Diseases of the Newborn 3-A, 3-B TORCH infections

what TORCH infection is a venereal disease that can also be acquired by exposure to infected blood?

Syphilis

what TORCH infection is known as the "greater imitator"?

Syphilis wide ranging clinical presentations

what type of TORCH infection has osteomyeltic lesions (humerus and tibia), osteochondritis

Syphillis

what organism causes syphilis

T. Pallidum a spirochete

TORCH

T: toxopasma O: other R: rubella C: CMV H: HSV

what type of TORCH infection is associated with hydrocephalus with diffuse intracranial calcification, chorioretinitis

Toxoplasm

what TORCH infection is caused by a protozoa?

Toxoplasmosis

definitive diagnostic test for HSV

Viral Culture HSV PCR tests for CSF (isolated herpes encephalitis)

what stain is done on urine sediment for diagnosis of CMV

Wright/Giemsa stain

what is the natural definitive host of Toxoplasmosis?

a cat

what is the most consistent finding in toxoplasmosis?

acute congenital chorioretinitis- tissue cyst formation with or without necrosis

Incubation time for syphillis

averages 3 weeks but can range from 10-90 days

why do infants wth congenital CMV infections also required abdominal imaging studies?

for documentation and monitoring of organomegaly

who is at most risk for CMV infection?

immunocompromised organ transplant recipients and individuals infected with HIV

infants who are not infected congenitally or perinatally with CMV are at high risk to acquire infection where?

in day care centers- saliva alone appears to be sufficient for transmission, kissing

when HSV is latent, where are the HSV virons located?

in the sensory ganglia

children with fewer than ____ recurrences of HSV are less likely to have neurologic sequelae

less than 3 recurrences

The likelihood of CONGENITAL infection and that the baby will be BORN with CMV depends on what?

maternal immune status

late congenital syphilis mainly manifests with what type of symptoms

neurologic

what type of mother who gets CMV is most protective of the baby?

one who got a recurrent CMV because they have memory, IgG that can be given to the baby through the placenta

Although exposure to some infectious agents shortly before birth results in infection at or shortly after birth, the infections they cause are really ______ infections.

perinatal

duration of treatment of HSV

60mg/kg daily divided in 3 doses for 14 days in disease limited to skin, eyes, or mouth minimum 21 days in HSV encephalitis and in disseminated disease

Tx of toxoplasmosis infection

pyrimethamine + Sulfadiazine for 1 year

after initial infection, HSV virons spread by ___ axonal flow where?

retrograde axonal flow to sensory ganglia where the virions establish latency

what is the major consequence of inapparent congenital CMV infection

sensorineural hearing loss

what is the major consequence of inapparent congenital CMV infection (asymptomatic)

sensorineural hearing loss 15-20% of these infants will develop Unilateral or b/l deafness ASYMPTOMATIC DOES NOT EQUAL BENIGN

what can differentiate between acquired and congenital syphilis?

slit-lamp exam and ophthalmic assessment - presence of interstitial keratitis

test for presence of what antibody for syphilis?

specific antitreponemal IgM antibody

saddle nose deformity can be seen in which TORCH infection?

syphilis

Hutchinson's Teeth is a manifestation of what?

syphilis Hutchinson's teeth: permanent incisor teeth are narrow and notched

if more than one day of therapy is missed for syphilis, what should be done?

the entire course should be restarted

transmission of toxoplasmosis

the mother is exposed from cat feces or eats raw/spoiled meat that has cysts of toxplasmosis prozoa and is transmitted to the baby by the placenta or hematogeneously

Most ASYMPTOMATIC neonates born with CMV are born to what type of women?

those who have preexisting immunity to CMV (recurrent infection) just because they are asymptomatic does not mean there will be no problems-can still have sequelae (sensorineural hearing loss)

C- section should preformed within how many hours after rupture of membranes with active genital HSV lesions?

BEFORE 6 HOURS

when diagnosis of isolated herpes encephalitis is STRONGLY SUSPECTED, but PCR and viral cultures are negative, what should be considered?

BRAIN BIOPSY

****Most common TORCH infection in the developed world/ Most common congenital infection

CMV

most important cause of congenital infection in the developed world, commonly leading to mental retardation and developmental disability

CMV

what HHV-5 virus causes the most morbidity and mortality?

