Congenital Infections and Syphilis
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Questions and Answers

What is the percentage of blood cultures that are positive in Streptococcal toxic shock?

  • 5% (correct)
  • 80-90%
  • 20-30%
  • 50-70%

    • Which of the following is a major risk factor for Streptococcal toxic shock?

  • Varicella zoster virus infection (correct)
  • Sickle cell disease
  • Rocky mountain spotted fever
  • Hypotension

    • What is the appropriate management for a 4-year-old boy with sickle cell disease who is admitted with fever and hypotension?

  • Vancomycin plus gentamicin
  • Ceftriaxone
  • Ceftriaxone plus vancomycin (correct)
  • Cefuroxime plus vancomycin

    • Which of the following pathogens is responsible for overwhelming post-splenectomy sepsis in asplenic children?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    What is the primary method of prevention for Streptococcal infections in post-splenectomy children?

    <p>Immunizations</p> Signup and view all the answers

    What is the name of the vaccine that is recommended annually for post-splenectomy children?

    <p>Influenza vaccine</p> Signup and view all the answers

    What is the risk factor for Capnocytophaga canimorsus infection?

    <p>Dog saliva exposure</p> Signup and view all the answers

    What is the clinical manifestation of Streptococcal toxic shock?

    <p>All of the above</p> Signup and view all the answers

    A 7-year-old boy develops mouth sores and rash after being treated with amoxicillin and acetaminophen. What is the most likely diagnosis?

    <p>Amoxicillin related</p> Signup and view all the answers

    A 16-year-old patient presents with oral ulcers and target-like rash. What is the most likely etiology?

    <p>Varicella zoster virus</p> Signup and view all the answers

    Which medication is associated with the highest risk of SJS/TEN?

    <p>Allopurinol</p> Signup and view all the answers

    A 12-year-old patient on infliximab for ulcerative colitis develops fever, malaise, cough, and pleuritic chest pain. What is the most likely diagnosis?

    <p>Mycoplasma pneumoniae</p> Signup and view all the answers

    Which of the following medications is associated with a lower risk of SJS/TEN?

    <p>Cephalosporins</p> Signup and view all the answers

    A patient develops a mucocutaneous rash after being treated with antibiotics and NSAIDs. What is the most likely diagnosis?

    <p>NSAID-related rash</p> Signup and view all the answers

    Which of the following is a case report of a medication associated with SJS/TEN?

    <p>Corticosteroids</p> Signup and view all the answers

    A patient develops a target-like rash after being treated with a medication. What is the most likely etiology?

    <p>Varicella zoster virus</p> Signup and view all the answers

    What is the most likely diagnosis for a newborn with maculopapular rash, microcephaly, chorioretinitis, hepatosplenomegaly, and bony changes?

    <p>CMV</p> Signup and view all the answers

    What is the suggested possible cause of Bell's palsy in children?

    <p>Herpes simplex virus</p> Signup and view all the answers

    What is a common manifestation of congenital syphilis in the mucocutaneous system?

    <p>Maculopapular rash followed by desquamation, blistering and crusting, condyloma lata</p> Signup and view all the answers

    What is the recommended approach to a situation where a patient's life may be at risk?

    <p>Treat it as a emergency</p> Signup and view all the answers

    What is the best management for Bell's palsy?

    <p>Steroids</p> Signup and view all the answers

    What is the prognosis for Ramsay Hunt syndrome?

    <p>Worse than Bell's palsy</p> Signup and view all the answers

    What is the significance of a drop in RPR from 1:128 to 1:64 after a single dose of IM penicillin in a pregnant woman with syphilis?

    <p>The treatment was successful, but the infant still needs to be treated</p> Signup and view all the answers

    What is the best course of action for a newborn whose mother was diagnosed with syphilis at 32 weeks of pregnancy, received a single dose of IM penicillin, and had a subsequent RPR drop to 1:64?

    <p>Full workup including LP, and give 10 days of IV penicillin regardless of workup findings</p> Signup and view all the answers

    What is the treatment for Ramsay Hunt syndrome?

    <p>Antiviral + corticosteroids</p> Signup and view all the answers

    What is the significance of pseudoparalysis in a newborn with congenital syphilis?

    <p>It is a common manifestation of congenital syphilis</p> Signup and view all the answers

    What is the percentage of facial nerve palsy cases in one review that are caused by Ramsay Hunt syndrome?

    <p>5%</p> Signup and view all the answers

    What is the recommended course of action for a newborn baby if the mother's HBsAg status is unknown?

    <p>Stat HBsAg on the mother and wait for results</p> Signup and view all the answers

    What is the recommended approach to a question that seems simple?

    <p>It probably is just that, a simple question</p> Signup and view all the answers

    What is the cause of paralysis in a patient with a cholesteatoma?

