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Med 2 - Week 39 > Perinatal Infections > Flashcards

Perinatal Infections Flashcards

1
Q

What is the length of the “neonate” period?

A

first 4 weeks of life

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2
Q

differentiate between congenital, perinatal, and post natal infectious routes

A
  1. congenital: in utero
    - either transplacental or ascending via cervix
  2. Perinatal: at the time of delivery
    - exposure to mothers blood, GU/GI flora and skin
  3. Post natal: after delivery
    - includes breast feeding
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3
Q

What is the status of the innate and adaptive immune systems in the third trimester?

A

Innate is developed by the third trimester but cells continue to mature in number and function during the weeks post birth

Adaptive immunity is developing (but not fully) in the third trimester.

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4
Q

Which Ab is transferred across the placenta?

A

IgG

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5
Q

What is the rationale behind giving the Tdap booster during pregnancy?

A

Higher cross-placental transfer of Abs can occur and reduces the risk/severity of pertussis in infancy. Recommended for every pregnancy in Canada as of 2018.

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6
Q

What pathogen types is the placenta NOT a good barrier against?

A
  1. many intracellular pathogens
    - virus: CMV, VZV, Rubella
    - bacteria: syphilis, listeria
    - parasites: toxoplasmosis
  2. Pathogens with placental tropism
    - listeria, malaria, toxoplasmosis
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7
Q

What STIs can be transmitted transplacentally?

A

VZV, Zika, Syphilis, HIV (1-2%) and HSV (5%)

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8
Q

What STIs causing pathogens can be transmitted perinatally?

A

HSV, HIV, HBV, gonorrhoea, chlamydia

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9
Q

What routine serologies need to be done in the first trimester?

A
  1. Syphilis (repeat in 3rd tri)
  2. HIV (repeat if high risk)
  3. Hep B
  4. Rubella
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10
Q

What are the components of the “CHEAP TORCHES”

A
  1. Chicken pox
  2. Hep B
  3. EBV
  4. AIDS (HIV)
  5. Parvovirus B19
  6. Toxoplasmosis
  7. Other (lol)
  8. Rubella
  9. CMV and Coxsackie virus
  10. Every STI
  11. Syphilis
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11
Q

What is the rate of congenital CMV infection? how many cause clinical disease?

A

1:200 births

only 10% cause clinical disease

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12
Q

What are some serious complications of congenital CMV?

A
  1. intrauterine growth restriction
  2. microcephaly
  3. chorioretinitis
  4. petechial rash + thrombocytopenia
  5. Hepatosplenomegaly
  6. sensorineural hearing loss (progressive)
  7. cognitive and motor delay
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13
Q

What are some findings on head U/S that help you differentiate between CMV and toxoplasmosis?

A

Periventricular calcifications = CMV

Parenchymal calcifications = toxoplasmosis

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14
Q

What treatment is available for congenital CMV? When is it used?

A

Ganciclovir for cases of severe neurological impairment

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15
Q

What is the risk of HIV transmission if the mother is not on ART? What if she is treated and VL suppressed?

A

about 40%

  • 20 to 25% during pregnancy
  • 10 to 15% from breastfeeding

If treated and VL suppressed, risk is <1%

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16
Q

When can neonatal serology be reliably used?

A

past 18 months

17
Q

What are the workup steps in a case of suspected neonatal HIV?

A
  1. test mothers serology and PCR for VL
  2. test newborns VL with PCR
  3. start empiric therapy within 6-12 hours
18
Q

What are the risks of developing chronic Hep B if you are infected perinatally, <5 years, or in adulthood.

A

perinatal: 90%
<5 years: 20-60%
adulthood: <5%

19
Q

What is the protocol if mother is Hep B infected or unknown status?

A

1 dose of the Hep B vaccine and Hep B immunoglobulin within 12 hours
- 95% effective at preventing transmission

20
Q

What are the possible complications of a congenital syphilis infection?

A
  • 40% spontaneous abortion
  • stillbirth
  • hydrops fetalis
  • osteochondritis
  • anemia, thrombocytopenia
  • teeth abnormalities
  • maculopapular rash and desquamation (weeks 1-8)
  • hepatosplenomegaly (weeks 1-8)
21
Q

What are the 3 possible presentations of congenital HSV? When does it present?

A

During the first 6 weeks of life

  1. Skin/eye/mouth disease
  2. HSV encephalitis
  3. Disseminated disease (CNS, pneumonia, liver dysfunction, skin infection)
22
Q

how do you diagnose congenital HSV?

A
  1. take swabs from the skin lesions for PCR as well as blood/CSF/nasopharynx if disseminated
23
Q

Treatment for HSV infection in neonates?

A

IV acyclovir

24
Q

What common symptom is associated with congenital rubella infection?

A

Congenital cataracts

25
Q

What are the 3 most common pathogens to cause sepsis/meningitis in the neonate?

A

Listeria
E. coli
GBS

26
Q

What are the 3 most common pathogens to cause meningitis from 3 months to adulthood?

A

S. pneumoniae
H. influenza
N. meningitidis

27
Q

What is the workup for a newborn with fever and lethargy?

A

Full septic workup

  • blood cultures
  • LP
  • urine culture

empiric ampicillin + gentamicin + acyclovir

Med 2 - Week 39 (4 decks)

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