Mi - Viral Infections in Pregnancy Flashcards
causes of a rash in pregnant women
VZV
EBV
HSV
CMV
parvovrius b19
enterovrius
measles
rubella
who gets CMV
chemo / AI pts
name some herpes viruses
HSV, VZV, CMV, EBV
what type of virus is herpes
DNA
can herpes viruses be cleared
no - cause lifelong latent infection reactivated under stress
how is HSV transmitted
close contact
sx of herpes
asymptomatic
painful vesicualr rash
lymphadenopathy
fever
Dx for herpes
viral detection - lesion swab for PCR
serology
how can foetus be infected with HSV
active rash in mothers genitals then PROM
how can neonates get HSV
kissing baby with oral herpes
direct contact with mothers infected secretions in delivery
3 types of HSV infection
primary - 1st time infected
non primary - prev infection with a type of HSV then ifnected with another
recurrent - latent reactivation
2 risks of HSV in pregnancy
vertical transmission - greatest if active infection in 3rd trimester
in utero infection - primary infection causing miscarriage / congenital abnormalities
Tx of HSV in preg
acyclovir suppression 6 weeks pre birth
Ix for HSV in preg
GUM referral to look for other STIs
HSV AB testing
acyclovir
C section if within 6 weeks pre birth
3 types of neonatal HSV
skin eye mouth (SEM)
CNS involvement
dissemninated
Sx, time frame of occurence and prognosis of SEM HSV in neonates
benign
first 14 days or up to 6 weeks
high risk of progression to CNS
Sx, time frame of occurence and Ix of CNS HSV in neonates
seizures, lethargy, irritability, poor feeding
2-3 weeks of life, up to 6
LP
Sx, time frame of occurence and prognosis of disseminated HSV in neonates
like sepsis - multi organ involvement
1st week of life
death, too late to treat here
Tx of neonatal HSV
acyclovir
incubation of VZV
7 to 13 days
timeline of VZV course
get infection
24hrs later, rash starts
lesions crusted over 5-7 days after
complications of maternal varicella
10% varicella pneumonia
encephalitis (rare)
3 types of congenital varicella syndrome
in utero
perinatal
postnatal
Sx of congenital varicella syndrome
neuro abnormalities
occular abnormalities
low birth weight
GI abnormalities
limb abnormalities & skin scarring
when would you Ix a pregnant woman with VZV for ?Tx
if no previous chicken pox or vaccination
when would you offer Tx to VZV pregnant woman
if VZV IGG <100
Tx for VZV pregnant woman
oral acyclovir 800mg or oral valaciclovir 1000mg
what % of people have CMV by 16 years old
40%
transmission and incubation of CMV
saliva / resp secretions / urine
4-8 weeks
Sx of CMV
mostly none
maculopapular rash, sore throat, temp, glands
Ix of CMV
PCR of urine / saliva
serology +/- bronchoscopy
when is the biggest risk to baby with CMV infection
3rd trimester
Sx of CMV for foetus
encephalitis
microcephaly
ventriculomegaly
–> poor development
jaundice
thrombocytopenia
hepatosplenomegaly
chroioretinitis
when is CMV tested for in baby
Guthrie card in 1st week of life
Ix for CMV for mother
check serology & compare to 8 week booking scan
USS +/- amniocentesis
Tx for CMV
NONE
conjunctivitis, rash, cough, fever, koplik spots. Dx?
measles
headache, low fever, sore throat, spots on soft palate. lymphadenopathy. Dx?
rubella
contrast the rashes of measles and rubella
measles = rash starts at hair line / behind ears and goes to chest over 3 days
rubella = rash starts on face then spreads to chest within hours
Ix of rubella
buccal swab for PCR and serology
when is rubella most a problem for foetus & what happens
1st trimester - pre 8 weeks = miscarriage, pre 10 weeks = 90% have foetal defects
rubella after 20 weeks gestation. prognosis?
FINE
congenital rubella syndrome Sx in neonate?
microcephaly
cataracts
retinopathy
bone lesions
purpura
hepatosplenomegaly
PDA heart
congenital rubella syndrome Sx developing in older child?
panencephalitis
hearing loss
DM
intelectual disability
thyroid dysfunction
complications for mother of measles in preg
secondary bacterial infections
otitis media / pneumonia / GI
encephalitis
measles Sx for foetus
foetal loss *** main one
preterm delivery
no congenital abnormalities
subacute sclerosing panencephalitis
Sx of SSPE & onset
progressive neuro Sx and neuro degeneration
7-10 years post infection
in whom in parvovirus b19 a particular worry and why
sickle cell pts - causes aplastic crisis
Sx of parvovirus in pregnancy
mostly none
erythema infectiosum / slapped cheek
polyarthropathy
when are you infectious in parvovirus
6 days post exposure to 1 week
parvovirus Sx in foetus before 20 weeks
hydrops fetalis 3% - accumulation of fluid in soft tissue, leads rapidly to death
foetal anomalies 1%
foetal loss 7%
parvovirus Sx in foetus after 20 weeks
none
enterovirus / hand, foot, mouth prognosis in preg women
usually fine, no severe outcomes
enterovirus / hand, foot, mouth prognosis/complications in neonates
myocarditis, hepatitis, encephalitis, bleeding, multi organ failure
complications for neonate from zika
microcephaly !!!
brain damage
seizures
limb movement issues