Gynecological and Pregnancy Related Infections Part 4 Flashcards
what are the most important infections that can cause fetal death
TORCH
T- toxoplasmosis (parasite)
Other- syphyllis (bacteria), parvovirus (DNA parvovirus), Varicella (DNA herpes virus)
R-Rubella (RNA virus)
C- CMV (DNA herpes virus)
H- HIV (RNA virus) /Herpes Simplex (DNA herpes virus)
transplacental spread of infection
toxoplasmosis infection is caused by?
the parasite toxoplasma gondii
what is the definitive host of toxoplasma gondii
cats and cysts are tramsitted through their feces
infection by toxoplasma gondii is through
direct ingestion of raw meat or cat feces (food or drink)
once ingested the toxoplasma gondii cyst forms?
tachyzoites which spread placentally to cause congenital infection
maternal infection with toxoplasmosis is typically _
asymptomatic
if anything there will be nonspecific lymphadenopathy and or fever
in general toxoplasmosis in a baby has effects on _ and _
gives rise to what disease processes
CNS and eyes givign rise to chorioretinitis, intracranial calcifications and hydrocephalus
seziures, blurred vision, intellectual disability
risk of severity of infection of toxoplasmosis is dependent upon? what can happen
gestational age at the time of infection, early infection can lead to still birth and neurologic deficiency
how do we screen/diagnose toxoplasmosis
we test antibodies/serology looking for IGM and IGG
done in high risk areas or with cause for concern
what is the treatment of toxoplasmosis
treatment is done to only protect the fetus and we use spiramycin or pyrimethamin-sulfadiazine
early congenital syphyilis occurs within 2 years of birth and occurs when _ crossses the placental barrier. It presents with?
treponema pallidum
presents with snuffles (mucus membrane involvement, rash on palms and soles, and genital rash)- secondary syphilis symptoms
also hepatomegaly and jaundice
late congenital syphilis occurs more than 2 years after birth , what the symptoms?
neurosphilis which can cause gummas in the bone and skin, hearing loss with 8th nerve disruption, saber shins, saddle nose, frontal bossing, hutchingtons teeth, intersitial keratitis of the corenal stroma
saber shin- bowing of tibias
saddle nose- depressed nasal brige
frontal bossing- prominent forehead
all pregnant women should be screened for syphilis when?
at their first visit with either nontreponemal or treponemal test, furst testing at 28 and 32 weeks if high risk
treatment for syphilis?
penicillin
varicella zoster virus spreads through?
respiratory droplets
primary infection of VZV is?
varicella or chicken pox with a rash in various stages of healing, fever, malaise and sometimes pneumonia
VZV remains latent in the sensory ganglia like the dorsal root and can reactivate to cause?
shingles along dermatones (painful)
maternal varicella (chickenpox) puts an infant at risk for?
congential varicella syndrome
what is congenital varicella syndrome
limb hypoplasia, and circatrical skin lesions
does maternal herpes zoster cause congential varicella syndrome?
no
neonatal varicella can be caused from maternal peripartum infection of either _ or _
maternal varicella or maternal herpes zoster
if there is a known peripartum exposure of maternal zoster or varicella what can er give prophallatically ?
immune globulin VZV
neonatal varicella can lead to _ because infants have poor immunity
disseminated varicella
disseminated neonatal varicella can be treated with
acyclovir
what antibody can cross the blood placenta barrier
IgG
at the beginning of all pregnancies you should test for immunity to VZV and that should be documented, and serology testing for _ should be conducted. if a pregnant patient is not immune for VZV when should you give the vaccine?
IgG
give after birth because it is a live vaccine and not safe during pregnancy
if there is expsoure to VZV in a pregnant patient give them _
if there is known disease of VZV in a pregnant patient give them _
VZV immune globulin to protect fetus
acycolvir
Parvovirus B19 is responsible for the illness _
erythema infectiosum/5th disease
what is the presentation of 5th disease
fever, slapped cheek malar rash and maybe arthralgias
ParvoB19 virus is cytotoxic to?
erythroid progenitor cells (RBC precursors)
complications of ParvoB19 virus in kids (mom usually asymptomatic, early infectio provides IGG protection for baby but infection during pregnancy causes devestating pathology)
aplastic anemia in people with sickle cell
fetal loss
fetal anemia
hyrops fetalis
the end result of parvovirus B19 in a fetus due to killing erythrocyte precursors is?
congestive heart failure and hydrops fetalis
accumulation of fluid in serous cavities like pleural or pericardial cavities
what is the pathophysiology behind hydrops fetalis
high cardiac output failure leads to increased venous pressure and lymphatic obstruction which causes fluid to accumulate
rubella aka german measles is a ?
self limiting illness with a head to toe rash (starts on face and move to trunk and extremities) there are petechieae on the soft pallate that precede the rash known as rose spots and URI/fever symptoms
rubella has the great risk of fetal harm if infected the first half of pregnancy anf can lead to?
congenital rubella
what is congenital rubella?
a syndrome that affects many organs and causes sensorinueral hearing loss, congenital heart disease ( PDA) and cataracts.
in congenital rubella babies can be considered blueberry muffin baby, why?
