Intrauterine Infections Flashcards
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.
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.
TORCHES
Hematogenous transmission may occur at ______ time during gestation or occasionally at the time of _______ via ________________.
any
delivery
maternal-to-fetal transfusion
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
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
•
The main routes of transmission of vertically transmitted infections are across the ________________ and across the female reproductive tract during ___________ .
placenta (transplacental)
childbirth.
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
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
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
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
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
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
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
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
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.
Diagnosis of Congenital Rubella
• Culture from blood, urine, CSF, oral/nasal secretions
•_______ titer
Treatment
• Supportive care
Prevention: ___________ in childhood and adolescence
IgM
Rubella vaccine
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
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
T
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
