Herpes and CMV: Brocato

Question 1

What are the most common infections seen in pregnancy?

Answer 1

HSV

CMV

Question 2

HSV 1 is what?

Answer 2

cold sores

90% exposure by age 10

Question 3

HSV 2 is what?

Answer 3

Genital

Question 4

You can get HSV 1 and 2 where?

Answer 4

Either place

Question 5

What are risks for HSV?

Answer 5

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

Question 6

TEST: New infections of HSV show what symptoms?

Answer 6

NOTHING! Most are asymptomatic

Question 7

When do vesicles appear?

Answer 7

2-14 days

then crust over

Question 8

TEST: what are seen in HSV Tzank test?

Answer 8

Inclusion bodies!

Question 9

How to diagnose HSV?

Answer 9

Clinical presentation
Viral culture
PCR
Serology
Tzank test + clinical

Question 10

Can you make diagnosis looking at HSV?

Answer 10

No… false positive 20%

Question 11

How do we treat HSV primary? Recurrent? severe?

Answer 11

Primary: acyuclovir or valacyclovir

Secondary or severe: gear up dosage, IV

Question 12

What is risk of transmission in primary infection in pregnancy?

Answer 12

30-60%

Question 13

What is risk in recurrent infection in pregnancy?

Answer 13

1-3%

Question 14

Does C section prevent vertical transmission?

Answer 14

Not totally

Question 15

Why is secondary infection better than primary?

Answer 15

Mom’s antibodies protect the baby

Question 16

CS indicated when in HSV?

Answer 16

active lesions

prodromal symptoms: vulva pain and burning and HSV history

Question 17

When do you vaginal deliver HSV pt?

Answer 17

With no flare: lo risk

Question 18

If baby is PROM, what is risk for HSV?

Answer 18

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

Question 19

Is breastfeeding okay in HSV?

Answer 19

Yes, if no breast lesions.

Question 20

What is CMV?

Answer 20

ds DNA virus
Beta herpes virus group
primary and latent infections

Question 21

What is most common congenital infection in US?

Answer 21

CMV: 0.2-2% of babies

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

Question 22

Risk of CMV?

Answer 22

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

Question 23

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

Answer 23

10%

Question 24

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

Answer 24

50%

Question 25

When is CMV risk worst in pregnancy? best?

Answer 25

Worst: first trimester Best: 3rd trimester

Question 26

What percent of infected pregnancies transmit CMV to fetus?

Answer 26

50%

Question 27

What are clinical manifestations of CMV?

Answer 27

Cold symptoms Fever Possible pneumonia, guillan barre

Question 28

Who gets severe CMV?

Answer 28

HIV | immunosuppressed

Question 29

What is the CMV incubation period?

Answer 29

1-2 months... avg. 40 days. | May not even know you go it!

Question 30

How is CMV diagnosis made?

Answer 30

Serology: IgG and IgM specific PCR

Question 31

TEST: IgM or IgG early?

Answer 31

IgM then IgG

Question 32

Avidity test of IgG means what?

Answer 32

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

Question 33

Less than 25% avidity to CMV test means what?

Answer 33

New infection to body, less response efficiency

Question 34

What iG should not be used to diagnosed CMV?

Answer 34

IgM

Question 35

What are the TORCH infections?

Answer 35

``` Toxoplasmosis Rubella CMV Herpes Syphilis ```

Question 36

TEST: What is the most common TORCHeS?

Answer 36

CMV

Question 37

TEST: What are ultrasound signs of CMV?

Answer 37

``` Cerebral calcifications Microcephaly Organomegaly Ascities Hydrops Low growth Oligohydramnios ```

Question 38

What is amniotic fluid?

Answer 38

Fetal urine

Question 39

Where does CMV replicated?

Answer 39

Fetal kidney-->amniotic fluid has virus in it | Amniocentesis for CMV

Question 40

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

Answer 40

Amniotic fluid for PCR

Question 41

KEY: What is less sensitive than amniotic fluid testing?

Answer 41

Fetal blood sampling

Question 42

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

Answer 42

Weeks to months after | Timing of testing is important! 21 weeks... lag between infections

Question 43

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

Answer 43

NO! no correlation to severity

Question 44

KEY: What predicts CMV severity?

Answer 44

Early exposure

Question 45

Tx for CMV?

Answer 45

Gancyclovir... but really no tx for pregnant women IgGCMV might be useful! Italian study

Question 46

Why do we not screen for CMV?

Answer 46

Theres no treatment... screening is pointless