Microbio - infections in pregnancy Flashcards
name 4 herpes viruses
HSV
VZV
CMV
EBV
HSV1+2 infection in a normal adult.
How long is the incubation period for oral infection? for genital infection?
Symptoms?
Oral infection - 2 to 12 days
Genital - 4 to 7 days
Symptoms: Painful vesicular rash
LNopathy
Fever
Route of infection of the foetus/neonate with HSV? give 3
- PROM –> ascending infection
- Infected genital secretions during delivery
- Kissing –> oral herpes
Mx of pregnant women with 1st symptomatic attack of HSV?
Refer to GUM
Acyclovir
Type-specific HSV antibody testing
Recommend CS if infection is in final 6 weeks of pregnancy
When in pregnancy is genital HSV infection the most risky? why?
3rd trimester –> greatest risk of transmission to fetus
Neonatal herpes - when does it present?
What are the signs/symptoms?
3days - 6wks post delivery
Lesions on skin/eyes/mouth
Neuro symptoms due to dissemination to brain
Diagnosis of neonatal HSV infection?
Tx?
Neonatal swabs for PCR - oral/rectal/mucosal/umbilical
Tx: acyclovir
VZV infection in normal patients - what are the symptoms? when is it infectious?
Prodromal fever + myalgia
Maculopapular rash –> vesicles –> crust in CROPS
Infectious from 48hours before onset of rash –> rash has crusted over
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?
Congenital varicella syndrome
Higher risk if infected in 2nd trimester
Worse in 3rd trimester
Features of congenital varicella syndrome
Skin scarring Limb hypoplasia Cataracts Cortical atrophy Psychomotor retardation
Route of infection of neonate with VZV during 3rd trimester/delivery?
- transplacental
- ascending from vagina
- direct contact with lesions during delivery
- contact with other infected person in early life
Maternal complications of VZV infection during pregnancy - give 2
Increased risk of pneumonia
Encephalitis
How to manage a pregnant women who is confirmed to have no Ig against VZV?
- Offer postpartum vaccination
- Advise to STAY AWAY from infected people
- Advise to see HCP immediately if they are potentially exposed to it
How to manage a pregnant woman who is confirmed to have no immunity against VZV and have been exposed to it?
If exposure was <10 days ago: give VZIG
Advise to stay away from other pregnant women for 4 weeks
Management of pregnant woman who presents with VZV like rash
ORAL acyclovir
- Isolate from other pregnant women + neonates until lesions have crusted over
CMV - clinical features?
How long does infection last?
Usually asymptomatic
Infection is lifelong - it is transmitted when it is reactivated
3 Routes of CMV infection to the neonate?
Transplacental
Via genital secretions
Breastfeeding
Most common cause of viral congenital infection?
CMV
Effects of congenital CMV infection on the child?
Most are asymptomatic. But neonates may have IUGR/jaundice/hepatosplenomegaly/encephalitis/microcephaly BUT
Later, risk of hearing defects + impaired intellectual performance
Risk factors for primary CMV infection during pregnancy?
Toddler at home, or being a childcare worker
Dx of CMV in neonates?
PCR of urine/saliva
Mx to prevent mother to child transmission of CMV?
none available
Rubella - how is it transmitted?
Respiratory
Symptoms of rubella infection in adults?
Fine macular rash
Lymphadenopathy
Prdrome
When is the most dangerous time for pregnant women to get rubella infection?
1st trimester - after 20weeks, there is no risk to the fetus
how common are fetal defects in rubella infection before 10 weeks gestation?
90%
Congenital rubella syndrome - what causes this?
Pregnant mother infected with rubella before 10 weeks gestation
Congenital rubella syndrome - features?
EYES: cataracts, glaucoma, pigmentary retinopathy
EARS: loss of hearing
HEAD: microcephaly, mental retardation, meningoencephalopathy
OTHER: congenital heart disease, splenomegaly, purpura
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?
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?
Rash distribution in measles?
Rash starts at hairline/being ears/forehead, then spreads across head
Rash distribution in rubella?
Starts on face and spreads downwards
Measles: symptoms?
Prodrome: fever, coryza, cojunctivitis
Rash - starts behind ears/hairline, then spreads
Complications of measles
Opportunistic bacterial infections
Encephalitis
Subacute sclerosing panencephalitis
What are manifestations of measles infection of a pregnant woman?
Mother: maternal morbidity
Fetus: Fetal loss + PTL
Management of pregnant woman with measles contact/confirmed infection
Measles Ig = attenuates the illness but doesn’t reduce risk of fetal loss or PTL
At what point in pregnancy is parvovirus B19 infection a danger?
before 20 weeks gestation
There is no documented risk after this
How is the foetus affected if infected with parvovirus B19?
If before 20/40:
Risk of hydrous fetalis
How to manage a pregnant women infected with parvovirus B19 at <20/40?
- Refer to fetal medicine
- Intrauterine transfusion
Most serious consequence of parvovirus B19 infection in a child? who is at risk?
Aplastic crisis - occurs in children with chronic haemolytic anemias (eg SCD, thalassemia) and immunodeficiency
Most common manifestation of parvovirus B19 infection in otherwise healthy child?
Erythema infectiosum
Fever, malaise, slapped cheek, myalgia
Name 3 enteroviruses
Polio
Coxsackie A and B
Echovirus
How can enterovirus infection manifest? give 4
- Hand foot and mouth
- Rash illness w fever
- meningitis/encephalitis
- myocarditis
Coxsackie infection in pregnancy is associated with…?
IUD
Myocarditis, hepatitis
Pregnant woman with rash presents. What do you need to ask in Hx?
Gestation Describe rash - distribution? timing? associated features Previous infections? Past immunisations Any known contacts with rash? Travel Hx
Pregnant woman with rash presents. What Ix do you order?
Check antenatal booking bloods
Swab/scrape from rash
Test for antibodies in serum
Zika virus - how does it affect normal healthy individuals?
80% ASYMPTOMATIC
Otherwise general: fever, myalgia, rash, headache, red eyes
5 features of congenital Zika syndrome
- Microcephaly + skull deformities
- Seizures
- Retinopathy, deafness
- Club foot
- Hypertonia
Current advice to women
Avoid trying for baby until 6 months after travel to a Zika area (viral shedding in semen)
If pregnant - avoid travel to Zika area
