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73 Cards in this Set
- Front
- Back
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What is TORCH?
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toxoplasmosis, other (syphilis, gonorrhea, hep B, listeria), rubella, cytomegalovirus, herpes simples
bacteria, viruses, and protozoa that cause fetal infections that may result in fetal death, congenital anomalies, serious CNS sequelae, intrauterine growth retardation or preterm birth |
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What other organisms can cause congenitally acquired infections?
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HIV, human parvovirus, varicella-zoster virus, measles virus
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What is primary clinical manifestation of herpes simplex?
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cutaneous vesicles, keratoconjunctivitis, microcephaly, CNS infection, hepatitis, pneumonitis, prematurity, respiratory distress, sepsis, convulsion, choriretinitis
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What is tx for HSV?
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acyclovir IV
ocular involvement: acyclovir IV plus topical trifluridine, iododeoxyuridine, or vidarabine |
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What is primary clinical manifestation of toxoplasmosis?
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chorioretinitis, ventriculomegaly, microcephaly, hydrocephaly, intracranial calcifications, ascites, hepatosplenomegaly, lymphadenopathy, jaundice, anemia, metnal retardation
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What is tx for toxoplasmosis?
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sulfadiazine PO for 1 year and pyrimethamine for 1 year and folinic acid for year
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What is primary clinical manifestation of early treponema pallidum?
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osteochondritis, periostitis, hepatosplenomegaly, skin rash, rhinitis, meningitis, IUGR, jaundice, hepatitis, anemia, thrombocytopenia, chorioretinitis
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What is tx for early treponema pallidum?
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aqueous crystalline Pen G IV or IM for 10-14 days
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What is primary clinical manifestation of late treponema pallidum?
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hutchinson's triad (interstitial keratitis, VIIIth nerve deafness, Hutchinson's teeth), mental retardation, hydrocephalus, saddle nose, mulberry molars
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What is tx for late treponema pallidum?
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procaine Pen G IM for 10-14 days
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What are primary clinical manifestations of hep B?
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prematurity, asymptomatic, long term effects include chronic hepatitis, cirrhosis, liver failure, and hepatocellular carcinoma
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What is tx for hep B?
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HBIG IM and hepB vaccine IM within 12hrs after birth, repeat hepB vaccine at 1 and 6 months
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What are primary clinical manifestations of rubella?
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early:IUGR, retinopathy, hypotonia, hepatosplenomegaly, thrombocytopenia, purpura, bone lesions, cardiac effects
late: hearing loss, mental retardation, daibetes rare: myocarditis, glaucoma, microencephaly, hepatitis, anemia |
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What is tx for rubella?
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supportive care
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What is primary clinical manifestation of cytomegalovirus?
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petechiae, hepatosplenomegaly, jaundice, prematurity, IUGR, increased LFT, hyperbilirubinemia, anemia, thrombocytopenia, interstitial pneumonitis, microcephaly, chorioretinitis, intracranial calcifications
late: hearing loss, mental retardation, learning and motor abnormalities, visual disturbances |
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What is tx for cytomegalovirus?
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IV ganciclovir
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What are primary clinical manifestations of gonorrhoeae?
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ophthalmia neonatorum, scalp abscess, sepsis, arthritis, meningitis, endocarditis
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What is tx for nondisseminated gonorrhoeae?
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ceftriaxone or cefotaxime 1 dose IV or IM
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What is tx for disseminated gonorrhoeae?
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ceftriaxone Q24 IV or IM
cefotaxime Q12 IV or IM |
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What is duration of tx for arthritis or septicemia from gonorrhoeae?
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7 days
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What is duration of tx for meningitis from gonorrhaeae?
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10-14 days
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What is tx in gonorrhoeae if hyperbilirubinemic?
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cofotaxime
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How can neonatal HSV be acquired?
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transplacental or ascending vaginal and cevical infections, perinatally via passage through birth canal with active herpes lesions, or postnatally
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What increases risk of HSV?
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primary maternal infection during delivery, prolonged rupture of membranes, presence of active lesions at vaginal birth, use of a fetal scalp monitor during active herpes infection
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Is neonate born vaginally more likely to develop HSV?
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10x
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What delivery to reduce exposure to HSV?
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cesarean section, 7 fold reduction in perinatal transmission
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Does cesarean section prevent all cases of neonatly HSV?
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no
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What 3 ways does HSV present?
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-disseminated infection (multiple organs) with or without encephalitis
-localized CNS infection -localized infection of skin, eyes, or mouth |
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What are signs of disseminated disease?
