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ENRP II > Gynecological and Pregnancy Related Infections Part 4 > Flashcards

Gynecological and Pregnancy Related Infections Part 4 Flashcards

1
Q

what are the most important infections that can cause fetal death

A

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

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2
Q

toxoplasmosis infection is caused by?

A

the parasite toxoplasma gondii

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3
Q

what is the definitive host of toxoplasma gondii

A

cats and cysts are tramsitted through their feces

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4
Q

infection by toxoplasma gondii is through

A

direct ingestion of raw meat or cat feces (food or drink)

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5
Q

once ingested the toxoplasma gondii cyst forms?

A

tachyzoites which spread placentally to cause congenital infection

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6
Q

maternal infection with toxoplasmosis is typically _

A

asymptomatic

if anything there will be nonspecific lymphadenopathy and or fever

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7
Q

in general toxoplasmosis in a baby has effects on _ and _

gives rise to what disease processes

A

CNS and eyes givign rise to chorioretinitis, intracranial calcifications and hydrocephalus

seziures, blurred vision, intellectual disability

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8
Q

risk of severity of infection of toxoplasmosis is dependent upon? what can happen

A

gestational age at the time of infection, early infection can lead to still birth and neurologic deficiency

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9
Q

how do we screen/diagnose toxoplasmosis

A

we test antibodies/serology looking for IGM and IGG

done in high risk areas or with cause for concern

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10
Q

what is the treatment of toxoplasmosis

A

treatment is done to only protect the fetus and we use spiramycin or pyrimethamin-sulfadiazine

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11
Q

early congenital syphyilis occurs within 2 years of birth and occurs when _ crossses the placental barrier. It presents with?

A

treponema pallidum

presents with snuffles (mucus membrane involvement, rash on palms and soles, and genital rash)- secondary syphilis symptoms

also hepatomegaly and jaundice

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12
Q

late congenital syphilis occurs more than 2 years after birth , what the symptoms?

A

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

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13
Q

all pregnant women should be screened for syphilis when?

A

at their first visit with either nontreponemal or treponemal test, furst testing at 28 and 32 weeks if high risk

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14
Q

treatment for syphilis?

A

penicillin

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15
Q

varicella zoster virus spreads through?

A

respiratory droplets

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16
Q

primary infection of VZV is?

A

varicella or chicken pox with a rash in various stages of healing, fever, malaise and sometimes pneumonia

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17
Q

VZV remains latent in the sensory ganglia like the dorsal root and can reactivate to cause?

A

shingles along dermatones (painful)

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18
Q

maternal varicella (chickenpox) puts an infant at risk for?

A

congential varicella syndrome

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19
Q

what is congenital varicella syndrome

A

limb hypoplasia, and circatrical skin lesions

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20
Q

does maternal herpes zoster cause congential varicella syndrome?

A

no

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21
Q

neonatal varicella can be caused from maternal peripartum infection of either _ or _

A

maternal varicella or maternal herpes zoster

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22
Q

if there is a known peripartum exposure of maternal zoster or varicella what can er give prophallatically ?

A

immune globulin VZV

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23
Q

neonatal varicella can lead to _ because infants have poor immunity

A

disseminated varicella

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24
Q

disseminated neonatal varicella can be treated with

A

acyclovir

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25
Q

what antibody can cross the blood placenta barrier

A

IgG

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26
Q

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?

A

IgG

give after birth because it is a live vaccine and not safe during pregnancy

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27
Q

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 _

A

VZV immune globulin to protect fetus

acycolvir

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28
Q

Parvovirus B19 is responsible for the illness _

A

erythema infectiosum/5th disease

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29
Q

what is the presentation of 5th disease

A

fever, slapped cheek malar rash and maybe arthralgias

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30
Q

ParvoB19 virus is cytotoxic to?

A

erythroid progenitor cells (RBC precursors)

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31
Q

complications of ParvoB19 virus in kids (mom usually asymptomatic, early infectio provides IGG protection for baby but infection during pregnancy causes devestating pathology)

A

aplastic anemia in people with sickle cell
fetal loss
fetal anemia
hyrops fetalis

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32
Q

the end result of parvovirus B19 in a fetus due to killing erythrocyte precursors is?

A

congestive heart failure and hydrops fetalis

accumulation of fluid in serous cavities like pleural or pericardial cavities

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33
Q

what is the pathophysiology behind hydrops fetalis

A

high cardiac output failure leads to increased venous pressure and lymphatic obstruction which causes fluid to accumulate

34
Q

rubella aka german measles is a ?

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

35
Q

rubella has the great risk of fetal harm if infected the first half of pregnancy anf can lead to?

A

congenital rubella

36
Q

what is congenital rubella?

A

a syndrome that affects many organs and causes sensorinueral hearing loss, congenital heart disease ( PDA) and cataracts.

37
Q

in congenital rubella babies can be considered blueberry muffin baby, why?