rubella can lead to extramedulalr hematopoiesis which gives rise to skin lesions that look like blueberries
this is also true for CMV
how do we screen for rubella
IgG rubella serology
if pregnant patient is nonimmune to rubella give vaccine after birth because it is a live vaccine and not safe during pregnancy
what is the m ost common congeital viral infection that leads to sensorineural hearing loss
CMV
DNA herpes virus
first episode of CMV is considered?
reactivation or new strain of CMV is considered?
primary
non-primary
CMV symptoms
usually asymptomatic but can cause mono-like symptoms with fever, headache, pharyngitis and also liver enzyme elevations
key histological feature of CMV
large purple basophilic viral inclusions termed Owl’s eye inclusions
CMV typically affects what cells
endothelial and mesnchymal cells
congential CMV symptoms
sensorineual hearing loss, CNS changes, chorioretinitis, sepsis
testing for CMV involves what?
not routine test in pregnancy , test if symptoms like mono symptoms, check IGG and IGM CMV serology, elevated liver enzymes, EBV is negative, Hep is negative
treatment for CMV
supportive care
Herpes simplex virus is transmitted to a baby by?
vertical transmission during birth with direct contact to sores
not transplacentally like other TORCH infections
neotnatal HSV (herpes simplex virus) causes what in an infant?
vesicles on the mouth, skin, eyes. CNS meningioencephalitis or dissimentated disease cauing sepsis and organ damage
all cases of neonatal HSV should be treated with?
acycolvir
if disseminated disease occurs then additional supportive care is also recommended
group B streptococcus is routinely screened in pregnant patients when?
35-37 weeks
how do you test for GBS colonization
vaginal and rectal swab
group B streptococcus refers to?
streptococcus agalactiae
group B streptococcous frequently colonizes the?
Genitourinary and Gastrointestinal tract
GBS can cause what in pregnant women
UTI, bacteruira/pyleonephritis, post partum endometritis, intraamniotic infection
neonatal GBS causes what in the neonate
sepsis, meningnitis, pneumonia either shortly after birth or up to 3 months after birth
prolonged labor of 18+ hours after rupture of membranes is a risk for early onsent neonatal GBS infection
microbiology of sttreptococcus agalactiae (GBS)
gram positive cocci in chains that is beta hemolytic meaing there is complete hemolysis around colony growth
lacenfield group B (carbohydrate antigen present)
GBS virulence factor
antiphagocytic capsule
B for babies: Beta hemolytic, Babies, beta lactam antibiotics
maternal infection with GBS is treated with?
beta lactam antibiotics
penicllin, cephalosporins,
retest urine culutres to make sure its gone
if a patient has GBS 35-37 weeks of pregnancy then they should be treated with what to prevent transmission to the neonate?
IV penicillin or ampicllin
clindamycin if allergic to penicillin
lochia
post-partum vaginal blood
what is post partum endometritis
infection of the endometrium after birth
symptoms of endometritis
fever, uterine tenderness, tachycardia, midline lower abdominal pain
risk factors of post partum endometritis
C-section (30 fold increase risk)
GBS colonization
prolonged labor
diabetes, HIV
endometritis is typically caused by?
many different organisms like Group A , group B strep, staph etc.
treatment for post partum endometritis
gentamycin + clindamycin
or ampicillin + sulbactam
what is an IUD
if its in too long what can happen
an intrauterine device that causes sterile inflammatory reactions that are toxic to sperm and eggs
if in too long it can cause an actinomyces infection
what is actinomyces
a fungal like bcteria that colonizes the vagina and can cause infection like PID
actinomyces form tangles collection of _ fragments called sulfur granules that are grossly yellow
mycelial fragments
what is lactatinoal mastitis
breast infection associated with breast feeding
lactational mastaitis is most on in the first _ months and is caused by?
3 months
caused by engorgement from inadequate emptying of the breasts that leads to compression of the mammary ducts and milk stasis
lactational mastitis can lead to
a bacterial infection or an abcess
risk factors for lactational mastitis
cracker/damaged nipples
signs and symptoms of lactational mastitis
red swollen breasts with fever and maliase also axillary lymphadenopathy sometimes
causative organism of lactational mastitis
staph aureus
treatment of lactational mastitis
continue breast feeding to completely empty the breast like pumping, hand express, etc.
lactational mastitis MSSA antiobiotic treatment
Cephalexin
Dicloxacillin
Amoxicillin/Clavulanate (augmentin)
lactational mastitis MRSA antibiotic treatment
clindamycin
trimethoprim/sulfamethoxazole
TMP-SMX: should not be used if the infant is less than 1 month old and is breastfeeding
beta lactamase inhibitor examples
c;avulanic acid
sulbactam
tazobactam
bind to active site of penicillinases not allowing it to b ind to penicillin binding proteins
clavalunate inhibits _
penicillinases
TMP-SMX inhibits what
folic acid production
TMP- stops DH4 to TH4
SMX- mimics PABA
side effect of SMX-TMP
kernicterus because SMX will displace billirubin from albumin and billirubin will cross the CNS and deposit in grey matter causing neurological damage that is irreversible
