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Perinatal Infections Flashcards

1
Q

What are the ToRCHES infections?

A 
Toxoplasmosis
Other
Rubella
CMV
HSV/Hep/HIV
Syphilis
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2
Q

What are the common ssx of torches infx?

A
  • SGA or IUGR
  • Thrombocytopenia
  • Jaundice/HSM
  • Microcephaly
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3
Q

Where is Toxoplasma acquired from?

A
  • Cat feces
  • Undercooked meat
  • Uncooked eggs
  • Unpasteurized milk
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4
Q

What should women never do when pregnant?

A

Change the cat litter box

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5
Q

Is there a prenatal screen for toxoplasmosis?

A

No

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6
Q

Is there a risk of transmission of toxo for a secondary or primary infection?

A

Primarily only

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7
Q

When in pregnancy is the will toxo have the most severe effects?

A

1st trimester

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8
Q

What happens to the chances of transmitting toxo with increasing gestational age? What about severity?

A

Risk of transmission increases

Severity decreases

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9
Q

Vertical transmission of toxoplasmosis infection is most likely to occur in what trimester?

A

2nd and 3rd

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10
Q

True or false: the majority of newborns with congenital toxo lack clinical signs

A

True

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11
Q

What is the classic triad of congenital toxoplasmosis? (3)

A
  • Hydrocephalus
  • Chorioretinitis
  • Intracranial calcifications
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12
Q

What are the later signs of toxoplasmosis?

A

Seizures

Hearing loss

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13
Q

What is chorioretinitis? S/sx?

A

Inflammation of the posterior portion of the uveal tract and retina

Manifests as blurry vision, retinal detachment, or glaucoma

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14
Q

What are the characteristics of calcifications (CMV and toxo)?

A

V if periventricular, but this is CMV

X (diffuse) in toxo

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15
Q

How do you diagnose toxoplasmosis? (4)

A
  • Serum IgM or persistent IgG
  • Fundoscopic exam
  • Head CT
  • LP
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16
Q

What is the treatment for toxoplasmosis? (4)

A
  • Pyrimethamine
  • Sulfadiazine
  • Leucovorin
  • Corticosteroids
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17
Q

True or false: you should treat babies for ANY known or suspected toxoplasmosis infection, even if asymptomatic

A

True

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18
Q

Can you treat mothers in pregnancy for toxo?

A

Yes

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19
Q

What is the incidence of MR and seizures with toxoplasmosis? Deafness?

A 
MR = 87%
Seizures = 82%
Deafness = 15%
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20
Q

What percent of adults are susceptible to Rubella?

A

10%

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21
Q

What is the viral family of Rubella?

A

Togaviridae

+ssRNA

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22
Q

What are the ssx of Rubella infections in adults?

A

Mild cold

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23
Q

What is the colloquial name for rubella?

A

German measles

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24
Q

How does rubella spread?

A

Respiratory droplets

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25
Q

What is the most common vaccine-preventable disease in the world?

A

Rubella

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26
Q

Is prenatal screening for Rubella recommended?

A

Yes

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27
Q

What happens to the severity of congenital rubella infection as gestational age increases?

A

Decreases

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28
Q

Maternal infection with Rubella from how many months before may cause neonatal infection?

A

1 month before conception

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29
Q

What are the four major organ systems affected with congenital rubella syndrome?

A

Eyes
Heart
Brain
Ears

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30
Q

What is the most common sequelae of congenital Rubella?

A

Hearing loss

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31
Q

What is the classic triad of congenital Rubella syndrome?

A
  • Deafness
  • Cataracts
  • Congenital heart disease
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32
Q

What are the two common congenital heart defects that can occur with congenital Rubella syndrome?

A

PDA

Pulmonary stenosis

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33
Q

When can congenital Rubella infection be definitively diagnosed?

A

First year of life

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34
Q

What is the treatment for congenital Rubella?

A

There is none

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35
Q

How do you follow Rubella? (3 lab tests)

A
  • Serum IgM
  • IgG
  • PCR
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36
Q

What is the most common presentation of congenital CMV?

A

Jaundice

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37
Q

What is the viral family of CMV?

A

Herpesviridae–dsDNA

38
Q

What is the most common congenital infection in the Developed world?

39
Q

Is transmission of CMV more common with primary or reactivations ?

A

Primary, but can be way of reactivations as well

40
Q

Is there prenatal screening for CMV?

41
Q

What percent of all newborns are infected with CMV?

42
Q

What percent of CMV infected infants will have severe involvement? A developmental delay? Die?

A
  • 10% will have severe involvement
  • 4-30% with severe involvement with die
  • 75% have Neurologic problems
43
Q

When should physiologic jaundice develop? When should it subside?

