Intrauterine Infections Flashcards by Iseoluwa Ojo

Intrauterine infections: Infection of the ________ while ___________________.

They are usually acquired by ________ entry of the organism from the ________ ________ into the fetus, though infection may also occur during ________ through the ________.

fetus ; still inside the womb.

transplacental ; mother’s bloodstream

Passage ; birth canal.

How well did you know this?

Not at all

Perfectly

Intrauterine infections

Are referred to as the _________ infections
They are a group of _________, _________, and _________ infections that gain access to the fetal bloodstream _________ via the _____________.

TORCHES

viral, bacterial, and protozoan

transplacentally ;chorionic villi.

How well did you know this?

Not at all

Perfectly

TORCHES

Hematogenous transmission may occur at ______ time during gestation or occasionally at the time of _______ via ________________.

any

delivery

maternal-to-fetal transfusion

How well did you know this?

Not at all

Perfectly

T – _____________
O – _____________ infections (see below)
R – _____________
C – _____________
H – ___________________
S - _____________

T – Toxoplasmosis
O – Other infections (see below) R – Rubella
C – Cytomegalovirus
H – Herpes simplex virus 2
S - Syphilis

How well did you know this?

Not at all

Perfectly

A further expansion of this acronym, CHEAPTORCHES, was proposed by Ford-Jones and Kellner in 1995:
C – ____________ and ____________
H – ____________
E – ____________
A – ____________ (_______ infection)
P – ____________
T – Toxoplasmosis
O – Other (GBS, Listeria, Candida)

C – Chickenpox and shingles
H – Hepatitis B, C, (D)
E – Enteroviruses
A – AIDS (HIV infection)
P – Parvovirus B19
T – Toxoplasmosis

How well did you know this?

Not at all

Perfectly

•
The main routes of transmission of vertically transmitted infections are across the ________________ and across the female reproductive tract during ___________ .

placenta (transplacental)

childbirth.

How well did you know this?

Not at all

Perfectly

Transplacental: Several pathogens can cross the placenta and cause (perinatal) infection.
This can result in ________________ or major ________________________. For many infections, the baby is more at risk at particular stages of pregnancy.

Spontaneous (abortion)

developmental disorders

How well did you know this?

Not at all

Perfectly

During childbirth:
• During birth, babies are exposed to maternal blood, body fluids, and to the maternal genital tract without the placental barrier intervening. Because of this, ___________ microorganisms (hepatitis B, HIV), organisms associated with _________________ diseases (e.g. Neisseria gonorrhoeae, Chlamydia), and normal fauna of the __________________ (e.g. Candida albicans) can be transmitted to the newborns.

blood-borne

sexually transmitted

genitourinary tract

How well did you know this?

Not at all

Perfectly

Specific intrauterine infections
Toxoplasmosis:
• Causative Organism – ______________
Transmission
• ______________
• ______________ route
• Oocysts excreted in ______________
• Found in ______________, contaminated ______________, and unpasteurized ______________
• Risk of fetal infection _____eases with gestational age
• Severity of fetal infection ______eases with gestational age

Toxoplasma gondii

• Transplacental ; Fecal-oral

cat feces; undercooked meat,

water/soil ; goat milk

increases ; decreases

How well did you know this?

Not at all

Perfectly

Clinical Manifestations of toxoplasmosis

• First Trimester infection – often results in —————
• Second Trimester – classic triad
• a. __________
• b. __________
• c. __________

• Third Trimester – often __________ at birth

death

Hydrocephalus ; Intracranial calcifications

Chorioretinitis

asymptomatic

How well did you know this?

Not at all

Perfectly

Diagnosis of toxoplasmosis

• Definitive – __________ organism from placenta, serum, or CSF
• Also available – ______ & _____ titer (Ig____ will be elevated if mother is infected regardless of transmission)

Treatment •___________plus_________ plus __________ (_______ acid) for 1 year

Isolating ; PCR ; IgM

PyrimethamineplusSulfadiazine

Leucovorin ; folinic

How well did you know this?

Not at all

Perfectly

Rubella

Causative Organism - __________
Transmission
__________
__________ secretions
The fetus is at highest risk of developmental abnormalities when infected during the first ______ wk of gestation.

Togavirus

Transplacental ; Respiratory

16 wk

How well did you know this?

Not at all

Perfectly

Clinical Manifestations of rubella
• “_____________” rash due to extramedullary hematopoiesis
• ___________
• ___________ bone disease (long bones)
IUGR, glaucoma, hearing loss, pulmonary stenosis, patent ductus arteriosus, lymphadenopathy, jaundice, hepatosplenomegaly, thrombocytopenia, interstitial pneumonitis, diabetes mellitus.

