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Hannah's Intersystem > Congenital and Perinatal Infections > Flashcards

Congenital and Perinatal Infections Flashcards

1
Q

Describe the characteristics of VZV

A

Herpesviridae

Enveloped dsDNA virus with icosahedral capsid

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2
Q

Where does latent VZV reside?

A

DRG

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3
Q

How long do chickenpox symptoms usually last?

A

2-6 days

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4
Q

List 3 complications of chickenpox

A

Secondary bacterial infection
Pneumonitis
Acute cerebellar ataxia (self-limiting, resolves within weeks)

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5
Q

What are the most common secondary bacterial infections in chickenpox?

A

S. pyogenes

S. aureus (bullous varicella)

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6
Q

What is an independent variable for maternal varicella?

A

Smoking

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7
Q

What symptoms are experienced by pregnant woman with varicella?

A

Respiratory symptoms day 2-5 (productive cough with haemoptysis)

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8
Q

When are deaths from maternal varicella most common?

A

In 3rd trimester

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9
Q

List 6 sequelae of a 1st trimester primary infection causing congenital varicella syndrome

A 
Limb hypoplasia
Cicatricial scarring
Microcephaly
Cataracts
Mental retardation
GI and genitourinary abnormalities
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10
Q

When is perinatal varicella a risk?

A

With a primary (i.e. no specific Ab) maternal infection -7 to +2 days from delivery

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11
Q

What does perinatal varicella cause?

A

Disseminated infection with 25-30% mortality rate (even with treatment)

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12
Q

When is prophylactic VZIG given?

A

<96hrs post-exposure

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13
Q

In what groups is prophylactic VZIG given?

A

Susceptible pregnant women
Infants whose mothers develop varicella <7 days prior to delivery and in 1st month of life
Immunocompromised
Premature babies

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14
Q

What is the effect of VZIG?

A

Prolongs incubation period to 30 days

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15
Q

How is acute varicella treated?

A

Acyclovir

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16
Q

When is oral vs. IV acyclovir used for varicella?

A

Oral: <24hrs of rash and no systemic symptoms
IV: pneumonitis, neurological symptoms, organ involvement, haemorrhagic rash

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17
Q

Describe the characteristics of the varicella vaccine. When is it given?

A

Live attenuated virus (OKA strain)
Seroconversion >90%
Given at 18 months (if >14, 2 doses given)

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18
Q

Describe the characteristics of CMV

A

Herpesviridae

dsDNA with icosahedral capsid

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19
Q

Is congenital CMV a developed or developing country problem?

A

Developed - in developing countries most women of reproductive age have already acquired immunity

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20
Q

List 4 routes of CMV transmission

A

Transplacental (haematogenous spread)
Perinatal (genital secretions, breast milk, saliva)
Toddlers in day-care
Adults via sexual or non-sexual close contact

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21
Q

What does postpartum CMV cause?

A

Sepsis-like syndrome (hepatomegaly, respiratory distress, atypical lymphocytosis)

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22
Q

What is the difference between primary and reactivation of CMV in terms of the % of women affected and the % of foetal transmission?

A

Primary: 1% of women, 20-50% foetal infection
Reactivation: 10-30% of women, 1-3% foetal infection

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23
Q

What are some of the possible sequelae of congenital CMV?

A

Sensorineural deafness
Learning difficulties
Seizures

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24
Q

How long is IgM detectable for in a primary CMV infection?

A

Can be detectable for months

25
Q

How can foetal CMV infection be confirmed?

A

PCR on amniotic fluid

Testing foetal cord blood

26
Q

What is done in the case of congenital CMV?

A

Counselling

Serial ultrasound

27
Q

What tests are performed at birth if the baby has congenital CMV but is not symptomatic?

A

Serial audiometry
Serial visual assessment
Psychomotor assessment
Monitor for pneumonitis

28
Q

What tests are performed at birth if the baby has congenital CMV and is symptomatic?

A

Confirm diagnosis with CMV detection in urine
Perform cranial ultrasound + other imaging
Multidisciplinary approach to management

29
Q

When is ganciclovir administered for CMV? What are the concerns?

A

Only to symptomatic neonates (via IV)

Concerns about carcinogenicity and reproductive toxicity

30
Q

Describe the characteristics of rubella

A

Togavirus

Enveloped ssRNA

31
Q

When are individuals infected with rubella considered infectious?

