Neonatal/congenital Infections

Front 1

Clinical manifestations of CMV in neonate

Back 1

LBW
chorioretinitis
pneumonia
microopthlamia
microcephaly
purpura
petechiae
intracranial calcifications
hearing loss
CN palsies

Front 2

Dx of CMV infecction

Back 2

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

Front 3

Prevention of CMV spread

Back 3

universal precautions in DCC

Front 4

how is the spread of toxo related to trimester of infection

Back 4

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

Front 5

clinical presentation of congenital toxo

Back 5

hydrocephalus
hepatosplenomegaly
microcephaly
chorioretinitis (blindness)
cerebral calcifications
jaundice
seizures
learning disabilities

Front 6

Sequelae of congenital toxo

Back 6

MR
learning disabilities
blindness in adolescence

Front 7

Dx fo congenital toxo prenatally

Back 7

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

Front 8

Dx of congenital toxo postnatally

Back 8

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

Front 9

Prevention of congenital toxo

Back 9

avoid cat litter and raw meats
wash fruits/veggies and hands after gardening

Front 10

When in a pregnancy is the likelihood for a fetus to become infected with rubella? when are they most likely to develop sx?

Back 10

1st (90%)
1st (85%)

Front 11

What are the sx of congenital rubella infection

Back 11

myopic developmental delay
haert murmur
cataracts
glaucoma
CHD, PDA, PS
hepatosplenomegaly
osteitis
meningoencephalitis
MR
"blueberry muffin rash"
hearing impairment

Front 12

dx fo congenital rubella syndrome

Back 12

IgM serum levels for rubell a
viral isolation
rising or stable rubella specific IgG
PCR

Front 13

treatment of congenital rubella

Back 13

none

Front 14

prevention of congenital rubella syndrome

Back 14

vaccine with MMR in childhood (2 doses)
knowledge of rubella status in child bearing age group

Front 15

What to do if a woman is exposed to rubella during pregnancy

Back 15

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

Front 16

When does neonatal HSV infection occur

Back 16

during delivery, intrauterine infection rare

Front 17

When do neonates present with HSV? How do they present (3 ways)

Back 17

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)

Front 18

dx of neonatal HSV infection

Back 18

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

Front 19

maternal dx of HSV

Back 19

culture cervix, see giant cells on PAP smear

Front 20

Prevention of neonatal HSV

Back 20

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

Front 21

What % of babies born to HBsAg + moms --> chronic carriers
% --> chronic liver dz?

Back 21

90% (most asx)
25% of chronic carriers --> chronic liver dz or hepatic ca

Front 22

Serology of a chronic HBV chronic carrier

Back 22

HBsAg +, anti-HBc, no anti-HBs

Front 23

What is the serology of a person vaccinated against HBV

Back 23

HBsAg -
anti-HBs +
anti-HBc -
anti-HBe -

Front 24

How to treat newborn if mom is HBsAg +

Back 24

give HBIG + HBV vaccine within 12 hrs (95% effective)

Front 25

When is HBV vaccine given?

Back 25

birth
1 and 6 months

Front 26

Perinatal transmission risk of HCV in US
what % develops chronic hepatitis from HCV vertical transmission? cirrhosis?

Back 26

5-6%
<10%
<5%

Front 27

Dx of HCV in neonate

Back 27

IgG persists for 12-15 months
RT PCR
liver enzymes and quantitative RNA PCR (viral load) if sx

Front 28

perinatal proph for HCV
who should be screened

Back 28

no immunoproph
no vaccine
only screen high risk pregnant women

Front 29

What is transmission risk of congenital syphilis from priamry infcction?
2ndary infection?
latent symphilis?

Back 29

70-100%
60-100%
30%

Front 30

Clinical presentation of congenital syphilis

Back 30

stillbirth, asx, or multisystemic
hepatosplenomegaly
jaundice
long bone lesions (moth-eaten)
maculopapular rash on soles and palms
anemia, thrombocytopenia, hemolysis, hemorrhage
pneumonitis

Front 31

Late manifestations of congenital syphi

Back 31

Hydrocephalus
Frontal bossing
saddle shaped nose
hihg arched palate
sort maxilla
hutchinson's teeth
hearin gloss
keratitis
perioral fissure

Front 32

Dx of congenital syph

Back 32

Screen w RPR/VDRL
confirm wiht FTA-ABS or MHA-TP (fluorescent treponemal AB)

Front 33

Diagnostic value of RPR

Back 33

highly sensitive, low speficity
false + in collagen vascular dz

Front 34

workup for newborn with congenitla syphilis

Back 34

physical exam
serology
CSF exam
long bone xray (look for osteitis)
chest xray for pneumonia

Front 35

treatment of syphilis in mom

Back 35

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

Front 36

How is chicken pox transmitted to neonates?
consequence

Back 36

through placenta
limb atrophy
scarring of skin
CNS and eye abnormalities

Front 37

when must mom get chicken pox in order for it to be transmitted to fetus

Back 37

if mom gets it w/i 5 days of delivery --> disseminated dz, including pneumonia and encephaltitis

Front 38

treatment for congenital varicella

Back 38

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

Front 39

Neonatal Parvovirus B19 infection

Back 39

fetal infection --> stillbirths, abortions, or hydrops fetalis

Front 40

What does GBS cause in neonate

Back 40

sepsis and meningitis
fever, hypothermia
N/V/D
poor feeding
decreased activity
irritibility
jaundice, hepatomegaly
respiratoyr distres
pallor, mottling

Front 41

Dx of GBS dz

Back 41

sepsis work up
blood cultures
CBC w differential
urinalysis and urine culture
CXR
CSF examination

Front 42

reasons to treat mom with GBS prior to delivery

Back 42

unown GBX status plus:
delivery at <37 wks
ROM >18 delivery time
intrapartum maternal fever >100.4

Front 43

Presentation fo neonatal listeria

Back 43

stillbirths
abortions
sepsis
granulomatosis infantisepticul- pale nodules, meningitis
can be transmittted vertically or horizontaly

Front 44

treatment of neonatal listeriosis

Back 44

IV antibiotics (ampicillin and gentamicin)

Front 45

Host defensees in neonate

Back 45

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