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Year 5 Path COPY WAKANA > Microbio - infections in pregnancy > Flashcards

Microbio - infections in pregnancy Flashcards

1
Q

name 4 herpes viruses

A

HSV
VZV
CMV
EBV

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2
Q

HSV1+2 infection in a normal adult.
How long is the incubation period for oral infection? for genital infection?
Symptoms?

A

Oral infection - 2 to 12 days
Genital - 4 to 7 days

Symptoms: Painful vesicular rash
LNopathy
Fever

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3
Q

Route of infection of the foetus/neonate with HSV? give 3

A
  1. PROM –> ascending infection
  2. Infected genital secretions during delivery
  3. Kissing –> oral herpes
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4
Q

Mx of pregnant women with 1st symptomatic attack of HSV?

A

Refer to GUM
Acyclovir
Type-specific HSV antibody testing
Recommend CS if infection is in final 6 weeks of pregnancy

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5
Q

When in pregnancy is genital HSV infection the most risky? why?

A

3rd trimester –> greatest risk of transmission to fetus

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6
Q

Neonatal herpes - when does it present?

What are the signs/symptoms?

A

3days - 6wks post delivery

Lesions on skin/eyes/mouth

Neuro symptoms due to dissemination to brain

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7
Q

Diagnosis of neonatal HSV infection?

Tx?

A

Neonatal swabs for PCR - oral/rectal/mucosal/umbilical

Tx: acyclovir

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8
Q

VZV infection in normal patients - what are the symptoms? when is it infectious?

A

Prodromal fever + myalgia
Maculopapular rash –> vesicles –> crust in CROPS

Infectious from 48hours before onset of rash –> rash has crusted over

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9
Q

Fetal complications if mother gets VZV in pregnancy? at what point in pregnancy is this risk of transmission higher? what point in pregnancy are complications worse?

A

Congenital varicella syndrome

Higher risk if infected in 2nd trimester

Worse in 3rd trimester

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10
Q

Features of congenital varicella syndrome

A 
Skin scarring
Limb hypoplasia
Cataracts
Cortical atrophy
Psychomotor retardation
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11
Q

Route of infection of neonate with VZV during 3rd trimester/delivery?

A
  • transplacental
  • ascending from vagina
  • direct contact with lesions during delivery
  • contact with other infected person in early life
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12
Q

Maternal complications of VZV infection during pregnancy - give 2

A

Increased risk of pneumonia

Encephalitis

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13
Q

How to manage a pregnant women who is confirmed to have no Ig against VZV?

A
  • Offer postpartum vaccination
  • Advise to STAY AWAY from infected people
  • Advise to see HCP immediately if they are potentially exposed to it
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14
Q

How to manage a pregnant woman who is confirmed to have no immunity against VZV and have been exposed to it?

A

If exposure was <10 days ago: give VZIG

Advise to stay away from other pregnant women for 4 weeks

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15
Q

Management of pregnant woman who presents with VZV like rash

A

ORAL acyclovir

  • Isolate from other pregnant women + neonates until lesions have crusted over
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16
Q

CMV - clinical features?

How long does infection last?

A

Usually asymptomatic

Infection is lifelong - it is transmitted when it is reactivated

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17
Q

3 Routes of CMV infection to the neonate?

A

Transplacental
Via genital secretions
Breastfeeding

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18
Q

Most common cause of viral congenital infection?

A

CMV

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19
Q

Effects of congenital CMV infection on the child?

A

Most are asymptomatic. But neonates may have IUGR/jaundice/hepatosplenomegaly/encephalitis/microcephaly BUT

Later, risk of hearing defects + impaired intellectual performance

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20
Q

Risk factors for primary CMV infection during pregnancy?

A

Toddler at home, or being a childcare worker

21
Q

Dx of CMV in neonates?

A

PCR of urine/saliva

22
Q

Mx to prevent mother to child transmission of CMV?

A

none available

23
Q

Rubella - how is it transmitted?

A

Respiratory

24
Q

Symptoms of rubella infection in adults?

