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Year 5 Path Microbiology > Infection in Pregnancy > Flashcards

Infection in Pregnancy Flashcards

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1
Q

What are the complications of viral infections during pregnancy?

A
  1. Maternal Complications (e.g. influenza, VZV)
  2. Foetal complications
    * Miscarriage/ Stillbirth/ Prematurity(e.g. rubella, measles)
    * Teratogenicity (VZV/ZIKA)
    * congenital disease (CMV + HSV)
    * persistent infection (HIV, Hepb/C)
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2
Q

What are characteristics of Herpes Viruses

A

Large family of enveloped viruses with double stranded DNA

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3
Q

How is HSV transmitted?

What is the incubation period or HSV (1+2) ?

A

Via close contact

2-12 days oropharyngeal
4-7 days genital

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4
Q

Which Herpes Viruses can cause Problems in Pregnancy?

A
  1. HSV
  2. VZV
  3. CMV
  4. EBV
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5
Q

What maternal investigations are done for a suspected HSV infection?

A
  • Viral Detection (PCR or lesions)
  • Serology
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6
Q

How can HSV infect foetuses?
How common is it?

A

Very uncommon

Active maternal genital infection needed and ascending infection with PROM (therefore highest risk in 3rd trimester)

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7
Q

How common is neonatal HSV infection? What are the complications?

A

Very severe due to potential development of HSV encephalitis

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8
Q

What is the most common route of Transmission for Neonatal HSV infection?

A

Generally can all be primary, non-primary or recurrent genital HSV infections

  1. Direct contact with infected maternal secretions during delivery (genital Herpes)
  2. oral herpes: kissing babies
  3. Tansmission via other relatives, hosptial staff etc.
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9
Q

What are the complications of in utero HSV infection?

A
  • Primary infection only
  • Miscarriage
  • Congenital abnormalities (ventriculomegaly, CNS abnormalities)
  • Preterm birth
  • IUGR
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10
Q

What is the management of maternal HSV infection during pregnancy?

A
  1. GUM clinic referral
  2. Aciclovir
  3. HSV antibody testing
  4. C-Secion (consider if active HSV in final 6 weeks before delivery)
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11
Q

What is the prognosis of neonatal HSV infecion?

A

Untreated: mortality >80%
(nreutological involvement common and severe

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12
Q

What are the three types of neonatal HSV infections?

A
  1. Skin, eyes , mouth (SEM)
  2. CNS involvement (+/- SEM)
  3. Disseminated
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13
Q

How and when does neonatal SEM (Skin eye mouth) HSV infection present?
How is it managed?

A

Can be initially benign, usually First 14 Days to max 6 weeks
1. Vesicular skin lesions
2. Eyes: watering (initially), progressing to Keratoconjunctivitis (may lead to cataracts anc choriorentinitis)

Management
* Must be treated due to high risk or cataracts and CNS progression
* Aciclovir

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14
Q

When and how does neonatal HSV infection with CNS involvement present?
What is the management?

A

Presents
Weeks 2-3 of life (up to 6)
Presentation with Meningoencephalitis

  • Seizures
  • Lethargy
  • Irritability
  • Poor feeding
  • Fevers

Management

  • Need CSF sample
  • Acyclovir (hard treat)
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15
Q

How does disseminated neonatal HSV infection present?

A

Very severe, probably lethal
Presents like sepsis
Often in 1st week of life
Multi-organ involvement (liver, lungs, CNS, heart, GI tract, renal tract, bone marrow)

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16
Q

What is the Route of Transmission for Varicella Zoster and Herpes Zoster?
How likely is transmison?

A

Respiratory transmission (with 70% infection rate in susceptible individuals)

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17
Q

What is the incubation period of VZV?

A

3-14 days

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18
Q

How many women of childbearing age are susceptible to varicella inection? What are the maternal complications=

A

10-20% of women of childbearing age are susceptible
* 10-20% of pregnant women with varicella will have varicella pneumonia.
* Encephalitis is rare but has mortality of 5-10%

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19
Q

What are the foetal complications of foetal varicella infection during pregnancy?

A

Congenital Varicella Syndrome

20
Q

What are the risk of vertical transmission of varicella to the foetus?

A

Generally transmission in first and 2nd Trimester
0.4% if maternal infection weeks 0-12
2% if weeks12-20

21
Q

What are the complications of congenital varicella syndromes?

A

Low Birth Weight

  • Hypertrophic scars (cicatricial skin lesions)
  • Limb defects (e.g., hypoplasia)
  • Ocular defects (e.g., chorioretinitis, cataracts, microphthalmia)
  • CNS defects (e.g., cortical atrophy, seizures, intellectual disability), hydrocephalus
22
Q

What is the management plan for Varicella exposure in pregnancy in a woman, who has had chickenpox or shingles before or had 2 doses of varicella vaccine ?

A

Sufficient evidence of immunity

23
Q

What is the managemnet of Varicella exposure in pregnancy in a woman, who has never had previous infection or immunisation?

A
  1. Urgent Antibody testing on recent blood sample
    If VZV IgG <100 mlU/ml offer PEP
    (Pre-conception and post partum counceling considered if no immunity documented)
24
Q

What is the Management of a pregnancy women with VZV IgG <100 mlU/ml presenting within 10 days from exposure?

