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Jonathan's Reproduction > Congenital and Perinatal Infections > Flashcards

Congenital and Perinatal Infections Flashcards

1
Q

What is perinatal infection?

A

Infectious during time of delivery

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2
Q

When is ascending infection most common?

A

When the placenta has ruptured

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3
Q

How does maternal infection lead to premature delivery or fetal death

A

Direct end-organ damage, chronic infection

non-specific effect. Mum is too weak to have baby

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4
Q

When is the Varicella virus vaccine given?

A

at 18 months, with the MMRV vaccine

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5
Q

Why is MMR given at 12 months?

A

Prevent cross reaction with maternal antibody

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6
Q

What is anthem and enanthem?

A 
anthem = rash on surface of the body 
enanthem = rash on mouth
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7
Q

What are the common herpes virus that affect humans

A

CMV
HSV type 1 + 2
Varicella Zoster
EBV

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8
Q

What is chicken pox?

A

Primary VZV infection

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9
Q

Where does VZV become dormant? What is it called if it reactivates?

A

DRG

Shingles

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10
Q

What is the typical presentation of VZV?

A

fever, lethargy, rash in 24 hours
Pruritic vesicular rash with ulcerated areas

Vesicles shed virus

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11
Q

What are the complication of VZV infection?

A

Secondary bacterial infection due to skin lesions
Pneumonitis
Acute cerebellar ataxia

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12
Q

At what stage of pregnancy is immune-suppression most obvious?

A

third trimester, so primary infection here is most dangerous as baby is most unprotected

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13
Q

T/F Smoking is an independent variable to fetal defect

A

True, it increases the risk of pneumonitis specifically

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14
Q

When is the fetus most susceptible to mental retardation and developmental abnormalities if the mother gets infected by VZV?

A

Primary infection in the first trimester

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15
Q

When will VZV infection cause perinatal varicella

A

Primary infection within 7 days before delivery, as mum doesn’t have the time to mount immune response

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16
Q

What is VZIG?

A

Concentrated preformed immunoglobulin given prophylactically within 96 hours post-exposure

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17
Q

what is the management of acute chicken pox in mothers

A

Acyclovir + negative pressure chamber to limit the spread

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18
Q

T/F We can clear cytomegalovirus

A

False, the infection is life-long

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19
Q

What kind of cell is produced when infected with CMV?

A

multinuclear giant cell

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20
Q

Where does CMV stay latent in?

A

White blood cells

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21
Q

T/F Reactivated CMV is much more infectious

A

False, primary infection is more infectious

22
Q

What is the mode of transmission for CMV?

A

via any body liquid

23
Q

T/F Most of the CMV exposures occur in adults of the developed world

A

True, and most exposures in the developing world are in children

24
Q

What are the common ways for babies to get CMV?

A

horizontal transmission (in day-care centre), or breast milk from mum postnatally

25
Q

2% of the live births will have congenital CMV. How much of the infected will be symptomatic? What are the symptoms?

A

10%

calcification around brain, microcephaly, significant long term sequelae

26
Q

Can asymptomatic babies develop long term sequelae

A

Yes, 10-15% will have long term sequelae such as unilateral sensory deafness

27
Q

How do we determine whether CMV infection is early or late?

A

IgG avidity test for how strongly the antibody binds. Late infection will test for higher avidity

28
Q

T/F IgM is a good diagnosis for acute CMV infection

A

False, IgM for CMV can persist for a long time, up to 18 months

Reactivated CMV can also cause rise of IgM

29
Q

Why is it important to retest for infections

A

To detect for rising titres of antibody

30
Q

How do we confirm fetal CMV infection?

A

amniotic fluid testing 6-8 weeks after primary infection, or at 20 weeks gestation

31
Q

If the foetus is symptomatic, what is the management option?

A

ultrasound to check for microcephaly or calcification

32
Q

Can we assume the baby is safe if the baby has asymptomatic congenital CMV?

A

No, we need to follow them up, as deafness can take five years to develop

33
Q

What is the treatment of CMV?

A

Ganciclovir IV for 6 weeks to half the rate of deafness

Valganiciclovir can also be added

34
Q

T/F Rubella viral infection can be infectious before symptoms are present

A

True, virus is shed is large amount in nasopharyngeal secretion

35
Q

What are the typical signs of rubella?

A

fever, lymphadenopathy in the occipital nodes

36
Q

What is the classic triad of congenital rubella syndrome?

A

ophthalmological,

cardiac and auditory abnormalities

37
Q

T/F Rubella infection is linked to diabetes and thyroid illness

A

True, they are the rarer presentations

38
Q

T/F Risk of congenital damage is highest in the third trimester

A

False, it’s in the first trimester when all the organs are forming

39
Q

How do we diagnose congenital rubella syndrome?

A

fetal amniotic fluid test for rising IgG and IgM (acute infection)

40
Q

Which virus causes “slapped cheek” syndrome?

A

Parvovirus

41
Q

T/F Parvovirus is self-limiting

A

True

42
Q

What are the presentations of parvovirus infection?

A

fine reticular rash on body, cheeck

circum-oral pallor

43
Q

What is Hydrops foetalis?

A

Parvovirus with haematological abnormalities (sickled cell) that reduce RBC lifespan. HF is a significant anaemia

44
Q

What is the treatment of Hydrops foetalis?

A

Intrauterine transfusion until the virus is cleared

45
Q

T/F HSV-1 is genital specific

A

False, HSV-2 is typically genital specific

46
Q

How will HSV be transmitted from the mother to baby?

A

perinatally during delivery if there is primary infection or reactivation

47
Q

What are the symptoms of congenital HSV infection

A

skin-eye-mouth disease
skin vesicle
delayed encephalitis
disseminated intravascular coagulation

48
Q

What is the management of herpes?

A

acyclovir

49
Q

What is the causative agent of syphilis?

A

Treponema pallidum

50
Q

What are the diagnostic tests for syphilis?

A

EIA and RPR

51
Q

What symptom can the baby develop if there is congenital Toxoplasma gondii infection?

A

delayed retinopathy

Jonathan's Reproduction (15 decks)

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