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perinatal infections Flashcards

1
Q

infection when during pregnancy causes congenital infection with the following organisms:
- toxo
- syphilis
- parvo
- vzv
- rubella
- cmv
- hsv
- zika

A
  • 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
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2
Q

EXAM THOUGHTS - congenital infection + this = what?
a. heart
b. intracranial calcification
c. hydrocephalus
d. syphilis

A

a. Rubella = heart
b. CMV = intracranial calcification (though toxo can have this in its triad)
c. Toxo = hydrocephalus
d. Syphilis = bones

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3
Q

causes of blueberry muffin rash

A

classic for rubella
also:
toxo
CMV
HSV
parvo
syphilis

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4
Q

neonatal treatment for congenital:
- toxo
- syphilis
- CMV
- HSV

A
  • toxo: Pyrimethamine + sulphadoxine +/- spiramycin for one year
  • syphilis: 10 days with benzylpenicillin or procaine penicillin
  • CMV: ganciclovir (IV), valganciclovir (PO)
  • HSV: aciclovir
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5
Q

types of bugs for perinatal:
A) early onset sepsis
B) viral infection

A

EOS: GBS, E.Coli, listeria
viruses: VZV, HSV, enterovirus

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6
Q

non-specific symptoms of all TORCH Infection

A

SGA / poor growth
hepslenmegaly
jaundice
thrombocytopaenia

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7
Q

most common congenital infection

A

CMV

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8
Q

most common cause of non hereditary SNHL

A

CMV

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9
Q

asymptomatic vs symptomatic congenital CMV infection from PRIMARY maternal infection - %

A

asymptomatic 90% - most have mild SNHL as older kids
symptomatic 10%

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10
Q

transmission rate to foetus of PRIMARY maternal CMV infection

A

30-50%

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11
Q

CMV infection in early pregnancy vs late pregnancy - outcomes

A

early = more neuro outcomes
late = acute visceral disease e.g. hepatitis, pneumonia

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12
Q

key features of CMV: neonatal and long term

A

neonatal: non-specific, + SNHL

long term: neuro
- periventricular calcifications
- seizures, chorioretinitis
- SNHL
- microcephaly

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13
Q

toxo: pregnant mother symptoms/signs vs neonate

A

pregnant mother: often asymptomatic +/- LN
neonate = CLASSIC TRIAD with those non-spec TORCH sx:
1) chorioretinitis
2) hydrocephalus
3) intracranial calcifications

(blueberry muffin rash)

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14
Q

toxo risk assessment: when highest risk of fetal damage, vs infection

A

highest risk of infection 3rd trimester, highest risk of fetal damage 1st trimester

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15
Q

stages of syphilis

A

primary: early localised as chancre
secondary (2-10w): disseminated with generalised LN + maculopapular rash + condyloma
latent
third: gummas + CV + neurosyphilis

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16
Q

syphilis risk assessment: when most at risk of infection

A

1st and 2nd stage

17
Q

syphillis: classic symptoms/signs

A

fetus: hydrops
early: maculopapular rash (palms and soles) + snuffles

late:
eyes
frontal bossing, saddle nose,
hutchinson teeth, saber shins
SNHL
cutaneous

18
Q

treponemal vs non-treponemal test

A

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

19
Q

parvovirus: symptoms/signs in pregnant mother vs fetus vs neonate

A

mother: pure red blood cell aplasia + symmetric arthritis
fetus: hydrops, anaemia
neonate: no permanent defects!

20
Q

greatest risk to foetus with parvovirus occurs when

A

<20 weeks - hydrops and fetal loss

21
Q

highest risk period for NEONATAL (not congenital) VZV, and WHY

A

if maternal infection occurs -7 days to 2 days post delivery
passive immunity from mum not conferred to newborn

22
Q

when to give ZIG for neonatal varicella risk

A

maternal chickenpox:
-7 to +2 days > treat
>2 to 28 days: depends on risk factors (given within 96h)

neonatal chickenpox:
aciclovir if severe

23
Q

congenital listeria = what would you see in the stem for mum!

A

unpasteurised milk, deli meats

24
Q

maternal rubella vs congenital rubella symptoms/signs

A

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)

25
Q

congenital rubella syndrome - timing of risk

A

4 weeks before conception and up to 20 weeks after

26
Q

herpes: usually spread in utero or intrapartum

A

intrapartum from infected secretion (90%)

27
Q

what makes a neonatal herpes birth high vs low risk

A

Low risk
1. Mother with recurrent genital infection, OR
2. Mother with primary infection seroconverted well prior to delivery, AND
3. Without genital lesions at delivery

High risk
1. Mother with primary genital infection close to delivery, OR
2. Infant born through birth canal with active HSV disease to mother with no prior history of active genital HSV

28
Q

neonatal HSV: when and what clinical manifestation

A

skin/eye/mouth - 10-12 days of life
CNS - meningoencephalitis ~2 weeks
disseminated - 10-12 days of life

29
Q

highest risk of HBV transmission to foetus based on maternal serology

A

sAg +ve = carrier (5-20% vertical transmission)
eAg +ve = higher risk carrier (90% transmission)

30
Q

highest risk of HIV vertical transmission

A

Can be transmitted early in gestation BUT MOST occur near or at delivery (and most are intrapartum during delivery)

31
Q

HIV vs HCV: for which does LUSCS reduce vertical transmission

A

HIV; no evidence for HCV

32
Q

TB most often spread via?

A

post delivery airborne transmission

33
Q

Zika virus: UNIQUE features

A
  1. severe microcephaly
  2. thin cerebral cortices with calcifcation
  3. macular scarring
  4. contractures
  5. marked early hypotonia
34
Q

neonatal conjunctivitis: key causes and duration

A
  1. chlamydia (coccobacillus) = most common
    5-14 days incubation
    pneumonia/staccato cough from 4 weeks
    azith
  2. gono (diplococcus):
    classically purulent AF, within 5 days
    ceftriaxone
  3. HSV

ID (9 decks)

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