A

Fine macular rash
Lymphadenopathy
Prdrome

25
Q

When is the most dangerous time for pregnant women to get rubella infection?

A

1st trimester - after 20weeks, there is no risk to the fetus

26
Q

how common are fetal defects in rubella infection before 10 weeks gestation?

A

90%

27
Q

Congenital rubella syndrome - what causes this?

A

Pregnant mother infected with rubella before 10 weeks gestation

28
Q

Congenital rubella syndrome - features?

A

EYES: cataracts, glaucoma, pigmentary retinopathy
EARS: loss of hearing
HEAD: microcephaly, mental retardation, meningoencephalopathy
OTHER: congenital heart disease, splenomegaly, purpura

29
Q

A call from the GP: 30 yr old woman
Second pregnancy
A child at playgroup has a rash
What should I do?

What questions would you ask the GP?

A

Describe the rash: distribution? fine? in crops?

Timing: when did the rash appear? date of contact? type of contact

Previous exposure/immunisation: has the mother ever had VZV? has mother ever had MMR vaccine?

30
Q

Rash distribution in measles?

A

Rash starts at hairline/being ears/forehead, then spreads across head

31
Q

Rash distribution in rubella?

A

Starts on face and spreads downwards

32
Q

Measles: symptoms?

A

Prodrome: fever, coryza, cojunctivitis

Rash - starts behind ears/hairline, then spreads

33
Q

Complications of measles

A

Opportunistic bacterial infections
Encephalitis
Subacute sclerosing panencephalitis

34
Q

What are manifestations of measles infection of a pregnant woman?

A

Mother: maternal morbidity

Fetus: Fetal loss + PTL

35
Q

Management of pregnant woman with measles contact/confirmed infection

A

Measles Ig = attenuates the illness but doesn’t reduce risk of fetal loss or PTL

36
Q

At what point in pregnancy is parvovirus B19 infection a danger?

A

before 20 weeks gestation

There is no documented risk after this

37
Q

How is the foetus affected if infected with parvovirus B19?

A

If before 20/40:

Risk of hydrous fetalis

38
Q

How to manage a pregnant women infected with parvovirus B19 at <20/40?

A
  • Refer to fetal medicine

- Intrauterine transfusion

39
Q

Most serious consequence of parvovirus B19 infection in a child? who is at risk?

A

Aplastic crisis - occurs in children with chronic haemolytic anemias (eg SCD, thalassemia) and immunodeficiency

40
Q

Most common manifestation of parvovirus B19 infection in otherwise healthy child?

A

Erythema infectiosum

Fever, malaise, slapped cheek, myalgia

41
Q

Name 3 enteroviruses

A

Polio
Coxsackie A and B
Echovirus

42
Q

How can enterovirus infection manifest? give 4

A
  • Hand foot and mouth
  • Rash illness w fever
  • meningitis/encephalitis
  • myocarditis
43
Q

Coxsackie infection in pregnancy is associated with…?

A

IUD

Myocarditis, hepatitis

44
Q

Pregnant woman with rash presents. What do you need to ask in Hx?

A 
Gestation
Describe rash - distribution? timing? associated features
Previous infections?
Past immunisations
Any known contacts with rash?
Travel Hx
45
Q

Pregnant woman with rash presents. What Ix do you order?

A

Check antenatal booking bloods
Swab/scrape from rash
Test for antibodies in serum

46
Q

Zika virus - how does it affect normal healthy individuals?

A

80% ASYMPTOMATIC

Otherwise general: fever, myalgia, rash, headache, red eyes

47
Q

5 features of congenital Zika syndrome

A
  1. Microcephaly + skull deformities
  2. Seizures
  3. Retinopathy, deafness
  4. Club foot
  5. Hypertonia
48
Q

Current advice to women

A

Avoid trying for baby until 6 months after travel to a Zika area (viral shedding in semen)

If pregnant - avoid travel to Zika area

Year 5 Path COPY WAKANA (63 decks)

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