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