Perinatally acquired infections Flashcards
machine like murmur and cataracts - what are the ddx?
TORCHES
HIV
TORCHES infections
toxoplasmosis other rubella CMV herpes / hepatitis syphilis
cats should point to what congenital infection risk?
toxoplasmosis
how is toxoplasmosis gondii acquired?
- cat feces
- undercooked meat
- uncooked eggs
- unpasteurized milk
how is risk of toxoplasmosis transmission affected by gestational age? severity of disease?
- risk increases as gestational age increases
- severity of disease decreases as gestational age increases (if a mother gets toxo first trimester, the severity will be worse)
vertical transmission for toxoplasmosis is most likely in which trimester(s)?
2nd and 3rd
what proportion of toxoplasmosis babies have CNS symptoms?
2/3
what is the most common neuro symptom with toxoplasmosis infection?
chorioretinitis
chorioretinitis is most likely associated with what infection?
toxoplasmosis
what are the CNS symptoms of toxoplasmosis?
- hydrocephalus
- chorioretinitis
- intracranial calcifications
- hydrocephalus
- chorioretinitis
- intracranial calcifications
which infection?
toxoplasmosis
is congenital toxoplasmosis infection usually symptomatic or asymptomatic?
asymptomatic
definition: chorioretinitis
- inflammation of the posterior portion of the uveal tract and retina
what is the uveal tract?
iris, ciliary body, choroid
where are the calcifications located in toxplasmosis?
caudate nucleus, choroid plexus, meninges, subependyma
which calcifications are usually periventricular?
CMV
diagnosing criteria for toxoplasmosis
- serum IgM titers or persistent IgM titers
- ophthamology exam
- neuro exam
- head CT
- LP for toxo PCR
which drugs are used for toxoplasmosis for first 21 weeks of gestation?
spiramycin
which drugs are used for toxoplasmosis confirmed after 18th week of gestation or few remaining weeks of gestation?
- pyrimethamine
- sulfadiazine
- leucovorin
- prednisone
what are the toxoplasmosis outcomes?
- mental retardation
- seizures
- cerebral palsy / spasticity
- deafness
rubella has what type of genome? which familiy?
RNA, togaviridae
how is rubella spread?
respiratory droplets
what is the most common vaccine preventable cause of birth anomalies in the world?
congenital rubella syndrome
CRS infection in fetuses shows what type of damage / which organs?
cellular damage and non-inflammatory necrosis of large organs:
EYES
HEART
BRAIN
EARS
what is the most common isolated sequela in CRS?
hearing loss
what is the classic triad of CRS?
deafness
cataracts
congenital heart disease
definition: cataracts
- clouding of the lens
- deposition of protein in the lens
when is the only time a diagnosis of rubella can be made?
how is it made?
first year of life
- culture of nasopharyngeal swab
- serum IgM titers
- rise in IgM titers over 2-3 weeks
- rtPCR
does rubella have a treatment?
no - only supportive care
what type of genome is CMV? which family?
DNA, herpes virus
what is the most common congenital infection in developed countries?
CMV
a jaundiced baby should make you think of what congenital infection?
CMV
the worst sequelae for CMV occur if the mother is infected in what trimester?
1st
what are the three most common symptoms of CMV in infected babies?
- petechiae / ecchymosis
- jaundice at birth or within a few HOURS (day 1)
- hepatosplenomegaly
calcifications seen in CMV have what pattern?
periventricular
how is CMV diagnosis made?
- urine CMV culture
- serum IgM titers
- head CT for periventricular calcifications
what is the treatment for CMV?
gancyclovir can be used in life threatening situations
what is the leading cause of childhood sensorineural hearing loss in developed countries?
congenital CMV
how can congenital HSV infection manifest?
what can these symptoms mimic?
when do initial symptoms occur?
- disseminated disease (50%)
- skin symptoms
- liver and lungs
almost indistinguishable from neonatal sepsis from bacteria or enterovirus
occur between birth and first 4 weeks
how does CNS disease present in congenital HSV?
- irritability
- lethargy
- poor feeding
- tremulousness
- seizures
2nd or 3rd week of life
diagnosis for HSV
- culture for PCR (vesicle fluid and/or CSF)
- Tzanck smear (not accurate)
- CBC, LFTs
what is the treatment for congenital HSV?
IV acyclovir x 14-21 days
pregnant mothers with Hep B are given what treatment?
give Ig and Hep B vaccine
what are the EARLY symptoms for congenital syphilis?
- mucocutaneous lesions, lymphadenopathy, rash
- metaphyseal drystrophy
- osteochondritis / periostitis
- snuffles (hemorrhagic rhinitis)
what are LATE symptoms for congenital syphilis?
- hutchison teeth
- sabre shins
- deafness, MR
- frontal bossing, saddle nose
risk of infection for infant born to HIV seropositive mother without treatment is what %?
25-30%
should HIV positive mothers breast feed?
NO
93% of infected neonates will be HIV positive by what age?
2 weeks
