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45 Cards in this Set

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Clinical manifestations of CMV in neonate
LBW
chorioretinitis
pneumonia
microopthlamia
microcephaly
purpura
petechiae
intracranial calcifications
hearing loss
CN palsies
Dx of CMV infecction
viral isolation from urine/saliva
in infected children, virus remains in body for 1-2 yrs
+ IgM anti-CMV AB (70% +)
4x increase in MV IgG titer
in utero: culture/serology of amniotic fluid
Prevention of CMV spread
universal precautions in DCC
how is the spread of toxo related to trimester of infection
if acquired in in 1st trimester, low chance of newborn infection, but most of those infected will be affected by it

If acquired in 3rd trimester, higher % of infection rate, but lower % of affection rate

infection only occurs when ther is primary infection
clinical presentation of congenital toxo
hydrocephalus
hepatosplenomegaly
microcephaly
chorioretinitis (blindness)
cerebral calcifications
jaundice
seizures
learning disabilities
Sequelae of congenital toxo
MR
learning disabilities
blindness in adolescence
Dx fo congenital toxo prenatally
detection of parasite in amniotic fluid or fetal blood
isolation by muouse inoculation (rare)
T. gondii IfM or IgA in fetal
blood
T. gondii DNA in amniotic fluid by PCR
Serial fetal US of ventricles
Dx of congenital toxo postnatally
ear eye and CNS exam
CT of head to look for calcifciation
Isolation of parasite in placenta, umbilical cord, blood by mouse innoc
PCR foro DNA detection in WBC, CSF, amniotic fluid
Toxo IgG or IgM serology
Persistent toxo IgG serology >12 mo
Prevention of congenital toxo
avoid cat litter and raw meats
wash fruits/veggies and hands after gardening
When in a pregnancy is the likelihood for a fetus to become infected with rubella? when are they most likely to develop sx?
1st (90%)
1st (85%)
What are the sx of congenital rubella infection
myopic developmental delay
haert murmur
cataracts
glaucoma
CHD, PDA, PS
hepatosplenomegaly
osteitis
meningoencephalitis
MR
"blueberry muffin rash"
hearing impairment
dx fo congenital rubella syndrome
IgM serum levels for rubell a
viral isolation
rising or stable rubella specific IgG
PCR
treatment of congenital rubella
none
prevention of congenital rubella syndrome
vaccine with MMR in childhood (2 doses)
knowledge of rubella status in child bearing age group
What to do if a woman is exposed to rubella during pregnancy
do serum rubella IgG test, if + then immune
if -, retest in 4 weeks, if -- again, retest in 6 weeks
if negative, then no rubella infection and no immunity against rubella
if initial test is - and followup tests are + then evidence of acute infection... council about risks
When does neonatal HSV infection occur
during delivery, intrauterine infection rare
When do neonates present with HSV? How do they present (3 ways)
2nd or 3rd week of life
1. mucocutaneous vesicular lesions of eye, skin, and mucous membranes
2. localized CNS dz --> hihg morbidity/mortality
3. disseminated dz (high mortality)
dx of neonatal HSV infection
viral isolation from newborn >48 hrs old
PCR on CSF of newborn
rapid Ag detection or AB staining of vesicle scrapings (less sensitive)
EEG, CT scan of temporal lobe focus
brain biopsy
maternal dx of HSV
culture cervix, see giant cells on PAP smear
Prevention of neonatal HSV
screen by history during preg and labor
avoid scalp monitors if active lesons
c-sectioin if active lesions
treat immediately after birth if primary dz and vaginal delivery
do surface cultures of neonate
What % of babies born to HBsAg + moms --> chronic carriers
% --> chronic liver dz?
90% (most asx)
25% of chronic carriers --> chronic liver dz or hepatic ca
Serology of a chronic HBV chronic carrier
HBsAg +, anti-HBc, no anti-HBs
What is the serology of a person vaccinated against HBV
HBsAg -
anti-HBs +
anti-HBc -
anti-HBe -
How to treat newborn if mom is HBsAg +
give HBIG + HBV vaccine within 12 hrs (95% effective)
When is HBV vaccine given?
birth
1 and 6 months
Perinatal transmission risk of HCV in US
what % develops chronic hepatitis from HCV vertical transmission? cirrhosis?
5-6%
<10%
<5%
Dx of HCV in neonate
IgG persists for 12-15 months
RT PCR
liver enzymes and quantitative RNA PCR (viral load) if sx
perinatal proph for HCV
who should be screened
no immunoproph
no vaccine
only screen high risk pregnant women
What is transmission risk of congenital syphilis from priamry infcction?
2ndary infection?
latent symphilis?
70-100%
60-100%
30%
Clinical presentation of congenital syphilis
stillbirth, asx, or multisystemic
hepatosplenomegaly
jaundice
long bone lesions (moth-eaten)
maculopapular rash on soles and palms
anemia, thrombocytopenia, hemolysis, hemorrhage
pneumonitis
Late manifestations of congenital syphi
Hydrocephalus
Frontal bossing
saddle shaped nose
hihg arched palate
sort maxilla
hutchinson's teeth
hearin gloss
keratitis
perioral fissure
Dx of congenital syph
Screen w RPR/VDRL
confirm wiht FTA-ABS or MHA-TP (fluorescent treponemal AB)
Diagnostic value of RPR
highly sensitive, low speficity
false + in collagen vascular dz
workup for newborn with congenitla syphilis
physical exam
serology
CSF exam
long bone xray (look for osteitis)
chest xray for pneumonia
treatment of syphilis in mom
PENICILLIN IV 10-14 days (NOT erythromycin)
every 3 months repeat RPR/VDRL
Repeat CSF in 6 mo if abnormal
repeat if CSF VDRL is + at 6 mo
How is chicken pox transmitted to neonates?
consequence
through placenta
limb atrophy
scarring of skin
CNS and eye abnormalities
when must mom get chicken pox in order for it to be transmitted to fetus
if mom gets it w/i 5 days of delivery --> disseminated dz, including pneumonia and encephaltitis
treatment for congenital varicella
none, but give VZIG to newborn if mom develops rash w/i 5 days of delivery
treat newborn with IV acyclovir if baby develops varicella
Neonatal Parvovirus B19 infection
fetal infection --> stillbirths, abortions, or hydrops fetalis
What does GBS cause in neonate
sepsis and meningitis
fever, hypothermia
N/V/D
poor feeding
decreased activity
irritibility
jaundice, hepatomegaly
respiratoyr distres
pallor, mottling
Dx of GBS dz
sepsis work up
blood cultures
CBC w differential
urinalysis and urine culture
CXR
CSF examination
reasons to treat mom with GBS prior to delivery
unown GBX status plus:
delivery at <37 wks
ROM >18 delivery time
intrapartum maternal fever >100.4
Presentation fo neonatal listeria
stillbirths
abortions
sepsis
granulomatosis infantisepticul- pale nodules, meningitis
can be transmittted vertically or horizontaly
treatment of neonatal listeriosis
IV antibiotics (ampicillin and gentamicin)
Host defensees in neonate
no IgG at birth except IgG from mom
Makes IgM, reaches adult level in 2-3 months
CMI at adult levels w/i weeks of birth
immature immune system overal