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41 Cards in this Set
- Front
- Back
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Toxoplasma gondii frequency, location, complications |
22.5% of population hot, humid, low elevation hearing loss, intellectual disability, blindness |
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toxoplasmosis risk factors |
inadequate cooked/cured meat-main risk contaminated soil, travel outside europe, US, canada cat litter, soil, water > direct cat contact |
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toxoplasmosis prevention |
cook meat until no pink--no raw or rare Wash utensils/surfaces/hands after meat wash all fruits/veg completely avoiding stray cats or adopting new cat keep cats indoors, don't feed raw meats use gloves or avoid changing cat litter wash/glove while gardening |
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Listeria monocytogenes--bacterial pathogen frequency, sequelae |
pregnant women are 14% of all cases Miscarriage, preterm birth, neonatal infection |
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Listeria sources
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deli meats, hot dogs, soft unpasteurized cheese, unpasteurized milk, "smoked" "kippered" or "jerky" fish |
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Listeria food changes |
Hot dogs and lunch meats--heat until steaming Soft cheeses--only with pasteurized milk cold smoked seafood only if cooked (casserole) |
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Listeria foods to avoid |
Refrigerated meat spreads/pates Refrigerated smoked seafood in cold section unpasteurized milk/cheese Rare, raw, undercooked meats |
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Listeria food tips |
cook to internal temp of 160 degrees Rinse raw produce under running water Scrub firm produce before cutting wash hands after handling meat, or gloves Wash utensils used with raw foods |
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CMV basics |
50% of all adults >40 usually no symptoms |
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CMV symptoms for healthy CMV symptoms for weak immune system CMV symptoms for babies |
Fever, sore throat, fatigue, swollen glands can lead to mono or hepatitis adults--problems with eyes, lungs, liver, esophagus, stomach, intestines Brain, liver, spleen, lung, growth, hearing loss (most common--at birth or later on) |
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CMV transmission |
sex, breastmilk, Direct contact with urine or saliva, vertical transmission in pregnancy, blood and organs |
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CMV prevention |
regular handwashing after diapers, wiping noses |
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hepatitis B What to do if positive |
checked in initial visit labs as Hep B surface antigen (HBsAg) determine carrier status, aware of symptoms, test susceptible contacts, abstain from ETOH and hepatotixic drugs like APAP, don't share personal items (toothbrushes, razors), babies get HepB at birth/1 mo/6mo, and hep B immune glob (H-BIG) at birth |
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Hep B risk factors |
More than 1 partner in previous 6 months, eval/tx for STI, recent or current injection drug use, Hep B + partner should be vaccinated during pregnancy |
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BV basics |
most common infection in childbearing age women source unknown, but changes flora STI?? probably not, but associated with other STIs |
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bv risk factors bv symptoms |
multiple partners, new partner, female partner, douching, condom use thin, white, malodorous discharge, often asymptomatic |
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bv associations |
PROM, preterm labor/birth, infection, postpartum endometritis, surgical complications after GYN surgery |
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Trichomonas vaginalis risk factors, symptoms |
New partner, multiple partners, other STIs, transactional sex, injection drugs malodorous, yellow-green vag discharge with vulvar irritation or asymptomatic |
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trich associations |
preterm labor, LBW, increased risk of HIV transmission tx can reduce HIV shedding and thus HIV transmission to seronegative partner |
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HIV statistics |
19% of new cases are women 62% AA, 35% white, 16% latina 40% decline of dx from 2005-2014 Opt-out testing high risk re-screened in 3rd trimester unknown status screened in labor |
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HIV and c/s |
advised if viral loads >1,000/mL, if patient not started on ART, or without prenatal care Vag delivery ok for woman on effective tx and low viral loads (<1,000/mL) at 34-36 weeks |
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PMTCT |
Universal HIV screening in pregnancy (opt-out), appropriate ARV's, appropriate method of birth team approach with HIV specialists and perinatology in the lead |
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GBS statistics and risk |
10-35% of women colonized 1-2% of babies to colonized moms develop it 5-9% mortality rate in cases 5-63/100,000 babies who don't receive abx Very low risk! |
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Zika virus |
40% of babies have neuro abnormalities |
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postpartum infections basics |
responsible for 12.7% of all maternal mortality 1-2% of vag birth infections 27% higher after C/S |
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2 components of newborn immune system |
Phagocytic (primary defense) Humoral (antibody-mediated, complement) cell-mediated |
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phagocytic component--Polymorphonucleated neutrophils/PMNs/neutrophils |
move to site of invasion, engulf germs, wall off/localize infection Good for small volume Bad if infant is stressed, premature, or bacterial load is large allows germs to spread and infection becomes systemic bypasses inflammatory response |
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Humoral immunity--IgA, IgM, IgG few and far between--55-80% |
IgG crosses placenta and protects baby against what mom fought against IgA present but at 1-2% of adult levels--breast milk helps IgM--11% of adult levels, gets used up until can make own at 6 months, less able to respond to specific pathogens (all are new) |
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Cell-mediated immunity--t-cells |
require "experience" to develop specific lymphocyte to comba antigens by 4-6 weeks, killing ability is 30-60% of an adult |
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newborn immune system basics |
Depends on GA--earlier = more vulnerable temporary immune sys deficit --> overwhelming newborn infections |
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chorio symptoms |
maternal fever, tachycardia, uterine tenderness, sweating, malodorous vag discharge |
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Risk factors for newborn sepsis |
chorioamnionitis, breaks in skin (cord stump, scalp electrode, skin abrasion, circumcision), skin colonization (GBS?), maternal skin flora, nosocomial, lack of colonization of GI tract |
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newborn infection symptoms |
vague and non-specific--lethargy, irritability, hypotonia, pallor, duskiness, cyanosis, grunting, retractions, apnea, high or low temp, poor feeding, abd distention, vomiting, jaundice NOT often fever |
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Newborn infection labwork |
Suggestive WBC--<3-4k, >25k Shift to the left--bands/monocytes >20-40% positive blood cultures positive CSF |
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guidelines for GBS tx of newborns |
If mom received prophylaxis 4+ hours before birth, no tx or cultures needed If mom received prophylaxis 2+ hours, baby cultured and observed If mom received no prophylaxis or <2hrs before birth, baby cultured and on abx |
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CNM responsibilities for GBS + babies |
watch for symptoms, careful exam, consult for sx (temp below 97, disinterest in eating) |
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Difference between viral and bacterial infections |
Virus--parasitic, replicates inside cell infant's immune system non-selective, so can attack important (neuron) cells too fortunately, only a few infect the newborn |
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virus transmission |
congenitally--syphilis, rubella, CMV acquired during birth--herpes nosocomial--URI in NICU |
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Viral symptoms |
Often none, mostly non-specific specific, major findings from congenital infections--CMV--petechiae, hepatosplenomegaly, microcephaly |
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viral dx and tx |
dx--isolation of culture, but very difficult tx--most ARVs not approved for newborns, so hopefully mom has been treated Supportive care needed some hyperimmune globulins and vaccines explored |
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Nosocomial infection prevention |
rooming in, early discharge handwashing, prevent sick people breastfeeding, even for a few days |
