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congenital infections Flashcards

1
Q

how can we make a prenatal diagnosis of congenital infections ?

A

using amniocentesis

percutaneous umbilical cord sampling

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2
Q

when during the pregnancy is rubella most commonly seenn ?

A

first trimesteric infection n

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3
Q

what is the triad for congenital rubella ?

A

congenital heart disease ( PDA, PS)
cataract
deafness

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4
Q

how would a mother present with a rubella infection ?

A

at early pregnancy, 11 weeks or so , she presents with fever, rash and lymph node affection , with no findings on ultrasound

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5
Q

what is the pathogenesis of rubella infection /

A

virus induced tissue damage

virus induced retardation of cell division

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6
Q

how does the timing of infection affect the extent of damage in rubella ?

A

first trimester - severely damaged infant
11-20 weeks - risk of deafness only
after 20 weeks - risk of fetal damage is minimal

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7
Q

how is a diagnosis of rubella made ?

A 
mother - seroconversion on screening
fetus - amniocentesis, CVS , PCR
infant - urinary PCR 
Blood or CSF culture 
Rubella specific IgM or persistently rising IgG
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8
Q

how are women with rubella treated ?

A

only given symptomatic treatment

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9
Q

how can rubella be prevented ?

A

MMR vaccine

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10
Q

what cells are targeted by the parvovirus B19 ?

A

erythroblastic red cell precursors

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11
Q

what is a common name for parvovirus B19 infection ?

A

slapped cheek disease

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12
Q

what is the mode of transmission of parvovirus ?

A

vertical transmission

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13
Q

how is a mother infected by parvovirus ?

A

through infected blood

respiratory secretions

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14
Q

how can parvovirus be diagnosed by lab investigations ?

A

findings will show
anemia
leukocytosis
reticulocytopenia

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15
Q

what is specifically found in fetal livers in parvovirus infectionn ?

A

inclusion bodies

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16
Q

how can i tell that the baby is anemic ?

A

severely edematous
has hepatosplenomegaly
( hydrops fetalis / buddha sign )

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17
Q

when is the risk of fetal loss the highest with parvovirus infections ?

A

in 2nd trimester

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18
Q

how can a diagnosis of parvo virus be made from the mother and the baby ?

A

B19 IgM
B19 IgG seroconversion
in the fetus :
B19 NAT , Hb

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19
Q

how can parvovirus infections be managed ?

A

no antiviral
regular screening
in cases of severe anemia intrauterine fetal blood transfusion can be done

20
Q

what is the most common congenital infection ?

A

cytomegalovirus

21
Q

what can CMV infection be confused with ?

A

EBV

22
Q

what is the C/P of CMV in mnothers ?

A

may be asymptomatic
or
glandular fever like illness

23
Q

how can CMV transmission occur ?

A

vertical transmission
during birth
through breast feeding

24
Q

how does the risk of the fetus change in CMV ?

A
  1. primary infection - risk of fetal damage throughout pregnancy
  2. secondary infection - risk of damage is low
25
Q

what is the presentation in CID ?

A

mental retardation
spastic diplegia
sensorineural hearing loss
epilepsy

26
Q

what do the intracranial calcifications associated with CMV look like ?

A

railway calcifications

27
Q

how can a diagnosis of CMV in the fetus be made ?

A

quantification of CMV but fetus must be at least 21 weeks

28
Q

what is the management for CMV ?

A

no specific anti-viral

however ganciclovir can reduce the sensorineural hearing loss

29
Q

what are the maternal consequences of varicella ?

A

varicella pneumonitis

30
Q

what does fetal varicella syndrome look like ?

A

skin scarring in dermatomal distribution
eye defects
limb hypoplasia
neurological abnormalities

31
Q

what are the fetal consequences if varicalla was acquired in :
1st and 2nd trimester
2nd and 3rd trimester
around delivery ?

A

1st and 2nd trimester - congenital varicella syndrome
2nd and 3rd - zoster in infancy
around delivery - neonatal varicella

32
Q

what effect does maternal shingles have on the fetus ?

A

no risk unless the mother is immunosuppressed or the shingles is disseminated

33
Q

what is the management and prevention for VZV ?

A

1.contact with shingles/chicken pox :
VZIG for susceptible within 10 days

2.Maternal chickenpox at birth:
VZIG for neonate

34
Q

what is the treatment for chickenpox ?

A

acyclovir for shingles

zoster immunoglobulins for child

35
Q

in neonatal HSV which types is relativley more common ?

A

HSV-2

36
Q

what is the presentationn nof neonatal HSV ?

A

localized infection - eye, mouth and skin

widespread with severe CNS sequelae

37
Q

what is toxoplasmosis infection ?

A

protozoal infection from cat faeces or undercooked meat

38
Q

what is the infectious stage of toxoplasmosis ?

A

tachyzoite

39
Q

what is the classical triad of congenital toxoplasmosis ?

A

intracranial calcifications
hydrocephalus
acute fundal chorioretinitis

40
Q

what do the intracranial calcifications in CMV vs Toxoplasmosis look like ?

A

CMV - railway or peri-ventricular

Toxoplasmosis - dotted

41
Q

what is the management of toxoplasmosis ?

A 
termination 
treatment :
sulphadiazine
pyrimethamine 
folic acid alternating with spiramycin
42
Q

what is the treatment of toxoplasmosis for the neonate ?

A

sulphadiazine
pyrimethamine
folic acid and must be continued for one year to avoid chorioretinitis

43
Q

if a woman has toxoplasmosis and wants to get pregnant what should be advised ?

A

to delay pregnancy until her serology is clear

44
Q

what are the manifestations of syphillus ?

A

interstitial keratitis
hutchinson’s teeth
clutton’s joint

45
Q

how can screening for syphilis be done ?

A

through EIA , followed by a confirmatory test of TPPA and follow up can be achieved by RPR

46
Q

what is the management of an neonate infected with syphilis ?

A

iv or IM penicillin for 10 days

47
Q

what is the clinical neonatal presentation of CMV ?

A 
petechia 
jaundice 
seizures 
hepatosplenomegaly 
small for gestational age

WH (68 decks)

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