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38 Cards in this Set
- Front
- Back
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What are the usual TORCHE agents that cause congenital infection?
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Toxoplasma gondii
Others: T. pallidum, VZV, Parvovirus B19, HIV, plasmodium falciparium Rubella CMV HSV |
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During the first trimester what are some factors that make the fetus more vulnerable to infection?
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Immature/developing organs
Remote from maternal immune response |
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What are the defects associated with a congenital rubella infection?
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Neonatal purpura & cataracts or glaucoma during first 2 months
Congenital heart disease during first trimester Retardation & deafness during first 4 months Retinopathy during first 5 months |
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A blueberry muffin baby with salt & pepper retinopathy and celery stalking osteitis most likely has which congenital infection?
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Rubella
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Under what circumstances does the clinical disease of congenital CMV arise?
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When primary maternal infection occurs in first trimester
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What are the clinical manifestations of cytomegalic inclusion disease?
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Small for gestational age
Thrombocytopenic purpura Microcephaly - periventricular calcifications Hepatosplenomegaly Chorioretinitis - tomato ketchup sign Sensorineural deafness |
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How many pregnancies result in babies with congenital CMV infection?
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0.6-3.4% - pregnancy activates latent infection but very few are primary infections so most babies born with subclinical congenital infections!
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When is the CMV virus most often acquired?
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Infancy (breastmilk)
Early childhood (day care) Sexually active young adults |
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What is the pathogenesis of a congenital toxoplasmosis infection?
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Infection of the placenta with secondary infection of the fetus
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During what gestational stage is the incidence of acquiring a congenital toxoplasmosis infection greatest if the mother develops a primary infection?
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60% during 3rd trimester
27-29% during 2nd trimester 9-14% during 1st trimester |
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How does the severity of the toxoplasmosis infection of the fetus relate to the gestational age?
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More severe when infected early
Most 3rd trimester infections are subclinical at birth but symptoms may develop up to age 20 |
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What is the classis triad of clinical manifestations of a toxoplasmosis congenital infection?
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Hydrocephalus (least common)
Chorioretinitis (most common) Intracranial calcifications (scattered or basal ganglia) |
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What are clinical manifestations of a toxoplasmosis congenital infection?
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Hydrocephalus (least common)
Chorioretinitis (most common) Intracranial calcifications (scattered or basal ganglia) Eye diseases (cataracts, microphthalmia) Hepatits Thrombocytopenia Splenomegaly Sensorineural deafness |
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What are the manifestations of a congenital VZV infection?
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Limb reduction defects
Cataracts More common in early gestation |
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What are the manifestations of a congenital Parvovirus B19 infection?
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Fetal hydrops with stillbirth
Does NOT cause congenital malformations |
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What congenital malformations does a Parvovirus B19 infection cause?
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NONE
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Are you more likely to obtain a congenital or perinatal HSV & HIV infection?
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Perinatal more common
But BOTH viruses can cross placenta to cause congential infection |
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What are the usual agents causing perinatal infections?
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Group B strep
HSV HBV CMV Enteroviruses (esp ECHO11 & coxsackie B) Chlamydia trachomatis HIV HPV VZV Neisseria |
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What are some pathogenetic mechanisms of perinatal infection?
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Amniotic infection syndrome
Maternofetal tranfusion Maternal genital secretions Breastfeeding Nosocomial infection |
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Which serotypes of Group B Strep cause perinatal infections?
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Ia
Ib II III |
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The risk of Group B Strep perinatal infection is increased by what factors?
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Premature labor
Prolonged membrane rupture Chorioamnionitis Lack of type-specific maternal antibody |
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Late-onset infections of Group B strep are mostly of which serotype?
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III for late-onset after perinatal period
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What is the most common cause of early-onset infection with Group B strep?
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Amniotic infection syndrome with ingestion/aspiration of organisms
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What are the clinical manifestations of early-onset GBS infection?
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Pneumonia
Septic shock Persistent fetal circulation Neutropenia with marked left shift |
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What are the clinical manifestations of late-onset GBS infection?
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Sepsis
Meningitis Osteomyelitis Facial cellulitis (cellulitis-adenitis syndrome) |
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What is the pathogenesis of a perinatal HSV infection?
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Primary infection of skin, oropharynx, or eye leading within 2-3 days to visceral dissemination to nervous system, liver, and/or lungs
Primary site of viral infection not apparent in 25-50% |
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What are the clinical manifestations of perinatal HSV infection and when do they appear?
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Onset at age 5-15 days
Hepatitis (fulminant course leading to DIC) Encephalitis (focal seizures, coma) Skin vesicles Pneumonia/respiratory failure Keratoconjunctivitis May simulate neonatal bacterial sepsis if no skin or CNS involvement |
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What is the pathogenesis of perinatal HBV infections?
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Transmission to baby at delivery by maternofetal transfusion
Incubation period of 60-120 days, then babies may become transient or chronic carriers |
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What are the clinical manifestations of perinatal HBV infections?
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Asymptomatic in infancy generally, fulminant Hep B very rare
Long-term sequelae are cirrhosis & primary hepatocellular carcinoma, transmission risk in adulthood |
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Which has a worse prognosis: congenital or perinatal HIV infection?
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WORSE in congenital!
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What percentage of babies born to HIV + moms will turn out to be infected with HIV?
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15-30%
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What are the clinical manifestations of pediatric HIV?
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Persistent thrush or other mucocutaneous candidiasis
Failure to thrive Encephalopathy Recurrent bacterial infections Interstitial pneumonia Malignancies |
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What is the best diagnostic tool for pediatric HIV?
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PCR looking for DNA in cells, RNA in plasma/serum
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What are the manifestations of a perinatal VZV infection?
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May be fulminant if mother's onset is 5 days before & up to 2 days after
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What are the manifestations of a perinatal Chlamydia trachomatis infection?
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Perinatal conjunctivitis, afebrile pneumonitis
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What are the manifestations of a perinatal Enterovirus infection?
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Myocarditis
Hepatits Sepsis-like syndrome |
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What are the manifestations of a perinatal CMV infection?
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Pneumonitis or hepatits
If mother breastfeeds baby will develop latent infection but no clinical disease |
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What are the manifestations of a perinatal HPV 6 or 11 infection?
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Laryngeal papillomas
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