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3002 > 95 Infections in the pregnancy and neonates > Flashcards

95 Infections in the pregnancy and neonates Flashcards

1
Q

What are the viruses responsible for infections in pregnancy and in the neonate?

A
  • Rubella
  • Varicella Zoster Virus (VZV)
  • Parvovorius
  • Cytomegalovirus (CMV)
  • Zika virus
  • Human Immunodeficiency Virus (HIV)
  • Hepatitis B Virus (HBV)
  • Hepatitis C Virus (HCV)
  • Herspes Simplex Virus (HSV)
  • Human Papilloma Virus (HPV)
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2
Q

What are the bacterias responsible for infections in the pregnancy and neonate?

A
  • Listeria monocytogenes
  • Chlamydia trachomatis
  • Neisseria gonorrhoea
  • Staphylococcus aureus
  • Treponema pallidum
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3
Q

Which protozoa cause infections in the pregnancy and neonate?

A
  • Toxoplasma gondii

* Trichomonas vaginalis

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4
Q

Which yeasts can cause infections in pregnancy and neonate?

A

Candida albicans

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5
Q

What does congenital mean?

A

Condition present at birth (inherited or caused by the environment)

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6
Q

What is the perinatal period?

A

Commonences at 22 weeks (154 days) of gestation and ends 7 days after birth

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7
Q

What is the neonatal period?

A

First 28 days

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8
Q

What is the postnatal period?

A

First 6 weeks after birth

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9
Q

How does vertical transmission occur?

A
  • Across the placenta (intrauterine)
  • During birth
  • Direct contact with maternal body fluids
  • Prolonged rupture of membranes
  • After birth (from mother or other contacts)
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10
Q

Manifestations in congenital infection?

A
  • Growth retardation
  • Congenital malformation
  • Foetal loss
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11
Q

Name organisms that cause congenital infection?

A
  • Rubella
  • CMV
  • HIV
  • Toxoplasma
  • Treponema pallidum
  • Parvovirus
  • VZV
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12
Q

Perinatal infection manifestations?

A
  • Meningitis
  • Septicaemia
  • Penumonia
  • Preterm labour
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13
Q

Name organisms that cause perinatal infection?

A
  • Gonococus
  • Chylamydia
  • HSV
  • VZV
  • Group B strep
  • E. coli
  • Listeria
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14
Q

Postnatal infection manifestations?

A
  • Meningitis
  • Septicaemia
  • Conjunctivitis
  • Penumonitis
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15
Q

Name organisms and their method of transmission that cause postal infection?

A
  • N. gonorrhoeae
  • Chlamydia
  1. Breast milk:
    • HIV
    • CMV
  2. Umbilicus:
    • Staphylococci
    • Tetanus
  3. Person-to-person:
    • Group B strep
    • Listeria
    • E.coli
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16
Q 
Rubella:
• Start?
• Initial signs?
• Symptoms/signs?
• Marker
A
  • Primary maternal rubella infection in 1st trimester
  • High risk of congenital rubella syndrome (60%)

• Initial signs –> hepatitis-associated jaundice, haemolysis, thrombocytopaenia

Symptoms and signs:
• Microcephalus, cataract, deafness, heart defects in foetus
• Low birth weight; failure to attain developmental milestones

Marker:
• IgM persists for 1st three months of life

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17
Q

What does MMR vaccine stand for?

A

Measles, mumps and rubella

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18
Q

History of MMR vaccine?

A
  • 1988 - vaccine introduced
  • 1998 - suggested link with autism
  • 2003 - measles eliminated from UK
  • 2006 - re-establisehd due to poor vaccine uptake
  • 2013 - “catch-up” programme introduced
19
Q

Why was pre-natal screening for Rubella susceptibility in pregnant women stopped in England in April 2016?

A
  • Rubella infection in UK is at a level defines as ELIMINATED by WHO
  • Screening for rubella susceptibility does not give any PROTECTION to the unborn baby in the current pregnancy
  • Test may offer FALSE REASSURANCE to women that they are not susceptible to rubella infection
  • Stopping antenatal screening is unlikely to result in increased rates of congenital rubella
20
Q

What does Varicella Zoster Virus (VZV) cause?