    <p>Tumor</p> Signup and view all the answers

    A baby is born to an HBsAg-positive mother and receives HBIG and HBV vaccine at birth. What is the recommended schedule for subsequent HBV vaccine doses?

    <p>1 and 6 months</p> Signup and view all the answers

    What is the significance of a CPS statement in relation to a Red Book?

    <p>CPS statements take precedence over Red Book</p> Signup and view all the answers

    What is the recommended age for testing an infant's HBsAg and anti-HBs status?

    <p>9-12 months</p> Signup and view all the answers

    What is the diagnosis for a patient with a history of two prior episodes of parotitis and a salivary swab growing viridans group streptococci?

    <p>Juvenile recurrent parotitis</p> Signup and view all the answers

    What is the cause of suppurative parotitis?

    <p>Bacterial infection</p> Signup and view all the answers

    What is the recommended course of action for a baby born to an HBsAg-positive mother if the baby's HBsAg status is negative and anti-HBs status is less than 10mIU/mL?

    <p>Revaccinate</p> Signup and view all the answers

    What is the recommended dose schedule for HBV vaccine in infants less than 2.0 kg at birth?

    <p>0, 1, 2, and 6 months</p> Signup and view all the answers

    What is the recommended course of action if the mother is a chronic carrier of hepatitis B?

    <p>Administer HBIG and HBV vaccine to the baby</p> Signup and view all the answers

    What is the timeframe within which HBIG should be administered to a term infant if the mother is HBsAg-positive?

    <p>Within 7 days of birth</p> Signup and view all the answers

    A baby born to an HBsAg-positive mother receives HBIG and HBV vaccine at birth, and subsequent HBV vaccine doses at 1 and 6 months. At 9 months, the baby is well. What is the most likely serologic pattern?

    <p>HBeAg-, HBcAg-, HBsAg+, HBcAb+, HBsAb+</p> Signup and view all the answers

    What is the recommended management for a well-appearing term newborn with a positive GBS status and no other risk factors?

    <p>Routine care with discharge at 24 hours</p> Signup and view all the answers

    What is the recommended management for a well-appearing term newborn with a negative GBS status and one other risk factor?

    <p>Close observation with vital signs every 3-4 hours for 24-48 hours</p> Signup and view all the answers

    What is the recommended management for a well-appearing term newborn with a negative GBS status and two or more other risk factors?

    <p>Individualized care with CBC and blood culture at birth</p> Signup and view all the answers

    What is a risk factor for early-onset sepsis in term neonates?

    <p>Maternal intrapartum GBS colonization during current pregnancy</p> Signup and view all the answers

    What is another risk factor for early-onset sepsis in term neonates?

    <p>Prolonged rupture of membranes (≥ 18 hours)</p> Signup and view all the answers

    What is the recommended approach to a well-appearing term newborn at risk of early-onset sepsis?

    <p>Examine at birth, observe 24-48 hours, and reassess and counsel pre-discharge</p> Signup and view all the answers

    What is the most likely diagnosis for a 4-week-old baby with a staccato cough, tachypnea, and conjunctivitis?

    <p>Chlamydia trachomatis</p> Signup and view all the answers

    What is the recommended treatment for N.meningitidis?

    <p>Rifampin x2 days</p> Signup and view all the answers

    What is the recommended treatment for invasive S.pyogenes disease?

    <p>Cephalexin</p> Signup and view all the answers

    What is the recommended management for a newborn exposed to Neisseria gonorrhoeae?

    <p>Culture of conjunctiva; IM ceftriaxone</p> Signup and view all the answers

    What is the recommended post-exposure prophylaxis for measles?

    <p>IG within 6 days of exposure</p> Signup and view all the answers

    What is the risk of conjunctivitis if the mother is untreated with Chlamydia trachomatis?

    <p>30% to 50%</p> Signup and view all the answers

    What is the recommended treatment for B.pertussis?

    <p>Azithromycin x5 days</p> Signup and view all the answers

    What is the recommended investigation for a 5-year-old child with fever, hepatosplenomegaly, and scleral icterus?

    <p>Hemoglobin electrophoresis</p> Signup and view all the answers

    What is the risk of pneumonia if the mother is untreated with Chlamydia trachomatis?

    <p>10% to 20%</p> Signup and view all the answers

    What is the recommended treatment for a family with recurrent pinworms?

    <p>Treat all family members with one dose of albendazole</p> Signup and view all the answers

    What is the management of a newborn exposed to Chlamydia trachomatis?

    <p>PCR testing recommended if develop symptoms</p> Signup and view all the answers

    What is the recommended treatment for a cat bite?