LBlueberry Muffin”

Cataracts; Radiolucent

How well did you know this?

Not at all

Perfectly

Congenital Rubella
Rubella has its teratogenic effect when the pregnant mother contracts the disease especially in the (early or late?) weeks of gestation.

Causes congenital defects, miscarriages and stillbirth.

early

How well did you know this?

Not at all

Perfectly

Congenital Rubella Syndrome
The classic triad presentation of congenital rubella syndrome consists of the following:

CNS abnormalities esp _________ _________ and _________
Ocular abnormalities including _________, and infantile _________
Congenital heart disease including _________________ and ________________ is present in 50% of infants infected in the first ___________’ gestation.

sensorineural deafness ; microcephaly

cataract ; infantile glaucoma

patent ductus arteriosus (PDA) ; pulmonary artery stenosis

2 months’ gestation.

How well did you know this?

Not at all

Perfectly

Diagnosis of Congenital Rubella
• Culture from blood, urine, CSF, oral/nasal secretions
•_______ titer
Treatment
• Supportive care
Prevention: ___________ in childhood and adolescence

IgM

Rubella vaccine

How well did you know this?

Not at all

Perfectly

Cytomegalovirus (CMV)

Causative Organism – ________________
Transmission

________________

Perinatal (contact with ________ _______ during delivery or ________ after delivery)
Contact with bodily fluids (urine/saliva)

Postnatal infection also acquired from ________…day care centres and hospitals are important sources.

Human herpesvirus 5; Transplacental

vagina fluid ;breast milk

fomites.

__________ Is the most important cause of congenital infection in the developed world, commonly leading to mental retardation and developmental disability.

CMV

Most infections occur in infants born to mothers with preexisting immunity and are clinically asymptomatic at birth. Hence 85% mostly have mild disease
Approximately 10% of cases of congenital cytomegalovirus occur in women with ____________ during pregnancy, and 90% of these infants have _________ sequelae.

primary infection

neurological

Clinical manifestations of CMV
• Majority are ____________ at birth
• ____________ ____________
• ____________, developmental delay, _______cephaly, sensorineural hearing loss, retinitis, jaundice, hepatosplenomegaly, thrombocytopenia, hypotonia, lethargy, poor suck
• Preterm infants may appear ____________ – apnea, bradycardia, intestinal distension

asymptomatic

Periventricular calcifications

IUGR ;microcephaly,

septic

CMV contd
Investigations

• __________ virus in urine, saliva, blood and respiratory secretions (viral cultures)
• Other investigations: CT scan, ________ test, __________ exam. Baseline lab: CBC, LFT, CSF analysis, PCR

Treatment:
• Antiviral drugs-________[_ administered via ______ for ___________ in newborns with severe congenital CMV disease
• Supportive care

• Isolating ; hearing test; ophthalmologic exam.

ganciclovir ; IV ; six weeks

Herpes simplex virus
Causative Organism – _____________________________ . It is a _________-stranded, (naked or enveloped?), (DNA or RNA?) virus.

Human herpesvirus 1 & 2.

double ; enveloped

DNA

HSV

Transmission
Perinatal (contact with __________ during delivery)
Contact after __________ of __________
Direct contact with ————- areas
Infection occurs in a susceptible host following exposure of abraded skin or mucosal surfaces to the virus.
After inoculation, the virus travels to the ___________, where it replicates and establishes latency.

vaginal fluid ; rupture of membranes

affected areas ; sensory ganglion

Clinical manifestations of HSV:

Localized to skin, eyes, and mucosal
• ______ lesions on an ___________ base Keratoconjunctivitis, cataracts, chorioretinitis
• ___________ lesions of the mouth, palate, and tongue

CNS disease
• ___________, lethargy, _________, tremor, poor feeding, ___________ instability, _______ anterior fontanelle

Vesicular ; erythematous base

Ulcerative ; Seizure,

irritability ; temperature ; full

Clinical manifestations of HSV Disseminated disease • Multiple organ involvement (CNS, skin, eye, mouth, lung, liver, adrenal glands) • May appear ________ – fever/hypothermia, apnea, irritability, lethargy, respiratory distress • Hepatitis, ascites, direct hyperbilirubinemia, neutropenia, disseminated intravascular coagulation, pneumonia, hemorrhagic pneumonitis, necrotizing enterocolitis, meningoencephalitis, skin

septic

Diagnosis of HSV • __________ of CSF, ______ titers, HSV culture of a lesion Treatment of HSV • ________ IV at a dose of ____ mg/kg per day IV divided every ______ hours

