Perinatal infections Flashcards
What are the clinical manifestations of perinatal toxoplasmosis infection?
1.Intracranial calcifications
2. Chorioretinitis
3. Hepatosplenomegaly
4. Hearing loss
5. Mental retardation
When is transmission of perinatal toxoplasmosis the highest in pregnancy?
3rd trimester (60%)
When is transmission of perinatal toxoplamosis the lowest in pregnancy?
1st trimester (15%)
When is the severity of disease for perinatal toxoplasmosis the highest in pregnancy?
1st trimester
When is the severity of disease for perinatal toxoplasmosis the lowest in pregnancy?
3rd trimester
What are the clinical manifestations of perinatal cytomegalovirus infection?
- Chorioretinitis
- Hepatosplenomegaly
- IUGR
- Fetal hydrops
When is transmission of perinatal cytomegalovirus the highest in pregnancy?
3rd trimester
When is transmission of perinatal cytomegalovirus the lowest in pregnancy?
1st trimester
When is the severity of disease for perinatal cytomegalovirus the highest in pregnancy?
1st trimester
When is the severity of disease for perinatal cytomegalovirus the lowest in pregnancy?
3rd trimester
How does the parvovirus work during pregnancy?
Replicates in the bone marrow and causes anemia, heart failure and hydrops
What is the vertical transmission rate for parvovirus?
25%
What is the vertical transmission rate for cytomegalovirus?
3%
What are the effects if you get parvovirus infection in the 1st trimester?
spontaneous abortion
What are the effects if you get parvovirus infection in the 2nd or 3rd trimester?
IUFD or hydrops
How does parvovirus present during pregnancy?
Most are asymptomatic infections
Could have rash, arthritis, flu like symptoms
How do you treat parvovirus infection in pregnancy?
weekly ultrasounds for 2 months post exposure/infection looking for hydrops
If hydrops present should receive transfusion
What are the maternal effects of varicella infection during pregnancy?
- Chickenpox
- Varicella pneumonia
- Encephalitis
- Shingles
What are the fetal effects of varicella infection during pregnancy?
- Spontaneous abortion
- IUFD
- Varicella embryopathy
What trimester is varicella pneumonia most common in?
3rd trimester
How do you treat varicella pneumonia?
IV acyclovir and ICU admission
When is there a high risk of mortality for the neonate with maternal varicella infection?
If infection occurs <5 days from delivery
How do you diagnose varicella in pregnancy?
Clinical diagnosis
History of exposure and presence of rash
PCR of vesicular fluid
ELISA for IgM and IgG
Can you give varicella vaccine during pregnancy?
No
How long should you defer pregnancy if you have received the varicella vaccine?
1 month
How do you contract the zika virus?
Transmitted via sex (vagina, oral, anal), materno-fetal, blood, body fluids
What are the symptoms of zika virus?
Most women are asymptomatic
Fever, rash, conjunctivitis, myalgia, arthralgia
Who should be screened for zika virus during pregnancy?
- Potential exposure
- Symptoms
- Traveled to endemic area
How do you diagnose zika virus?
IgM testing and NAT of serum and urine
What is the treatment of zika virus?
PREVENTION
If contemplating conception after exposure to zika virus how long should you wait?
Female exposed–>8 weeks
Male exposed–> 6 months
What is the management if patient is positive for zika virus during pregnancy?
Serial ultrasounds for growth and anatomy
MFM and ID consults
Inform pediatric team
What are the clinical symptoms for listeria in pregnancy?
GI or flu like symptoms
What are the fetal effects of listeria infection during pregnancy?
Fetal loss
Preterm labor
What are the neonatal effects of listeria infection during pregnancy?
Sepsis
Meningitis
death
How do you diagnose listeria infection during pregnancy?
Blood culture
How do you treat listeria infection during pregnancy?
High dose IV ampicillin for 14 days
How do you treat listeria infection during pregnancy if PCN allergic?
Trimethoprim with sulfamethoxazole
How do you decide who needs testing and treatment for listeria infection in pregnancy?
Asymptomatic= no testing or treatment just observation for 2 months
Mildly symptomatic, no fever= send blood culture and treat if positive
Febrile with or without symptoms= test and treat simultaneously