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Infectious Disease > Week 4: Congenital infections Part I > Flashcards

Week 4: Congenital infections Part I Flashcards

1
Q

What is horizontal transmission?

A

Person-to-person

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2
Q

What is vertical transmission?

A

mother-to-child

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3
Q

Types of vertical transmission

3 listed

A
  • Intrauterine
  • Intrapartum
  • Post-partum
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4
Q

What is intrauterine vertical transmission?

A

before birth- transplacental

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5
Q

What is intrapartum vertical transmission?

A

during the birth process

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6
Q

What is post-partum vertical transmission?

A

breastfeeding

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7
Q

Perinatal vertical transmissions

A
  • Intrauterine
  • Intrapartum
  • Post-partum
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8
Q

Congenital vertical transmissions

A

Intrauterine

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9
Q

Describe the forms of vertical transmission and routes of transmission

A
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10
Q

How long is the neonate period?

A

First 28 days of life

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11
Q

Neonate immune system

A

immunocompromised

The immune system is still developing

  • Global: all aspects of immune system
  • Deficiency is inversely related to gestational age and birth weight
  • Premature infants: Transplacental maternal IgG - doesn’t begin until 28 weeks gestation
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12
Q

When does transplacental maternal IgG begin

A

doesn’t begin until 28 weeks gestation

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13
Q

TORCH AKA

A
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14
Q

Incidence of Chlamydia per 1000 live births

A

150

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15
Q

Incidence of Chlamydia Number per year

A

593,637

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16
Q

Incidence of CMV per 1000 live births

A

10

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17
Q

Incidence of CMV Number per year

A

39,576

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18
Q

Incidence of Sepsis per 1000 live births

A

4

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19
Q

Incidence of Sepsis Number per year

A

15,830

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20
Q

Incidence of HSV, Toxo, VZV per 1000 liver births

A

1

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21
Q

Incidence of HSV, Toxo, VZV Number per year

A

3,958

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22
Q

Incidence of HIV per 1000 live births

A

0.5

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23
Q

Incidence of HIV Number per year

A

1,979 (53 in 2011)

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24
Q

Incidence of Congenital Syphilis per 1000 liver births

A

0.14

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25
Q

Incidence of Congenital Syphilis Number per year

A

554 (348 in 2013)

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26
Q

Incidence of Congenital Rubella per 1000 live births

A

0.001

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27
Q

Incidence of Congenital Rubella number per year

A

4 (1 in 2013)

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28
Q

CHEAP TORCHES L

A
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29
Q

Prototypes of vertical Infection

A
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30
Q

In Utero “congenital” infection

A
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31
Q

Potential effects of congenital infection

A
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32
Q

In utero prototype of congenital Rubella Syndrome

A
  • Microcephaly
  • Cataracts
  • Blueberry muffin rash
  • Dermal erythropoiesis
  • Heart defects
  • Sensorineural deafness

None of these are pathognomonic

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33
Q

Congenital In Utero syndromes

A
  • Toxoplasmosis
  • Rubella
  • CMV
  • LCMV
  • Other (syphilis)
  • HSV
  • VZV - scarring, limb
  • Parvovirus B-19 - hydrops
34
Q

Congenital In Utero syndromes that are asymptomatic at birth

A
  • HIV
  • Syphilis
35
Q

When to suspect congenital syndromes

A

Maternal Hx

36
Q

Tests for in utero infection

37
Q

Congenital syndromes

38
Q

Signs and symptoms of Congenital Rubella

A
  • Sensorineural deafness
  • Cataracts
  • Congenital Heart disease
39
Q

Signs and symptoms of Congenital Toxoplasmosis

A
  • Hydrocephalus
  • Intracranial calcifications - diffuse
  • Chorioretinitis
40
Q

Signs and symptoms of Congenital Cytomegalovirus

A
  • Microcephaly
  • Intracranial calcifications - ventricular
41
Q

Signs and symptoms of Congenital Parvovirus B-19

A
  • Diffuse edema (in utero hydrops fetalis)
42
Q

Signs and symptoms of Congenital Varicella Zoster

A
  • Limb abnormalities
  • Cicatricial lesions
43
Q

Signs and symptoms of Congenital Treponema Pallidum

A
  • Skin lesions - including palms and soles
  • Dactylitis
  • Osteochondritis
  • Periostitis
  • Rhinorrhea (Snuffles)
44
Q

Chorioretinitis

45
Q

Hydrocephalus with calcifications

46
Q

Short limb syndrome and scarring of the skin

47
Q

Leutic gummas

48
Q

Wimberger sign AKA

A

Metaphysitis

49
Q

Metaphysitis

50
Q

Hydrops fetalis

51
Q

Modes of perinatal infections

A
  • Transplacental infection
  • Ascending infection
  • Maternal-fetal transfusion
  • Inoculation (inhale, ingest)
52
Q

