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Obstetrics > perinatal infections > Flashcards

perinatal infections Flashcards

1
Q

how is toxoplasmosis transmitted?

A

ingestion

  • cat feces
  • undercooked meats
  • insects in soil
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2
Q

for toxoplasmosis, what is the vertical transmission rate?

A

depends on trimester
1st tri: 15%, high severity
2nd tri: 30% intermediate severity
3rd tri: 60% mild severity

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3
Q

what are the two forms of toxoplasmosis?

A

it is an intracellular parasite

  • trophozite = invasive
  • cyst/oocyst = inactive
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4
Q

how is toxo diagnosed?

A

serologies, but these are notoriously poor

  • IgM reflects acute infection
  • IgG reflection immunity or prior infection (usually within a few weeks)

if both are negative but suspicion is high, then retestin 2-3 weeks

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5
Q

symptoms of toxoplasmosis

A

nonspecific generally, rarely viremia is possible

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6
Q

treatment for toxoplasmosis:

A
  • MFM consult
  • spiramycin acutely to prevent transplacental transfer
  • if fetal infection: pyrimethamine, sulfadiazine, folinic acid
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7
Q

what are fetal effects/presentation of toxoplasmosis?

A
  • intracranial calcification
  • chorioretinitis
  • hearing loss
  • mental retardation
    (all “head” problems)
  • hepatosplenomegaly
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8
Q

is there screening for toxoplasmosis?

A

only in immunocompromised women

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9
Q

how is cmv transmitted?

A
  • sexual direct, or saliva contact

- incubation time 40 days, viremia in 2-3 weeks

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10
Q

what is prevelance of CMV? what is transmission rate? risk of neonatal disease?

A
  • prevalence 3%. maternal immunity does not protect fetus.
  • transmission rate increases by trimester (30->38->40%), overall 30%
  • neonatal disease occurs in 30% (defined as s/s at birth and sequelae)
  • risk of neonatal death 30% in affected neonates
  • 65-80% have neuro morbidity
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11
Q

what are features of CMV infection for fetus?

A
  • intracranial calcifications
  • abdominal calcifications
  • hepatosplenomegaly
  • IUGR
  • hydrops
  • microcephaly (distinct from toxo)

*congenital hearing loss most common severe sequelae

2nd infection- risks negligible for fetus

5% fetuses exhibit congenital CMV

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12
Q

how do you diagnose CMV?

A

CMV IgG x2 taken 3-4 weeks apart

1) either it turns negative to positive
2) 4-fold increase in titer

fetal diagnosis:

  • amniotic fluid PCR, better than Cx
  • no correlation to infection severity
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13
Q

what is treatment for CMV

A

no approved meds

  • antivirals for AIDS/transplant patients
  • Ig’s are experimental
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14
Q

how is parvovirus transmitted?

A
  • respiratory secretions

- hand to mouth

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15
Q

what is vertical transmission rate of parvovirus?

A

25%

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16
Q

what are possible fetal outcomes of parovirus?

A
  • 1st trimester: SAB
  • late 2nd trimester and 3rd trimester: hydrops and IUFD
    hydorps only in 1% maternal infxns (erythrocyte p antigen required)

replicates in bone marrow - 10% of non-immune hydrops

17
Q

what does parvovirus present like?

A

5-10 d after exposure, rash, arthritis, flu like symptoms

20% asymptomatic

18
Q

how do you diagnose parovirus?

A
  • ELISA PCR for IgG and IgM
  • PCR is more sensitive

If known exposure and negative testing; retest in 3-4 weeks
Fetal infxn dx with amnio PCR

19
Q

what is fetal survival?

A
  • if treated: 80%

- if untreated: 20%

20
Q

what is fetal surveillance with parvo?

A

for 2-3 months after exposure/mat infection, q1-2 week serial US for fetal wellbeing.
PUBS for anemia assessment severity

if no complications by 8-12 weeks, they are unlikely to occur

MCA dopplers are best predictor of fetal anemia

21
Q

what are maternal effects of varicella/chickenpox?

A
  • varicella PNA. 20% pregnant women. 5% mortality (tx with IV acyclovir, ICU admission).
  • encphalitis - rare
  • shingles = reactivation of latent virus (minimal fetal risk)
22
Q

fetal effects of varicella

A
  • IUFD
  • SAB
  • Varicella embryopathy: 2%, 13-20 weeks pretty much only risk
  • -> skin scarring, limb hypoplasia, chorioretinitis, microcpehaly, mental retardation.

if before 13 weeks: malfromations uncommon, if after 20 weeks just skin contracture

23
Q

when is the highest risk time of maternal infection for fetal mortality?

A
  • < 5 days before delivery, and 2 days PP -> therefore give zoster PEppx
24
Q

how do you diagnose varicella?

A
  • clinical- hx, exposure/presence of rash
  • PCR of vesicular or throat swab (confirmation of acute infection)
  • ELISA for VZV IgM and IgG (latter good for immunity determination)
25
Q

what is zoster post-exposure ppx?

A
  • Varicella zoster immune globulin (1 vial/10 kg body weight to max of 5 vials); 60-80% effecting in preventing infection
  • Acyclovir: 800 mg PO 5x daily x 7 days (85% effective in preventing maternal sx)
26
Q

varicella vaccine:

  • schedule?
  • live or not?
  • recommendations in/around pregnancy?
A
  • 2 doses SQ 4-8 weeks apart
  • live attenuated
  • contraindicated in pregnancy; recommend waiting 1 month to become pregnant
27
Q

how does one get listeria?

A
  • chilled hot dogs, cold cuts
  • refrigerated smoked meats
  • unpasteurized milk and cheese
  • unwashed raw fruits and vegetables
28
Q

how do you diagnose listeria?

A

blood cx

29
Q

what are symptoms?

A

generally know if things are recalled
CDC requires to report to health department

  • asymptomatic
  • mild (mild GI or flu-like sx - myalgia/N&V/diarrhea)
  • febrile +/- other sx
30
Q

fetal effects of listeria?

A

IUFD, PTL

31
Q

management listeria?

A

depends on sx.

  • if asx- monitor pt for 2 months for sx
  • mild sx but no fever: either tx as asx or sent bcx and treat if positive
  • fever - sent bcx tx with IV ampicillin (6 gm/day) +/- gentamycin x 14 days (or bactrim if PCN allergic)
32
Q

symptoms of zika

A

fever, maculopapular rash, arthralgia, conjunctivitis, myalgia, prutiis, vomiting
20% of adults are symptomatic. most are mild.

33
Q

fetal risks

A
  • microcephaly

- intracranial/opthalmic anomalies

34
Q

who should be screened for zika?

A
  • travel to pandemic area

- sx

35
Q

how do you diagnose?

A
  • pts who had exposure, without ongoing exposure or sx: no testing
  • pts who had exposure and are now sx: concurrent IgM and NAT testing up to 12 weeks after sx onset
  • pts who are asx but with ongoing exposure: testing as above at least 3 tiem sin pregnancy
36
Q

tx of zia

A

prevention: no travel to endemic areas, use of DET/permethrin, clothing that convers skin
abstinence: until del or use of barriers. if known exposure by female - wait 8 weeks to conceive. if male - 6 months

MFM/ID comanagement
serial US
peds team communication

Obstetrics (45 decks)

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