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Congenital and perinatal infections Flashcards

1
Q

Describe the different timings of congenital and perinatal infections?

A

Prenatal: acquired/carried by mother and transmitted to developing foetua

Perinatal: infection transmitted around time of delivery

Postnatal/Postpartum: infection acquired after delivery (from family, health care workers, community, etc.)

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2
Q

Describe the different modes of infection for congenital and perinatal infections?

A

Vertical transmission: mother to foetus (e.g. transplacental)/baby (e.g. breast milk)

Horizontal transmission: one person/baby to another

Ascending: vaginal organisms producing foetal infection

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3
Q

Describe varicella zoster virus?

A

Herpesviridae family

Large

Icosahedral

dsDNA

Enveloped

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4
Q

Where does the latent infection of VZV reside?

A

Dorsal root ganglia

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5
Q

What does VZV cause?

A

Chickenpox and herpes zoster (shingles, after reactivation)

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6
Q

What is the incubation period for chickenpox?

A

10-21 days (median 14)

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7
Q

How is chickenpox transmitted/

A

Respiratory

Direct contact

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8
Q

Describe the presentation and duration of chickenpox?

A

Fever
Lethargy
Pruritic vesicular rash

2-6 days

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9
Q

Describe the complications of chickenpox?

A

Secondary bacetrial infection: commonly strep pyogenes or staph aureus (enter via skin lesions)

Pneumonitis: more common in adults

Acute cerebellar ataxia

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10
Q

In which population is chickenpox most severe?

A

Pregnant adults

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11
Q

Describe the consequeces of maternal varicella for the mother?

A

Respiratory symptoms days 2-5

Death most common in third trimester (2% mortality)

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12
Q

Describe the consequences of congenital varicella syndrome?

A

Limb hypoplasia

Cicatrical scarring (dermatomal)

Microcephaly

Cataracts

Mental retardation

GIT and genitourinary abnormalities

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13
Q

Describe how the risk of congenital varicella syndrome varies with gestation?

A

2-12 weeks: 0.55%

12-28 weeks: 1.4%

Latest gestation: 28 weeks

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14
Q

When does perinatal varicella occur?

A

When mother develops primary maternal varicella -7 to +2 days from delivery

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15
Q

Describe the rate of transmission of primary maternal varicella to the neonate?

A

17-30% transmission

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16
Q

Describe the mortality associated with perinatal varicella?

A

25-30%

Disseminated infection

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17
Q

What is prophylactic VZIG used for?

A

Prophylactic varicella zoster immunoglobulin

Given post-exposure (<96 hours) to: suscpetible pregnant women, infants whose mothers develop varicella < 7 days prior to delivery and in first month of life, immunocompromised and premature babies (< 28 weeks)

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18
Q

Describe the treatment of varicella?

A

Acyclovir

Oral if <24 hours of rash and no systemic symptoms

IV if pneumonitis, neuro symtpoms, organ involvement, haemorrhagic rash

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19
Q

Describe the varicella vaccine?

A

Live attenuated virus

Given at 18 months (MMRV) or to non-immune adults in ‘high-risk’ occupations

100% protection against severe disease, 70% protection against any disease

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20
Q

Describe cytomegalovirus?

A

Herpesviridae family

Icosahedral

dsDNA

Lipid envelope

Produces multinucleate giant cells

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21
Q

Where does the latent infection of CMV reside?

A

WBCs

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22
Q

Desribe the epidemiology of CMV?

A

Primary infection

Recurrent infection: reactivation or re-infection (with different strain)

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23
Q

Describe the transmission of CMV?

A

Saliva
Urine
Blood
Semen
Breast milk
Cervical secretions
Transplacental
Transplant tissue

Of those who are seropositive, 10% will be shedding virus at any one time
90% of immunosuppressed patients shedding virus

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24
Q

Describe the seroepidemiology of CMV?

A

World-wide, no seasonal predilection

Dependent on: SES, cultural background, geographic location, exposure to children, age

Increased rates during childhood, adolescence and child-bearing years

Most exposure in childhood in developing countries, lots in adults in developed countries

