Microbio - infections in pregnancy

Question 1

name 4 herpes viruses

Answer 1

HSV
VZV
CMV
EBV

Question 2

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

Answer 2

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

Symptoms: Painful vesicular rash
LNopathy
Fever

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

3rd trimester –> greatest risk of transmission to fetus

Question 6

Neonatal herpes - when does it present?

What are the signs/symptoms?

Answer 6

3days - 6wks post delivery

Lesions on skin/eyes/mouth

Neuro symptoms due to dissemination to brain

Question 7

Diagnosis of neonatal HSV infection?

Tx?

Answer 7

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

Tx: acyclovir

Question 8

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

Answer 8

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

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

Question 9

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?

Answer 9

Congenital varicella syndrome

Higher risk if infected in 2nd trimester

Worse in 3rd trimester

Question 10

Features of congenital varicella syndrome

Answer 10

Skin scarring
Limb hypoplasia
Cataracts
Cortical atrophy
Psychomotor retardation

Question 11

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

Answer 11

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

Question 12

Maternal complications of VZV infection during pregnancy - give 2

Answer 12

Increased risk of pneumonia

Encephalitis

Question 13

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

Answer 13

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

Question 14

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

Answer 14

If exposure was <10 days ago: give VZIG

Advise to stay away from other pregnant women for 4 weeks

Question 15

Management of pregnant woman who presents with VZV like rash

Answer 15

ORAL acyclovir

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

Question 16

CMV - clinical features?

How long does infection last?

Answer 16

Usually asymptomatic

Infection is lifelong - it is transmitted when it is reactivated

Question 17

3 Routes of CMV infection to the neonate?

Answer 17

Transplacental
Via genital secretions
Breastfeeding

Question 18

Most common cause of viral congenital infection?

Answer 18

CMV

Question 19

Effects of congenital CMV infection on the child?

Answer 19

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

Later, risk of hearing defects + impaired intellectual performance

Question 20

Risk factors for primary CMV infection during pregnancy?

Answer 20

Toddler at home, or being a childcare worker

Question 21

Dx of CMV in neonates?

Answer 21

PCR of urine/saliva

Question 22

Mx to prevent mother to child transmission of CMV?

Answer 22

none available

Question 23

Rubella - how is it transmitted?

Answer 23

Respiratory

Question 24

Symptoms of rubella infection in adults?

Answer 24

Fine macular rash
Lymphadenopathy
Prdrome

Question 25

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

Answer 25

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

Question 26

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

Answer 26

90%

Question 27

Congenital rubella syndrome - what causes this?

Answer 27

Pregnant mother infected with rubella before 10 weeks gestation

Question 28

Congenital rubella syndrome - features?

Answer 28

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

Question 29

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?

Answer 29

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?

Question 30

Rash distribution in measles?

Answer 30

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

Question 31

Rash distribution in rubella?

Answer 31

Starts on face and spreads downwards

Question 32

Measles: symptoms?

Answer 32

Prodrome: fever, coryza, cojunctivitis | Rash - starts behind ears/hairline, then spreads

Question 33

Complications of measles

Answer 33

Opportunistic bacterial infections Encephalitis Subacute sclerosing panencephalitis

Question 34

What are manifestations of measles infection of a pregnant woman?

Answer 34

Mother: maternal morbidity Fetus: Fetal loss + PTL

Question 35

Management of pregnant woman with measles contact/confirmed infection

Answer 35

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

Question 36

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

Answer 36

before 20 weeks gestation There is no documented risk after this

Question 37

How is the foetus affected if infected with parvovirus B19?

Answer 37

If before 20/40: | Risk of hydrous fetalis

Question 38

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

Answer 38

- Refer to fetal medicine | - Intrauterine transfusion

Question 39

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

Answer 39

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

Question 40

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

Answer 40

Erythema infectiosum Fever, malaise, slapped cheek, myalgia

Question 41

Name 3 enteroviruses

Answer 41

Polio Coxsackie A and B Echovirus

Question 42

How can enterovirus infection manifest? give 4

Answer 42

- Hand foot and mouth - Rash illness w fever - meningitis/encephalitis - myocarditis

Question 43

Coxsackie infection in pregnancy is associated with...?

Answer 43

IUD | Myocarditis, hepatitis

Question 44

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

Answer 44

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

Question 45

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

Answer 45

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

Question 46

Zika virus - how does it affect normal healthy individuals?

Answer 46

80% ASYMPTOMATIC Otherwise general: fever, myalgia, rash, headache, red eyes

Question 47

5 features of congenital Zika syndrome

Answer 47

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

Question 48

Current advice to women

Answer 48

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