Kitty!
Classical triad of congenital toxo
Chorioretinitis, cerebral calcifications, hydrocephalus
Name 3 physical exam findings that can be seen in infants infected with syphilis
Snuffles (copious nasal secretions), HSM, LAD, edema, rash (maculopapular consisting of small dark red-copper spots that is most severe on the hands and feet)
Name 3 manifestations of congenital rubella syndrome
Cataracts, CHD, sensorineural hearing impairment, microcephaly, growth restriction, HSM, thrombocytopenia, and “blueberry muffin” lesions
Name the three major classifications of cCMV
cCMV disease (symptomatic infection), cCMV infection only (asymptomatic), cCMV with isolated hearing loss
3 major manifestations of neonatal HSV
Disseminated, CNS, SEM
Difference between the cerebral calcifications in toxo versus CMV
Toxo - intracranial, variable
CMV - periventricular
Late findings of congenital syphilis that can occur years later
Interstitial keratitis, eighth cranial nerve deafness, Hutchinson teeth (peg-shaped, notched central incisors), anterior bowing of the shins, frontal bossing, mulberry molars, saddle nose, rhagades (perioral fissures), and Clutton joints (symmetric, painless swelling of the knees)
Most common CHD in congenital rubella syndrome
PDA, branch pulmonary artery stenosis
Name 3 manifestations of congenital CMV
Jaundice 2/2 direct hyperbilirubinemia, petechiae 2/2 thrombocytopenia, purpura, hepatosplenomegaly, microcephaly, intracerebral calcifications, retinitis.
Primary genital HSV infection (25 to 60% compared to 2% in reactivation of previously acquired HSV infection)
Clinical illness is typically more severe when toxo is acquired during this trimester of pregnancy
First trimester
Labs obtained during evaluation for congenital syphilis
CBC with Plt count; CSF - cell count, protein, VLDR; CXR, long bone XR (if clinically indicated)
Treatment for congenital rubella syndrome
Supportive
CMV is the leading cause of ____ in children in the United States
Non-genetic cause of sensorineural hearing loss
T/F: If a birthing parent has no history of HSV or HSV lesions, the neonate is not at risk for neonatal HSV infection
FALSE - more than 3/4 of neonates contract HSV from a birthing parent without history or clinical findings suggestive of HSV
Modes of diagnosis for congenital toxoplasmosis
Prenatally - toxo PCR of amniotic fluid, fetal ultrasound for anatomic abnormalities
Postnatally - toxo PCR, serology (IgG and IgM)
Treatment for proven or highly probable congenital syphilis
Aqueous crystalline penicillin G, 50 000 U/kg, IV, every 12 hours (1 wk or younger), then every 8 h for infants older than 1 wk, for a total of 10 days of therapy (preferred)
OR
Penicillin G procaine, 50 000 U/kg, IM, as single daily dose for 10 days
Diagnostic testing for congenital rubella
rubella RNA PCR, rubella IgM, a fourfold increase in rubella IgG antibody titer in paired acute and convalescent serum specimens (collected at least 10 days apart), viral culture
Diagnosis of cCMV can be made from ___ to ___ after birth via detection of CMV in urine or saliva. After this time period, CMV detection in urine or saliva can indicate _____ or _____
birth to 3 weeks
congenital or postnally acquired CMV***
Treatment for neonatal HSV infection
Prophylaxis?
SEM - 14 days of acyclovir
Disseminated or CNS - 21 days of acyclovir
PPX - acyclovir 300 mg/m2/dose TID times for 6 months after the completion of IV acyclovir therapy (weight adjusted, ANC should be monitored)
Treatment for congenital toxoplasmosis
Lab to monitor while on treatment and why
Oral therapy with pyrimethamine, sulfadiazine, and folinic acid (P/S/FA), usually for 12 months
ANC to assess for neutropenia (from pyrimethamine)
Time period that confers higher fatality risk for varicella infection in neonates in regard to birthing parent
What do these neonates receive?
5 days before to 2 days after delivery - because there is little opportunity for development and transfer of antibody across the placenta prior to delivery, and the infant’s cellular immune system is immature.
Varicella-zoster IgG
Mechanism behind blueberry muffin rash
Extramedullary erythropoiesis in the skin
Treatment for cCMV disease versus cCMV with isolated hearing loss versus cCMV infection only
When should treatment be started and why?
cCMV disease - 6 months of valganciclovir
cCMV with isolated hearing loss - 6 weeks of valganciclovir
cCMV infection only - nothing
Within 13 weeks of birth (time period for improved audiologic outcomes)
T/F: Neonate with HSV CNS disease is s/p 21 days of IV acyclovir, so they can be discharged with close follow-up
FALSE - repeat CSF HSV PCR needed to confirm clearance. If negative, then treatment is complete. If positive, another 7 days needed with repeat CSF HSV PCR