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44 Cards in this Set

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what organism is responsible for acute, flaccid paralysis found in infants?
1. clostridium botulinum
2. neurotoxin that irreversibly block acetylcholine release from peripheral neurons
how is Clostridium botulinum acquired?
1. via ingestion of spores in honey
2. via inhalation of spores
3. neurotoxin that irreversibly block acetylcholine release from peripheral neurons
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?
Clostridium botulinum!!
what are si/sx of infant botulism?
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
what should you think of based on acute onset of flaccid descending paralysis c/ clear sensorium, s/ fever or paresthesias?
Clostridium botulinum!!
1. can confirm by demonstrating botulinum toxin in serum or toxin/organism in feces
what is tx for infant botulism?
1. intubate
2. supportive care
3. NO abx or antitoxin needed in infants
what is acquired in mothers via ingestion of poorly cooked meat or through contact c/ cat feces?
Toxoplasmosis!!
when is neonatal dz of toxoplasmosis a concern?
1. toxo only causes neonatal dz if acquired during pregnancy (1%)
2. carriers are common (10-30%)
what % of women who acquire toxoplasmosis during pregnancy transmit infxn to fetus?
1. 1/3 or women who acquire toxo during pregnancy transmit infxn to fetus
2. 1/3 of fetuses are clinically affected
what are the sequelae of toxoplasmosis?
1. intracerebral calcifications
2. hydrocephalus
3. chorioretinitis
4. microcephaly
5. severe mental retardation
6. epilepsy
7. intrauterine growth retardation (IUGR)
8. heptatosplenomegaly
what good is screening for toxo prior to giving birth?
screening is uesless b/c acquisiton prior to birth is common and clinically irrelevant
what recommendations should be made to pregnant women regarding cats and meat?
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
if fetal infxn of toxo is established, what is the next step?
1. Utz to determine major anomalies
2. provide counseling
what is the % chance of fetal transmission with a first-trimester maternal rubella infxn?
80% chance of fetal transmission
what is the % chance of fetal transmission with a second-trimester maternal rubella infxn?
50% chance of fetal transmission
what is the % chance of fetal transmission with a third-trimester maternal rubella infxn?
5% chance of fetal transmission
what are si/sx of fetus with rebella infxn?
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
what should you think of in an infant with "blueberry muffin rash", hearing loss, and microcephaly?
Rubella!!
how do you confirm a neonate rubella infxn?
1. confirm with IgM rubella antibody in neonate's serum
2. or viral culture
what is tx for infants with rubella?
1. prevention by universal immunization of all children against rubella
2. no effective therapy fo ractive infxn
what is the #1 congenital infxn, affecting 1% of births?
CMV!!! (cytomegalovirus)
how is CMV transmitted?
1. CMV (cytomegalovirus) is transmitted through bodily fluids/secretions
2. infxn is often asymptomatic
what happens with primary seroconversion of CMV during pregnancy?
1. increased risk of severly affected infant
2. congential infxn can occur if mother reinfected during pregnancy
what is the risk of transplacental transmission of infxn with CMV?
1. 1% risk of transplacental transmission of infxn c/ CMV
2. approx 10% of infected infants manifest congenital defects of varying severity
what are congenital defects of an infant with CMV infxn?
1. microcephaly
2. intracranial calcifications
3. severe mental retardation
4. chorioretinitis
5. IUGR
what torchs infxns in children have intracerebral calcifications as sequelae?
1. toxoplasmosis
2. CMV
what % of infants with CMV develop later neurologic sequelae?
1. 10-15% of asymptomatic, but exposed infants developlater neurologic sequelae
What virus is important to perform a C-section delivery so baby will not acquire the infxn?
1. HSV!!! (herpes simplex virus)
what is an important precaution in a pregnant women with HSV?
1. C-section delivery!!
what % of babies delivered vaginally willl acquire HSV?
50%
HSV is a/c significant morbidity and mortality
What are si/sx of HSV?
1. vesicles
2. seizures
3. respiratory distress
4. possible pneumonia, meningitis, encephalitis
5. possible impaired neurologic development after resolution
what is tx for HSV?
1. acyclovir (markedly decreases mortality)
what torch infxn has nearly a 100% transmission from infected mother to infant during pregnancy?
1. syphilis!!
2. occurs after the first tri in the vast majority of cases
what torch infxn is transmitted after the first tri in the vast majority of cases?
1. syphilis!!
what % of fetal/perinatal deaths occur with syphilis?
40% of affected infants
when do you seen early and later manifestations of syphilis in an affected infant?
1. early manifestations in the first 2 yrs
2. later manifestations in the next 2 decades
what are si/sx of early dz with syphilis (ToRCH)?
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)
where do you seen blood tinged nasal secretions (snuffles), diffuse osteochondritis, and saddle nose?
1. early syphilis infxn in infant!
what are snuffles?
1. blood-tinged nasal secretions
2. seen in early syphilis infxn in infants
what are si/sx of late dz with syphilis (torch dz)?
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)
where do you seen hutchinson teeth, mulberry molars, bone thickening, anterior bowing of tibia?
late syphilis infxn in child
what are saber shins?
1. anterior bowing of tibia
2. sign of late syphilis dz in a child
how do you dx syphilis?
1. RPR/VDRL and fluorescence treponemal antigen (FTA) serologies in mother c/ clinical findings in infant
how do you tx syphilis?
1. procaine penicillin G for 10-14 days