Week 4: Congenital infections Part I Flashcards
1
Q
What is horizontal transmission?
A
Person-to-person
2
Q
What is vertical transmission?
A
mother-to-child
3
Q
Types of vertical transmission
3 listed
A
- Intrauterine
- Intrapartum
- Post-partum
4
Q
What is intrauterine vertical transmission?
A
before birth- transplacental
5
Q
What is intrapartum vertical transmission?
A
during the birth process
6
Q
What is post-partum vertical transmission?
A
breastfeeding
7
Q
Perinatal vertical transmissions
A
- Intrauterine
- Intrapartum
- Post-partum
8
Q
Congenital vertical transmissions
A
Intrauterine
9
Q
Describe the forms of vertical transmission and routes of transmission
A
10
Q
How long is the neonate period?
A
First 28 days of life
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
12
Q
When does transplacental maternal IgG begin
A
doesn’t begin until 28 weeks gestation
13
Q
TORCH AKA
A
14
Q
Incidence of Chlamydia per 1000 live births
A
150
15
Q
Incidence of Chlamydia Number per year
A
593,637
16
Q
Incidence of CMV per 1000 live births
A
10
17
Q
Incidence of CMV Number per year
A
39,576
18
Q
Incidence of Sepsis per 1000 live births
A
4
19
Q
Incidence of Sepsis Number per year
A
15,830
20
Q
Incidence of HSV, Toxo, VZV per 1000 liver births
A
1
21
Q
Incidence of HSV, Toxo, VZV Number per year
A
3,958
22
Q
Incidence of HIV per 1000 live births
A
0.5
23
Q
Incidence of HIV Number per year
A
1,979 (53 in 2011)
24
Q
Incidence of Congenital Syphilis per 1000 liver births
A
0.14
25
Incidence of Congenital Syphilis Number per year
554 (348 in 2013)
26
Incidence of Congenital Rubella per 1000 live births
0.001
27
Incidence of Congenital Rubella number per year
4 (1 in 2013)
28
CHEAP TORCHES L
29
Prototypes of vertical Infection
30
In Utero "congenital" infection
31
Potential effects of congenital infection
32
In utero prototype of congenital Rubella Syndrome
* Microcephaly
* Cataracts
* Blueberry muffin rash
* Dermal erythropoiesis
* Heart defects
* Sensorineural deafness
None of these are pathognomonic
33
Congenital In Utero syndromes
* Toxoplasmosis
* Rubella
* CMV
* LCMV
* Other (syphilis)
* HSV
* VZV - scarring, limb
* Parvovirus B-19 - hydrops
34
Congenital In Utero syndromes that are asymptomatic at birth
* HIV
* Syphilis
35
When to suspect congenital syndromes
Maternal Hx
36
Tests for in utero infection
37
Congenital syndromes
38
Signs and symptoms of Congenital Rubella
* Sensorineural deafness
* Cataracts
* Congenital Heart disease
39
Signs and symptoms of Congenital Toxoplasmosis
* Hydrocephalus
* Intracranial calcifications - diffuse
* Chorioretinitis
40
Signs and symptoms of Congenital Cytomegalovirus
* Microcephaly
* Intracranial calcifications - ventricular
41
Signs and symptoms of Congenital Parvovirus B-19
* Diffuse edema (in utero hydrops fetalis)
42
Signs and symptoms of Congenital Varicella Zoster
* Limb abnormalities
* Cicatricial lesions
43
Signs and symptoms of Congenital Treponema Pallidum
* Skin lesions - including palms and soles
* Dactylitis
* Osteochondritis
* Periostitis
* Rhinorrhea (Snuffles)
44
Chorioretinitis
45
Hydrocephalus with calcifications
46
Short limb syndrome and scarring of the skin
47
Leutic gummas
48
Wimberger sign AKA
Metaphysitis
49
Metaphysitis
50
Hydrops fetalis
51
Modes of perinatal infections
* Transplacental infection
* Ascending infection