A

A few days after birth–NOT at birth or within 24 hours.

Should subside after a week-ish

44
Q

What is the classic rash associated with CMV?

A

Blueberry muffin rash

45
Q

When in pregnancy will the infant have the most severe consequences?

46
Q

What percent of pregnant women with primary CMV remain asymptomatic?

47
Q

What are the three most common s/sx of CMV?

A
  • Petechiae/ecchymosis
  • Jaundice at birth or within a few hours
  • HSM
48
Q

What are the head CT findings with congenital CMV?

A

PeriVentricular calcifications

49
Q

What is the treatment for CMV?

A

Ganciclovir

50
Q

How do you diagnose CMV infections?

A

Urine culture

51
Q

What is the leading cause of sensorineural hearing loss in developed countries?

52
Q

What fraction of hearing loss from CMV is found at birth?

53
Q

When is transmission of HSV more common from mother to fetus (primary/secondary? Symptomatic asymptomatic)?

A

Primary and symptomatic infections most common, but can occur with either

54
Q

Can HSV be transmitted in mothers who have secondary asymptomatic infections?

A

Yes, but not as bad as primary symptomatic

55
Q

What percent of congenital HSV is acquired from the maternal genital tract?

56
Q

Which is more important in the diagnosis of HSV infected infants: history or physical?

A

Physical, since most infections asymptomatic

57
Q

What are the ssx of congenital herpes?

A
  • Disseminated disease
  • skin s/sx followed by poor feeding, lethargy
  • Liver and lung involvement
58
Q

When do most ssx present with congenital HSV?

A

3 days of age, but for sure before 4 weeks of age

59
Q

What is the incidence of CNS disease with HSV? S/Sx?

A

1/3 of cases

Irritability, lethargy, poor feeding, seizures

60
Q

How do you diagnose herpes?

A

Culture from vesicles, mucous membranes

61
Q

What fraction of congenital herpes present with skin s/sx? CNS involvement? What is the significance of this?

A

20% SEM
30% CNS

CNS does not have skin s/sx, so difficult to diagnose

62
Q

Is there a treatment for HSV?

63
Q

Before what timeframe will congenital HSV present?

A

Within 4 weeks

64
Q

What should be done if a mother is about to deliver, and has an active HSV-2 outbreak?

65
Q

What is the mortality of congenital HSV with treatment? What are the sequelae if they survive?

A

20%

-Microcephaly, seizures, deafness, blindness etc

66
Q

What presentation of HSV has the worst prognosis?

A

Disseminated

67
Q

What is the viral family of Hep B?

A

dsDNA (Hepadnaviridae)

68
Q

What is the viral family of Hep A?

A

Picornaviridae

69
Q

What is the viral family of Hep C?

A

Flaviviridae

70
Q

What is the viral family of Hep D?

A

Deltavirus–family remains unassigned

71
Q

What is the viral family of Hep E?

A

Hepeviridae

72
Q

True or false: transmission of syphilis can occur at any stage of the infection

73
Q

What are the three stages of syphilis?

A
  1. Painless ulcers
  2. rash and fever
  3. Gummas and CNS
74
Q

True or false: neurosyphilis can occur at any stage of infection

75
Q

Hutchinson teeth = ?

A

Congenital syphilis

76
Q

What is the classic ssx of syphilis

77
Q

What is the mortality of congenital syphilis?

78
Q

What are the nose findings of syphilis?

A

Saddle nose

79
Q

What are the 3 major clinical s/sx of syphilis?

A
  • Snuffles
  • Metaphyseal dystrophy
  • HSM/jaundice
80
Q

What are the characteristics of x-ray findings of congenital syphilis?

A

Metaphyseal dystrophy

81
Q

Is there prenatal screening for syphilis? Should you treat the baby even if the mother has a negative VDRL near birth?

A

Yes

No need to treat if mother was negative

82
Q

How do you diagnose congenital syphilis?

A

VDRL
RPR

Confirm with treponemal test

83
Q

What is the treatment for congenital syphilis in the neonate?

84
Q

What is the viral family of HIV?

A

retroviridae

85
Q

What are the three major infections in which PCN is still useful?

A
  • GAS
  • GBS
  • Syphilis
86
Q

What is the risk of HIV infection in seropositive mothers?

87
Q

When do symptoms present with congenital HIV? Are there sepsis like s/sx?

A

12-18 months

Does not present like sepsis

88
Q

How do you diagnose HIV?

89
Q

How many positive tests do you need to have with HIV?

A

2 positive tests or 3 negatives

90
Q

What is the treatment for HIV?

A

Perinatal AZT

Infectious Disease (18 decks)

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