congenital (4%): triad is brain, eye, skin
  • perinatal (86%): typically vertical from mom to baby during delivery process is most common
  • postnatal (10%)
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13
Q

primary vs secondary HSV infection

A

-primary infection much worse: more viral shedding and less IgG to fight it

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14
Q

three presentations with HSV

A
  • disseminated
  • skin, eye, mouth
  • CNS
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15
Q

disseminated HSV

A
  • most lethal, multiorgan involvement
  • earliest presentation (within first five days of life)
  • 10-50% have NO lesions
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16
Q

SEM HSV

A
  • most common
  • localized form, limited to skin and mucus membranes
  • clustered, reddened, erythromatous base with pustule
  • presents with lesions 1 week or later, not at birth
  • remove roof and culture lesion
  • if untreated, will progress to disseminated or CNS disease
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17
Q

CNS HSV

A
  • latest presenting form (DOL 10-18)
  • initially may have subtle, nonspecific findings
  • seizures
  • abnormal LP
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18
Q

about CMV

A

-most common congenital infection worldwide

19
Q

CMV transmission

A
  • transplacental and intrapartum: maternal infection first half of pregnancy associated with greater risk of neonatal infection and greater severity
  • breast milk (freeze milk for VLBW)
20
Q

CMV presentation

A
  • IUGR
  • jaundice
  • HSM
  • purpura
  • blueberry muffin rash
  • microcephaly
  • periventricular calcifications and chorioretinitis (ophtho needs to look at eyes)
21
Q

CMV diagosis

A

-send urine culture

22
Q

CMV sequelae

A
  • mortality
  • 10-20% major neurodevelopment problems: DEAFNESS, visual impairment, cognitive delays, spastic quadriplegia
  • increased risk for dental caries
23
Q

about VZV

A
  • congenital infection is rare

- mild to severe neonatal disease that presents before DOL 10: CNS abnormalities, limb abnormalities, and skin lesions

24
Q

most concerning mode of transmission for VZV

A

-maternal onset between 5 days prior to delivery until 2 days after delivery: infant is exposed and born before the mom can transfer immunity via the placenta

25
Q

what does VZIG do?

A

decreases intensity of illness if given shortly (within 3-5 days) after exposure, does not prevent infection

26
Q

clinical manifestations of VZIG

A
  • usually very severe
  • skin lesions
  • severe resp. distress/pneumonia
  • necrotic visceral lesions - fatal
27
Q

about hepatitis B

A
  • greatest risk for transmission is at birth, followed by postpartum
  • least common transmission during 1st or 2nd trimester transplacental
28
Q

hepatitis B presentation

A
  • most are asymptomatic
  • 70-90% become chronic carriers
  • infant will have elevated LFTs/bili, serologic markers
29
Q

infants born to HBsAg positive mom:

A
  • HBIG and HepB vaccine within 12 hours

- HepB vaccine at 1-2 and 6 months

30
Q

infants born to HBsAg unknown mom:

A
  • hepB vaccine within 12 hours
  • HBIG if you find that mom is positive or within 1 week if results not available (preferable to give to preterm LBW within 12 hrs)
  • HepB vaccine at 1-2 and 6 months
31
Q

about chlamydia:

A
  • extremely common
  • 50% of infants acquire infection during delivery, usually conjunctivitis
  • occurs at DOL 5-12
32
Q

chlamydia presentation:

A
  • initially water, then purulent
  • swollen eyelids
  • RED, THICKENED CONJUCTIVAE
  • can also be pneumonia; occurs at 4-12 weeks of life
33
Q

chlamydia treatment

A

-erythromycin

34
Q

about gonorrhea

A
  • gram negative bacteria
  • transmission is usually during delivery
  • can be disseminated or eye infection
35
Q

gonorrhea presentation

A

usually appears 4 days after birth with purulent drainage

-rapid corneal ulceration’s which lead to scarring and blindness

36
Q

about syphilis

A
  • gram negative spirochete

- one of the few bacteria that can readily cross the placenta causing fetal infection

37
Q

presentation with congenital syphilis infection

A
  • prematurity
  • SAB/stillborn/perinatal if untreated
  • hydrops
  • IUGR
38
Q

when should mother be treated for syphilis to consider it adequate?

A

4 weeks or more before delivery

39
Q

presentation with early congenital syphilis

A
  • symptoms before the age of 2
  • HSM, jaundice
  • lymphadenopathy
  • lesions on palms and soles
  • rhinitis (sniffles)
  • rhagedes (cracks in lips which scar)
  • CNS involvement
40
Q

presentation with late congenital syphilis

A

-after 2 years if congenital infection isn’t treated:

Hutchison’s triad: blunted upper incisors, keratitis and 8th nerve deafness

41
Q

how is syphilis treated?

A

-penicillin G

42
Q

about toxoplasmosis:

A
  • protozoan

- transmitted transplacentally during primary maternal infection

43
Q

toxoplasmosis presentation

A
  • usually asymptomatic at birth
  • chorioretinitis
  • CNS defects: hydrocephaly, intracranial calcifications
  • IUGR, microcephaly
  • blueberry muffin rash
44
Q

toxoplasmosis treatment

A
  • treatable but not curative
  • sulfadiazine and pyrimethamine
  • folinic acid
  • corticosteroids if elevated CSF protein or active chorioretinitis

sepsis (2 decks)

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