Infectious Diseases—Congenital and Newborn Infections

Joseph Lister Listeria monocytogenes

First to use antiseptic technique in surgery Gram positive rod—does not form spores, found in soil, water, vegetation, dairy products, meat, and poultry Will grow in the refrigerator Most healthy adults have no symptoms with an infection 1-5% are healthy carriers

CMV Prematurity Developmental anomalies/birth defects Persistent postnatal infection Deafness/intellectual disability/seizures AIDS

Herpes virus 5 Most common intrauterine viral infection—most patients are asymptomatic—fetuses, newborns, and immunocompromised individuals are susceptible to severe complications. What can infection cause? Which patients can develop pneumonia, blindness, or (this disease type) mononucleosis?

Neisseria gonnorrhoeae Chlamydia trachomatis

If the mother has one of these STIs they can be transmitted to the infant during birth and cause eye infection

Toxoplasmosis Serological detection of organisms in tissue samples Microscopic ID of parasites in tissue biopsy Molecular ID of T. Gondii genetic material in specimens using PCR or DNA probes Antibiotics for 3-4 weeks

In healthy individuals the immune system can prevent disease but the parasite will remain for life and can re-emerge to cause disease Estimated that 60 million Americans are infected 95% in some developing countries Major foodborne infection What is diagnosis? Treatment?

Herpes simplex virus 30-50% Disease localized to skin, eyes, or mouth Encephalitis with/without skin, eyes, or mouth involvement Disseminated infection involving multiple organs having a 60-70% fatality rate

In utero infections are rare, most cases are acquired during delivery (natal/perinatal) Virus can cross the placenta If mother acquires the infection near the time of delivery, what is the risk of transmission? Infections are almost always symptomatic and frequently fatal What are the three categories?

Perinatal infections during home birth

Infection during labor and delivery HSV, CMV, HIV, or Hep B may be transmitted Some of maternal flora may cause infection as sepsis Group B streptococci and E. Coli are most common cause followed by listeria—this sepsis may lead to meningitis with a high mortality rate These are risks for what type of infections?

Natal/perinatal

Infections acquired during delivery

Postnatal

Infections after delivery through newborn period (first four weeks of life)

Congenital

Infections occurring anytime before birth and at birth (prenatal and natal)

Prenatal infections 1st trimester (first 12 weeks)

Infections of the fetus any time before birth—usually blood-borne through the placenta What is usually the most dangerous time to have most infections?

Congenital Chagas disease

Pseudocysts (clusters of parasites in heart muscle tissue)—follows the characteristic final symptomatic stage (CHF) Heart failure resulting from T. Cruzi infection—one of the leading causes of death in Latin American children

HIV Breast milk and across the placenta Availability of testing and treatment (from 25% to 1%)

Single-stranded RNA retrovirus If mother is infected, the fetus has a 25% chance of infection This is more likely if mother has high viremia, has AIDS, or low CD4+ cell count Infant may not have symptoms until opportunistic infections start Transmission may also occur through what? What decreased the rate of mother-to-child transmission?

Rubella (German/three day measles)

Single-stranded RNA virus Risk of congenital infection is highest in first trimester (90% before 11 weeks) Virus inhibits mitosis which leads to underdeveloped organs and tissues Infection can lead to miscarriage, stillbirth, or congenital defects (ex., deafness, cataracts, mental retardation, and heart defects)

Zika virus microcephaly

Spread via mosquitos and sex (oral/anal/vaginal) Incubation period of 3-12 days and lives in semen for up to 93 days Pregnant women need to avoid traveling to this area or having sex with someone who has

Toxoplasmosis Other (coxsackie, chicken pox, chlamydia, HIV, lymphocytic choriomeningitis—rodent poop) Rubella (German measles) Cytomegalovirus (CMV) Herpes simplex TORCH

These lead to intrauterine growth retardation and affected children will continue to grow on the low percentiles of the growth chart

Vivian (Henrickson) Act Antivirals

This act will raise awareness for both patients and doctors to test for CMV Testing antibodies (IgG and IgM) can detect prior infection or current infection The virus can be found in saliva and the sooner the treatment begins the better (esp., for newborns—reduce hearing loss and developmental delays) What has been proven to decrease the debilitating side effects of the CMV virus?

CMV 1/150

This can be spread from small children to parents (ex., through diapers or sippy cups) What number of newborns test positive for this and thus may experience hearing loss, neurodevelopmental problems (ex., cerebral palsy or ALL)?