    <p>Amoxicillin-clavulanate</p> Signup and view all the answers

    What is the next step in management for a 5-month-old girl with a UTI, who has been given cefixime, and has a culture result of E. coli > 108/L, resistant to amp, Septra, and cephalosporins, but sensitive to cipro and gent?

    <p>Repeat urinalysis and culture</p> Signup and view all the answers

    What is the appropriate prophylaxis for a child with grade IV VUR who has completed treatment for their second UTI, with an organism resistant to TMP SMX and nitrofurantoin?

    <p>Trimethoprim</p> Signup and view all the answers

    What should be done if the 5-month-old girl remains symptomatic after being given cefixime?

    <p>Repeat urinalysis and urine culture</p> Signup and view all the answers

    What is the significance of a repeat positive urine culture in a 5-month-old girl with a UTI?

    <p>It may be a sign of contamination</p> Signup and view all the answers

    Why is it important to repeat the urinalysis and culture in a 5-month-old girl with a UTI?

    <p>To determine if the infection is still present</p> Signup and view all the answers

    What is the goal of repeating the urinalysis and culture in a 5-month-old girl with a UTI?

    <p>To determine if the infection has resolved</p> Signup and view all the answers

    What is the recommended antibiotic prophylaxis for children with asplenia?

    <p>Amoxicillin 10 mg/kg/dose bid for 0-5 years and Penicillin V 300 mg BID for &gt;5 years</p> Signup and view all the answers

    What is the recommended testing for Chlamydia trachomatis in sexually active individuals?

    <p>Nucleic acid amplification test (NAAT) on first catch urine or urethra/vaginal/cervical swab</p> Signup and view all the answers

    What is the recommended treatment for uncomplicated gonococcal infection in children ≥9 years?

    <p>Ceftriaxone 250 mg IM SD plus Azithromycin 1 g SD</p> Signup and view all the answers

    What is the recommended education for caregivers of children with asplenia?

    <p>Awareness of the need for urgent assessment for fever illnesses</p> Signup and view all the answers

    What is the recommended testing for Syphilis in sexually active individuals?

    <p>Serology</p> Signup and view all the answers

    What is the recommended treatment for a well newborn infant of a mother with untreated gonorrhea?

    <p>Ceftriaxone 250 mg IM SD plus Azithromycin 1 g SD</p> Signup and view all the answers

    Study Notes

    Congenital Infections

    • Congenital infections can cause a range of symptoms, including maculopapular rash, microcephaly, chorioretinitis, hepatosplenomegaly, and bony changes.
    • The most likely diagnosis for a newborn with these symptoms is Toxoplasmosis, Rubella, CMV, or Syphilis.

    Early Onset Manifestations of Congenital Syphilis

    • Systemic manifestations: prematurity, IUGR, FTT
    • Mucocutaneous manifestations: snuffles, maculopapular rash followed by desquamation, blistering, and crusting, condyloma lata
    • Reticuloendothelial manifestations: hepatosplenomegaly, lymphadenopathy
    • Hematologic manifestations: Coomb's negative hemolytic anemia, thrombocytopenia
    • Skeletal manifestations: pseudoparalysis, osteochondritis, diaphyseal periostitis, demineralization/destruction of proximal tibia metaphysis, osteitis
    • Neurologic manifestations: aseptic meningitis, hydrocephalus, cranial nerve palsy

    Management of Congenital Syphilis

    • If the mother is diagnosed with syphilis at 32 weeks of pregnancy and receives a single dose of IM penicillin, the infant should receive a full workup including LP and 10 days of IV penicillin regardless of the workup findings.

    Streptococcal Toxic Shock

    • Definition: hypotension or shock PLUS two or more of the following: renal impairment, disseminated intravascular coagulation, hepatic abnormalities, adult respiratory distress syndrome, scarlet fever rash, or soft tissue necrosis.
    • Isolation of S. pyogenes from a normally sterile body site is also required for diagnosis.

    Pediatric Infections

    • Infections in asplenic children: Streptococcus pneumoniae, Haemophilus influenzae type b, Neisseria meningitidis, Capnocytophaga canimorsus, and Salmonella spp.
    • Preventive interventions for children post-splenectomy: immunizations (Prevnar 13 & 23-valent polysaccharide vaccine, Quadrivalent meningococcal vaccine & 4CMenB, H. Influenzae type b, Influenza vaccine), and HB vaccine.

    Hepatitis B

    • Prevention: HBIG and HB vaccine within 12 hours of birth for infants born to HBsAg-positive mothers.
    • Management: HB vaccine at 1 and 6 months, HBsAg & anti-HBs at 9-12 months.
    • Serologic patterns: HBeAg+, HBcAg+, HBsAg+, HBaAb+, HBsAb+; HBeAg-, HBcAg-, HBsAg+, HBcAb+, HBsAb+; HBeAg-, HBcAg-, HBsAg-, HBcAb+, HBsAb+.

