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MD1 - Reproduction Block > 4. Congenital perinatal infectons > Flashcards

4. Congenital perinatal infectons Flashcards

1
Q

What are the timing of congenital perinatal infections?

A

· Perinatal (intrauterine)
o Infection acquired/carried by mother and transmitted to the developing getus

· Perinatal
o Infection transmitted around the time of delivery

· Postnatal/Postpartum
o Infection acquired after delivery
o Family, health care workers, community

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2
Q

What are the modes of infection?

A 
- Vertical transmission
	o From mother to fetus (transplacental)
	o From mother to baby (breast milk)
- Horizontal transmission
	o From one person/baby to another 
- Ascending infection
	o Vaginal organisms producing fetal infection
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3
Q

What are the effects on the fetus?

A 
- Non specific effects of maternal infection
	o Fetal death
	o Premature delivery (influenza)
- Specific effects of infection
	o Benign/self-limiting
	o End organ damage (Rubella, CMV)
	o Chronic infection e.g. Hepatitis B/C, HIV
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4
Q

What are the common features of herpes virus?

A
  • Primary infection
  • Dormant period
  • Reactivation when immunocompromised, elderly.
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5
Q

What are the characteristics of Varicella Zoster Virus? (VZV)

A
  • Herpesviridae family
  • Large 120nm
  • Icosahedral
  • dsDNA
  • Enveloped
    Latent infection – Dorsal root ganglia
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6
Q

What is the infectious period for chicken pox?

A

10-21 days

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7
Q

What is the mode if infection of chicken pox?

A

Respiratory/Direct contact with lesions

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8
Q

What are the symptoms of chicken pox?

A

Fever, lethargy, pruritic vesicular rash

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9
Q

What are the complications of chicken pox?

A 
- Secondary bacterial infection (through skin lesions)
	o Commonly Strep pyo 
	o Staph aureus (Purpura Fulminans)
- Pneumonitis
	o More common in adults (25x)
	o Tachypnoea, cough, haemoptysis
- Acute cerebellar ataxia
1/4000, complete recovery 2-4 weeks
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10
Q

What are the features of maternal VZV?

A
  • 0.5% occurs in childbearing age
  • There is a relative state of immunosuppression during pregnancy
  • More severe in pregnant adults
  • Smoking is an independent variable
  • Respiratory symptoms day 2-5
    o Productive cough with hemoptysis
    Deaths most commonly occur in 3rd trimester due to increased cardiorespiratory requirement for baby
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11
Q

What is the mode of transmission for congenital VZV syndrome

A

Cross placental transmission

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12
Q

What will a primary infection of VZV cause in the first trimester for the foetus?

A 
o Cicatricial scarring (dermatomal)
	o Limb hypoplasia
	o Microcephaly, cataracts
	o Mental retardation
           GI & Genitourinary abnormalities
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13
Q

What are the features of Perinatal VZV?

A 
- Primary maternal varicella
	o -7 to +2 days from delivery
	o Lack specific antibody
- 17-30% transmission to neonate
- Disseminated infection
Mortality 25-30%
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14
Q

Who should be given prophylactic VZIG?

A
  • Given post exposure (
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15
Q

What vaccine is available for VZV?

A 
o Live attenuated virus (OKA strain)
	o Seroconversion 90%
	o Given at 18m
	o 2 doses > 12 y.o.
Non-immune adults in high risk occupations
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16
Q

What treatments are available for VZV?

A
  • Acyclovir
    o Treatment for acute varicella
    § Oral if
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17
Q

What are the characteristics of CMV?

A
  • Hepesviridae
  • Icosahedral capsid
  • dsDNA
  • Spherical lipid envelope
  • Multinucleate giant cells
    Latent infection in WBC
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18
Q

How can CMV be transmitted?

A
  • Saliva
  • Urine
  • Breast milk
  • Blood
  • Semen
  • Cervical secretion
  • Transplacental
  • Transplant tissue
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19
Q

Where is the most likely place for CMV to be transmitted?

A

Transmission occur mostly from day care centres (75%) and virus can live on surfaces up to 24 hours

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20
Q

What is the seroepidemiology of CMV?

