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Reproductive > Congenital and perinatal infections > Flashcards

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
Q

Describe how and why CMV may be acquired postpartum?

A

Low birth weight infants have little maternal Ab

Transfusion acquired
Horizontal spread from shedders
Breast milk

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26
Q

Describe the presentation of postpartum CMV in a neonate?

A

Non specific, sepsis-like syndrome

Hepatomegaly
Respiratory distress
Atypical lymphocytosis

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27
Q

What is the most common congenital viral infection?

A

Congenital CMV

0.3-2% all live births

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28
Q

Which form of CMV is riskiest for the baby?

A

Primary infection in mother

10% symptomatic
Mortality 10-30%
Long-term sequelae

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29
Q

Describe the prevalence and rates of fetal infection for both primary and reactivation CMV in the mother?

A
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30
Q

Describe the prevalence and risk of long-term sequelae for asymptomatic and symptomatic neonatal CMV?

A
31
Q

Describe the laboratory tests for CMV?

A

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
Q

Describe the interpretation of laboratory results for CMV testing?

A

Primary infection: IgG and IgM often positive
IgM detectable for months

Reactivation: IgM may be detectable

So, can be hard to distinguish

33
Q

How can foetal infection with CMV be confirmed?

A

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
Q

Describe the actions that occur if a baby infected with CMV is normal at birth?

A

Serial audiometry and visual assessment

Psychomotor assessment

Watch for pneumonitis

35
Q

Describe the actions taken if a baby with CMV infection is symptomatic at birth?

A

Confirm diagnosis: urine in first 2 weeks

Cranial US and other imaging
Developmental paediatrician
Physio
Sppech therapist
OT
Audiometry and visual assessment

36
Q

Describe the treatment for CMV?

A

Ganciclovir

Omly administered to symptomatic neonates
IV for 6 weeks

Consider oral valganciclovir for 6 months

37
Q

Describe rubella virus?

A

Togavirus family

ssRNA

Enveloped

38
Q

When is the peak for rubella infection?

A

Winter-Spring

39
Q

How many patients with rubella infection are symptomatic?

A

50-75%

40
Q

What is the incubation period for rubella virus?

A

14-21 days

41
Q

How is rubella transmitted?

A

Nasopharyngeal secretions

Infectious from -7 to +14 days of symptoms

42
Q

Describe the clinical presentation of rubella?

A

Low-grade fever

Lymphadenopathy (nodes on back of neck for 2-3 weeks)

Exanthem

Polyarthralgia/arthritis

43
Q

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

A

< 4 weeks: 85%

4-8 weeks: 20%

9-12 weeks: 5%

> 16 weeks: rare

>12 weeks: retinopathy and deafness only

44
Q

Describe the consequences of congenital rubella syndrome?

A

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
Q

Describe the investigation of rubella?

A

Serological confirmation: IgG seroconversion or rising titre, IgM

Foetal diagnostic testing: amnitoic fluid

46
Q

Describe the preventin of rubella?

A

Live attenuated vaccine (MMR)

Seronegative women vaccinated postpartum (not during pregnancy)

47
Q

Describe parvovirus?

A

aka Erythrovirus

ssDNA

IP 4-21 days

48
Q

Describe the effect of parvovirus?

A

Shortens lifespan of RBC progenitors

Fever
Rash (slapped cheek) and generalised maculopapular

Arthralgia and rash in adults

Anaemia

49
Q

Describe the effect of congenital parvovirus infection?

A

Hydrops foetalis (anaemia)

Foetal loss: < 10 weeks: 10%
9-20 weeks: 3%

50
Q

Describe the treatment for congenital parvovirus infection?

A

Intrauterine infusions

51
Q

Describe the diagnosis of parvovirus?

A

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
Q

Describe the effects of primary infection with HSV during pregnancy?

A

Miscarriage

IUGR

Preterm labour (<1%)

53
Q

Describe the effects of primary infection with HSV near the time of delivery?

A

Three patterns of disease:

Skin-eye-mouth (vesicles, otherwse looks well)
Encephalitis
Disseminated (DIC, hepatitis, very unwell)

54
Q

Describe the management for primary infection with HSV during pregnancy?

A

Acyclovir treatment and suppression until delivery

Caesarean section

55
Q

Describe the management of recurrent infection with HSV during pregnancy?

A

Acyclovir suppression

Avoid instrumentation

Careful clinical examination for lesions at time of delivery

Investigate baby for colonisation

56
Q

Describe the rates of transmission of syphilis to the foetus at the different stages of the disease?

A

Primary: 90%
Secondary: 60-90%
Early latent: 40%
Late latent: <10%
Tertiary: rare

57
Q

Describe the outcomes of congenital syphilis?

A

40% stillbirth

Premature delivery

Early and late onset disease: hepatosplenomegaly, lymphadenopathy, snuffles, rash

58
Q

Describe the antenatal screening program for syphilis?

A

Routine screening at first antenatal visit

Repeat at 28-32 weeks and at delivery if at high risk

Repeat with each pregnancy

59
Q

Describe the rate of transmission of chalmydia to the foetus?

A

50% transmission

25% conjuncitvitis
10% pneumonia

60
Q

Describe the presentation of toxoplasma gondii infection at birth?

A

70-90% asymptomatic at birth

May develop symptoms as late as adolescence

Rash, lymphadenopathy, chorioretinitis, hydrocephalus

61
Q

What is the rate of chronic carriage of Hep B in congenitally infected babies?

A

90% chronic carriage

62
Q

Describe the antenatal screening for Hep B?

A

HBsAg screening at first antenatal visit

63
Q

Describe the treatment for congenital Hep B infection?

A

Hep B Ig (preferably within 12, def within 48 hrs delivery)

64
Q

Describe the rate of Hep C perinatal transmission?

A

High viral load: 6%

Undetectable viral load: <1%

HIV coinfected: 10-45%

65
Q

Describe the rate of maternal-foetal transmission of HIV?

A

0-30%

Dependen on viral load, CD4 count, mode of delivery(Caesarean 0.7 relative protection)

66
Q

Describe how a foetus or neonate can become infected with Group B strep?

A

Infected via ascending infection or colonised at delivery

20-30% carriage rates in bowel/vagina

67
Q

Describe the rate of colonisation of Group B strep in neonates?

How many of these develop disease?

A

40-70% babies colonised

1% invasive disease

68
Q

Describe the presentation of Group B strep infection in a neonate?

A

Pneumonia

Sepsis

Meningitis

69
Q

Describe the maternal risk factors for the development of Group B strep infection in her baby?

A

Preterm delivery

Prolonged ruptured membranes

Intrapartum fever

Chorioamnionitis

Previous baby with GBS

70
Q

Describe the two presentations of Group B strep infections in neonates?

A

EARLY ONSET

First 48 hours
Pneumonia and septicaemia
Peripartum infection common

LATE ONSET

Colonisation at birth
Possibly breats milk transmission
Meningitis

71
Q

Describe the treatment for Group B strep infection?

A

Penicillin and gentamicin

72
Q

Describe how Group B strep presence is detected?

A

Genital swab > charcoal transport medium > Todd Hewitt broth and antibiotics > orange pigment indicates presence

PCR detects any that are missed

73
Q

For which infections is antenatal serological screening performed/

A

Rubella

Syphilis

Hep B

Hep C

HIV

May also consider VZV, CMV and toxoplasma gondii

Reproductive (21 decks)

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