Infectious Disease In Pregnancy

Question 1

AIDS Diagnoses in Pregnancy

Answer 1

OIs
Neoplasia (including advanced Cervical CA)
TB
Recurrent PNA
Dementia/Encephalopathy
Wasting Syndrome
CD4 count <200

Question 2

Correlates of increased perinatal HIV transmission

Answer 2

Advanced disease
placental inflammation
STDs
Druation of rupture of membranes

Question 3

Delivery plan in HIV+

Answer 3

C/S at 38wks when Viral load >1000K
Start IV AZT 3h prior to scheduled C/S
If NSVD planned, avoid AROM, instrumentation, episiotomy
Breastfeeding not recommended

Question 4

HCV

Answer 4

INdications for testing

• IVDU
• Recipients of blood or organs < 1992
• HD
• Elevated LFTs

Screen with EIA, confirm with RIBA
Acute illness, HCV PCR

5% risk of perinatal transmission

Question 5

Blueberry Muffin Baby

Answer 5

Congenital CMV
1% pregnant women develop primary CMV
40% infants become infected
Only 10-15% of these overtly symptomatic

Severe:
US: severe symmetrical IUGR, microcephaly, intracerebral calcifications, ventriculomegaly, hepatomegaly, echogenic bowel
Clinical: chorioretinits, HSM, thrombocytopenia, purpuric rash

Dx:
Prenatal: Amnio
Postnatal: Urine culture or PCR

Question 6

CMV

Answer 6

Congenital CMV
1% pregnant women develop primary CMV
40% infants become infected
Only 10-15% of these overtly symptomatic

Severe:
US: severe symmetrical IUGR, microcephaly, intracerebral calcifications, ventriculomegaly, hepatomegaly, echogenic bowel
Clinical: chorioretinits, HSM, thrombocytopenia, purpuric rash

Dx:
Prenatal: Amnio
Postnatal: Urine culture or PCR

Question 7

Listeriosis

Answer 7

Listeria monocytogenes: aerobic and facultative anaerobic, gram-postiive bacillus. Soil, decaying vegetables. Common deli meats, hot dogs, soft cheeses, smoked seafood, and patés.
Path: binds E-cadherin of the intestinal host cell, access hepatic and hematopoetic systems. Affinity for the meninges and placental membranes.
Path: Vulnerable populations include pregnant women, especially in their third trimester, persons receiving chronic steroid therapy, the elderly, and other immunocompromised groups. Outbreaks are typically sporadic.
Incidence:12:100,000.
Px: Flu-like illness with fever, headache, myalgias, and URI sx, mild and resolve without treatment.
The incubation period is highly variable, ranging from 11-70 days. CNS invasion is uncommon, and maternal mortality is extremely rare. However, fetal sequelae are significant and include premature birth, neonatal infection, and death. The spectrum of infection may include granulomatosis infantiseptica (with evidence of infection in utero that usually leads to stillbirth), early onset systemic illness noted near the time of birth, or late onset meningitis, diagnosed after day 3 of life. Siegman-Igra et al reviewed 553 cases of listeriosis in pregnancy and noted that 55% of women who were bacteremic suffered a subsequent neonatal demise. Ampicillin, 2g IV Q 4h, is the treatment of choice. In patients allergic to penicillin, trimethoprim-sulfamethoxazole is an acceptable alternative. Two weeks of antibiotic therapy is recommended for patients with bacteremia.

Question 8

Congenital Rubella SYndrome

Answer 8

Microcephaly, Cataracts, Hearing Impairment IUGR
- other findings: Congenital glaucoma and heart defects
Mother immune
Baby at risk for natural infection, may develop SSPE