A

If under 20 Weeks: IVIG

If >20 Weeks:IVIG or Antivirals
Oral aciclovir 800mg
OR
Oral Valaciclovir 1000mg TDS
until day 14 post exposure

25
Q

What is the epidemiology of CMV infection?
How is it transmitted?

A
  1. Transmission via Saliva/Respiratory secretions/urine
  2. Common childhood infection, 2-6% infected by 6 months, 40% infected by 16
26
Q

What is the incumbation period of CMV?

A

4-8 weeks
(but virus persists lifelong)

27
Q

What are the symptoms of CMV infection in childhood?

A

Mostly asymptomatic (unproblematic if not in prengnacy/immunocompromised)

Maculopapular rash, infectious mononucleosis-like illness

28
Q

How is CMV diagnosed?

A
  • PCR of urine/saliva/ amniotic fluid
  • Serology
29
Q

How is a maternal primary CMV infection transmitted to the baby? How likely is transmission?

A
  • In utero: 1+2nd trimester 30%, 3rd: 70%

Also transmission preinatally and postnatall (also transmission via breast milk and saliva)

30
Q

What is the presentation of Congenital CMV infection?

A

At birth (10% show symtpoms, 90% initially asymptomatic)

  • jaundice, petechiae, hepatosplenomegaly
  • CNS: microcepahtly, ventricumeglay
    Later
  • progressive permanent sensorineural hearing loss (first 3 years of life)
  • other cognitive complications (learning disability etc)
31
Q

How is Congenital CMV infection Confirmed/ diagnosed?

A
  1. Maternal Serology
  2. Neonatal (Urine and Saliva PCR) –> within first 3 weeks of life
    Options
  3. Foetal Aminocentesis
32
Q

What is the management of CMV infection in pregnancy?

A

Most important question: Is this primary infecion? (Check booking blood and and now)

If seroconversion susptected –> referal to foetal medicine (for USS and amniocentesis)

No treatment available

33
Q

What neonatal tests need to be done with a maternal history of CMV infection in pregnancy?

A

Neonates are investigated – urine and saliva CMV PCR within 1st 21 days

34
Q

What is the route of transmission and incubation period of Rubella?

A

12-21 days
Via respiratory

35
Q

How likely if foetal transmission of maternal Rubella infection in Pregnancy?

A

Greatest risk is in the 1st trimester
If infection before 8 weeks -> 20% spontaneous abortion
If infection before 10 weeks 90% incidence of fetal defects
If infection after 18-18 weeks -> hearing defects and retinopathy
If infection after 20 weeks no documented cases

36
Q

What are the consequences of foetal Rubella infection?

A
  1. Miscarriage, Stillbirth, Small birth weight, Foetal Growth Restriction
  2. Congenital Rubella syndrome
37
Q

What is the presentation of congenital Rubella syndrome?

A

2/3 asymptomatic at birth and develop complicaitons over time

Triad of 3 cs
1. Cardiac (PDA, Pulmonary Artery stenosis)
2. Cataracts (and other eye manifestations)
3. Cochlear: bilateral sensorineurla hearing loss

Other early features
* CNS: Meningioencephalitis
* GI: hepatosplenomegaly, jaundice
* Haem: Petechiae, Haemolytic anaemia

Later
* CNS: Hearing loss, intelectual diasability, panencephalitis
* Endo: DM, thyroid disfunction

Later
* Hearing loss
Intellecual diability
Panenceoahlitis
Endocrine disfunction (diabetes and thyroid)

38
Q

What are the maternal and foetal complications of measles infection in pregnancy

A

Maternal

  • Secondary bacterial infections
  • Otitis media / pneumonia (mortality 10%) / gastrointestinal
  • Encephalitis
39
Q

What are the foetal complications of Measels in Pregnancy?

A

Foetal

  • Foetal loss
  • preterm delivery
  • SSPE (sub-acute sclerosing panencephalitis) 7-10 years later
40
Q

What is the route of Transmission and incubation period for Parvovirus?

A

Respiratory, Blood Products
6-8 days

41
Q

What is the presentation of Parvovirus 19?

A

Mostly asymptomatic
Erythema infectiosum/ slapped cheek/5ths disease
Polyarthropathy
Transient aplastic crisis

42
Q

What are the foetal complications of maternal Prarvovirus infections?

A

Generally 30-60% of adults have antibodies

Before 20 Weeks
* 33% transmission –> hydrops fetalis, fetal abnormalities, fetal loss

After 20 weeks: no risk

43
Q

What is Fetal hydrops/ Hydrops fetalis?

A

Cytotoxic to fetal red blood precursor cells

  • anaemia
  • accumulation of fluid in soft tissues and serous cavities (ascities, pleural effusionsoedema etcc. )
  • can rapidly cause fetal death
44
Q

What is the pregnancy managment of maternal Parvovorus before 20 weeks?

A
  • Refer to fetal medicine for monitoring
  • Check maternal booking IgG Parvovirus antibodies
  • May require intrauterine transfusion
45
Q

What is the prognosis of enterovirus infection in pregnancy?

A

Generally not associated with severe outcomes

Of all enterovirus: Coxacie virus is associated with highest risk

  • Perinatal newborn infection can occur in last week of pregnancy
  • Neonates are at risk of myocarditis, fulminant hepatitis , encephalitis , bleeding and multi-organ failure.

Year 5 Path Microbiology (25 decks)

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