Questions from S 19 Flashcards
Phone call from obstetric team
37/40 pregnant woman
Exposed to colleague with rash in office
What infections to be concerned of?
Vesicular
- HSV 1/2
- VZV (Primary/ Herpes Zoster
- Enterovirus
- Mpox
Maculopapular
-Measles
- Rubella
- Parvo B19
- HIV
- CMV
- EBV
- Group A Strep
- Staph Aureus
- Mpox - start as maculopapular
- enterovirus - start as maculopapular
Phone call from obstetric team
37/40 pregnant woman
Exposed to colleague with rash in office
what investigations to send?
Swab of lesions in VTM - HSV/ VZV/ Enterovirus/ Mpox
Oral fluid swab in VTM - Measles/ Rubella
Clotted blood - Measles/ Rubella/ Parvo B19/ HIV/ CMV/ EBV
EDTA blood - Mpox
Phone call from obstetric team
37/40 pregnant woman
Exposed to colleague with rash in office
Generally unwell with fever, with no rash present
ALT has risen to 200
What investigations would you perform?
HBsAg + neutralisation
Anti-HCV - consider RNA if window period
HIV Ag/Ab
HAV IgM/ IgG
HEV IgM/ IgG
CMV IgM/ IgG
EBV VCA IgM/ VCA IgG/ EBNA IgG
Parvo IgM/ IgG
Phone call from obstetric team
37/40 pregnant woman
Exposed to colleague with rash in office
Generally unwell with fever, with no rash present
ALT has risen to 200
Has history of a new recent sexual partner
Does this change your investigations?
Same tests as before
HAV/ HEV can be transmitted faecal-orally
HBV/ HCV/ HIV can be transmitted sexually
CMV/ EBV can be transmitted sexually/ close contact
Increases risk of an STI such as HSV being the cause
Additional tests:
HSV 1/2 swab + EDTA - can cause hepatitis without any skin lesions
HIV
Syphilis
Chlamydia
Gonorrhoea
Phone call from obstetric team
37/40 pregnant woman
with HSV in pregnancy
What is management?
Antenatal bloods to check for HSV type specific antibodies. Assume primary until disproven
Swab genitals
EDTA blood for HSV DNA PCR - also do VZV/ Entero/ Adeno
IV aciclovir 10mg/kg TDS - as has evidence of systemic infection
Treat for 14 days minimum. Does not need to all be IV
2 pregnant woman died after having caesarean sections in Kent in 2018
What was the cause?
Disseminated HSV1 infection
Possibly caused by transmission from surgeon with herpetic whitlow
Systemic HSV infection untreated
What is the morality rate?
HSV infection untreated - 80% mortality
If CNS infection and survives, likely high morbidity
Haematologist calls asking about what tests to perform on new blood transfusion service
What testing is recommended on blood products?
Routine testing
Travel related
HBsAg
Anti-HBc
HBV DNA - pooled in 24 donations
Anti-HCV
HCV RNA - pooled in 24 donations
HIV 1/2 Ag/Ab
HIV RNA - pooled in 24 donations
HTLV 1/2 antibody
HEV RNA - pooled in 24 donations
CMV IgM/ IgG
Syphilis EIA
If risk factors:
HAV RNA - pooled in 96 donations
West Nile Virus RNA - pooled in 16 donations
Parvo B19 DNA - pooled in 96 donations
Plasmodium
Trypanosoma Cruzi
Haematologist calls asking about what tests to perform on new blood transfusion service
Patient is anti-HBc positive
Can they donate blood?
Yes
If meets this criteria:
HBsAg neg
Anti-HBc pos
Anti-HBs >100
HBV DNA negative
Haematologist calls asking about what tests to perform on new blood transfusion service
Discover HEV or HAV positive testing pool
What action to take?
Go back to pool, and test individual samples - identify likely source
Check there application - see if they are well
Refer to GP/ hepatology for assessment
Repeat HAV or HEV testing to confirm result
Discard blood donation
Haematologist calls asking about what tests to perform on new blood transfusion service
Discover HEV or HAV positive testing pool and identify patient who is source
How long before they can donate blood again?
6 months temporary exclusion after date of positive donation
May be extended if they have chronic infection
Haematologist calls asking about what tests to perform on new blood transfusion service
Discover Parvo B19 positive testing pool and identify patient who is source
How long before they can donate blood again?
4 weeks temporary exclusion after date of positive donation
Renal patient needs vaccinated against HBV
What are different brands of vaccine and dose?
Twinrix - HAV/ HBV combination
Engerix - 40 micrograms. This is double dose. Non-renal patients is 20 micrograms
Fendrix - 20 micrograms
Renal patient needs vaccinated against HBV
What is routine vaccine schedule?
Routine schedule is:
0
1 month
6 months
Renal patients:
0
1 month
2 months
6 months
Renal patient needs vaccinated against HBV
Completed vaccine course
When to check for immunity?
8 weeks after completion of immunisation is best
can be done at a minimum 4 weeks after immunisation
