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Reproductive > Herpes and CMV: Brocato > Flashcards

Herpes and CMV: Brocato Flashcards

1
Q

What are the most common infections seen in pregnancy?

A

HSV

CMV

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2
Q

HSV 1 is what?

A

cold sores

90% exposure by age 10

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3
Q

HSV 2 is what?

A

Genital

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4
Q

You can get HSV 1 and 2 where?

A

Either place

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5
Q

What are risks for HSV?

A 
Minority ethnicity
hx of HSV
lower income
number of sexual partners
duration of sexual activity
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6
Q

TEST: New infections of HSV show what symptoms?

A

NOTHING! Most are asymptomatic

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7
Q

When do vesicles appear?

A

2-14 days

then crust over

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8
Q

TEST: what are seen in HSV Tzank test?

A

Inclusion bodies!

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9
Q

How to diagnose HSV?

A 
Clinical presentation
Viral culture
PCR
Serology
Tzank test + clinical
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10
Q

Can you make diagnosis looking at HSV?

A

No… false positive 20%

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11
Q

How do we treat HSV primary? Recurrent? severe?

A

Primary: acyuclovir or valacyclovir

Secondary or severe: gear up dosage, IV

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12
Q

What is risk of transmission in primary infection in pregnancy?

A

30-60%

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13
Q

What is risk in recurrent infection in pregnancy?

A

1-3%

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14
Q

Does C section prevent vertical transmission?

A

Not totally

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15
Q

Why is secondary infection better than primary?

A

Mom’s antibodies protect the baby

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16
Q

CS indicated when in HSV?

A

active lesions

prodromal symptoms: vulva pain and burning and HSV history

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17
Q

When do you vaginal deliver HSV pt?

A

With no flare: lo risk

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18
Q

If baby is PROM, what is risk for HSV?

A

1: weigh prematurity. start antivirals. CS if symptomatic mom
2: low risk without flare, antivirals until delivery

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19
Q

Is breastfeeding okay in HSV?

A

Yes, if no breast lesions.

20
Q

What is CMV?

A

ds DNA virus
Beta herpes virus group
primary and latent infections

21
Q

What is most common congenital infection in US?

A

CMV: 0.2-2% of babies

30-40k infants diagnosed
pregancy infeciton rate is 0.7-4%
Recurrent preg. infection is 13,5%

22
Q

Risk of CMV?

A 
Poor
immigrant 
first pregnant <15 yo
child care workers
families with young children
23
Q

What % of child care workers are exposed to CMV within a year?

A

10%

24
Q

What % of families with young children are exposed to CMV within a year?

A

50%

25
Q

When is CMV risk worst in pregnancy? best?

A

Worst: first trimester
Best: 3rd trimester

26
Q

What percent of infected pregnancies transmit CMV to fetus?

A

50%

27
Q

What are clinical manifestations of CMV?

A

Cold symptoms
Fever
Possible pneumonia, guillan barre

28
Q

Who gets severe CMV?

A

HIV

immunosuppressed

29
Q

What is the CMV incubation period?

A

1-2 months… avg. 40 days.

May not even know you go it!

30
Q

How is CMV diagnosis made?

A

Serology:
IgG and IgM specific
PCR

31
Q

TEST: IgM or IgG early?

A

IgM then IgG

32
Q

Avidity test of IgG means what?

A

High: old infection, well responded to
Low: newer infection, working on response

33
Q

Less than 25% avidity to CMV test means what?

A

New infection to body, less response efficiency

34
Q

What iG should not be used to diagnosed CMV?

A

IgM

35
Q

What are the TORCH infections?

A 
Toxoplasmosis
Rubella
CMV
Herpes
Syphilis
36
Q

TEST: What is the most common TORCHeS?

A

CMV

37
Q

TEST: What are ultrasound signs of CMV?

A 
Cerebral calcifications
Microcephaly
Organomegaly
Ascities
Hydrops
Low growth
Oligohydramnios
38
Q

What is amniotic fluid?

A

Fetal urine

39
Q

Where does CMV replicated?

A

Fetal kidney–>amniotic fluid has virus in it

Amniocentesis for CMV

40
Q

KEY: what is more sensitive than culture for CMV diagnosis?

A

Amniotic fluid for PCR

41
Q

KEY: What is less sensitive than amniotic fluid testing?

A

Fetal blood sampling

42
Q

KEY: when does fetal CMV infection occur in relation to maternal infection?

A

Weeks to months after

Timing of testing is important! 21 weeks… lag between infections

43
Q

KEY: Does detection of CMV in amniotic fluid predict diseaes severity?

A

NO! no correlation to severity

44
Q

KEY: What predicts CMV severity?

A

Early exposure

45
Q

Tx for CMV?

A

Gancyclovir… but really no tx for pregnant women

IgGCMV might be useful! Italian study

46
Q

Why do we not screen for CMV?

A

Theres no treatment… screening is pointless

Reproductive (31 decks)

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