Neonatal Encephalitis; Mode of transmission! - USMLE Forums
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  #1  
Old 02-04-2012
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Kids Neonatal Encephalitis; Mode of transmission!

A neonate is born at 30 weeks gestational age to a mom who received no prenatal care. Approximately 12hrs after birth, neonate develops a high fever and has seizure for which anti-convulsants are given. Examination of the child reveals a diminished cramming reflex, which at birth was normal. A lumbar puncture demonstrates a mononuclear pleocytosis and elevated protein levels. A PCR test of CSF is sent but results are not available for 48hrs. MRI of the brain is performed, which demonstrated abnormalities in temporal lobes bilaterally, felt to be compatible with severe encephaitis. What is the most likely factor in the development of this infection?
a- absence of antibodies in the mother
b- exposure of mother to poorly cooked pork
c- passage through an infected birth canal
d- 3 day rash in the mother
e- transplacental transmission
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Old 02-04-2012
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Ans ........ E........
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Old 02-04-2012
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I would go with C.............
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Old 02-04-2012
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this is HERPES ENCEPHALITIS


so it is transplacental transfer
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mononuclear pleocytosis and increased protein -----> VIRAL

B/L Temporal Lobe Involvement -----> HSV-1

Mode of transmission -----> Skin / Mucus Membrane Contact


I would pick C.
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Old 02-04-2012
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Quote:
Originally Posted by haga View Post
mononuclear pleocytosis and increased protein -----> VIRAL

B/L Temporal Lobe Involvement -----> HSV-1

Mode of transmission -----> Skin / Mucus Membrane Contact


I would pick C.
isnt HSV 1 transmitted transplacentally and not thru the birth canal??

infection of the birth canal wud be HSV 2 right??
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Quote:
Originally Posted by mbbs2010 View Post
isnt HSV 1 transmitted transplacentally and not thru the birth canal??

infection of the birth canal wud be HSV 2 right??
Yes.

I was guessing C was the answer, don't know for sure.
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Old 02-04-2012
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Quote:
Originally Posted by haga View Post
Yes.


I was guessing C was the answer, don't know for sure.


im confused too! thats why asked
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@misspatho

what's the answer and why???
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I go for C
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Old 02-04-2012
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Default answer is C

yup its HSV infection

but 90% of HSV is transmitted INTRAPARTUM.. or during child birth

http://www.doh.wa.gov/notify/guidelines/pdf/herpes.pdf

http://www.virologyj.com/content/6/1/40
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Old 02-06-2012
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THE ANSWER IS C
temporal lobe affected-- herpes encephalitis.. 2 most common neonatal encephalitis are- Herpes encephalitis and CMV I was stuck between C and E.. and it turns out that Herpes Encephalitis can be transmitted by both.. Transplacental and infected birth canal.. BUT INFECTED BIRTH CANAL IS MOST COMMON.. Other transplacental transimissions would be TORCH... a-absence of antibodies in the mother may affect the child's resistance to various pathogens but herpes is a syncitial virus and antibodies play a minor role in protection b-exposure to poorly cooked pork would b toxoplasmosis d-3 day rash is rubella C n E as explained above.
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