perinatal infections Flashcards
infection when during pregnancy causes congenital infection with the following organisms:
- toxo
- syphilis
- parvo
- vzv
- rubella
- cmv
- hsv
- zika
- toxo: throughout
- syphilis: throughout
- parvo: up to 20/40
- vzv: first trim
- rubella: up to 20/40
- cmv: first 6 months
- hsv: throughout
- up to 20/40
EXAM THOUGHTS - congenital infection + this = what?
a. heart
b. intracranial calcification
c. hydrocephalus
d. syphilis
a. Rubella = heart
b. CMV = intracranial calcification (though toxo can have this in its triad)
c. Toxo = hydrocephalus
d. Syphilis = bones
causes of blueberry muffin rash
classic for rubella
also:
toxo
CMV
HSV
parvo
syphilis
neonatal treatment for congenital:
- toxo
- syphilis
- CMV
- HSV
- toxo: Pyrimethamine + sulphadoxine +/- spiramycin for one year
- syphilis: 10 days with benzylpenicillin or procaine penicillin
- CMV: ganciclovir (IV), valganciclovir (PO)
- HSV: aciclovir
types of bugs for perinatal:
A) early onset sepsis
B) viral infection
EOS: GBS, E.Coli, listeria
viruses: VZV, HSV, enterovirus
non-specific symptoms of all TORCH Infection
SGA / poor growth
hepslenmegaly
jaundice
thrombocytopaenia
most common congenital infection
CMV
most common cause of non hereditary SNHL
CMV
asymptomatic vs symptomatic congenital CMV infection from PRIMARY maternal infection - %
asymptomatic 90% - most have mild SNHL as older kids
symptomatic 10%
transmission rate to foetus of PRIMARY maternal CMV infection
30-50%
CMV infection in early pregnancy vs late pregnancy - outcomes
early = more neuro outcomes
late = acute visceral disease e.g. hepatitis, pneumonia
key features of CMV: neonatal and long term
neonatal: non-specific, + SNHL
long term: neuro
- periventricular calcifications
- seizures, chorioretinitis
- SNHL
- microcephaly
toxo: pregnant mother symptoms/signs vs neonate
pregnant mother: often asymptomatic +/- LN
neonate = CLASSIC TRIAD with those non-spec TORCH sx:
1) chorioretinitis
2) hydrocephalus
3) intracranial calcifications
(blueberry muffin rash)
toxo risk assessment: when highest risk of fetal damage, vs infection
highest risk of infection 3rd trimester, highest risk of fetal damage 1st trimester
stages of syphilis
primary: early localised as chancre
secondary (2-10w): disseminated with generalised LN + maculopapular rash + condyloma
latent
third: gummas + CV + neurosyphilis
syphilis risk assessment: when most at risk of infection
1st and 2nd stage
syphillis: classic symptoms/signs
fetus: hydrops
early: maculopapular rash (palms and soles) + snuffles
late:
eyes
frontal bossing, saddle nose,
hutchinson teeth, saber shins
SNHL
cutaneous
treponemal vs non-treponemal test
treponemal:
- against t.palladium protein
- not for disease activity, positive for life
non-treponemal:
- against a lipoprotein on the cell wall
- for disease activity, sensitive but not specific
parvovirus: symptoms/signs in pregnant mother vs fetus vs neonate
mother: pure red blood cell aplasia + symmetric arthritis
fetus: hydrops, anaemia
neonate: no permanent defects!
greatest risk to foetus with parvovirus occurs when
<20 weeks - hydrops and fetal loss
highest risk period for NEONATAL (not congenital) VZV, and WHY
if maternal infection occurs -7 days to 2 days post delivery
passive immunity from mum not conferred to newborn
when to give ZIG for neonatal varicella risk
maternal chickenpox:
-7 to +2 days > treat
>2 to 28 days: depends on risk factors (given within 96h)
neonatal chickenpox:
aciclovir if severe
congenital listeria = what would you see in the stem for mum!
unpasteurised milk, deli meats
maternal rubella vs congenital rubella symptoms/signs
maternal: cephalocaudal maculopapular rash, post-auricular lymphadenopathy, polyarthritis
neonate:
1. CVS: PDA, pulmonary artery stenosis
2. Sensorineural deafness
3. Eyes: microphthalmia, cataracts
extra-dermal haematopoeisis (blueberry muffin rash)