A
  • Increased rate during childhood, adolescence and child-bearing years
  • Developed countries
    o 1 year 14%
    o 2 years 26%
    o 10 years 33%
    o Adults 40-60%
  • Developing countries
    o 3 years 80%
    o Adults >90%
    o Don’t see congenital CMV very often because most people are immune
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21
Q

What is the route of infection for CMV?

A
  • Trans placental – Haematogenous
  • Perinatal – Genital secretions, breast milk, saliva
  • Later – Toddlers in day-care
  • Adults – Sexual/non-sexual close contact
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22
Q

What is the route of post-partum infection for CMV?

A
  • Infants
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23
Q

What are the consequences of post-partum infection of CMV?

A

Causes sepsis-link syndrome
o Hepatomegaly
o Respiratory distress
Atypical lymphocytosis

24
Q

What is the rate of congenital CMV?

A

0.3-2% of all births

25
Q

What is the consequences of primary infection of congenital CMV?

A
  • 0.3-2% of all births
  • Primary infection
    o 10% symptomatic
    § 10-15% long term sequalae if asymptomatic
    o 10-30% mortality
    o Long term sequelae
  • If symptomatic presents with (80-100% long term sequalae)
    o Owl eye viral inclusions
    o Rash & Hepatosplenomegaly
26
Q

What is the source and the rates of CMV fetal infection?

A 
Fetal infection
Primary
- 1% of women
- 20-50% Fetal infection
Reactivation
- 10-30% of women
1-3% fetal infection
27
Q

Why is IgM lab test useless for testing primary infection for CMV infection?

A

IgM remains positive for months and years so can’t be used to time primary infection

28
Q

What lab test can we use to test for primary or secondary infection of CMV?

A

Avidity test – early in infection the avidity is low, as immune system matures the antibody bind more strongly

29
Q

How do we confirm fetal CMV infection?

A
  • PCR amniotic fluid
  • Fetal (cord) blood
    o IgM sensitivity 70-80%
    o VMC PCR sensitivity 10-30%
    o Non-specific – anemia, platelets LFT
30
Q

What are the consequences of fetal CMV infection?

A 
If baby is normal at birth
- Serial audiometry
	o Deafness 5-15%
	o Delayed up to 5 years
- Serial visual assessment
	o Chorioretinitis
	o Optic atrophy
- Psychomotor assessment
	o Microcephaly, developmental delay, behavioral

If symptomatic
- Confirm diagnosis with CMB in the first 2 weeks via urine
- Cranial ultrasound
- Need multidisciplinary approach to management

31
Q

What is the treatment for CMV infection?

A
  • Ganciclovir
  • Given to symptomatic
    6m of treatment will half the sensory and neurological deficit.
32
Q

What are the characteristics of Rubella virus?

A
  • Togavirus
  • ssRNA, enveloped
  • Human only reservoir
  • 25-50% infections asymptomatic
33
Q

How is Rubella transmitted?

A
  • Nasopharyngeal secretions
    o Highly infectious = 50-90% of susceptible in an outbreak
    Infectious form -7 to 14 days
34
Q

What is the infectious period of Rubella?

A

14-21 days

35
Q

What is the clinical presentation of Rubella?

A
  • Fever – low grade
  • Lymphadenopathy (95%) persists for 2 weeks
    o Occipital, postauricular, posterior cervical
  • Exanthem
    o Maculopapular; face à trunk à limbs
  • Polyarthralgia/arthritis
36
Q

What is the outcome of congenital rubella syndrome?

A
  • Infection in the 1st trimester is the most damaging
  • Gestational age influences deficit
    o >12/40 Retinopathy and deafness only
  • Outcome
    o 1/3 lead normal life
    o 1/3 live with parents
    o 1/3 institutionalized
  • Classical triad
    o Ophthalmological – cataracts, glaucoma, retinopathy
    o Cardiac – Patent Ductus arteriosis, Pulmonary artery stenosis
    o Auditory – Sensorineural deafness
  • Other symptoms
    o Neurological – Meningoencephalitis, behavioral
    o Others – IGUR
37
Q

What investigations can be done to test for Rubella?

A 
- Serological confirmation
	o IgG
	o IgM
- Fetal diagnostic testing
	o Amniotic fluid, cord blood
	o Fetal IgM
38
Q

What can be done to prevent Rubella?

