Pediatrics, Infections

Front 1

what organism is responsible for acute, flaccid paralysis found in infants?

Back 1

1. clostridium botulinum
2. neurotoxin that irreversibly block acetylcholine release from peripheral neurons

Front 2

how is Clostridium botulinum acquired?

Back 2

1. via ingestion of spores in honey
2. via inhalation of spores
3. neurotoxin that irreversibly block acetylcholine release from peripheral neurons

Front 3

what should you think of in 95% of cases of infants age 3 wk to 6 mon, peak 2-4 mo c/ acute, flaccid paralysis?

Back 3

Clostridium botulinum!!

Front 4

what are si/sx of infant botulism?

Back 4

1. constipation
2. lethargy, poor feeding
3. weak cry, decreased sponteaneous movement
4. hypotonia
5. drooling
6. decreased gag and suck reflexes
7. as dz progresses--loos of head control and respiratory arrest

Front 5

what should you think of based on acute onset of flaccid descending paralysis c/ clear sensorium, s/ fever or paresthesias?

Back 5

Clostridium botulinum!!
1. can confirm by demonstrating botulinum toxin in serum or toxin/organism in feces

Front 6

what is tx for infant botulism?

Back 6

1. intubate
2. supportive care
3. NO abx or antitoxin needed in infants

Front 7

what is acquired in mothers via ingestion of poorly cooked meat or through contact c/ cat feces?

Back 7

Toxoplasmosis!!

Front 8

when is neonatal dz of toxoplasmosis a concern?

Back 8

1. toxo only causes neonatal dz if acquired during pregnancy (1%)
2. carriers are common (10-30%)

Front 9

what % of women who acquire toxoplasmosis during pregnancy transmit infxn to fetus?

Back 9

1. 1/3 or women who acquire toxo during pregnancy transmit infxn to fetus
2. 1/3 of fetuses are clinically affected

Front 10

what are the sequelae of toxoplasmosis?

Back 10

1. intracerebral calcifications
2. hydrocephalus
3. chorioretinitis
4. microcephaly
5. severe mental retardation
6. epilepsy
7. intrauterine growth retardation (IUGR)
8. heptatosplenomegaly

Front 11

what good is screening for toxo prior to giving birth?

Back 11

screening is uesless b/c acquisiton prior to birth is common and clinically irrelevant

Front 12

what recommendations should be made to pregnant women regarding cats and meat?

Back 12

1. pregnant women should be told to avoid undercooked meat
2. wash hands after handling cat
3. do not change little box
4. cautionary measures for toxoplasmosis

Front 13

if fetal infxn of toxo is established, what is the next step?

Back 13

1. Utz to determine major anomalies
2. provide counseling

Front 14

what is the % chance of fetal transmission with a first-trimester maternal rubella infxn?

Back 14

80% chance of fetal transmission

Front 15

what is the % chance of fetal transmission with a second-trimester maternal rubella infxn?

Back 15

50% chance of fetal transmission

Front 16

what is the % chance of fetal transmission with a third-trimester maternal rubella infxn?

Back 16

5% chance of fetal transmission

Front 17

what are si/sx of fetus with rebella infxn?

Back 17

1. IUGR
2. cataracts
3. glaucoma
4. chorioretinits
5. patent ductus arteriosus
6. pulmonary stenosis
7. atrial or ventricular septal defect
8. myocarditis
9. microcephaly
10. hearing loss
11. blueberry muffin rash
12. mental retardation

Front 18

what should you think of in an infant with "blueberry muffin rash", hearing loss, and microcephaly?

Back 18

Rubella!!

Front 19

how do you confirm a neonate rubella infxn?

Back 19

1. confirm with IgM rubella antibody in neonate's serum
2. or viral culture

Front 20

what is tx for infants with rubella?

Back 20

1. prevention by universal immunization of all children against rubella
2. no effective therapy fo ractive infxn

Front 21

what is the #1 congenital infxn, affecting 1% of births?

