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MRCOG Antenatal Part 2 Revision - Hay > Infectious Diseases - Listeriosis and Syphilis > Flashcards

Infectious Diseases - Listeriosis and Syphilis Flashcards

1
Q

What dietary advice should you give to avoid listeriosis?

A

Avoid raw food, soft cheeses, un-pasturised milk, reheated food

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2
Q

In pregnancy how does listeriosis present?

A

2/3 women will have flu-like symptoms, GI symptoms, fever.

Often mis diagnosed as UTI/flu

Rarely can cause meningitis, endocarditis, respiratory failure

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3
Q

Listeriosis may have what impact on the pregnancy?

A

May cause:
- Chorioamnionitis
- septic miscarriage
- fetal inutero

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4
Q

How does early onset neonatal disease present

A

Most common after acute febrile illness
- neonate symptomatic at birth or within in few days of birth
- Associated with disseminated granulomas involving liver, placenta, solid organs, septic shock, respiratory disease

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5
Q

How does late onset neonatal disease present?

A

Occurs in term neonates after uncomplicated pregnancy, typically meningitis

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6
Q

How to treat listeriosis?

A

Antibiotics once infection is suspected - ampicillin, pen G, amnioglycosides

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7
Q

What type of pathogen causes syphilis?

A

Treponema pallidum

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8
Q

What is the incubation period of syphilis?

A

10-90 days

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9
Q

How does primary symphilis present?

A

Chancre - genital/peri-anal/rectal
Indurated painless ulcer

Regresses spont after 2-6 weeks

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10
Q

What proportion develop secondary syphilis if untreated?

A

25%

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11
Q

How does secondary symphilis present?

A

6-8 weeks after primary syphilius - fever, malaise, macula-papular rash (mm and palms/soles), lymphadenopathy, mouth ulcers, condylomata lata

Resolves within 1-3 months

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12
Q

If untreated what proportion will develop tertiary/late syphilis?

A

30%

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13
Q

How does tertiary syphilis present?

A

Gumma, joints, skin/resp tract/ sub-periosteal aspect of long bones, chariots joints

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14
Q

Quatarnary syphilis

A

Aortic aneurysms/aortis

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15
Q

What stage is transmission of syphilus the greatest?

What is the risk with primary infection?

A

Early disease

40%

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16
Q

Effect of syphilis in pregnant

A

Bacteria can cross placenta from 14 weeks, infecting baby.
30-40% fetal loss.
1/3 that survive will have congenital syphilis.
Higher risk of transmission if primary infection or later gestation.

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17
Q

What are the 3 main types of serological tests for syphilus? Name examples

A

1 . Non-treponmeal test (non-specific) -→ VDRL and rapid plasma reagin (RPR) test

  1. Treponemal tests (specific) →
    - EIA treponema enzyme immunoassay
    - CLIA
    - TPHA
    - TPPA
    - fluorescent treponema antibody absorption (FTA-ABS) assay
    - microhaemagglutination assay for T palladium antibody (MHA-TP) (detect antibody to treponemal antigen)
    - CLIA
  2. T-pallidum specific IgM antibody tests - anti-treponema IgM EIA and immunoblot
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18
Q

For non-treponmeal tests
- When do they become reactive?

A

4-8weeks after the infection

19
Q

For non-treponmeal tests
Sensitivity for primary, latent and late syphilis?

A

60-90%

20
Q

For non-treponmeal tests
Sensitivity for secondary syphilis?

A

100%

21
Q

For non-treponmeal tests, false +ve rate and false -ve?

A

Both about 1%

22
Q

For non-treponmeal tests, what factors make false +ve test more likely?

A

Elderly
Pregnant
Drug addiction
Malignancy
Autoimmune disease (SLE)
Viral disease (Epstein Barr, hepatitis)
Protozoal
Mycoplasma infection

23
Q

What tests are used as primary screening tests for syphilis?

A

Treponema EIA/CLIA (preferable testing IgM and IgG) or TPPA

24
Q

In pregnancy if screening treponema serology test is positive? what should be done

A

Retest original sample for difference serological test or send second sample for treponema serology

25
Q

If second treponemal serology +ve?

A

Performed quantitative non-treponema test RPR or VDRL
Refer to GUM/paeds/neoantes

26
Q

If a second test does confirm syphilis, what test should be sent?

A

RPR/VDRL - helps stage the infection and indicated need for treatment

27
Q

What RPR/VDRL titres indicated active disease that needs treatment?

A

> 16

28
Q

Sensitivity of FTA-ABS for syphilis?

A

85-100% at all stage of the disease

29
Q

Sensitivity of MHA-TP for syphilis?

A

60-85%

30
Q

False +ve rate of MHT-TP and FTA-ABS

A

1%

31
Q

What is the prozone phenomenon?

A

False negative response (most common with RPP test) resulting from overwhelming antibody timers which interfere with the proper formation of the antigen-antibody lattice to form +ve flocculation.

More likely with HIV co-infection

32
Q

Table summaries how to test for syphilis in prengnacy

A
33
Q

What proportion of babies with congenital syphilis will be asymptomatic at birth?

A

2/3rds

Most will develop symptoms by 5 weeks

34
Q

What test is used to monitor the response to treatment for syphilis?

A

RPR/VDRL test

35
Q

When does treponmeal screening tests become +vce in relation to the chance?

A

Negative before chancre develops and up to 2 weeks afterwards.

36
Q

Roughly what proportion of +ve UK screening are due to false +ve?

Adequately treated before pregnancy?

A

23% false +ve

46% adequately treated pre-pregnancy

37
Q

If syphilis in pregnancy, when to refer to Fetal Medicine?

What can be seen on USS?

A

26 weeks

Hydrops, hepatosplenomegaly, intraheptic microcacifications, placentomegaly.

38
Q

When should retreatement of syphilis be considered?

A

Uncertainty of adequacy of treatment
The serological cure RPR/VDRL 4 for drop did not occur

39
Q

Treatment of syphilis

A

Single dose Benzadine penicillin G 2.4

40
Q

What reaction may occur when Ben Pen is given in treatment of syphilis?

A

Jarisch-Herxheimer reaction (40%) - pregnancy women may experience uterine contractions which resolve within 24 hrs

41
Q

If a woman has been treated before pregnancy, doe the neonate need testing?

A

Not at risk of re-infection so neonate does not need testing

42
Q

How are infants to mothers diagnosed and/or treated for syphilis during pregnancy tests for congenital syphilis?

A

RPR/VDRL ration and IgM at birth, then 3 monthly until negative

If remain stable or increased, evaluate and treat for congenital syphilis

43
Q

Which babies should be treated for congenital syphilis?

A

the case of:
- Infants with suspected congenital syphilis
- Infants born to mothers treated less than four weeks prior to delivery
- Infants of mothers treated with non-penicillin regimens
Infants born to untreated mothers
- Infants born to mothers who were inadequately treated or who have no documentation of being treated

MRCOG Antenatal Part 2 Revision - Hay (72 decks)

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