A

-7 to +14 days from onset of nasopharyngeal secretions

32
Q

What is the clinical presentation of rubella?

A

Low-grade fever
Lymphadenopathy (occipital, postauricular, posterior cervical)
Exanthem (maculopapular)
Polyarthralgia/arthritis

33
Q

When is risk of damage due to congenital rubella syndrome highest?

A

16 weeks)

34
Q

What is the classical triad of congenital rubella syndrome?

A

Opthalmological (cataracts, glaucoma, retinopathy)
Cardiac (patent ductus arteriosus, PA stenosis)
Auditory (sensorineural deafness)

35
Q

What are some symptoms of congenital rubella syndrome other than the classical triad?

A

Neurological (meningoencephalitis, behavioural)
Others (rash, thrombocytopaenia)
Late endocrinopathies (DM, thyroid dysfunction)

36
Q

How is rubella prevented?

A

Live attenuated vaccine (highly effective)

Seronegative women are vaccinated postpartum

37
Q

Describe the characteristics of parvovirus

A

ssDNA

38
Q

What is fifth disease? What are the symptoms?

A

Erythema infectiosum, caused by parvovirus
Symptoms include fever, “slapped cheek” rash and generalised macropapular lace-like lash, arthralgia in adults, and acute aplastic crisis in those with chronic haemolytic anaemias

39
Q

What does congenital parvovirus infection cause?

A

Hydrops foetalis

40
Q

How is foetal loss prevented in congenital parvovirus infection?

A

Intrauterine transfusions

41
Q

How is congenital parvovirus diagnosed?

A

Ultrasound at 1-2 weekly intervals for 6-12 weeks
Foetal blood sampling
Intrauterine transfusion

42
Q

What does a primary HSV infection during pregnancy cause?

A

Abortion, IUGR, preterm labour

43
Q

What does a primary HSV infection close to delivery cause?

A

Skin-eye-mouth disease
Encephalitis
Disseminated (hepatitis, DIC)

44
Q

How is primary HSV infection during pregnancy managed?

A

Acyclovir treatment and suppression until delivery

C section

45
Q

How is recurrent HSV infection during pregnancy managed?

A

Acyclovir suppression
Avoid instrumentation
Careful clinical examination for lesions
Investigation of baby for colonisation

46
Q

What are the 3 main outcomes of congenital syphilis infection?

A

Stillbirth
Premature delivery
Early- and late-onset disease

47
Q

What are 3 benefits of antenatal screening for syphilis?

A

To prevent congenital infection
To prevent further sexual transmission
To prevent progression to tertiary syphilis

48
Q

When is syphilis screening performed?

A

Routine at 1st antenatal visit
Repeat at 28-32 weeks and delivery if high risk (young, single, low SES, etc)
Repeat with each pregnancy

49
Q

What are the outcomes of congenital infection with toxoplasma gondii?

A

70-90% asymptomatic at birth

Rash, chorioretinitis, hydrocephalus

50
Q

Describe the characteristics of hepatitis B

A

Glycolipid-enveloped ds DNA virus

51
Q

What increases the risk of hepatitis B transmission?

A

HBeAg or PCR+ women have greater risk of transmission

52
Q

What is done if maternal hepatitis B infection is diagnosed?

A

Infant is vaccinated at birth, 2, 4 and 6 months (performed universally anyway)
Hepatitis B Ig (BIG) is administered with 12-48hrs of delivery

53
Q

What factors influence maternal-foetal transmission of HIV?

A

Viral load
CD4 count
Duration of ruptured membranes
Mode of delivery

54
Q

What % of babies are colonised with Group B streptococcus at birth? How many of these develop invasive disease?

A

40-70%

1%

55
Q

What symptoms are seen in peripartum GBS infection?

A

Pneumonia
Sepsis
Meningitis (more common with late-onset infection)

56
Q

List 5 maternal risk factors for transmission of GBS to baby

A 
Preterm delivery
Prolonged ruptured membranes
Intrapartum fever
Chorioamnionitis
Previous baby with GBS
57
Q

How is GBS infection treated?

A

Penicillin and gentamicin

58
Q

How is GBS infection prevented?

A

Intrapartum chemoprophylaxis (screening for carriage and administration of antibiotics)

59
Q

What antenatal serological screening should be routinely performed, either pre-conception or at the 1st antenatal visit?

A 
Rubella
Syphilis
HBV
HCV
HIV

Hannah's Intersystem (16 decks)

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