Perinatal and Pediatric Infections (Dr. Freij)
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True or false. CMV is transmitted from mother to fetus in about 50% of cases.
How can primary CMV infection be diagnosed in pregnancy?
- 1) virus isolation from urine, buffy coat, or cervical secretions
- 2) measurement of CMV IgM antibosies
- 3) 4-fold increase in CMV IgG titer
- 4) PCR
Which antiviral is usually used to treat CMV?
True or false. Diagnosis by isolation of congenital CMV from urine or saliva must be done within first week of life?
False, diagnosis by isolation of CMV from urine or saliva must be done within first two weeks of life.
Which viral is known for causing sensorineural hearing loss and eye abnormalities?
What are the 2 most common ways in which perinatal CMV is transmitted from mother to fetus?
- 1) passage through birth canal
- 2) ingestion of infected breast milk
True or false. Perinatal CMV is usually benign and has subclinical symptoms.
How is neonatal HSV infection usually transmitted from mother to fetus?
What are some risk factors for acquiring neonatal HSV infection?
- 1) cervical HSV infection
- 2) multiple genital lesions
- 3) prematurity
- 4) prolonged rupture of maternal membranes
- 5) intrauterine instrumentation
- 6) absent or low titers of maternal HSV antibodies
What are the 2 main abnormalities associated with intrauterine HSV infection?
- 1) microencephaly
- 2) chorioretinitis
What are the 3 main clinical manifestations of neonatal HSV?
- 1) skin/eyes/mucous membranes (SEM)
- 2) localized CNS involvement
- 3) disseminated disease
Cutaneous lesions, chorioretinitis, ulcerative mouth lesions and neurological abnormalities are descriptive of what perinatal viral infection?
Neonatal HSV (SEM disease)
Focal or generalized seizures, lethargy, apnea, and skin lesions are symptoms of which perinatal HSV infection?
Neonatal HSV encephalitis
Which neonatal HSV disease can resemble sepsis?
Disseminated neonatal HSV disease
How is neonatal HSV normally treated? Prevented?
Acyclovir (Valacyclovir); C-section
Which perinatal viral infection presents with a heterogenous rash?
What are some complications of varicella infection?
- 1) Bacterial superinfection
- 2) pneumonia
- 3) arthritis
- 4) encephalitis
- 5) bleeding diathesis
Zoster virus is more common in _____ than in _____.
How can VZV be detected?
PCR from skin lesions and serologic assays
What are the most characteristic features of fetal varicella syndrome?
cutaneous scars on hypoplastic extremities
What are some common clinical abnormalities of Varicella Syndrome?
- 1) Cutaneous scars
- 2) Limb hypoplasia
- 3) Shingles in infancy
- 4) CNS abnormalities
- 5) CNS abnormalities
- 6) Uni- or bilateral ocular abnormalities
- 7) autonomic dysfunction
How is Varicella normally treated? Prevented?
Acyclovir (Valacyclovir); infants should receive 125 units of varicella zoster immunoglobulin as soon as possible if mother has symptoms 5 days before or 2 days after delivery
What is the most commonly identified condition of parvovirus infection in children? Adult?
Erythema; flu-like illness and symmetric polyarthropathy
Patients who have a chronic infection with parvovirus usually present with what symptoms?
- 1) chronic anemia
- 2) transient aplastic crisis
- 3) hemophagocytic syndrome
What is the most likely diagnosis of a child who comes into your office with a"slapped cheek" rash?
How would you go about diagnosing parvovirus in the lab?
- 1) IgM anti-B19 antibodies by day 3
- 2) IgG anti-B19 antibodies by end of the first week
- 3) PCR
What are some complications of parvovirus infection?
- 1) hydrops fetalis, death
- 2) Spontaneous abortion, stillbirth, hydropic infant
- 3) chronic anemia
- 4) direct infection of fetal heart > cardiac dysfunction
What are the most common complications of toxoplasmosis?
- 1) hepatitis
- 2) pneumonia
- 3) myocarditis
- 4) encephalitis
- 5) deafness
True or false. Transplacental spread of T. gondii is more common in the third trimester but is less severe; and is less common in the first trimester but is more severe.
What is the usual treatment for maternal Toxoplasmosis?
Spiramycin and folic acid antagonists (pyrimethamine and sulfadiazine)
What is main abnormality to look for when identifying congenital Toxoplasmosis?
Eye abnormalities, some CNS involvement and hearing loss
What are the techniques used to diagnose congenital toxoplasmosis?