    Medications Associated with SJS/TEN

    • Highest risk: allopurinol, sulfonamides, sulfasalazine, anticonvulsants, antiretroviral medications, NSAIDs (oxicam).
    • Lower risk: antibiotics, antidepressants, NSAIDs (diclofenac).

    Facial Nerve Palsy in Children

    • Causes: idiopathic (Bell's palsy), infection-related (otitis media, Lyme disease, Varicella zoster virus), tumors (cholesteatoma, facial nerve schwannoma, vestibular schwannoma, meningioma).
    • Treatment: corticosteroids for Bell's palsy, antiviral + corticosteroids for Ramsay Hunt syndrome.

    Parotitis Differential Diagnosis

    • Suppurative parotitis: bacterial infection
    • Viral parotitis: viral infection
    • Parotid salivary duct stone: stone in the parotid duct
    • Juvenile recurrent parotitis: recurrent episodes of parotitis in children.

    Management of Newborns at Risk of Early-Onset Sepsis

    • Risk factors for early-onset sepsis in term neonates:
    • Maternal intrapartum GBS colonization during current pregnancy
    • GBS bacteriuria during current pregnancy
    • Previous infant with invasive GBS disease
    • Prolonged rupture of membranes (≥ 18 hours)
    • Maternal fever (≥ 38.0°C)
    • Approach to well-appearing term newborns at risk of early-onset sepsis:
      • GBS status: Positive (no other risk factors, adequate IAP) → Routine care
      • GBS status: Positive (other risk factors or no IAP) → Close observation
      • GBS status: Negative/unknown (no other risk factors) → Routine care
      • GBS status: Negative/unknown (other risk factors) → Close observation
    • Close observation: Examine at birth, observe 24-48 hours (vital signs q3-4h), reassess and counsel pre-discharge
    • Individualized care: Consider CBC after 4 hours

    Antibiotic Prophylaxis

    • Antibiotic prophylaxis for children with asplenia:
    • Amoxicillin 10 mg/kg/dose bid (0-5 years) or Penicillin V 300 mg bid ( > 5 years)
    • Antibiotic prophylaxis for children with asplenia:
    • Minimum of two years post-splenectomy and for all children

    Sexually Transmitted Infections

    • Major pathogens and testing:
      • Chlamydia trachomatis: Nucleic acid amplification test (NAAT)
      • Neisseria gonorrhoeae: Nucleic acid amplification test (NAAT)
      • Treponema pallidum: Serology
      • HIV: Serology
      • Hepatitis B/C: Serology
    • Treatment of uncomplicated gonococcal infection in children:
      • Anogenital infection: Ceftriaxone 250 mg IM SD plus Azithromycin 1 g SD
      • Pharynx: Ceftriaxone 250 mg SD plus Azithromycin 1 g SD

    Management of Exposed Infants

    • Management of exposed infants:
      • Well-appearing: Conjunctival culture, IM ceftriaxone 50 mg/kg (maximum 125 mg)
      • Unwell: Conjunctival, blood, and CSF cultures, consult ID with established disease (IV ceftriaxone)

    Neisseria gonorrhoeae

    • Clinical aspects:
      • Conjunctivitis: Prominent bilateral purulent discharge, onset usually days 2-5 after birth
      • Other manifestations: Scalp abscess, disseminated disease, septic arthritis, bacteremia, meningitis

    Chlamydia trachomatis

    • Risk of disease if mother untreated:
      • 30% to 50% risk of conjunctivitis
      • 10% to 20% risk of pneumonia
    • Management of exposed infant:
      • No antibiotic prophylaxis recommended
      • Close clinical follow-up
      • PCR testing recommended if develop symptoms
      • Treat if PCR testing is positive

    Urinary Tract Infections

    • Management of UTI:
      • If asymptomatic: Repeat urinalysis and culture
      • If symptomatic: Urinalysis and urine culture should be repeated and antimicrobial therapy modified pending results

    Prophylaxis

    • Prophylaxis for grade IV VUR:
      • Amoxicillin

    Infection Control

    • Post-exposure prophylaxis:
      • N.meningitidis: Rifampin x2 days
      • S.pyogenes: Cephalexin
      • B.pertussis: Azithromycin x5 days, erythromycin x14 days
      • Measles: IG within 6 days of exposure
      • Rubella: Generally none, but IG may be considered in pregnancy if termination not an option

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    Description

    This quiz covers the symptoms and diagnosis of congenital infections, including Toxoplasmosis, Rubella, CMV, and Syphilis, as well as the early onset manifestations of congenital Syphilis.

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