* Maternal-fetal transfusion
* Inoculation (inhale, ingest)
52
Feature os perinatal infections
* Manifestations influenced by pathogen
* Normal wt/AGA (Appropriate for Gestation Age)
* No malformations
**Manifestations vary**
* Sepsis syndrome
* Focal infections
* Asymptomatic infection
* Other
53
Symptomatic perinatal infections
* Conjunctivitis
* GC, Chlamydia
* Sepsis
* GBS, E coli, Listeria
* Disseminated HSV
* Neonatal Enterovirus
54
Asymptomatic perinatal infections
* Hepatitis B, C
* HIV
* Human papillomavirus
55
GBS AKA
Group B strep
56
GBS Early-onset neonatal sepsis mode of transmission
Ascending infection, ingestion/inhalation
57
GBS Early-onset neonatal sepsis delivery
Term
AGA (or premature)
58
Signs & Symptoms GBS Early-onset neonatal sepsis
* Not dysmorphic
* no congenital anomalies
* Symptomatic shortly after or by 3rd day of life
* Sepsis syndrome
* +/- pneumonia or other focal infection, DIC
59
GBS Early-onset neonatal sepsis fatality rate
Case fatality rate up to 50%
60
Risk factors for Early-onset neonatal sepsis
61
Tests for infant bacterial sepsis
* Blood and urine cultures for bacteria
* Cerebrospinal fluid bacterial cultures as indicated clinically
* Bacterial cultures of other sites as indicated clinically
62
Tests for infant viral sepsis early-onset neonatal sepsis
* Conjunctiva
* Nasopharynx
* Umbilicus
* Stool
* Vesicles
* HSV DFA on any vesicles
* CSF
* PCR for enterovirus
* PCR for HSV
63
Common clinical manifestations of intrauterine infections
* Low birth weight AKA small for Gestational age (SGA)
* Possible malformation
* Rash
* Jaundice/direct bilirubin
* Hepatosplenomegaly
* Anemia, low platelets
* Stable
* or Asymptomatic
64
Common clinical manifestations of perinatal infections
* Normal weight (AGA)
* No malformations
* Sepsis syndrome
* Coagulopathy/DIC
* Hepatitis
* Conjunctivitis
* Unstable
* or Asymptomatic
65
In utero causative organisms
* HIV
* CMV
* HSV
* VZV
* Toxoplasma
* Syphilis
* Rubella
* LCMV
* Parvovirus B-19
66
Perinatal causative organisms
* HIV
* CMV
* HSV
* VZV
* Enterovirus
* GC/Chlamydia/HPV
* Hepatitis B/C/E
* E coli/GBS/Listeria
67
Post-natal causative organisms
* HIV
* CMV
* Hepatitis B Virus
68
Tests for Toxoplasmosis congenital infection
* Toxo IgG on newborn
* If positive, special double-sandwich IgM for toxo
69
Tests for Syphilis congenital infection
* RPR titer on mom and baby
70
Tests for Rubella congenital infection
Rubella IgM on newborn
71
Tests for CMV congenital infection
Urine for CMV shell vial FA
72
Tests for Neonatal herpes congenital infection
* DFA on any vesicles
* HSV culture of nasal swab
* conjunctival swab, stool, CSF
73
Tests for LCMV congenital infection
LCMV IgG/IgM titers on mom & baby
74
Tests for viral sepsis perinatal infection
* Viral cx of nose, throat, stool, vesicles
* CSF for HSV and Enterovirus PCR
75
Tests for Bacterial sepsis perinatal infection
* blood
* CSF
* Urine cultures
76
Tests for Focal bacterial infection perinatal infection
Bacterial cultures of the source (bone, joint, abscess, etc)
77
Tests for conjunctivitis perinatal infection
Cultures of pus for GC/other bacteria, scraping of conjunctiva for HSV and Chlamydia
78
Tests for Hepatitis B/C perinatal infection
* Long-term f/u of serologies, PCR
79
TORCH titers
There is no such thing as TORCH titers
80
Take-home points of congenital infections