PCR ; IgM Acyclovir ; 60 eight hours

Congenital syphilis Causative Organism – __________ _________ a ____________. Transmission ______________

Treponema pallidum spirochetes. Transplacental

Clinical manifestations of congenital syphylis : • Perinatal ________ may result from congenital infection in more than 40% of affected, untreated pregnancies. • Most affected infants are __________ at birth • Early Congenital Syphilis (symptoms at __________ of age) • __________ rash, “__________,” maculopapular rash, lymphadenopathy, hepatomegaly, poor feeding, thrombocytopenia, anemia, meningitis, chorioretinitis, osteochondritis, pneumonia, skin lesions. • Late congenital Syphilis (symptoms after __________ of age): __________ Teeth, __________ nose, __________ loss, etc

death ; asymptomatic 1-2 months ; Maculopapular rash, snuffles ; 2 years Hutchinson Teeth ; saddle nose hearing loss

Diagnosis of Congenital Syphillis • __________ microscopy • VDRL Treatment of Congenital Syphillis • ________

Dark field Penicillin

OTHERS: Congenital HIV infection 95% of paediatric HIV are acquired ___________ Period 1, before birth: The fetus is ___________ infected via the ___________ or the ___________ membranes, especially if the membranes are ___________. Period 2, delivery: (most, few , or some?) vertical infections occur during delivery. The length and the amount of contact the neonate has with infected maternal blood and vaginal secretions is contributory

vertically; haematologically placenta ; amniotic membranes inflamed.; Most

HIV contd Preterm and LBW neonates have an increased risk due to their reduced —————- and _________________. Period 3, after birth: Postnatal vertical transmission occurs with the _________ of HIV in the _________. Diagnosis: ________ to detect viral DNA in peripheral blod. Treatment: _________ drugs

skin barrier ; immunologic defenses ingestion ; breast milk. PCR ; ARV drugs

Hepatitis B virus HBV is a ________ -stranded (DNA or RNA?) virus The incubation period for HBV infection ranges from ________ to ________ Majority of infections occur at __________________

double ; DNA 6 weeks to 6 months time of delivery

HBV is a ( small or large?) virus and (does or does not?) cross the placenta, hence it (can or cannot?) infect the fetus unless there have been breaks in the maternal-fetal barrier, e.g. via ____________. Pregnant women who are infected with HBV can transmit their disease to their babies at ________. If not vaccinated at birth, many of these babies develop lifelong HBV infections, and many develop _________ or ___________ later in life. Prevention: ______________________________

large ; does not amniocentesis. ; birth. liver failure ; liver cancer Active and passive (HBIG) immunization

Congenital varicella ___________ , is caused by the ___________ virus The disease can be serious in neonates, depending on the ___________ of infection in the mother. Fetal exposure to the virus during the first ___________ of pregnancy (particularly during the ___________ to the ________ week of gestation) may result in congenital varicella syndrome. When VZV infection occurs later during pregnancy (i.e., second or third trimester), the developing fetus’ defense mechanisms against infection (fetal immune system) may be able to mount a response to the invading organism, typically resulting in a benign course.

Chickenpox ; varicella-zoster timing ; 20 weeks sixth ; 20th

If Congenital Varicella Syndrome develops within the final days before delivery, or within a day or two afterward, there is a risk of neonatal varicella that can be ________ and even ____________. Baby presents with the general features of ____________ in addition to cutaneous ____________ and ___________ Affected newborns may have _____ birth weight and characteristic abnormalities of the skin; the arms, legs, hands, and/or feet (extremities); the brain; the eyes; and/or, in rare cases, other areas of the body. Prevention: ________________

severe ; life-threatening. TORCHES ; vesicular rashes and scarring Varicella vaccine

Parvovirus Parvovirus B19 (B19V) is a ______-stranded DNA virus _____________ , perhaps the most serious complication of parvovirus B19 infection, occurs when a nonimmune woman is infected, usually in the first __________ of pregnancy. Associated pleural and pericardial effusions Can cause intrauterine anemia leading to congestive cardiac failure

single ; Hydrops fetalis 20 weeks

Zika Virus Zika virus disease (Zika) is a disease caused by the Zika virus, which is spread to people primarily through the ______ of an ________________________. Zika can be transmitted from a man to his sex partners.

bite infected Aedes species mosquito.

The Zika virus can spread from an infected mother to her fetus during pregnancy or at delivery T/F

Zika virus infection during pregnancy can cause ___________, as well as other severe fetal brain defects. Diagnosis: __________ to look for Zika virus

microcephaly blood tests

There is a vaccine to prevent or medicine to treat Zika virus. T/F

F There isn’t