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perinatal infection > Herpes and CMV > Flashcards

Herpes and CMV Flashcards

1
Q

prevalence of neonatal herpes

A

5/100000

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2
Q

symptoms of a primary HSV infection in a pregnant woman

A

florid warts
urinary retention
systemic symptoms

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3
Q

symptoms of recurrent HSV in pregnant women

A

ulcerative lesions on vulva, vagina or cervix

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4
Q

which type of herpes has the worst prognosis for fetal neurological morbidity

A

local CNS herpes

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5
Q

which type of herpes is associated with the highest risk of fetal/neonatal death

A

disseminated infection

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6
Q

what are the three classification of herpes

A

disease locaised to skin/eye/mouth - 45%
local CNS disease - 30%
disseminated infection - 25% a

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7
Q

how is herpes transmitted to fetus

A

at delivery through maternal genital tract especially when an infection is acquired in the third trimester 6 weeks around time of delivery when baby born before maternal antibodies develop

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8
Q

risk factors for herpes transmission

A

presence of transplacental antibodies
duration of SROM
use of fetal scalp electrodes

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9
Q

how to diagnose herpes

A

swab, then confirm with viral culture/PCR and screen for other STIs

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10
Q

How to treat herpes

A

aciclovir 400mg TDS non teratogenic

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11
Q

how to differentiate between primary or recurrent HSV

A

type specific HSV antibody testing available 6 weeks before delivery. If antibodies are present, no need for caesarean

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12
Q

how to manage delivery in a woman infected in third trimester with HSV or within 6 weeks of delivery

A

caesarean as 41% risk of transmission. or if woman chooses vaginal birth, avoid ROM and fetal scalp electrodes avoid also. consider IV aciclovir intrapartum/

Reasoning, mother is continually shedding virus and hasn’t had a chance to develop antibodies yet, so highest risk of transmission

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13
Q

how to manage women infected HSV in first or second trimester

A

daily suppressive aciclovir from 36 weeks onwards. give this to recurrent herpes also. inform neonatologist

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14
Q

Symptoms of disseminated HSV

A

Blistering rash, liver dysfunction, CSF gives meningoencephalitis looks like sepsis

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15
Q

What precautions must be taken for HSV patients

A

Easily spread to other patients

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16
Q

Horizontal transmission of CMV can occur where

A

in post partum in delivery room from other people

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17
Q

Vertical transmission of CMV can occur through which 3 routes

A 
in utero (transplacental)
during delivery
breast feeding
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18
Q

Prevalence of CMV`

A

0.2%-2%

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19
Q

diagnosis of CMV in a neonate

A

urine or saliva samples within 3 weeks of birth

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20
Q

What is the leading cause of sensorineural hearing loss (non genetic)

A

CMV

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21
Q

When in pregnancy is the highest risk of CMV affecting the fetus

A

all stages of pregnancy

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22
Q

What ophthalmic symptoms can cytomegalic inclusion disease cause

A

optic atrophy

choroidoretinitis

23
Q

What feature of CMV can you see on brain imaging

A

periventricular calcification

24
Q

can congenital CMV cause jaundice

A

yes and HSM

25
what hematological features of cytomegalic inclusion disease
TCP and haemolytic anaemia
26
is CMV teratogenic
no
27
is rubella teratogenic
yes
28
what is viral angiitis with CMV
infection of endothelial cells causing reduced brain perfusion and organ damage
29
What percentage of CMV infected foetuses wil show abnormalities at birth
10%
30
What percentage of mothers with primary infection CMV will transmit to detus
40%
31
what percentage of mothers with reactivation of CMV will transmit to fetus
2% transmission as mother already has existing immunity.
32
manifestations of reactivation CMV from mother in a fetus
unilateral deafness, lower abnormalities but severe disease can occur. less virus shedding by fetus
33
Of the neonates symptomatic with Cytomegalic inclusion disease at birth, what is the main sequelae presented
CNS involvement | and 65% hearing loss
34
of the neonates asymptomatic at birth, 10% will have what defect
hearing loss
35
Management of CMV infection
close monitoring for 2-6 years of audiology and trial of antiviral therapy
36
Diagnosis of CMV in maternal infection
PCR - mainly Detection of Early Antigen Fluorescent Foci DEAFF is a cell culture method Serology for CMV IgG, avidity and IgM
37
Diagnosis of CMV in fetus antenally
Amniocentesis and CMV DNA present at 21/40
38
Diagnosis of CMV postnatally
CMV in urine/saliva in first 3 weeks of life if positive, verify with blood sample serology but PCR preferred.
39
Prevention of CMV
no vaccine no prevention
40
Treatment of CMV in neonate with organ disease
valganciclovir oral OR ganciclovir IV for 6/12 audiology f/u till 6yo ophthal review for cataracts
41
when is the highest risk to fetus for maternal HSV
PERINATALLY in third trimester at 85% transmission risk | pre and post natal has 20% risk of transmission
42
Risk factors for neonatal transmission of HSV
primary maternal infection and symptomatic infection maternal antibody status PROM Fetal scalp electrode use damages mucous membranes and increases susceptibility Vaginal birth
43
What is the risk of transmission to fetus with primary maternal HSV infection
57%
44
What is the risk of transmission to fetus with non primary maternal HSV infection but first episode
25 % - HSV can be contracted but asymptomatic for a period of time, The first episode of symptoms would be later and be non primary HSV
45
What is the risk of transmission to fetus with recurrent maternal HSV infection
2%
46
Neuro symptoms of HSV congenital
microcephaly intracranial calcification hydraencephaly
47
Cutaneous manifestations of HSV congenital
scarring, lesions, pigmentation
48
ophthalmic manifestations of HSV
microophthalmia, retinal dysplasia, optic atrophy, chorioretinitis
49
features of HSV CNS disease
encephalitis - seizure, lethargy, irritable, poor feeding presents 10 days - 4 weeks PN bulging fontanelle
50
features of disseminated fetal HSV
DIC pneumonia Hepatitis CNS - encephalitis
51
what HSV feature may not present in a disseminated case of neonatal HSV
20% will not have skin lesions
52
diagnosis of HSC in neonate
ALT in disseminated HSV | PCR from any specimens
53
treatment of HSV disseminated and CNS disease
21 days high dose aciclovir 60mg/kg/day IV | monitor neutrophils and ensure hydration
54
treatment of HSV in skin, eyes, mouth involvement SEM
14 days high dose aciclovir 60mg/kg/day IV | monitor neutrophils and ensure hydration

perinatal infection (10 decks)

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