congenital infections1.txt

  1. how do you confirm congenital rubella infection?
    serology as clinical diagnosis unreliable
  2. up to how many weeks GA is rubella most dangerous for fetes? what happens?
    • 8-10 weeks
    • hepatosplenomegaly, growth retardation
    • heart: PDA, PS
    • sensorineural hearing loss
    • eyes: glaucoma, cataract, retinopathy
  3. what is the problem with rubella infection at 13-16 weeks?
    sensorineural deafness
  4. what has prevented rubella?
  5. what is the most common congenital infection?
  6. out of all pregnant women who become infected with CMV, what % of infants become infected?
  7. when is maternal CMV important?
    if it is their first time CMV infection, otherwise if woman is already immune - unlikely to damage fetes
  8. what % of CMV infected infants are normal at birth?
  9. what happens to the other 10% of not normal infants?
    • 5% get CMV inclusion disease
    • 5% problems later in life - sensorineural hearing loss
  10. what are features of CMV inclusion?
    • hepatosplenomegaly
    • petechiae
    • microcephaly
    • SGA
    • choroidoretinitis
    • seizires
    • pneumonitis
    • thrombocytopenia
  11. how can you get toxoplasmosis?
    • raw or undercooked meat - tissue cysts
    • contaminated vegetables
    • contact with faeces of recently infected cats
  12. what are the features of congenital toxoplasmosis?
    • choroidoretinitis
    • cerebral calcification
    • hydrocephalus
  13. what determines damage to fetus in toxoplasmosis?
    • 1st trimester - 25% infection, 75% damage
    • 2nd trim - 50% infection, 55% damage
    • 3rd trim - 65% infection, <5% damage
  14. if there is an asymptomatic infant with toxoplasmosis, are they at risk of anything in future?
    yes choroidoretinitis in adulthood
  15. what blood test do you do to see if there is maternal infection with toxo?
    • not IgM as it can stay positive for 3 yrs!!
    • need combo of IgG, IgM IgA and avidity
  16. what tests to do for fettle infection?
    • imaging
    • PCR on amniotic fluid
    • post natal serology IgG until 12 months
  17. what are treatment options during pregnancy if toxoplasmosis is found?
    • termination
    • sulphadiazine/pyrimethamine/folinic acid alternating with spiramycin
  18. what is Rx for neonate with congenital toxoplasmosis?
    sulphadiazine/pyrimethamine/folinic acid
  19. how can congenital toxoplasmosis be prevented?
    • avoid undercooked meats and undercooked vegetables
    • avoid cat litter
  20. when is the risk of fettle varicella syndrome highest?
    first 20 weeks of pregnancy
  21. what are features of F varicella synd?
    • Limb hypoplasia
    • Eye defect
    • Neuro
    • Skin scarring in a dermatomal distribution
  22. what other stage in pregnancy is it dangerous for the FETUS if mother is exposed to varicella?
    • week before and 2 days after birth
    • viral load is high
    • fetes is unprotected - doesn't have maternal Abs
    • high risk of disseminated chickenpox as immune system is weak
  23. what is given to exposed susceptible women? up to when can you give this?
    VZIg within 10 days of exposure
  24. if pregnant woman actually gets chickenpox, what is given?
  25. what is given to neonate born in the high risk period?
    • VZIg
    • aciclovir prophylaxis
  26. what is the risk of maternal shingles in pregnancy to the fetes?
    • no risk
    • unless mother immunosuppressed
    • or shingels disseminated
  27. what is congenital syphilis caused by?
    treponema pallidum
  28. how common is congenital syphilis?
    very rare
  29. how is syphilis detected in pregnant woman?
    antenatal screening
  30. what can prevent transmission of syphilis?
    • treatment during pregnancy
    • im procaine penicillin for 10 days
    • or 1 dose benzathine penicillin
  31. what are early signs of congenital syphilis? up to what age?
    • up to 2 yrs
    • skin rashes
    • syphilitic snuffles
    • osteochondritis, periostitis
    • hepatosplenomeagly
    • GN
    • thrombocytopenia
  32. what are late manifestations of congenital syphilis?
    • cluttons joints
    • gummatous involvement
    • hutchinson's teeth
    • interstitial keratitis
  33. what is Rx of infected neonate with syphilis?
    iv or im penicillin for 10 days
  34. what does early onset GBS infection mean - hours?
    48 hours of birth
  35. what is the manifestation of early onset GBS?
  36. how does neonate get GBS?
    passage through colonised birth canal
  37. what are RF for developing early GBS disease?
    • prematurity
    • prolonged ROM
    • maternal pyrexia
    • previous infected baby
    • documented GBS during pregnancy
  38. what is the outcome of early GBS disease?
    high mortality
  39. what is definition of late onset GBS?
    > 1 week after birth
  40. what is the clinical manifestation of late GBS?
  41. what is mortality of late GBS cf to early GBS?
    • lower mortality in late
    • 5%
  42. what are the main complications of late GBS?
    longterm neurological sequelae
  43. how is GBS diagnosed?
  44. how is GBS prevented?
    • mother with risk factors needs intrapartum antibiotics
    • monitor baby for sepsis
    • infection control
  45. what is Rx of GBS infection?
    iv penicillin and gentamicin
  46. what can listeria cause in baby?
    meningitis or sepsis
  47. what time frame does listeria infection happen in baby?
    within 2 weeks of birth
  48. what is Rx of listeria infection?
    • iv amoxicillin and gentamicin
    • 2-3 weeks
  49. how does mum get listeria?
    • soft cheese
    • pate
  50. what is ophthalmia neonatorum?
    infectious neonatal conjunctivitis
  51. what are 4 main causes of ophthalmia neonatorum?
    • gonorrhoea
    • chlamydia trachomatis
    • staph aureus
    • strep pneumo
  52. how many days after birth does gonococal conjunct present?
    5 days
  53. what is feature and Ix and Rx of gonoc conjunct?
    • purulent discharge
    • eye swab - M&C
    • Rx: benpen or cefotaxime
  54. how many days after birth does chlamydial conjunct present?
    6-21 days
  55. what is features, Ix and Rx of chlamydial conjunct?
    • mucopurulent discharge
    • NAAT on eye swab
    • Rx: topical tetracycline and systemic erythromycin
  56. apart from conjunctivitis from chlamydia, what else can neonate get?
    • pneumonitis
    • staccato cough, dyspnoea
    • 3 weeks - 3 months
    • Rx: erythromycin 10-14 days
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congenital infections1.txt