Congenital and Perinatal Infections

Question 1

when is the fetus at highest risk from toxins, mutagens, and infections

Answer 1

1st trimester

Question 2

routes of infection for congenital infection

Answer 2

maternal viremia
through cervix
aniocentesis

Question 3

TORCH means?

Answer 3

Toxoplasmosis
Other: Syphilis, Hep B, VZV, Parvo B19, HIV, HTLV1
Rubella
CMV
HSV
*most common congenital and perinatal infections

Question 4

Common TORCH presentation

Answer 4

rash
chorioretinitis
microcephaly
hepatosplenomegaly
IUGR

Question 5

What is the most common manifestation of congenital infection?

Answer 5

hearing loss!

Question 6

Most common congenital infection in US?

Answer 6

CMV>Toxo>syphilis>rubella

Question 7

CMV

Answer 7

human herpesvirus
Large DNA genome 
Ubiquitous (50-90% humans +)
usually harmless/ asymptomatic
giant cells (owl eye)

Question 8

CMV tissue tropism

Answer 8

salivary glands
kidney
endothelial cells 
fibroblasts 
PMNs
monocytes

Question 9

CMV site of latency

Answer 9

hematopoietic progenitor cells

Question 10

Symptoms of a primary CMV infection

Answer 10

asymptomatic or mononucleosis, rash, jaundice, hepatosplenomegaly

Question 11

Sx of CMV reactivation

Answer 11

retinitis, gastroenteritis, organ rejection

Question 12

risk factors for congenital CMV

Answer 12

no prior CMV infection 
pregnancy at young age 
first pregnancy
new sex partner during pregnancy
frequent contact with babies or toddlers
mother subclinically ill

Question 13

What is the more common mode for CMV to spread from mother the child in utero? Can it cross the placenta?

Answer 13

through mom’s blood

can cross placenta but much less likely to do so in reactivation infection

Question 14

is it common for congenitally infected neonates with CMV to have sx?

Answer 14

no, only 10% are symptomatic

Question 15

Of the asymptomatic CMV infected neonates, what is the negative outcome they my experience and how common is it?

Answer 15

15% develop late disabilities

Question 16

Tx for congenital CMV

Answer 16

Gancyclovir but has its own toxicity

vaccine in development but no current vaccine!

Question 17

Which HSV infection is more severe, 1 or 2?

Answer 17

HSV2

Question 18

this one goes for all congenital viral infections, is primary infection or reactivation more severe?

Answer 18

primary

Question 19

in HSV, does the mother’s presentation (i.e. sx or not) matter in terms of severity for the fetus?

Answer 19

yeahhhhhh

if she is symptomatic it is worse than if she is subclinical

Question 20

what is the most common scenario in which a baby acquires HSV from its mother?

Answer 20

mom has a reactivation of HSV2 at birth and neonate acquires it at time of birth
*rarely develops into severe infection

Question 21

what is the most severe scenario in which a baby acquires HSV from its mother?

Answer 21

mom has primary HSV2 during pregnancy and fetus is born with disseminated virus
*very poor prognosis: mental impairment, death

Question 22

Tx for congenital HSV

Answer 22

IV acyclovir

Question 23

Prevention for congenital HSV

Answer 23

C section if mom has frequent outbreaks of genital herpes

antiviral prophylaxis

Question 24

Congenital varicella syndrome is _____ rare. If the mother has a ________ infection it can impair ____ and ______ development in the fetus. The prognosis is _______. Treatment ______ for the ______.

Answer 24

very rare
primary 
limb and brain 
poor
acyclovir for the mom

Question 25

if you see a “blueberry muffin baby” what is it?

Answer 25

congenital rubella

Question 26

In congenital rubella, does the virus infect the placenta or the fetus first?

Answer 26

placenta

Question 27

is it common for congenital rubella to cause severe disease in the fetus?

Answer 27

yes, 80% of newborns who are infected early on will have severe disease

Question 28

What sx does congenital rubella cause?

Answer 28

hearing loss
congenital heart defects (PDA)
opthalmic probs (cataracts)
IUGR
neuro: mental and psychomotor retardation, microcephaly

Question 29

rubella prevention?

Answer 29

vaccine!!

Question 30

what are some other names for parvovirus b19?

Answer 30

5th disease

erythema infectiosum

Question 31

parvovirus b19 is most commonly seen in :

Answer 31

school age children in winter/spring

Question 32

parvovirus b19 presentation

Answer 32

biphasic:
febrile illness no rash
then slapped cheek rash on face
erythematous maculopapular rash + arthralgias + arthritis

Question 33

if a pregnant woman is seronegative for parvo B19, how should you counsel her?

Answer 33

you should tell her that if she is infected while pregnant she is at risk for fetal death

Question 34

How do you treat and prevent parvo B19?

Answer 34

you can’t :/

Question 35

How are retroviruses passed on perinatally? and what viruses am I referring to?

Answer 35

HTLV1 and HIV

transmitted via infected maternal lymphocytes which are in the breastmilk

Question 36

How do you prevent an infant with an HIV+ mom from getting HIV?

Answer 36

antepartum, intrapartum, and postpartum antiretroviral prophylaxis for baby and mom should be on antiretroviral meds (ZDV)

Question 37

What HIV meds should be avoided during pregnancy?

Answer 37

efavirenz (teratogenic in first trimester)

Question 38

a neonate infected with HBV at the time of birth is at risk for what?

Answer 38

90% risk for chronic infection

Question 39

List the congenital viruses that can be prevented by vaccination of the mother

Answer 39

rubella
varicella
HBV