Congenital infections

Question 1

What is the most common infective cause of congenital hearing loss?

Answer 1

CMV

Question 2

“blueberry muffin rash” + sensorineural deafness

Answer 2

Rubella

Question 3

Rubella - what does negative IgM and IgG indicate

Answer 3

Patient is susceptible to rubella

Question 4

Rubella- what does negative IgM and positive IgG indicate

Answer 4

Immune -Vaccinated or previous infection

Question 5

Rubella - what does positive IgM and positive IgG indicate

Answer 5

Acute infection or false positive IgM

Question 6

What is the incidence of congenital CMV infection?

Answer 6

0.2%-2.2% (1 in 50-1 in 500)

Question 7

What proportion of babies with congenital CMV will develop symptoms at birth?

Answer 7

10-15%

Question 8

What proportion of babies with congenital CMV will develop symptoms after 2 years?

Answer 8

10-15%

Question 9

What is the risk of VZV causing congenital disease in first trimester

Answer 9

0.4%

Question 10

What is the risk of VZV causing congenital disease in second trimester

Answer 10

2%

Question 11

Incidence of listeria infection in pregnancy

Answer 11

12 per 100,000

Question 12

What is the fetal mortality rate with listeriosis?

Answer 12

20-30%

Question 13

Management of a genital Herpes lesions at 32 weeks gestation

Answer 13

Swab to confirm HSV
Bloods to determine whether this is a primary or initial infection or recurrence
Start acyclovir until birth
If a primary or initial infection advise C-section delivery

Question 14

What is the difference between a primary or initial HSV infection?

Answer 14

Primary - first ever infection with either HSV 1 or HSV 2
Initial- has previously had either a HSV 1 or HSV 2 infection and has since developed another HSV infection i.e. previously HSV2 and now has HSV 1

Question 15

What is the mortality rate with disseminated neonatal herpes?

Answer 15

30%

Question 16

What proportion of neonatal herpes cases present with disseminated or neurological disease?

Answer 16

70%

Question 17

How should confirmed listeria infection be treated in pregnancy?

Answer 17

Amoxicillin or ampicillin

Co-trimoxazole if pen allergic

Question 18

What is the treatment for maternal toxoplasmosis infection?

Answer 18

Spiramycin to prevent transplacental spread

Question 19

What is the treatment for fetal toxoplasmosis confirmed on amniotic fluid PCR?

Answer 19

pyrimethamine, folinic acid and sulfadiazine

N.b. cant give pyrimethamine in first trimester as it is teratogenic