A

Chicken pox (shingles)

21
Q

Primary maternal VZV infection in 1st 20 weeks of gestation causes…

A
  • Congenital varicella syndrome

* Eye defects, hypo plastic limb, microcephalus

22
Q

VZV infection around delivery causes…

A
  • Neonatal varicella syndrome

* Rash, pneumonitis

23
Q

VZV prevention and treatment?

A
  1. Aciclovir (IV) - high dose
  2. VZV immunoglobulin:
    • To mother or neonate
    • Within 7-10 day of exposure
    • May prevent foetal/ neonatal varicella syndrome
  3. Live vaccine:
    • Not part of routine childhood vaccination schedule
    • Varivax
    • Varilrix
24
Q 
Parvovirus B19:
• When?
• Result in...
• Monitor for?
• What is "fifth disease"?
A
  • Maternal infection during 1st 20 weeks of gestation
  • Foetal anaemia, hydros in <10%
  • Monitor for foetal ascites
  • Slapped cheek syndrome (“fifth disease”)
25
Q

How to diagnose parvovirus?

A
  • Amniocentesis
  • Chorionic villus sampling
  • (Cordocentesis - decreasing use)
26
Q

CMV:
• VIrus family?
• When?
• Result in…

A
  • Herpes family of viruses
  • Maternal infection = either primary or reactivation
  • May cause deafness, retardation in foetus
27
Q

How to diagnose CMV?

A

NAAT on:
• Amniotic fluid
• Neonatal blood/ urine within 3 weeks of birth

28
Q

Listeria monocytogenes causes?

A

Listeriosis

29
Q

Listeriosis:
• Transmission?
• Consequences of infection in pregnancy?

A
  • Transplacental transmission
  • Infection in early pregnancy 􏰁􏰁􏰁􏰁􏰁–> foetal death
  • Infection in later pregnancy –> associated with premature birth
30
Q

Complications of foetal infection of listeriosis?

A 
􏰁􏰁􏰁• Bacteraemia
• Hepatosplenomegaly
• Meningoencephaly
• Thrombocytopaenia
• Prenumonits
31
Q

What does intrapartum exposure to listeriosis cause?

A

Meningitis, bacteraemia

32
Q

How to diagnose listeriosis?

A

Culture: blood, CSF, placental tissue, lochia

33
Q

Treatment and management of listeriosis?

A

Take specialist advice re: antibiotics

34
Q

What causes toxoplasmosis?

A

Taxoplasma gondii

35
Q

How is toxoplasmosis transmitted?

A
  • Definitive hosts: cats
  • Faecal contamination
  • Infected, under-cooked meat
  • Infected fruit and vegetables
36
Q

Infected toxoplasmosis pregnancy –> ___ chance of transplacental transmission

A

1:3

37
Q

Infection in 1st and 2nd trimester leads to…

A
  • Stillborn
  • Death soon after birth
  • Cerebral calcification
  • Cerebral palsy
  • Epilepsy
  • Chorioretinitis
38
Q

Maternal toxoplasmosis infection confirmed by presence of …

A

IgM antibodies

39
Q

Treatment of toxoplasmosis?

A

Spiramycin

40
Q

Ways to reduce HIV vertical transmission?

A
  • HIV testing
  • Counselling
  • Antiretroviral medication
  • Delivery by caesarean section prior to onset of labour
  • Discouraging breastfeeding
41
Q

Causative agent for syphilis?
Presentation?
Treatment

A
  • Treponema pallidum
  • Rare in neonates due to ore-natal screening
  • Fever, rash, condylomata, mucosal fissures
  • Treatment = benzylpenicillin
42
Q

Staphyloccocus aureus:
• Causes what syndrome?
• Toxin?

A
  • Scalded skin syndrome

* S. aureus toxin

43
Q 
Zika virus:
• Spread?
• Symptoms?
• Risks of maternal infection?
• Vaccine?
• Prevention?
A
  • Spread through bite of infected Aedes species mosquito
  • Fever, rash, joint pain, conjunctivits
  • May be transmitted from male to sexual partner(s)
  • Infection during pregnancy - severe congenital brain effects e.g. microcephaly, Guillain-Barré syndrome
  • No vaccine (yet) or treatment
  • Prevention - barrier contraception, avoid mosquito bites
44
Q

Influence of maternal microbiota on baby?

A
  • Newborn’s gut microbiota can affects its own immune system

* Some evidence - mother’s microbiome shapes the immune system of her offspring

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