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TAS Perinatal Medicine ✅ > Congenital Infections ✅ > Flashcards

Congenital Infections ✅ Flashcards

1
Q

What is a congenital infection?

A

An infection acquired by the fetus transplacentally

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2
Q

What do the consequences of a congenital infection depend on?

A
  • Nature of the infection

- Gestation when it is acquired

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3
Q

Other than transplacentally, how else might a foetus become infected by it’s mother?

A
  • Ascending infection

- Direct contact with infected secretions during delivery

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4
Q

When is the risk of congenital defects from rubella infection highest?

A

In the first trimester

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5
Q

Why is the risk of serious congenital defects following rubella infection highest in the first trimester?

A

It interferes with early embryogenesis

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6
Q

Give 6 congenital infections

A
  • CMV
  • Toxoplasmosis
  • Rubella
  • Syphilis
  • Varicella zoster
  • Parvovirus B19
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7
Q

What can congenital rubella infection cause when contracted in the first trimester?

A
  • Heart defects
  • Cataracts
  • Deafness
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8
Q

Why is congenital rubella now very rare?

A

Prevented by paternal vaccination

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9
Q

What are the features of congenital rubella infection?

A
  • Eye involvement
  • CNS involvement
  • Congenital cardiac defects
  • Sensorineural deafness
  • Pneumonitis
  • Bone involvement
  • Rash
  • IUGR
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10
Q

What are the eye features of congenital rubella infection?

A
  • Glaucoma
  • Cataracts
  • Chorioretinitis
  • Microphthalmia
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11
Q

What are the CNS features of congenital rubella infection?

A

Microcephaly

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12
Q

What congenital cardiac defects are associated with congenital rubella infection?

A
  • PDA

- Pulmonary artery stenosis

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13
Q

What bone pathology can occur in congenital rubella infection?

A

Viral osteodystrophy

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14
Q

Which feature of congenital rubella infection differentiate it from congenital CMV or toxoplasma?

A
  • Glaucoma
  • Congenital cardiac defects
  • Greater degree of IUGR
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15
Q

What is the most common congenital infection?

A

CMV

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16
Q

What is the incidence of congenital CMV?

A

0.5-1 per 1000 live births

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17
Q

What % of mothers seroconvert CMV during pregnancy?

A

1-2%

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18
Q

What is the mother-to-infant transmission rate of CMV?

A

40%

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19
Q

Is the risk to the infant higher in primary CMV during pregnancy or reactivation?

A

Much higher in primary infection

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20
Q

What % of infants with congenital CMV are severely affected?

A

5-10%

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21
Q

What are the features of congenital CMV?

A
  • Eye involvement
  • CNS involvement
  • Sensorineural deafness
  • Hepatosplenomegaly
  • Pneumonitis
  • Bone involvement
  • Rash
  • IUGR
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22
Q

What are the eye features of congenital CMV infection?

A

Chorioretinitis

23
Q

What are the CNS features of congenital CMV infection?

A
  • Periventricular calcification

- Microcephaly

24
Q

What bone pathology can occur in congenital CMV infection?

A

Viral osteodystrophy

25
Q

Which features of congenital CMV infection differentiate it from congenital rubella or toxoplasma?

A
  • Periventricular calcification

- Pneumonitis more significant

26
Q

What % of infants with congenital CMV infection are asymptomatic?

A

80-90%

27
Q

What % of infants with asymptomatic CMV infection develop sensorineural deafness?

A

10-15%

28
Q

Why is it important to diagnose sensorineural deafness caused by congenital CMV infection?

A

Treatment with oral valganciclovir has been shown to reduce the severity of hearing loss

29
Q

How is congenital CMV infection diagnosed?

A

Viral DNA detection by PCR amplification

30
Q

What samples can be used for PCR in the diagnosis of congenital CMV infection?

A
  • Amniotic fluid
  • Fetal or infants blood
  • Urine
  • Cerebrospinal fluid
  • Saliva collected at less than 3 weeks of age
31
Q

How long will an infant with congenital CMV continue to excrete CMV in the urine?

A

Several months

32
Q

Is congenital toxoplasmosis common?

A

Not in UK

33
Q

Does congenial toxoplasmosis develop from primary maternal infection or maternal re-infection?

A

Usually primary maternal infection

34
Q

How does the time that CMV is contracted impact the severity of fetal abnormalities?

A

The earlier it is contracted, the more severe the fetal abnormalities

35
Q

At what stage of pregnancy is the transmission rate of congenital toxoplasmosis highest?

A

Second trimester

36
Q

What are the features of congenital toxoplasmosis?

A
  • Eye features
  • CNS features
  • Hepatosplenomegaly
  • Pneumonitis
  • Bone features
  • Rash
  • IUGR
37
Q

What are the eye features of congenital toxoplasmosis?

A
  • Chorioretinitis
  • Microphtalmia
  • Cataracts
38
Q

What are the CNS features of toxoplasmosis?

A
  • Learning difficulties
  • Microcephaly
  • Peripheral calcification
  • Hydrocephalus
  • Hypotonia
  • Seizures
39
Q

What bone pathology may be seen in congenital toxoplasmosis?

A

Epiphyseal plate anomaly

40
Q

Which features of congenital toxoplasmosis differentiate it from congenital rubella or CMV?

A
  • Peripheral calcification
  • Hypotonia
  • Seizures
  • Hydrocephalus
  • No sensorineural deafness
  • Epiphyseal plate anomaly
41
Q

How does congenital toxoplasmosis present when it is acquired in the second trimester?

A

It is usually sub-clinical, presenting later in childhood with choric-retinitis or with seizures or learning problems

42
Q

Why is congenital syphilis rare?

A

As mothers are routinely screened

43
Q

How can congenital syphilis be prevented in mothers with a pre-existing syphilis infection?

A

Antibiotic treatment given for more than 4 weeks before delivery

44
Q

What is the problem with primary syphilis infection during pregnancy?

A

There is a very transmission rate and high risk of miscarriage and stillbirth

45
Q

What clinical features are specific to congenital syohils?

A
  • Rash
  • Desquamation of soles of hands and feet
  • Metaphyseal bone lesions in infancy
46
Q

Why is it uncommon for mothers to develop chickenpox?

A

Most are immune

47
Q

What can congenital VZV cause?

A

Congenital varicella fetopathy, including marked scarring of the skin

48
Q

When is the risk of congenital VZV highest?

A

If there is maternal viraemia shortly before birth

49
Q

Why is the risk of congenital VZV highest when there is maternal viraemia shortly before birth?

A

The infant will not have received protection from the transfer of maternal antibodies

50
Q

What is true of most cases of maternal infection with parvovirus B19?

A

The foetus is unaffected

51
Q

What can parvovirus B19 infection during pregnancy sometimes cause?

A

Severe fetal anaemia

52
Q

What can severe fetal anaemia caused by parvovirus B19 infection lead to?

A

Fetal hydros

53
Q

How is anaemia in the foetus monitored in congenital parvovirus B19 infectioN?

A

Middle cerebral artery velocity waveform on Doppler USS

54
Q

How is severe foetal anaemia caused by parvovirus B19 treated?

A

Intrauterine transfusion

TAS Perinatal Medicine ✅ (16 decks)

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