A
  • Vaccine (live attenuated)
  • Seronagtive women vaccinated postpartum
    o Avoid vaccination during pregnancy
39
Q

What are the features of Parovirus?

A

ssDNA virus

40
Q

What is the infectious period of Parovirus

A

4-21 days

41
Q

How does Parovirus cause disease?

A 
- Shorten RBC progenitor
	o Acute aplastic crisis
	o Chronic hemolytic anemia 
- Erythema infectiosum; Fifth disease
- Arthalgia + rash in adults
42
Q

What happens in congenital parovirus infection?

A
  • 60-70% pregnant women immune
  • Hydrops foetalis (anemia)
  • Higher chance of fetal loss in first trimester
    o May require intrauterine transfusion
43
Q

How do you diagnose a parovirus infection?

A 
Serology
- IgG past infection; Immunity
- IgM present at time of rash; positive for 2-4 months
PCR
Ultrasound at 1-2 weekly intervals
Fetal blood sampling
Intrauterine transfusion.

Serology
- IgG past infection; Immunity
- IgM present at time of rash; positive for 2-4 months
PCR
Ultrasound at 1-2 weekly intervals
Fetal blood sampling
Intrauterine transfusion.
44
Q

How is Herpes Simplex virus transmitted to baby?

A 
- Usually infection via secretion from mother during labor
	o Skin-eye-mouth
	o Encephalitis
	o Disseminated
45
Q

When is the risk of transmission of HSVhighest ?

A
  • Risk of transmission highest when mom gets infected (primary infection)
    Leads to abortion, IUGR, preterm labor
46
Q

What is the management of HSV?

A
  • Primary infection during pregnancy
    o Acyclovir treatment and suppression until delivery
    o Caesarean section
  • Recurrent disease during pregnancy
    o Acyvlovir suppression
    o Avoid instrumentation
    o Careful clinical examination for lesions
    o Investigation of baby for colonization
47
Q

What is the most likely cause of Syphilis transmission to fetus?

A 
- Transmission to fetus
	o Primary 90%
	o Secondary 60-90%
	o Early latent 40%
Late latent
48
Q

What are the outcomes of congenital syphilis infectioN?

A

o Stillbirth 40%
o Premature delivery

49
Q

How is Congenital Syphilis prevented?

A

Antenatal screening important to prevent congenital infection, prevent further sexual transmission and progression to tertiary syphilis

  • Non-Treponemal test (VLRL, RPR) to test for non-specific antibodies. Reduced if treatment is effective
  • Treponemal test (EI, TPHA, TPPA, FTA-Abs)
    positive slighly earlier, positive for life
50
Q

Taxoplasma Gondii

A
  • Primary infection 1/1000
  • 75% women susceptible
  • 70-90% asymptomatic at birth
    o Rash, LN, Chorioretinitis, hydrocephalus
  • IgM unreliable
  • Screening not recommended
  • Education regarding routes of infection important
51
Q

How is Group B strep transmitted to baby?

A
  • Carriage in bowel/vagina 20-30%
  • Baby infected via ascending infection or colonized at delivery
  • 40-70% colonized
  • 1% invasive disease
52
Q

What are the maternal risk factor for postpartum group B strep infection?

A
  • Preterm delivery
  • Prolonged ruptured membranes
  • Intrapartum fever
  • Chorioamnionitis
  • Previous baby with GBS
53
Q

What is the early onset infection of Group B Strep?

A
  • First 48h
  • Peripartum infection
  • Pneumonia & Septicaemia common
54
Q

What is the late onset infection of Group B strep?

A
  • Colonisation at birth
  • Possibly breast milk transmission
  • Meningitis common
55
Q

What is the treatment of Group B strep

A

Penicillin + Gentamicin

56
Q

How can Group B Strep be prevented?

A
  • Intrapartum chemoprophylaxis
    o Screening for carriage
    o Risk factors for neonatal disease
57
Q

What are the standard pre-pregnancy screening?

A
  • Routing screening test including varicella
  • Vaccinate with MMR + Varicella
  • Check rubella immunity after 1-2 months and revaccinate if necessary
  • Avoid pregnancy for 1 month
    Women in contact should have CMV serology check and be counseled appropriately

MD1 - Reproduction Block (15 decks)

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