Infectious diseases pregnancy - TORCH Flashcards by Anna Hay

What is the incubation of parvovirus? How is it spread?

Respiratory

5-10days

How well did you know this?

Not at all

Perfectly

When does the rash appear with parvovirus?

Rash does not occur until 17-18 days after infection and about 5 days after the disappearance of virus from serum and respiratory droplets.

Therefore patients presenting with the clinical features of infection are usually no longer infectious

How well did you know this?

Not at all

Perfectly

What % of people are sero+ve?

60%

How well did you know this?

Not at all

Perfectly

How do children commonly present with parvovirus?

Erythema infectious/fifths disease ‘slapped-cheek’

Fever, facial rash

How well did you know this?

Not at all

Perfectly

How do adults present B19?

Variable
Some asymptomatic
Fever, malaise, arthraligia
Rare - aplastic crisis

How well did you know this?

Not at all

Perfectly

Risk of vertical transmission:
<15 weeks
15-20 weeks
Term
Generally

<15: 15%
15-20% - 25%
Term 70%
30%

How well did you know this?

Not at all

Perfectly

Risks to pregnancy effected by parvovirus?

Fetal death 5-10% (highest risk 2nd tri)
Nonimmune fetal hydrops - 3% 9-20 weeks
Fetal anaemia

How well did you know this?

Not at all

Perfectly

If B19 IgM +ve what does this suggest

Recent infection, will be detect days 3 after symptoms but can remain high for up to 6 months

If negative repeat after 2-3 weeks

How well did you know this?

Not at all

Perfectly

If B19 IgG +ve what does this suggest

Immunity, rises on day 7 but remains high for life

How well did you know this?

Not at all

Perfectly

IgG and IgM -ve

Susceptible

How well did you know this?

Not at all

Perfectly

What other infections should you always test for?

Rubella

How well did you know this?

Not at all

Perfectly

If maternal Dx of parvovirus is confirmed, how should the foetus be monitored?

Refer FMU 4 weeks after onset of Sx, for serial USS and doppler
Assessing for anaemia, heart failure and hydros
1-2 weeks MCA and peak systolic velocity

How well did you know this?

Not at all

Perfectly

B19 when should cordiocentesis be considered/

If MCA peak systolic resistance is >18

How well did you know this?

Not at all

Perfectly

Who is at higher risk of aplastic crisis with B19?

Sickle cell, heredity anaemias (spherocytosis, thalassaemia, pyruvate kinase deficicency ,auto-immune haemolytic anaemia

How well did you know this?

Not at all

Perfectly

How Is Rubella spread?

Resp droplet

How well did you know this?

Not at all

Perfectly

What % of infected with rubella have symptoms?

What symptoms may there experience?

50-75%

Fever, rash, arthralgia, lymphadenopathy (post-auricular/sub-occiptal)

How well did you know this?

Not at all

Perfectly

Describe finding with congenital rubella syndrome?

Eyes - cataracts, retinopathy, glaucoma
Heart - patent ductus/valve stenosis, VSD
Ear - deafness

How well did you know this?

Not at all

Perfectly

What is the risk of congenital rubella syndrome? Management?
< 11 weeks

90% - Offer TOP

How well did you know this?

Not at all

Perfectly

What is the risk of congenital rubella syndrome? Management?
11-16 weeks

10-20%, deafness common = Amniocentesis

How well did you know this?

Not at all

Perfectly

What is the risk of congenital rubella syndrome? Management
> 20 weeks

No babies effected.- NAD

How well did you know this?

Not at all

Perfectly

What advice should you give a person who has rubella

Inform PHE (notifiable)
Avoid contact with pregnancy women, stay off work, contact health protection taeam

How well did you know this?

Not at all

Perfectly

How is measles spread

Resp illness

How well did you know this?

Not at all

Perfectly

What type of pathogen is measles?

Single-stranded, enveloped RNA virus

How well did you know this?

Not at all

Perfectly

What is the common presentation of measles?