Feature os perinatal infections

A
  • Manifestations influenced by pathogen
  • Normal wt/AGA (Appropriate for Gestation Age)
  • No malformations

Manifestations vary

  • Sepsis syndrome
  • Focal infections
  • Asymptomatic infection
  • Other
53
Q

Symptomatic perinatal infections

A
  • Conjunctivitis
    • GC, Chlamydia
  • Sepsis
    • GBS, E coli, Listeria
    • Disseminated HSV
    • Neonatal Enterovirus
54
Q

Asymptomatic perinatal infections

A
  • Hepatitis B, C
  • HIV
  • Human papillomavirus
55
Q

GBS AKA

A

Group B strep

56
Q

GBS Early-onset neonatal sepsis mode of transmission

A

Ascending infection, ingestion/inhalation

57
Q

GBS Early-onset neonatal sepsis delivery

A

Term

AGA (or premature)

58
Q

Signs & Symptoms GBS Early-onset neonatal sepsis

A
  • Not dysmorphic
  • no congenital anomalies
  • Symptomatic shortly after or by 3rd day of life
  • Sepsis syndrome
    • +/- pneumonia or other focal infection, DIC
59
Q

GBS Early-onset neonatal sepsis fatality rate

A

Case fatality rate up to 50%

60
Q

Risk factors for Early-onset neonatal sepsis

61
Q

Tests for infant bacterial sepsis

A
  • Blood and urine cultures for bacteria
  • Cerebrospinal fluid bacterial cultures as indicated clinically
  • Bacterial cultures of other sites as indicated clinically
62
Q

Tests for infant viral sepsis early-onset neonatal sepsis

A
  • Conjunctiva
  • Nasopharynx
  • Umbilicus
  • Stool
  • Vesicles
  • HSV DFA on any vesicles
  • CSF
    • PCR for enterovirus
    • PCR for HSV
63
Q

Common clinical manifestations of intrauterine infections

A
  • Low birth weight AKA small for Gestational age (SGA)
  • Possible malformation
  • Rash
  • Jaundice/direct bilirubin
  • Hepatosplenomegaly
  • Anemia, low platelets
  • Stable
  • or Asymptomatic
64
Q

Common clinical manifestations of perinatal infections

A
  • Normal weight (AGA)
  • No malformations
  • Sepsis syndrome
  • Coagulopathy/DIC
  • Hepatitis
  • Conjunctivitis
  • Unstable
  • or Asymptomatic
65
Q

In utero causative organisms

A
  • HIV
  • CMV
  • HSV
  • VZV
  • Toxoplasma
  • Syphilis
  • Rubella
  • LCMV
  • Parvovirus B-19
66
Q

Perinatal causative organisms

A
  • HIV
  • CMV
  • HSV
  • VZV
  • Enterovirus
  • GC/Chlamydia/HPV
  • Hepatitis B/C/E
  • E coli/GBS/Listeria
67
Q

Post-natal causative organisms

A
  • HIV
  • CMV
  • Hepatitis B Virus
68
Q

Tests for Toxoplasmosis congenital infection

A
  • Toxo IgG on newborn
  • If positive, special double-sandwich IgM for toxo
69
Q

Tests for Syphilis congenital infection

A
  • RPR titer on mom and baby
70
Q

Tests for Rubella congenital infection

A

Rubella IgM on newborn

71
Q

Tests for CMV congenital infection

A

Urine for CMV shell vial FA

72
Q

Tests for Neonatal herpes congenital infection

A
  • DFA on any vesicles
  • HSV culture of nasal swab
  • conjunctival swab, stool, CSF
73
Q

Tests for LCMV congenital infection

A

LCMV IgG/IgM titers on mom & baby

74
Q

Tests for viral sepsis perinatal infection

A
  • Viral cx of nose, throat, stool, vesicles
  • CSF for HSV and Enterovirus PCR
75
Q

Tests for Bacterial sepsis perinatal infection

A
  • blood
  • CSF
  • Urine cultures
76
Q

Tests for Focal bacterial infection perinatal infection

A

Bacterial cultures of the source (bone, joint, abscess, etc)

77
Q

Tests for conjunctivitis perinatal infection

A

Cultures of pus for GC/other bacteria, scraping of conjunctiva for HSV and Chlamydia

78
Q

Tests for Hepatitis B/C perinatal infection

A
  • Long-term f/u of serologies, PCR
79
Q

TORCH titers

A

There is no such thing as TORCH titers

80
Q

Take-home points of congenital infections

Infectious Disease (82 decks)

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