OK , so another fun day !
Here are some more notes I made today for the virtual chatfest... made notes only from one chapter... had made some charts/tables do not know whether it will come out right...
Q32 Symptoms of early onset and late onset GBBS infection ?
Ans : Early onset :within few hrs to days of birth , fulminant pneumonia and sepsis. Ususally the result of vertical transmission from mother to neonate with a 50% mortality rate.

Late onset : Occuring after the first week of life , characterized by meningitis. This is usually hospital acquired with a 25% mortality rate.

Q 33:

Organism Transmission Fetal infection Neonatal infection Prevention/Treatment
Toxoplasma Gondii Vertical transmission only during primary infection , else Mom has lifelong immunity(IgG pos) Ist tri infection risk is low but more lethal , 3rd tri infection risk is high but aympyomatic. SYMMETRIC IUGR,
Nonimmune
Fetal hydrops,
Microcephaly,
Intracranial calcifications Chrioretinitis, seizures, HSM,
Thrombocy-topenia Avoid infected cat feces,
Raw goat milk, and undercooked meat

Treat : Pyrimethamine
And sulfadiazine
Varicella Spread by resp droplets
90% of Women are immune by adulthood Transplacental infection rate is 25-40% Congenital Varicella Syndroime—“zigzag” skin lesions, micropthalmia, cataracts, chorioretinitis, extremity hypoplasia and motor and sensory defects. Greatest Neonatal risk if maternal rash appears bet 5 days antepartum and 2 days postpartum. VZIG to susceptible gravida within 96 hrs of exposure.
Live attenuated Varivax III can be given to non pregnant or postpartum to varicella IgG Ab negative women.

Treat: IV acyclovir if mom has varicella pneumonia.
rubella Via Respiratory droplets
Vertical transmission from Mom to fetus or neonate only during viremia or primary infection , otherwise Mom has life long immunity (IgG Pos) Transplacental infection rate > 90% in the first ten weeks of pregnancy but only 5% in the 3rd trimester. SYMMETRIC IUGR, microcephaly , VSD Congenital Rubella Syndrome
Cong Deafness,
Cong heart disease, Cataracts,
Mental retardation, HSM, throm-bocytopenia ,
Blueberry muffin rash All preg women should undergo rubella IgG Ab screen. Avoid known rubella cases.
Active immunization after delivery . It is a live attenuated virus vaccine so not to be given during preg and after vaccine preg should be avoided for one month (?)
CMV Spread by infected body secretions. Vertical transmission from mother to fetus during viremia of a primary infection. After primary infection there is a residual lifelong LATENCY , fetal infection can occur with reactivation. With maternal primary infection transplacental infection rate is 50% , less that 1% with recurrent infection.
Nonimmune
Hydrops,
SYMMETRIC
IUGR,
Microcephaly and cerebral calcifications
Congenital CMV syndr is the MOST common congenital VIRAL syndrome in the USA.
Petechiae,
Meningoence-phalitis,HSM,
Thrombocyto-penia and Jaundice. Follow universal precautions with all body fluids. Avoid transfusion with CMV pos blood.

Treat: GAnciclovir.
HSV(mainly HSV 2) Spread by intimate mucocutane-ous contact.
Tansplacental transmission from mother to fetus can occur with viremia during primary infection but is rare. HSV infection –residual life long LATENCY with periodic recurrent attacks. MOST common route of fetal infection is contact with maternal genital lesions. Transplacental infection rate is 50% with primary infection. Spontaneous Abortions,
SYMMETRIc IUGR, microcephaly , cerebral clacifications With passage through HSV infected canal, neonatal attack rate is 50%. Those who survive have severe sequlae:
Meningoence-phalitis, Men retar, HSM,
Pneumonia,
Jaundice,
petechiae C-section should be performed in the case of genital HSV at the time of labor.
If membranes have been ruptured >8-12hrs, the virus may have already infected the fetus.




Q 33 Major route of vertical transmission of HIV ?
Contact with infected genital SECRETIONS at the time of vaginal delivery.

Q 34 Prevention of Neonatal infection with HIV ?
Antiviral Prophylaxis starting at 14 weeks and continuing throughout pregnancy , labor and delivery. ZDV should be part of the regimen.
Mode of delivery : C-section offered at 38 weeks unless undetectable levels on virus in blood(<1000 copies/ml)
Guidelines for vaginal delivery:
Avoid aminotomy as long as possible,
do not use scalp electrodes,
avoid forceps or vaccum,
Use gental neonatal resuscitation
Breast feeding – better to avoid in HIV pos women
Universal precautions when handling body fluids

Q 35 How would you diagnose primary maternal Syphilis ?
Ans Dark Field Microscopy of lesion , VDRL and RPR are not positive in primary

Q 36 Lesion of tertiary Syphilis ?
Ans Gummas