- 1) isolation of parasite from placenta or blood
- 2) PCR from urine, CSF or serum
- 3) IgM and IgG antibody detection
What is the best treatment for neonatal Toxoplasmosis?
- 1) Folic acid antagonists (pyrimethamine and sulfadiazine)
- 2) leucovorin supplements
- 3) steroids for infants (chorioretinitis)
Which 2 pathogens are mostly responsible for early-onset sepsis neonatorum?
- 1) Group B Streptococci
- 2) E. coli
Which pathogen is mostly responsible for late-onset sepsis neonatorum?
What are the 5 risk factors for developing neonatal sepsis?
- 1) premature onset of labor
- 2) prolonged rupture of fetal membranes
- 3) chorioamnionitis
- 4) maternal fever
- 5) use of arterial and venous umbilical catheters, along with many others
True or false. There are no specific signs or symptoms for neonatal sepsis.
What lab abnormalities are expected with neonatal sepsis?
- 1) abnormal WBC counts
- 2) unexplained metabolic acidosis
- 3) hyperglycemia
How can neonatal Group B Streptococcal sepsis be prevented?
administration of intrapartum antibiotic and prophylaxis
Compare and contrast early-onset sepsis and late-onset sepsis.
- Sudden onset and can be fulminant
- Primary focus is inflammation of lungs
- Respiratory distress, apnea, hypotension and DIC
- Insidious onset
- Common signs are poor feeding and fever
- Present with bacteremia, followed by meningitis
- Osteomyelitis, arthritis, breast abscess, myocarditis also seen
What are the risk factors for early-onset Group B Streptococcal disease?
- 1) premature delivery
- 2) low birth weight
- 3) increased interval between membrane rupture and delivery
- 4) rupture of membranes
- 5) amnionitis and intrapartum fever
Which race is most commonly affected by early-onset Group B Streptococcal disease?
True or False. The most common spread of EBV infection is via blood transfusions.
False, the most common spread of EBV infection is via intimate contact.
What are the clinical manifestations of EBV?
- 1) infectious mononucleosis
- 2) Burkitt's lymphoma
- 3) nasopharyngeal carcinoma
- 4) B-cell lymphoma (children with immunodeficiencies)
What is the "classic" presentation of infectious mononucleosis and what are the complications?
- exudative pharyngitis
- atypical lymphocytes
- aseptic meningitis
- rupture of spleen
- hemolytic anemia
How is infectious monnucleosis diagnosed?
heterophile antibodies and EBV-specific antibodies
How is mononucleosis treated?
Steroids are used for treatment in what perinatal infection?
Transmission? Clinical presentation?
- infected respiratory secretions
- Clinical presentation
- roseola infantum
Describe roseola infantum.
- Acute febrile illness of infants
- Abrupt onset of fever, followed by erythematous
- Rash on trunk, spread to neck, upper extremities and face
- Complications include: convulsions, hemiplegia (rare), encephalopathy and thrombocytopenic purpura
What is the treatment for Staphylococcal scalded skin syndrome?
Oral or parenteral antibiotics
What is the first thing that should come to mind when you hear Kawasaki Disease?
Coronary heart disease!
What is the "classic" diagnostic criteria for Kawasaki Disease?
- fever for 5 days
- bilateral conjunctival injection without exudate (bulbar most involved)
- changes in oral mucosa ("strawberry tongue", erythema, dryness and peeling of lips)
- changes in hands and/or feet (erythema, swelling, desquamation of finger and toes)
- rash (Scarlet fever, erythema multiform)
- cervical lymphadenopathy
What are the 3 clinical phases of Kawasaki disease? Describe them.
- Acute febrile phase
- lasts 1-2 weeks
- pericardial infusion
- Subacute febrile phase
- begins after fever, rash and lymphadenopathy
- ends at 4weeks after onset of fever
- Convalescent (Recovery/Healing) phase
- continues until ESR returns to normal
- lasts 6-8 weeks
Lab features of Kawasaki?
- Normal to elevated WBC count
- Elevation of ESR
- Normocytic anemia
- Thrombocytopenia (not common)
Which race is at the highest risk for devleoping Kawasaki disease?
What is the standard treatment for Kawasaki disease?
IGIV and aspirin
What is the management of Kawasaki disease?
- echocardiograms at diagnosis, at 2-3 weeks and at 6-8 weeks
What is the causative agent for Kawasaki Disease?
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