50-90% 100% For life (remain latent in various cells) Presence of inclusion bodies (abnormally enlarged nuclei) Interferon and anti-CMV gamma globulin and Fomivirsen injection (antisense RNA drug) to inhibit replication of retinal cells Safe sex practices, treat transplanted organs for this No vaccine

What percent of adults in the US are infected by CMV by the age of 40? This is transmitted through bodily secretions and most infections are asymptomatic What percent of patients test positive for antibodies against CMV in other countries? Once infected the patient has this virus for how long? How do you diagnose? Treat? Prevent?

Rubella and CMV

Which two conditions from TORCH cause sensorineural hearing loss and result in mental retardation that initially manifests as speech delay?

Listeria

Will cross the placenta or infect during birht May cause miscarriage or stillbirht May cause septicemia or meningitis after birth 90% mortality rate untreated

Congenital syphilis Snuffles, Hutchinson's teeth, interstitial keratitis, and deafness

Caused by treponema pallidum (a spirochete bacteria) Transmitted through placental transfer If mother is positive for primary or secondary forms the fetus will die If positive for latent form there will be mental retardation and organ malfunction in the fetus After birth, the fetus with latent infection will present with widespread rash (first two years of life) What are characteristic features of this?

Congenital chagas disease Kissing bugs, assassin bugs, or vampire bugs (suck blood from lips—50% of bugs found in Texas carry the infection) Swelling at site of infection Asymptomatic stage (10-20 years) Severe constipation/irregular heartbeat/CHF—fatal

Caused by trypanosomiasis cruzi (a flagellate) If mother is infected, the Protozoa can cross the placenta (1-5% chance) Newborns asymptomatic but if not treated, the infection can become chronic Moms should be screened if exposed to the triatomine insect called what? What are the three stages?

Parvovirusvirus B19-fifth disease

Common childhood viral infection that affects 1-5% of pregnant women (half of adults are immune) Soreness in joints for several days or weeks, fever, headache, sore throat, rash If zero negative pregnant woman becomes infected virus can cross the placenta This can cause birth defects, prematurity, and fetal death

Hepatitis B (HBV) Chronic hepatitis HBV and hepatic cancer Kernicterus-neurotoxic brain damage

1/3 of Americans have antibodies against this 1/25 are chronically infected with it This can be acquired either in utero or perinatally Most infections are asymptomatic Infant will have jaundice at birth (first 24 hours and after 3-4 days)—this is not normal They will also have a fever, seizures, altered cry, and change in muscle tone (Physiologic jaundice occurs 2-4 days after birth and resolves in 1-2 weeks) These infants are more likely to develop what? Strong association between what? What type of brain damage can occur as a result of this?

Listeria monocytogenes Noninvasive Invasive (fever, diarrhea, arthromyalgia, headache that can lead to sepsis and death) Focal (very rare in immunocompromised patietns but treatable with antibiotics)

Avoids exposure to the immune system via unique method of transferring itself to neighboring cells without leaving the host cell The intracellular life cycle makes it hard for macrophages to get to it Immunocompromised individuals are at greatest risk for this exposure to any raw food/utensils. What are the 3 outcomes of infection?

Ophthalmia neonatorium Eyrthromycin or 1% silver nitrate placed on the eyes immediately after birth

Caused by Neisseria gonorrhoeae—acquired by newborn from the infected mother during birht Untreated this may lead to blindness—symptoms are more severe than neonatal chlamydia infection Treatment is what?

Chlamydia infection Inclusion conjunctivitis/neonatal conjunctivitis Trachoma

Caused by chlamydia trachomatis Infection ranges from irritation to blindness Different serotypes cause different issues, what does D-K cause? A-C? (These are also the three diseases caused by bacteria that multiply in the cells of conjunctiva)

Neonatal conjunctivitis Within first 4 days of birth Extensive eyelid inflammation Risk of corneal rupture

Caused by serotypes D-K chlamydia (these also cause STIs) Over 50% of infants born to mothers with genital infection, will contract infection during passage through the birth canal Presents within the first 3 weeks of life Usually heals without permanent damage Persistent or untreated disease can spread to lower respiratory tract 5-14 days after birth Not as extensive inflammation of eyelid Rare corneal involvement Chlamydial pneumonia complications What is this gonorrhoea comparison?

Toxoplasmosis Primary infection in the mother Early in pregnancy Miscarriage, stillbirth, or damage to brain/other organs Infant may be asymptomatic at birth but have neurological injury or chorioretinitis months/years later

Caused by toxoplasma gondii A sporozoan or apicomplexan Complex life cycle with cats as the definitive host Acquire from ingesting cysts from infected, undercooked meat or from cat feces Infection is asymptomatic or mild in mother In utero transmission occurs only in what type of mother? When is it most severe? What does this result in?