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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
Q

what hematological features of cytomegalic inclusion disease

A

TCP and haemolytic anaemia

26
Q

is CMV teratogenic

A

no

27
Q

is rubella teratogenic

A

yes

28
Q

what is viral angiitis with CMV

A

infection of endothelial cells causing reduced brain perfusion and organ damage

29
Q

What percentage of CMV infected foetuses wil show abnormalities at birth

A

10%

30
Q

What percentage of mothers with primary infection CMV will transmit to detus

A

40%

31
Q

what percentage of mothers with reactivation of CMV will transmit to fetus

A

2% transmission as mother already has existing immunity.

32
Q

manifestations of reactivation CMV from mother in a fetus

A

unilateral deafness, lower abnormalities but severe disease can occur.
less virus shedding by fetus

33
Q

Of the neonates symptomatic with Cytomegalic inclusion disease at birth, what is the main sequelae presented

A

CNS involvement

and 65% hearing loss

34
Q

of the neonates asymptomatic at birth, 10% will have what defect

A

hearing loss

35
Q

Management of CMV infection

A

close monitoring for 2-6 years of audiology and trial of antiviral therapy

36
Q

Diagnosis of CMV in maternal infection

A

PCR - mainly
Detection of Early Antigen Fluorescent Foci DEAFF is a cell culture method
Serology for CMV IgG, avidity and IgM

37
Q

Diagnosis of CMV in fetus antenally

A

Amniocentesis and CMV DNA present at 21/40

38
Q

Diagnosis of CMV postnatally

A

CMV in urine/saliva in first 3 weeks of life
if positive, verify with blood sample
serology but PCR preferred.

39
Q

Prevention of CMV

A

no vaccine no prevention

40
Q

Treatment of CMV in neonate with organ disease

A

valganciclovir oral OR ganciclovir IV for 6/12
audiology f/u till 6yo
ophthal review for cataracts

41
Q

when is the highest risk to fetus for maternal HSV

A

PERINATALLY in third trimester at 85% transmission risk

pre and post natal has 20% risk of transmission

42
Q

Risk factors for neonatal transmission of HSV

A

primary maternal infection and symptomatic infection
maternal antibody status
PROM
Fetal scalp electrode use damages mucous membranes and increases susceptibility
Vaginal birth

43
Q

What is the risk of transmission to fetus with primary maternal HSV infection

A

57%

44
Q

What is the risk of transmission to fetus with non primary maternal HSV infection but first episode

A

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
Q

What is the risk of transmission to fetus with recurrent maternal HSV infection

A

2%

46
Q

Neuro symptoms of HSV congenital

A

microcephaly
intracranial calcification
hydraencephaly

47
Q

Cutaneous manifestations of HSV congenital

A

scarring, lesions, pigmentation

48
Q

ophthalmic manifestations of HSV

A

microophthalmia, retinal dysplasia, optic atrophy, chorioretinitis

49
Q

features of HSV CNS disease

A

encephalitis - seizure, lethargy, irritable, poor feeding
presents 10 days - 4 weeks PN
bulging fontanelle

50
Q

features of disseminated fetal HSV

A

DIC
pneumonia
Hepatitis
CNS - encephalitis

51
Q

what HSV feature may not present in a disseminated case of neonatal HSV

A

20% will not have skin lesions

52
Q

diagnosis of HSC in neonate

A

ALT in disseminated HSV

PCR from any specimens

53
Q

treatment of HSV disseminated and CNS disease

A

21 days high dose aciclovir 60mg/kg/day IV

monitor neutrophils and ensure hydration

54
Q

treatment of HSV in skin, eyes, mouth involvement SEM

A

14 days high dose aciclovir 60mg/kg/day IV

monitor neutrophils and ensure hydration

perinatal infection (10 decks)

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