Microbiology 11 - Viral infections in pregnancy

Question 1

most common manifestation of congenital rubella

Answer 1

SNHL

Question 2

Classic triad of rubella seen at birth

Answer 2

Microcephaly
Cataracts
PDA

Question 3

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

Answer 3

In the first trimester, >20 weeks the risk of congenital infection is negligible

Question 4

Symptoms of rubella infection in adults?

Answer 4

Fine maculopapular rash
Lymphadenopathy
Prodrome

Question 5

treatment of rubella

Answer 5

no antiviral treatment available

Question 6

HHV5 - what is it also known as?

Answer 6

cytomegalovirus

Question 7

what is the most common congenital viral infection?

Answer 7

CMV

Question 8

CMV type of virus and mode of transmission?

Answer 8

DNA, vertically in utero/delivery/breast feeding or horizontally via saliva

Question 9

when can you diagnose congenital CMV infection?

Answer 9

CMV DNA <3 weeks life

Question 10

what is the leading cause of SNHL?

Answer 10

CMV

Question 11

CMV - clinical features?

How long does infection last?

Answer 11

Usually ASYMPTOMATIC

infection is lifelong, it is transmitted when it is reactivated

Question 12

what % of those infected with CMV are asymptomatic at birth?

Answer 12

90%

Question 13

Effects of congenital CMV infection on the child?

Answer 13

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

Later, risk of hearing defects + impaired intellectual performance (affects the CNS)

Question 14

Dx of CMV in neonates?

Answer 14

PCR blood/urine/saliva

Question 15

management of CMV

Answer 15

if have significant organ disease –> valganciclovir (PO)/galnciclovir (IV) for 6 months
audiology follow up until 6 months age
Ophthalmology review

Question 16

acquisition of HSV at what time poses the greatest risk to foetus?

Answer 16

near delivery/ <6weeks of EDD (Recommend CS)

Question 17

when does most HSV transmission to foetus occur?

Answer 17

Peripartum

Question 18

Neonatal herpes - signs and symptoms

Answer 18

SEM = skin, eye and mouth disease: scarring, active lesions, hyper/hypopigmentation, microphthalmia, chorioretinits

CNS disease: seizures, irritability, lethargy etc

Disseminated infection involving many organs e.g. DIC, hepatitis, pneumonitis , encephalitis (HIGH mortality)

Question 19

management of HSv in neonate

Answer 19

if SEM; 14 days IV aciclovir

21 days IV acyclovir disseminated or CNS disease

Question 20

diagnosis of HSV

Answer 20

HSV PCR - neonatal swabs

Question 21

WHEN IS risk of VZV infection highest in pregnant woman?

Answer 21

13-20 weeks (2nd trimester)

Question 22

what are the risks of shingles during pregnancy?

Answer 22

Does NOT pose a risk

Question 23

Features of congenital varicella syndrome

Answer 23

Skin scarring
limb hypoplasia
chorioretinitis, cataracts
IUGR
Microcephaly

Question 24

Maternal complications of VZV infection during pregnancy

Answer 24

pneumonia, encephalitis, sepsis

Question 25

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

Answer 25

If exposure was <10 days ago and <20/40: give VZIG

Advise to stay away from other pregnant women for 4 weeks

Question 26

Management of pregnant woman who presents with VZV like rash

Answer 26

ORAL acyclovir if <24 hours since onset

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

Question 27

how is parvovirus b19 transmitted?

Answer 27

respiratory droplets and blood

Question 28

clinical presentation of parvovirus B19

Answer 28

Erythema infectiosum (fifth disease), arthralgia, transient aplastic crisis, non-immune hydrops fetalis

Question 29

pathophysiology of parvovirus B19

Answer 29

It has a tropism for rapidly dividing erythrocyte precursors and it suppresses erythrogenesis

Question 30

the outcome of congenital parvovirus b19 infection

Answer 30

virus crosses placenta and destroys foetal RBCs –> foetal anaemia –> high output cardiac failure –> hydrops fetalis

Question 31

when is the worst gestation to get parvovirus infection

Answer 31

<20 BAD (50% mortality if untreated)

>20/40 risk negligible

Question 32

diagnosis of parvovirus B19

Answer 32

PCR and serology

foetus: blood and amniotic fluid samples for PCR virus

Question 33

treatment of foetal parvovirus B19 infection

Answer 33

referral to foetal medicine unit
intrauterine blood transfusion
If child survives hydrops stage, survival quite good

Question 34

Rash distribution in measles?

Answer 34

rash starts behind the ears and then spreads to forehead and rest of body

Question 35

Rash distribution in rubella?

Answer 35

starts on face and spreads downwards

Question 36

Measles: symptoms?

Answer 36

Prodrome: fever, coryza, cojunctivitis, Koplik spots

Rash - starts behind ears/hairline, then spreads

Question 37

Complications of measles

Answer 37

Otitis media, pneumonia, hepatitis, encephalitis, SSPE (6-15 years later)

Question 38

What are manifestations of measles infection of a pregnant woman?

Answer 38

the risk of measles in pregnancy is mainly to the MOTHER
Mother: increased maternal morbidity
Foetus: PTL, foetal loss, NO congenital abnormality

Question 39

treatment of measles

Answer 39

measles IVIG if <6 days of exposure, doesn’t reduce risk of PTL or foetal loss

Question 40

Zika virus - how does it affect normal healthy individuals?

Answer 40

80% ASYMPTOMATIC

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

Question 41

5 features of congenital Zika syndrome

Answer 41

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

Question 42

Current advice to women

Answer 42

Men do not conceive until 6 months after return from Zika area e.g. South America, Central America, Carribbean. Women do not until 2 months after.
Abnormalities usually detected 2nd or 3rd trimester