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25
Describe how and why CMV may be acquired postpartum?
Low birth weight infants have little maternal Ab Transfusion acquired Horizontal spread from shedders Breast milk
26
Describe the presentation of postpartum CMV in a neonate?
Non specific, sepsis-like syndrome Hepatomegaly Respiratory distress Atypical lymphocytosis
27
What is the most common congenital viral infection?
Congenital CMV 0.3-2% all live births
28
Which form of CMV is riskiest for the baby?
Primary infection in mother 10% symptomatic Mortality 10-30% Long-term sequelae
29
Describe the prevalence and rates of fetal infection for both primary and reactivation CMV in the mother?
30
Describe the prevalence and risk of long-term sequelae for asymptomatic and symptomatic neonatal CMV?
31
Describe the laboratory tests for CMV?
IgG: appears and remains for life IgM positive: acute infection IgG avidity: Ab binds Ag weakly in first 3-4 months of infection NA detection
32
Describe the interpretation of laboratory results for CMV testing?
Primary infection: IgG and IgM often positive IgM detectable for months Reactivation: IgM may be detectable So, can be hard to distinguish
33
How can foetal infection with CMV be confirmed?
Amnitoic fluid \> PCR Have to get timing right (allow enough time mother's primary infection and baby neginning to shed virus into amnioitic fluid)
34
Describe the actions that occur if a baby infected with CMV is normal at birth?
Serial audiometry and visual assessment Psychomotor assessment Watch for pneumonitis
35
Describe the actions taken if a baby with CMV infection is symptomatic at birth?
Confirm diagnosis: urine in first 2 weeks Cranial US and other imaging Developmental paediatrician Physio Sppech therapist OT Audiometry and visual assessment
36
Describe the treatment for CMV?
Ganciclovir Omly administered to symptomatic neonates IV for 6 weeks Consider oral valganciclovir for 6 months
37
Describe rubella virus?
Togavirus family ssRNA Enveloped
38
When is the peak for rubella infection?
Winter-Spring
39
How many patients with rubella infection are symptomatic?
50-75%
40
What is the incubation period for rubella virus?
14-21 days
41
How is rubella transmitted?
Nasopharyngeal secretions Infectious from -7 to +14 days of symptoms
42
Describe the clinical presentation of rubella?
Low-grade fever Lymphadenopathy (nodes on back of neck for 2-3 weeks) Exanthem Polyarthralgia/arthritis
43
Describe how the risk of damage in congenital varicella syndrome varies with gestation?
\< 4 weeks: 85% 4-8 weeks: 20% 9-12 weeks: 5% \> 16 weeks: rare \>12 weeks: retinopathy and deafness only
44
Describe the consequences of congenital rubella syndrome?
1/3: normal life, live with parents, institutionalised Opthalmological: cataracts, glaucoma, retinopathy Cardiac: patent ductus arteriosus, PA stenosis Auditory: sensorineural deafness Neurological: meningoencephalitis, behavioural
45
Describe the investigation of rubella?
Serological confirmation: IgG seroconversion or rising titre, IgM Foetal diagnostic testing: amnitoic fluid
46
Describe the preventin of rubella?
Live attenuated vaccine (MMR) Seronegative women vaccinated postpartum (not during pregnancy)
47
Describe parvovirus?
aka Erythrovirus ssDNA IP 4-21 days
48
Describe the effect of parvovirus?
Shortens lifespan of RBC progenitors Fever Rash (slapped cheek) and generalised maculopapular Arthralgia and rash in adults Anaemia
49
Describe the effect of congenital parvovirus infection?
Hydrops foetalis (anaemia) Foetal loss: \< 10 weeks: 10% 9-20 weeks: 3%
50
Describe the treatment for congenital parvovirus infection?
Intrauterine infusions
51
Describe the diagnosis of parvovirus?
SEROLOGY IgG: past infection, immunity IgM: acute infection, positive for 2-4 months NA DETECTION US at 1-2 weekly intervals for 6-12 weeks if mother infected foetal blood smpaling if mother infected
52
Describe the effects of primary infection with HSV during pregnancy?
Miscarriage IUGR Preterm labour (\<1%)
53
Describe the effects of primary infection with HSV near the time of delivery?
Three patterns of disease: Skin-eye-mouth (vesicles, otherwse looks well) Encephalitis Disseminated (DIC, hepatitis, very unwell)
54
Describe the management for primary infection with HSV during pregnancy?
Acyclovir treatment and suppression until delivery Caesarean section
55
Describe the management of recurrent infection with HSV during pregnancy?
Acyclovir suppression Avoid instrumentation Careful clinical examination for lesions at time of delivery Investigate baby for colonisation
56
Describe the rates of transmission of syphilis to the foetus at the different stages of the disease?
Primary: 90% Secondary: 60-90% Early latent: 40% Late latent: \<10% Tertiary: rare
57
Describe the outcomes of congenital syphilis?
40% stillbirth Premature delivery Early and late onset disease: hepatosplenomegaly, lymphadenopathy, snuffles, rash
58
Describe the antenatal screening program for syphilis?
Routine screening at first antenatal visit Repeat at 28-32 weeks and at delivery if at high risk Repeat with each pregnancy
59
Describe the rate of transmission of chalmydia to the foetus?
50% transmission 25% conjuncitvitis 10% pneumonia
60
Describe the presentation of toxoplasma gondii infection at birth?
70-90% asymptomatic at birth May develop symptoms as late as adolescence Rash, lymphadenopathy, chorioretinitis, hydrocephalus
61
What is the rate of chronic carriage of Hep B in congenitally infected babies?
90% chronic carriage
62
Describe the antenatal screening for Hep B?
HBsAg screening at first antenatal visit
63
Describe the treatment for congenital Hep B infection?
Hep B Ig (preferably within 12, def within 48 hrs delivery)
64
Describe the rate of Hep C perinatal transmission?
High viral load: 6% Undetectable viral load: \<1% HIV coinfected: 10-45%
65
Describe the rate of maternal-foetal transmission of HIV?
0-30% Dependen on viral load, CD4 count, mode of delivery(Caesarean 0.7 relative protection)
66
Describe how a foetus or neonate can become infected with Group B strep?
Infected via ascending infection or colonised at delivery 20-30% carriage rates in bowel/vagina
67
Describe the rate of colonisation of Group B strep in neonates? How many of these develop disease?
40-70% babies colonised 1% invasive disease
68
Describe the presentation of Group B strep infection in a neonate?
Pneumonia Sepsis Meningitis
69
Describe the maternal risk factors for the development of Group B strep infection in her baby?
Preterm delivery Prolonged ruptured membranes Intrapartum fever Chorioamnionitis Previous baby with GBS
70
Describe the two presentations of Group B strep infections in neonates?
EARLY ONSET First 48 hours Pneumonia and septicaemia Peripartum infection common LATE ONSET Colonisation at birth Possibly breats milk transmission Meningitis
71
Describe the treatment for Group B strep infection?
Penicillin and gentamicin
72
Describe how Group B strep presence is detected?
Genital swab \> charcoal transport medium \> Todd Hewitt broth and antibiotics \> orange pigment indicates presence PCR detects any that are missed
73
For which infections is antenatal serological screening performed/
Rubella Syphilis Hep B Hep C HIV May also consider VZV, CMV and toxoplasma gondii

Reproductive (21 decks)

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