Gynecologic and Pregnancy Related Infections Part 4

Question 1

What are the TORCH infections?

Answer 1

• Toxoplasmosis
• Other –> syphilis, VZV, parvovirus B19
• Rubella
• CMV
• HSV/HIV

Question 2

What is toxoplasmosis?

Answer 2

• Protozoan parasite

- Found in cat feces and raw meat

Question 3

What causes the congenital infection in toxoplasmosis?

Answer 3

• Tachyzoites which spread transplacentally

Question 4

What are the congenital effects of toxoplasmosis?

Answer 4

• Chorioretinitis
• Intracranial calcifications
• Hydrocephalus
• Stillbirth

Question 5

How is toxoplasmosis diagnosed?

Answer 5

• Serology with IgG and IgM

Question 6

What is seen in early congenital syphilis?

Answer 6

• Mucous membrane involvement –> rhinitis
• Rash on soles and palms
• Condyloma lata
• Hepatomegaly with jaundice

Question 7

What is seen in late congenital syphilis?

Answer 7

• Neurosyphilis –> sensorineural hearing loss
• Gumma formation
• Bone and teeth involvement
• Interstitial keratitis

Question 8

What bone and teeth malformations are seen in late congenital syphilis?

Answer 8

• Saber shins
• Saddle nose
• Frontal bossing
• Hutchinson’s teeth (central tooth notching)

Question 9

What is the treatment for syphilis?

Answer 9

• Penicillin

Question 10

What is primary varicella?

Answer 10

• Chicken pox
• Fever, malaise, diffuse vesicular rash
• Varicella pneumonia

Question 11

What is reactivation of herpes zoster?

Answer 11

• Latent in sensory ganglia
• Reactivation in peripheral nerves
• Vesicles along dermatomes

Question 12

What is congenital varicella syndrome?

Answer 12

• Limb hypoplasia
• Cicatricial skin lesions
• Neurological and eye abnormalities

Question 13

What is neonatal varicella?

Answer 13

• Peripartum maternal VZV
• Exposed infant –> treat with immune globulin
• Severe/disseminated –> treat with acyclovir

Question 14

What does parvovirus B19 look like in a child?

Answer 14

• Slapped cheeks

Question 15

What complications arise from parvovirus B19?

Answer 15

• Fetal loss
• Fetal anemia
• Hydrops –> high risk of fetal death

Question 16

What is seen in congenital rubella syndrome?

Answer 16

• Sensorineural hearing loss
• Heart disease –> PDA
• Cataracts and glaucoma
• Blueberry muffin baby

Question 17

What does congenital CMV look like?

Answer 17

• Sensorineural hearing loss
• Intellectual disability
• Chorioretinitis

Question 18

When is GBS screened for?

Answer 18

• 35-37 weeks with a swab

Question 19

What is the risk to a newborn with GBS?

Answer 19

• Sepsis
• Meningitis
• Pneumonia

Question 20

What is the virulence in GBS?

Answer 20

• Anti-phagocytic carbohydrate capsule

Question 21

What is the treatment of GBS intrapartum?

Answer 21

• Penicillin G or Ampicillin

Question 22

What is seen in post partum endometritis?

Answer 22

• Fever
• Uterine tenderness
• Tachycardia
• Midline lower abdominal pain

Question 23

What are some risk factors for post partum endometritisi?

Answer 23

• Colonization with GBS

- C section delivery

Question 24

What is the treatment for endometritis?

Answer 24

• Gentamicin PLUS clindamycin
  OR
• Ampicillin/sulbactam

Question 25

What causes an infection of actinomyces?

Answer 25

• IUD

Question 26

What is actinomyces?

Answer 26

• Anaerobic, filamentous gram pos bacteria

Question 27

What does actinomyces infection look like?

Answer 27

• Ascends from the uterus to give PID like symptoms

Question 28

What is the treatment for MSSA lactational mastitis?

Answer 28

• Amoxicillin/clavulanate

Question 29

What is the treatment for MRSA lactational mastitis?

Answer 29

• Bactrim

Question 30

What does clavulate do?

Answer 30

• Inhibits penicillinases

Question 31

What is the spectrum of Bactrim?

Answer 31

• Many gram neg and gram pos

- NO anaerobic coverage with small protozoan coverage

Question 32

What does Bactrim do?

Answer 32

• Displaces bilirubin from its binding site in plasma causing kernicterus in neonates