Neonatal Infectious Disease

Question 1

Treatment for congenital cutaneous candidiasis?

Answer 1

Presentation- diffuse, deep beefy maculopapular rash at delivery; invasive fungal infection (involves both epidermis/dermis); ascending infection from the genital tract– look for preterm PROM.

History of instrumentation (i.e. cerclage), IVF, broad-spectrum antibiotic exposure, preterm labor during pregnancy increases risk.

Systemic antifungal treatment with amphotericin-B, along with therapy to cover staph infections (nafcillin/gentamicin).

Question 2

Definition of chorioamnionitis?

Answer 2

Infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, etc.

Confirm with fluid culture/placental pathology usually, but usually a clinical diagnosis since diagnosed at the time of delivery.

Categories:
(1) Isolated maternal temp with or without persistence (39C or greater, or 38-38.9C– concerning if temp does not decrease within 30 minutes of initial temp); no other clinical risk factors
(2) Suspected maternal chorio (temp + signs of maternal/fetal infection– leukocytosis, purulent cervical discharge, fetal tachycardia)
(3) Confirmed– above + culture/pathology positive

Question 3

Treatment for maternal chorio

Answer 3

Depends on allergy to PCN, but usually as follows. q6-q8h:

No PCN allergy: Amp + Gent
Mild PCN allergy: Cefazolin + Gent
Significant PCN allergy: Clinda/Vanc + Gent

Question 4

When to treat congenital CMV infection?

Answer 4

Signs of moderate to severe infection, including: microcephaly, chorioretinitis, hepatitis with transaminitis, hepatomegaly/splenomegaly, IUGR, intracranial calcifications, thrombocytopenia with petechiae.

Regimen dependent on symptoms (valganciclovir- oral 6 months; ganciclovir- IV 6 weeks)

Question 5

True or False: Treat isolated sensorineural hearing loss with anti-viral therapy.

Answer 5

False;

Therapy not recommended, only serial audiology follow-up for progressive hearing loss.