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HD 2 > Pregnancy and Infection > Flashcards

Pregnancy and Infection Flashcards

1
Q

What is different about infection in pregnancy?

A

Relative immunosuppression

Physiological changes in mother

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2
Q

Name an infection in pregnancy that is harmful to the mother only.

A

Influenza

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3
Q

Name infections in pregnancy that are harmful to the foetus. (6)

A 
Toxoplasmosis
HSV
Syphilis
Parvovirus B19
CMV
Rubella
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4
Q

Name infections in pregnancy that are harmful to both the mother and the foetus. (3)

A

Hepatitis
VZV
HIV

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5
Q

What does TORCH stand for?

A 
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes simplex virus (and HIV, hepatitis)
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6
Q

What IgG mean about the timing of the infection?

A

This signifies past infection and is protective in many cases. It peaks about a month after infection.

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7
Q

How is infection diagnosed?

A

Serology

PCR

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8
Q

Cytomegalovirus - how many UK adults have evidence of past exposure?

A

50% ( i.e. they are CMV IgG positive)

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9
Q

How is CMV transmitted?

A

Saliva, blood, blood products, sexual intercourse, organ transplantation or via mother

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10
Q

What is significant about the primary of infection of CMV? (2)

A

Often subclinical

More likely to cause congenital CMV

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11
Q

When is congenital CMV more likely in pregnancy?

A

1st trimester

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12
Q

What is the prevalence of congenital CMV?

A

~ 7 per 1000 live births

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13
Q

How many % of babies with congenital CMV are symptomatic?

What are the symptoms/complications? (4)

A

13%

IUGR, hepatosplenomegaly, microcephaly, sensorineural deafness

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14
Q

How is congenital CMV diagnosed?

A

Maternal serology - CMV IgG and IgM

Neonatal urine/saliva (for PCR)

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15
Q

What is the commonest congenital cause of sensorineural hearing loss?
How many % of these children develop SNHL in the first 5 to 7 years of life?

A

CMV

10%

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16
Q

How many % of UK adults are immune to Varicella Zoster Virus?

A

80-90% (i.e. VZV IgG positive)

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17
Q

How is VZV transmitted?

A

Droplets/airborne

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18
Q

VZV is highly infectious - how many people can 1 infected person infect? What is the term for this?

A

10-12

R(0)

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19
Q 
Rank these diseases from most to least contagious:
Ebola
Hep C
HIV
Measles
Mumps
SARS
A 
Measles
Mumps
SARS
HIV
Ebola
Hep C
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20
Q

How is VZV diagnosed? (3)

A

Clinically
Swab of vesicle fluid (for viral PCR)
Maternal serology

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21
Q

How is VZV prevented?

A

Varicella Zoster ImmunoGlobulin (post exposure)

Vaccination (pre-exposure)

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22
Q

Within how many days of exposure is VZIG effective?

A

Within 10 days

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23
Q

Why can pregnant women not be given the VZV vaccine?

A

It is a live attenuated vaccine

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24
Q

What is the treatment for VZV?

A

Aciclovir

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25
What lung condition can VZV cause?
Pneumonitis
26
What does congenital varicella cause? (8)
Skin lesions, limb hypoplasia, microcephaly, hydrocephaly, neurodevelopmental delay, cataracts, and also GI, genitourinary and cardiac abnormalities. It may also lead to miscarriage of the pregnancy.
27
Is the risk of congenital varicella higher in the first or second trimester?
Second
28
When does neonatal varicella occur?
When the mother has VZV around the time of delivery (most severe if 5 days before to 2 days after delivery).
29
How is neonatal varicella treated?
VZIG and acyclovir
30
Herpes simplex virus - how many adults have HSV 1 antibodies by age 40?
>90%
31
What is HSV 2 seroprevalence related to?
Sexual activity
32
How many % primary HSV infection is asymptomatic?
>80%
33
Neonatal HSV infection - how many % of neonates acquire infection perinatally?
90%
34
70% of untreated cases of neonatal HSV infection leads to ______.
Disseminated HSV infection
35
Does HSV 1 or HSV 2 cause 70% of neonatal HSV infections?
HSV 2
36
What causes most cases of HSV 1 neonatal infection?
Maternal acquisition of genital HSV 1 late in pregnancy
37
How is neonatal HSV treated?
Aciclovir
38
What is the mortality of treated neonatal HSV?
25%
39
What is another name for rubella?
German measles
40
What are the symptoms of rubella?
Rash Lymphadenopathy Arthralgia
41
When in the pregnancy is the risk of congenital rubella highest?
Before 11 weeks
42
What may congenital rubella before 20 weeks cause?
Foetal loss
43
What are the symptoms of congenital rubella? (4)
Microcephaly Heart disease Purpura Cataracts/other eye problems
44
MMR - what type of vaccine is this? What does it provide lifelong protection against (with two doses)?
Live attenuated vaccine | Measles, Mumps, Rubella
45
How many % of adults have past exposure to Parvovirus B19?
~60%
46
What is the cellular target for Parvovirus B19?
Erythrocytes
47
When in the pregnancy is the risk of Parvovirus B19 highest?
0-20 weeks: 9% risk of fetal loss | 9-20 weeks: 3% risk of hydrops fetalis
48
What parasite causes toxoplasmosis? What is its natural host?
Toxoplasma gondii | Cats
49
How do humans become intermediate hosts of toxoplasmosis?
Ingestion of oocysts (eating infected meat or via contact with cat faeces)
50
What are the symptoms of toxoplasmosis?
Commonly asymptomatic Lymphadenopathy Fever
51
How many % adults are T.gondii IgG positive?
40%
52
When is pregnancy is toxoplasmosis most risky to the foetus?
1st trimester
53
What are the clinical features of congenital toxoplasmosis?
IUGR, hydrocephalus, cerebral calcification, microcephaly, hepatosplenomegaly
54
What are some potential treatments for congenital toxoplasmosis?
Spyramicin | Pyrimethamine/sulfadiazine/folinic acid
55
Syphilis is an STI due to what organism?
Treponema pallidum
56
When is the highest risk of transmission of syphilis from mother to child?
1st trimester or peripartum
57
How is syphilis treated?
Penicillin
58
What is syphilis in pregnancy associated with? (3)
Miscarriage Still birth Prematurity
59
What is Hutchinson's triad (syphilis signs)?
Deafness, teeth and interstitial keratitis
60
What are the symptoms of early (0-2 years) congenital syphilis?
``` Rash Rhinorrhoea Osteochondritis Perioral fissures Lymphadenopathy GN ```
61
What are the symptoms of late (>2 years) congenital syphilis?
``` Hutchinson’s teeth Clutton’s joints High arched palate Deafness Saddle nose deformity Frontal bossing ```
62
When is the antenatal infection screen done?
At 12 weeks
63
What does the antenatal infection screen test for?
``` Hep B HIV Rubella Syphilis CMV/toxoplasma/VZV ```

HD 2 (25 decks)

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