Back 21

CMV!!! (cytomegalovirus)

Front 22

how is CMV transmitted?

Back 22

1. CMV (cytomegalovirus) is transmitted through bodily fluids/secretions
2. infxn is often asymptomatic

Front 23

what happens with primary seroconversion of CMV during pregnancy?

Back 23

1. increased risk of severly affected infant
2. congential infxn can occur if mother reinfected during pregnancy

Front 24

what is the risk of transplacental transmission of infxn with CMV?

Back 24

1. 1% risk of transplacental transmission of infxn c/ CMV
2. approx 10% of infected infants manifest congenital defects of varying severity

Front 25

what are congenital defects of an infant with CMV infxn?

Back 25

1. microcephaly
2. intracranial calcifications
3. severe mental retardation
4. chorioretinitis
5. IUGR

Front 26

what torchs infxns in children have intracerebral calcifications as sequelae?

Back 26

1. toxoplasmosis
2. CMV

Front 27

what % of infants with CMV develop later neurologic sequelae?

Back 27

1. 10-15% of asymptomatic, but exposed infants developlater neurologic sequelae

Front 28

What virus is important to perform a C-section delivery so baby will not acquire the infxn?

Back 28

1. HSV!!! (herpes simplex virus)

Front 29

what is an important precaution in a pregnant women with HSV?

Back 29

1. C-section delivery!!

Front 30

what % of babies delivered vaginally willl acquire HSV?

Back 30

50%
HSV is a/c significant morbidity and mortality

Front 31

What are si/sx of HSV?

Back 31

1. vesicles
2. seizures
3. respiratory distress
4. possible pneumonia, meningitis, encephalitis
5. possible impaired neurologic development after resolution

Front 32

what is tx for HSV?

Back 32

1. acyclovir (markedly decreases mortality)

Front 33

what torch infxn has nearly a 100% transmission from infected mother to infant during pregnancy?

Back 33

1. syphilis!!
2. occurs after the first tri in the vast majority of cases

Front 34

what torch infxn is transmitted after the first tri in the vast majority of cases?

Back 34

1. syphilis!!

Front 35

what % of fetal/perinatal deaths occur with syphilis?

Back 35

40% of affected infants

Front 36

when do you seen early and later manifestations of syphilis in an affected infant?

Back 36

1. early manifestations in the first 2 yrs
2. later manifestations in the next 2 decades

Front 37

what are si/sx of early dz with syphilis (ToRCH)?

Back 37

1. jaundice
2. increased liver function tests
3. hepatosplenomegaly
4. hemolytic anemia
5. rash follwed by desquamation of hands and feet
6. wartlike lesions of mucous MBs
7. blood-tinged nasal secretions (snuffles)
8. diffuse osteochondritis
9. saddle nose (secondary to syphilitic rhinitis)

Front 38

where do you seen blood tinged nasal secretions (snuffles), diffuse osteochondritis, and saddle nose?

Back 38

1. early syphilis infxn in infant!

Front 39

what are snuffles?

Back 39

1. blood-tinged nasal secretions
2. seen in early syphilis infxn in infants

Front 40

what are si/sx of late dz with syphilis (torch dz)?

Back 40

1. hutchinson teeth (notching of permanent upper 2 incisors)
2. mulberry molars (both at 6 yr)
3. bone thickening (frontal bossing)
4. anterior bowing of tibia (saber shins)

Front 41

where do you seen hutchinson teeth, mulberry molars, bone thickening, anterior bowing of tibia?

Back 41

late syphilis infxn in child

Front 42

what are saber shins?

Back 42

1. anterior bowing of tibia
2. sign of late syphilis dz in a child

Front 43

how do you dx syphilis?

Back 43

1. RPR/VDRL and fluorescence treponemal antigen (FTA) serologies in mother c/ clinical findings in infant

Front 44

how do you tx syphilis?

Back 44

1. procaine penicillin G for 10-14 days