A

rubella can lead to extramedulalr hematopoiesis which gives rise to skin lesions that look like blueberries

this is also true for CMV

38
Q

how do we screen for rubella

A

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

39
Q

what is the m ost common congeital viral infection that leads to sensorineural hearing loss

A

CMV

DNA herpes virus

40
Q

first episode of CMV is considered?

reactivation or new strain of CMV is considered?

A

primary

non-primary

41
Q

CMV symptoms

A

usually asymptomatic but can cause mono-like symptoms with fever, headache, pharyngitis and also liver enzyme elevations

42
Q

key histological feature of CMV

A

large purple basophilic viral inclusions termed Owl’s eye inclusions

43
Q

CMV typically affects what cells

A

endothelial and mesnchymal cells

44
Q

congential CMV symptoms

A

sensorineual hearing loss, CNS changes, chorioretinitis, sepsis

45
Q

testing for CMV involves what?

A

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

46
Q

treatment for CMV

A

supportive care

47
Q

Herpes simplex virus is transmitted to a baby by?

A

vertical transmission during birth with direct contact to sores

not transplacentally like other TORCH infections

48
Q

neotnatal HSV (herpes simplex virus) causes what in an infant?

A

vesicles on the mouth, skin, eyes. CNS meningioencephalitis or dissimentated disease cauing sepsis and organ damage

49
Q

all cases of neonatal HSV should be treated with?

A

acycolvir

if disseminated disease occurs then additional supportive care is also recommended

50
Q

group B streptococcus is routinely screened in pregnant patients when?

A

35-37 weeks

51
Q

how do you test for GBS colonization

A

vaginal and rectal swab

52
Q

group B streptococcus refers to?

A

streptococcus agalactiae

53
Q

group B streptococcous frequently colonizes the?

A

Genitourinary and Gastrointestinal tract

54
Q

GBS can cause what in pregnant women

A

UTI, bacteruira/pyleonephritis, post partum endometritis, intraamniotic infection

55
Q

neonatal GBS causes what in the neonate

A

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

56
Q

microbiology of sttreptococcus agalactiae (GBS)

A

gram positive cocci in chains that is beta hemolytic meaing there is complete hemolysis around colony growth

lacenfield group B (carbohydrate antigen present)

57
Q

GBS virulence factor

A

antiphagocytic capsule

B for babies: Beta hemolytic, Babies, beta lactam antibiotics

58
Q

maternal infection with GBS is treated with?

A

beta lactam antibiotics

penicllin, cephalosporins,

retest urine culutres to make sure its gone

59
Q

if a patient has GBS 35-37 weeks of pregnancy then they should be treated with what to prevent transmission to the neonate?

A

IV penicillin or ampicllin

clindamycin if allergic to penicillin

60
Q

lochia

A

post-partum vaginal blood

61
Q

what is post partum endometritis

A

infection of the endometrium after birth

62
Q

symptoms of endometritis

A

fever, uterine tenderness, tachycardia, midline lower abdominal pain

63
Q

risk factors of post partum endometritis

A

C-section (30 fold increase risk)
GBS colonization
prolonged labor
diabetes, HIV

64
Q

endometritis is typically caused by?

A

many different organisms like Group A , group B strep, staph etc.

65
Q

treatment for post partum endometritis

A

gentamycin + clindamycin

or ampicillin + sulbactam

66
Q

what is an IUD

if its in too long what can happen

A

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

67
Q

what is actinomyces

A

a fungal like bcteria that colonizes the vagina and can cause infection like PID

68
Q

actinomyces form tangles collection of _ fragments called sulfur granules that are grossly yellow

A

mycelial fragments

69
Q

what is lactatinoal mastitis

A

breast infection associated with breast feeding

70
Q

lactational mastaitis is most on in the first _ months and is caused by?

A

3 months

caused by engorgement from inadequate emptying of the breasts that leads to compression of the mammary ducts and milk stasis

71
Q

lactational mastitis can lead to

A

a bacterial infection or an abcess

72
Q

risk factors for lactational mastitis

A

cracker/damaged nipples

73
Q

signs and symptoms of lactational mastitis

A

red swollen breasts with fever and maliase also axillary lymphadenopathy sometimes

74
Q

causative organism of lactational mastitis

A

staph aureus

75
Q

treatment of lactational mastitis

A

continue breast feeding to completely empty the breast like pumping, hand express, etc.

76
Q

lactational mastitis MSSA antiobiotic treatment

A

Cephalexin
Dicloxacillin
Amoxicillin/Clavulanate (augmentin)

77
Q

lactational mastitis MRSA antibiotic treatment

A

clindamycin
trimethoprim/sulfamethoxazole

TMP-SMX: should not be used if the infant is less than 1 month old and is breastfeeding

78
Q

beta lactamase inhibitor examples

A

c;avulanic acid
sulbactam
tazobactam

bind to active site of penicillinases not allowing it to b ind to penicillin binding proteins

79
Q

clavalunate inhibits _

A

penicillinases

80
Q

TMP-SMX inhibits what

A

folic acid production

TMP- stops DH4 to TH4
SMX- mimics PABA

81
Q

side effect of SMX-TMP

A

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

ENRP II (25 decks)

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