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irritability, respiratory disress, skin vesicles, seizures, coagulopathy, jaundice, shock
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What are symptoms of CNS HSV?
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temp instability, irritability, lethargy, poor feeding, bulging fontanel, tremors, seizures
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What is the onset for disseminated, SEM, and CNS HSV?
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disseminated and SEM: 10-12 days of life
CNS: 16-19 days of life |
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Which HSV has worst prognosis?
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disseminated, 29% mortality
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What is mortality from SEM?
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zero
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What is antiviral of choice for HSV?
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IV acyclovir in 3 divided doses for 14 days is SEM and 21 days if CNS or disseminated
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Who needs dose reduction of acyclovir?
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renal dysfunction, SrCr greater than 0.8mg/dL
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Is recurrence of HSV common?
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yes, neurologic sequelae if occurs more than 3x in first 6 months of life
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What causes Toxoplasmosis?
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protozoan Toxoplasma gondii
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What causes toxoplasmosis?
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maternal infestion of uncooked meat or contact with infected cats
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Is toxoplasmosis human to human transmission?
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only transplacental
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When is transmission to infant highest?
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if disease acquired during 3rd trimester
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When is more severe toxoplasmosis?
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earlier in gestation
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What symptoms for toxoplasmosis?
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most are asymptomatic, most common is chorioretinitis (may develop permanent visual loss)
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What is used to reduce vertical transmission of T. gondii?
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pyrimethamine with sulfadiazine to mother
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Who is treated if inutero diagnosis of toxoplasmosis?
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mother and fetus
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When can pyrimethamine not be used?
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1st trimester (teratogenic)
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What is tx of neonatal toxoplasmosis?
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pyrimethamine, sulfadiazine, and folinic acid
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Why is folinic acid given?
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decrease potential hematologic toxic effects of pyrimethamine
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What causes syphilis?
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spirochete Treponema pallidum
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How is syphilis acquired?
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direct contact with ulcerative, deunuded lesions of mucous membranes or skin of infected person
vertical transmission: transplacentally or during delivery by contact of new born with genital lesions |
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Is incidence of congenital syphallis increasing or decreasing?
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decreasing
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What results in 40% of pregnancies in women with untreated early syphilis?
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spontaneous abortion, still birth, nonimmune hydrops, premature delivery, perinatal death
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When is early syphilis?
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before 2 years of life
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When is late syphilis?
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after 2 years
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What are the classic presentations of congenital syphilis?
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bone lesions, hepatosplenomegaly, erythematous maculopapular rash on hands and feet, rhinitis
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What is preferred tx for syphilis?
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parenteral Pen G, IV preferred over IM because of higher CSF concentrations
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What is required if 1 day of syphilis therapy is missed?
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entire course must be restarted
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How is hep B virus infection transmitted?
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rarely transplacentally, most infected around time of birth from exposure to maternal HBV positive genital tract secretions and blood
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What symptoms do newborns with HBV have?
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asymptomatic, can be chronic carrier of of hep B surface antigen, develop long term sequelae (chronic hepatitis, cirrhosis, hepatocellular carcinoma)
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What is used to reduce neonatal chronic carrier rates of HBV?
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combined hep B vaccine and hep B immune globulin
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Who is vaccinated with hep B at birth?
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all infants
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What is prevalence of rubella?
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decreased since vaccine
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How is fetus infected with rubella?
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crosses placenta
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What is result of infection with rubella?
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spontaneous abortion, still birth, birth defects
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When is rate of congenital infection highest?
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1st trimester, can be at any time
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What are characteristics of congenital rubella syndrome?
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hearing loss, cataracts, and congenital heart disease, intrauterine growth retardation
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What is tx for congenital rubella syndrome?
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no effective meds, universal immunization with vaccine
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What is the most common cause of congenital infection?
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cytomegalovirus, 40,000/year
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How does transmission of CMV occur?
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transplacentally at any stage of pregnancy or during delivery
breast milk or close contact also |
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Is transmission of CMV higher in primary or recurrent infection?
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primary
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What are most common manifestations of CMV?
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90% asymptomatic, petechiae, hepatosplenomegaly, jaundice, and prematurity
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What is prognosis of CMV?
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20% mortality, most surviving have permanent damage (visual deficity, hearing loss, seizure disorders, learning and motor disabilities)
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What is tx for CMV?
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no proven effective tx, ganciclovir IV has been used but severe AE
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What AE from ganciclovir?
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neutropenia, anemia, thrombocytopenia
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