Prodrome: Fever, malaise, cough, coryza & conjucitivits
3-4 days later
Maculopapular rash, head to truck to lower extremes
Koplik spots - small white lesions on erythematous base.

Incubation of measles?

10-12 days, rash appears 14 days after expose

When is someone with measles infective?

4 days before to 4 days after onset of rash

If susceptible what % of people expose to measles will become infected

90%

Possible compilations of measles to mother?

Pneumonia Encephalitis Preg women - high risk morbidity/mortaility 4-10 years later subacute sclerosing pan encephalitis

Management of non-immune pregnant women who are exposed to measles?

IVIG within 6 days of exposure

How should patients with measles be managed?

Supporive, isolated in airborne isolation room.

Impact of measles on foetus?

No increased in congenital abnormalities Increased risk - low birth weight - NICU - pregnancy loss - neonatal mortality

When is congenital measles most likely to occur?

Presence of rash at birth or within 1st 10 days of life Risk mortality and subacute sclerosis panencephlitis

What is the most common congenital viral infection in pregnancy?

Cytomegalovirus

What type of pathogen is cytomegalovirus?

DNA

Most common maternal symptoms of cytomegalovirus?

Asymptomatic - self-limiting febrile illness If immunocompromised - pneumonia, hepatitis

Risk of fetal infection with primary infection of cytomegalovirus?

30-40% Risk highest in 1st/early 2nd trimester

Risk of fetal infection with reactivation of cytomegalovirus?

1-2%

What % of women seroconvert cytomegalovirus in pregnancy?

What is the incubation of cytomeaglovirus?

3-12 weeks

How is cytomegalovirus spread?

Sexual contact/bodily fluids (blood/breast/urine)

What % of congenital CMV show symptoms at birth? What % later become symptomatic?

90% show no manifestation at birth (10% do) A further 10% later develop signs in later life

What is the most common cause of congenital sensorineural deafness?

Cytomegalovirus

Fetal risks of CMV

Sensorineural deafness Hepatopsplenomegaly IUGR Microcepahly Thrombocytopenia Seizures

How to diagnose fetal infection of CMV?

Amniocentesis 6-8 weeks after seroconversion/reactiveation or >20 weeks

How to manage pregnancy if fetal CMV confirmed?

Detailed USS every 2-3 weeks Fetal MRI 28-32 weeks

If high avidity IgG CMV are high (>60%), what does this mean

Suggests infection >3 months ago

Advise to avoid contracting CMV - consider for women working in childcare who are pregnancy

Wash hands after changing nappies, wash toys, avoid charing food/cutlery with children, avoid kissing young children

What type of pathogen is toxoplasmosis?

Obligate intracellular protozoan

What is the incubation period of toxoplasmosis

5-23 days

How is toxoplasmosis spread?

Becomes sexually mature in cat intestines, producing oocysts which are excreted in stool. Infection occurs through ingestion of contaminated food including vegetable or infected meat.

Presentation in adults?

Human infection usually asymptomatic / produces glandular fever - like illness. Lymphadenopathy involving the posterior cervical chain is commonest clinical manifestaton.

What % of women become infected with toxoplasmosis during pregnancy?

1:500

Risk of fetal infection with toxoplasmosis if primary infection occurs in: 1st trimester

17%

Risk of fetal infection with toxoplasmosis if primary infection occurs in: 2nd trimester

25%

Risk of fetal infection with toxoplasmosis if primary infection occurs in: 3rd trimester

60%

Risk to foetus with toxoplasmosis infection in pregnancy

10% Eye problems only - choriorentinitis can lead to blindness 20-30% - multiple anomalies - hydrocephalus, cerebral microcalcifications, jaundice, thrombocytopenia 60% no symptoms Organ most commonly effect is the eyes 👀

How to Dx toxoplasmosis in pregnancy, in mother and foetus

Mother - serology - high IgM or 4 fold increase IgG Fetus - amniocentesis 6 weeks after seroconversion

What medication can given to reduce the risk of transmission of toxoplasmosis? By what % do these medications reduce the risk of transmission?

Spiromycin or Pyrimethamine + sulfadazine and colonic acid 70%