Infections in Pregnancy Flashcards
What are the congenital TORCH infections?
Toxoplasma gondii
Other: Syphilis, Parvovirus B19, VZV + Listeria
Rubella
Cytomegalovirus
Herpes Simplex 2
Give 4 common clinical signs of TORCH infections
Delayed growth
Hepatosplenomegaly
Jaundice
Thrombocytopenia
What is Toxoplasmosis caused by? How is usually acquired? How is it transmitted to the foetus?
Protozoan: Toxoplasma gondii
Contact with cat faeces/ litter
Undercooked meat, esp. pork + lamb.
Transmitted via placenta. If in first 6m- congenital toxoplasmosis
How does Toxoplasmosis manifest in the mother?
Usually asymptomatic
Lymphadenopathy (rarely)
What is the classic triad of congenital toxoplasmosis?
Chorioretinitis- yellow/ white scars on fundoscopy
Hydrocephalus- macrocephaly
Intracranial calcifications- seen on CT
What dermatological manifestation can arise in congenital toxoplasmosis?
Blueberry muffin rash
(purple-blue marks)
What is syphilis caused by? How is it transmitted?
Spirochete bacterium: Treponema pallidum
Sexual contact, inc. vaginal, anal, + oral
What is primary syphilis characterised by?
chancres (painless skin ulcers)
usually on the labia, anal region or cervix.
When does the second stage of syphilis occur? How can this manifest?
2-10w post infection- disseminated in blood stream
Generalised lymphadenopathy
Maculopapular rash: start on trunk + spread to limbs, eventually to palms, soles, genitalia, + other mucous membranes.
Condyloma lata: smooth, white, painless, wart-like lesions on genitals + around anal region.
How does tertiary syphilis present?
Gummas: granulomatous lesions form
Cardiovascular damage
Neurosyphilis
When is syphilis most infectious to a foetus?
Primary + Secondary stages
Via placenta/ during childbirth
What does congenital syphilis often result in?
Hydrops fettles: abnormal accumulation of fluid in soft tissues.
Greatly increases risk for still-birth
What happens to babies born with congenital syphilis?
Develop characteristic features:
Early signs: appear within 2y of life
Late signs: after child is 2y old
Give 2 early signs of congenital syphilis
Maculopapular rash involving palms + soles
Snuffles/ increased nasal secretions (laden with treponema)
What are 6 late signs of congenital syphilis?
Frontal bossing
Saddle nose
Short maxilla
Hutchinson teeth: small, notched, + widely spaced permanent teeth.
Saber shins: bending of shinbone or tibia.
Progessive damage to vestibulocochlear nerve (CNVIII): deafness or hearing loss.
How is parvovirus B19 transmitted to the mother? How is it transmitted to the foetus?
Mother: resp secretions
Foetus: Placenta
What are the signs and symptoms of parvovirus B19 in the mother?
Arthritis: small joints of hands, wrists, knees, + feet, often symmetrical
Red cell APLASIA: decreased RBC production in BM= absence of reticulocytes in BM
What happens to a foetus if they acquire parvovirus B19?
Develop anemia.
Fewer RBCs to carry oxygen, so the heart will pump a larger volume of blood to give the growing fetus all the oxygen it needs.
This raises the pressure inside fetal blood vessels, + fluid may start to leak out.
Ultimately result in hydrops fetalis- great risk for spontaneous abortion or still-birth (esp. in first half of pregnancy)
What happens to a foetus if they survive parvovirus B19 in utero?
No permanent defects/ malformations
How is VZV transmitted to the mother? How is it transmitted to the foetus?
Mother: Resp secretions/ Contact with the oral or skin lesions
Foetus: Placenta
How does VZV manifest in a mother?
Fever, headache, + overall weakness.
After 2-3 days, develop an intensely pruritic, vesicular rash, which starts on the trunk + spreads outward, eventually covering entire body.
When is the foetus most vulnerable to VZV?
First + Second trimester as still undergoing major development
How does congenital VZV manifest?
Underdeveloped
Low birth weight
Limb atrophy
Microcephaly
Eye defects: cataracts (opacification of the lens)
Neuro defects: cortical atrophy or brain degeneration, + intellectual disability.
How does Listeria present in the mother?
Fever
Fatigue
Gastroenteritis: D+V + abdo cramps.
Amnionitis
Sepsis
What is Listeria? How is it transmitted to the mother? How is it transmitted to the foetus?
Bacteria: Listeria Monocytogenes
Mother: Unpasteurized dairy products + deli meats.
Foetus: placenta
What are the consequences of Listeria transmission to the foetus?
Spontaneous abortion or still-birth.
If survives to term: may develop sepsis + meningitis (fatal if untreated)
What is Rubella? What is it caused by? How is it transmitted to mother? How is it transmitted to foetus?
Rubella aka. German Measles
Virus: Rubella virus
Mother: Resp secretions
Foetus: Placenta, 1st trimester-congenital rubella syndrome.
How does rubella manifest in the mother?
Maculopapular rash: starts from head + neck, spreads downward
Postauricular lymphadenopathy
Polyarthritis: >,5 joints.
What is the characteristic triad of congenital rubella syndrome?
Cataracts
Congenital heart defects: PDA
Deafness
What murmur may be heard in a baby with congenital rubella syndrome?
Continuous rumbling murmur, AKA “machinery” murmur.
Which congenital infections may cause a “blueberry muffin rash”?
Toxoplasmosis
Rubella
Cytomegalovirus
How is cytomegalovirus transmitted to the mother? How is it transmitted to the foetus?
Mother: Sexual contact/ organ transplantation.
Foetus: Placenta
How does CMV manifest in the mother?
Usually asymptomatic
Some develop mononucleosis-like Sx: fever, lymphadenopathy, + sore throat.
How does congenital CMV present? (5)
Petechiae
Progressive + permanent deafness
Eye abnormalities: chorioretinitis
Neuro: Seizures + intellectual disability, often a/w microcephaly.
Periventricular calcifications: seen on CT
How is HSV-2 transmitted? When is it usually transmitted to the foetus?
direct contact with infected areas of the skin or mucous membranes
foetus: During birth when passing through vaginal secretions
How does HSV-2 manifest in the mother?
Usually asymptomatic
Can develop genital herpes: vesicular skin lesions on vaginal mucosa, mons pubis, cervix, + labia.
How does congenital HSV-2 present?
Vesicular skin lesions- mainly involve scalp, eyelid margins, + oral mucosa.
Can lead to meningoencephalitis: presents with lethargy, irritability + seizures.