CMV

what type of TORCH infection is associated wtih microcephaly with periventricular calcifications, thrombocytopenia, purpura, hearing loss

CMV

MCC of infectious cause of MR in children

CMV 2nd most common cause of congenital mental retardation (2nd to Down Syndrome)

Truly _____ infections are acquired in utero and are usually established by the time of delivery.

CONGENITAL

what labs should you get to diagnose Toxoplasmosis?

CSF and blood work to check for IgM to detect IgG would take greater than 1 year of infection, IgA within 6 months

Most important study in diagnostic evaluation of congenitally infected infant with CMV??? prognostic as well as diagnostic

CT scan of head

what TORCH infection is characterized by rash at birth, low birth weight, small head size, HEART abnormalities, visual problems, and bulging fontanelle?

Congenital Rubella Syndrome

what is the most severe from of congenital CMV infection

Cytomegalic inclusion disease (CID)

what is the most common cause of mental retardation in children?

Down syndrome

route of congenital infection of CMV route of perinatal transmission

transplacental perinatal: aspiration, breastfeeding

HSV infection can be detected by PCR in CSF up to how long after initiating anti-viral therapy

up to 1 week agter

what is the hallmark of any CMV infection

very LARGE cells with large nuclei with large intranuclear inclusions

If a baby has limited skin, eye, and mouth infection of HSV- is this benign?

very low mortality rate but if NOT treated appropriately can progress to isolate herpes encephalitis or disseminated infection

manifestations of early congenital syphilis occurs when

within the first 3 to 7 weeks after birth

can a person get CMV from kissing?

yes, saliva alone appears to be sufficient for transmission

CMV mononucleosis - hallmark symptoms

Fever Severe malaise

Tx of CMV

Ganciclovir

what type of HSV is most common cause of HSV infection in neonate?

HSV-2 (below the belt) - 73%

what has a higher mutation rate: HSV 1 or 2?

HSV-2 has higher mutation rate

family, subfamily, and genera of HSV

Herpesviridae family Alphaherpesvirinae subfamily Simplex virus genera

Tx of infants with HSV?? oral or IV???

High Dose IV acyclovir ** Note: ORAL acyclovir is NEVER tx for initial disseminated HSV Oral acyclovir is ONLY considered for use for recurrences limited to skin, mucus membranes

presence of what antibodies are presumptive evidence of primary infection of CMV?

IgG and IgM if lots of IgG: recurrence If lots of IgM: primary infection

what is a prognostic sign of poorer outcome and poorer neurologic development in CMV?

Intracerebral calcifications

what type of CMV children are at increased risk for neurodevelopmental sequelae?

Intracerebral calcifications CID

with RECURRENT maternal infection of CMV, is the risk of transmission to the fetus higher or lower? why?

LOWER, because memory causes faster more rapid response from IgG which crosses the placenta

****describe the structure of HSV1 and 2

Large, double stranded DNA virus with an icosahedral nucleocapsid

can oral acyclovir ever be used to treat a neonatal HSV infection?

NOOOOOOO, it only has 10-20% bioavailabillity. can only be used in recurrent infection in older ages that is limited to skin and mucus membranes

when can oral acyclovir be used for HSV?

ONLY FOR RECURRENCES- IV must be used for INITIAL infections

Tx of syphilis

PCN

"blueberry muffin rash" and "celery-stalking" lucency of long bones

Rubella

what TORCH infection puts children at risk for malformation of the HEART, eyes, or brain?

Rubella

what infection has abnormalities attributed to reduced cell division during fetal development?

Rubella

what is known as German Measles?

Rubella

Disseminated HSV infection effects which 3 things most frequently?

1. Liver 2. CNS 3. Lungs

2 Side effects of Acyclovir

1. Neutropenia 2. Nephrotoxicity

infection of baby in what trimester is more serious?

1st and 2nd trimester

Timing of infection influences fetal effects. Infection during what trimester is more likely to result in fetal loss or organ malformation?

1st trimester

Untreated syphilis progresses through how many stages? what are they?

4 stages 1. Primary 2. Secondary 3. Latent 4. Tertiary

classic triad of toxoplasmosis

1. Focal necrotizing chorioretinitis 2. Hydrocephalus 3. Scattered Cerebral calcifications on xray/CT

4 signs and symptoms common to most congenital infections

1. Hepatosplenomegaly 2. Jaundice 3. Fetal growth retardation 4. Microcephaly