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Kat's Pathology > Viral Infections in Pregnancy > Flashcards

Viral Infections in Pregnancy Flashcards

1
Q

What are the general consequences of viral infections during pregnancy (6)

A 
Increased morbidity/mortality/complications for the mother 
Miscarriage/stillbirth 
Teratogenicity
IUGR/prematurity
Congenital disease 
Persistent infection
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2
Q

What viral infections increase morbidity/mortality/complications for the mother (3)

A

Influenza
Varicella Zoster
Hepatitis E

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3
Q

What viral infections increase chance of miscarriage/stillbirth (2)

A

Rubella

Measles

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4
Q

What viral infections increase chance of teratogenicity (2)

A

Varicella Zoster

Zika

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5
Q

What viral infections cause IUGR/prematurity (2)

A

CMV

Herpes Simplex Virus

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6
Q

What viral infections cause increase the risk of congenital disease (2)

A

CMV

HSV

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7
Q

What viral infections cause persistent infections in the child (2)

A

HIV

Hepatitis B/C

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8
Q

What viral infections are associated with a rash illness (13)

A 
Varicella Zoster (Chickenpox)
Epstein Barr Virus
HSV
Cytomegalovirus
Parvovirus B19 (5th disease)
Enterovirus
Measles 
Rubella
Influenza 
Hepatitis A, B, C, E
HIV
HTLV
Travel-Associated Viruses - yellow fever, dengue, zika
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9
Q

What are some herpes viruses (4)

A

HSV
VZV
CMV
EBV

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10
Q

What type of viruses are herpes viruses

A

DNA viruses

Life-long infections once exposed

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11
Q

What is characteristic about herpes infections

A

Capacity to reactivate - shingles, recurrent cold sores/genital herpes

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12
Q

What are the two forms of herpes simplex viruses

A

HSV 1

HSV 2

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13
Q

How is HSV transmitted

A

Close contact

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14
Q

What is the incubation period of HSV (3)

A

Oropharyngeal and or-facial infection 2-12 days
Genital infection 4-7 days after sexual exposure
Latency established in nerve cells

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15
Q

What are the symptoms of HSV (4)

A

Asymptomatic
Painful vesicular rash
Lymphadenopathy
Fever

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16
Q

How is HSV diagnosed (2)

A

Clinical

Virus detection - culture, antigen detection, PCR, serology

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17
Q

What are the routes of infection of the foetus/neonate in pregnancy (4)

A

Ascending infection if PROM
Direct contact with infected maternal genital secretions during delivery
Oral herpes in mother post delivery (kissing baby)
Contact with relatives, hospital staff in babies born to susceptible mothers

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18
Q

What type of HSV infection poses the greatest risk to the baby

A

Primary genital infection in the 3rd trimester poses the greatest risk of transmission to the infant

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19
Q

How is a 1st clinical attack of genital herpes in pregnancy treated (4)

A

GUM clinic
Aciclovir
Type-specific HSV antibody testing
Caesarean recommended if primary HSV in final 6 weeks of pregnancy

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20
Q

How are recurrent HSV outbreaks managed in pregnancy (2)

A

Maternal Antibody offers some protection to infants in postnatal period but may not prevent transmission
Prolonged rupture of membranes and invasive fetal monitoring in labour should be avoided

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21
Q

When does neonatal herpes present

A

3 days - 6 weeks post delivery

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22
Q

How does neonatal herpes present (4)

A

Lesions of skin, eye, mouth 7-12 days
Neurological symptoms +/- SEM 2-6 weeks
Disseminated disease with/without vesicles frequently involving brain 4-11 days
Mortality in untreated cases of disseminated disease exceeds 80%

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23
Q

How is neonatal HSV diagnosed (2)

A

Neonatal swabs - oral, rectal, mucosal, umbilical

+/- EDTA blood for HSV PCR

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24
Q

What is the treatment for neonatal HSV

A

Aciclovir

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25
Q

What are the two presentations of VZV

A

Chickenpox

Shingles

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26
Q

How is VZV transmitted

A

Respiratory

70% attack rate in susceptible individuals
Infectious from 48hrs before onset of rash until all lesions have crusted over

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27
Q

What is the incubation period for VZV

A

7-23 days (mean 2 weeks)

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28
Q

What are the symptoms of VZV infection (3)

A

prodromal fever, malaise, myalgia (adults>children)
Centripetal maculopapular rash mainly in areas that are not exposed to pressure
Vesicular rash appearing in crops

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29
Q

How is VZV diagnosed (3)

A

Clinical
vesicle fluid for VZV PCR, (electron microscopy)
NOT serology

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30
Q

What are the foetal complications if the mother catches VZV during early pregnancy

A

Congenital varicella syndrome
0.4% for maternal infection between 0-12/40
2% for maternal infection between 12-20/40

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31
Q

What does congenital varicella syndrome consist of (8)

A 
Skin scarring
Limb hypoplasia
Muscular atrophy
Rudimentary digits
Cortical atrophy
Psychomotor retardation
Choreoretinitis
Cataracts
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32
Q

What is the pathogenesis of congenital varicella syndrome

A

fetal zoster following initial VZV infection (Short latency due to poorly developed fetal cell-mediated immunity)

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33
Q

What occurs if primary varicella is caught in the 3rd trimester (2)

A

Severe disseminated haemorrhagic neonatal VZV -purpura fulminans
30% case fatality in untreated cases

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34
Q

How is neonatal varicella contracted if the mother is infected in the 3rd trimester (3)

A

The route of infection could be transplacental, ascending vaginal or result from direct contact with lesions during or after delivery

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35
Q

What is meant be primary varicella in the 3rd trimester

A

7 days prior to delivery - 7 days postpartum.

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36
Q

What are the complications of VZV for the mother (2)

A

Pneumonia

Encephalitis (rare complication - mortality 5-10%)

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37
Q

What increases the risk of pneumonia as a complication in primary VZV in the mother (5)

Mortality?

A 
Smoke cigarettes, 
Have chronic obstructive lung disease, 
Are immunosuppressed 
Have extensive or haemorrhagic rash
2nd half of pregnancy

20-40% case fatality in untreated cases

38
Q

How is VZV treated in pregnant women (3)

A

VZV Immunoglobulin

  • All pregnant women susceptible to VZV ( irrespective of gestation) with a significant exposure to VZV within 10d
  • Infants exposed to chickenpox when <7 days old only if mother VZV IgG negative

Treatment of confirmed VZV - Aciclovir

Vaccination

  • Ideally pre-conception counselling should cover varicella Hx if non-immune could delay pregnancy for 2 doses of vaccine.
  • Can also vaccinate post-partum if not identified pre-conception.
39
Q

What proportion of infants are infected with CMV worldwide

A

2-6% by 6 months

40
Q

What is the prevalence of CMV in the UK

A

40% infected by 16 years old

In adults seroprevalance increases by 1% PA

41
Q

What is the natural history of CMV

A

Virus persists lifelong in individual, reactivation leads to further transmission (vertical & horizontal) via bodily fluids (eg. nappy-changing)

42
Q

What are the symptoms of CMV (2)

A

Most asymptomatic

Rarely maculopapular rash, Infectious mononucleosis-like illness

43
Q

How is CMV diagnosed (2)

A

Detection of virus- urine, saliva, amniotic fluid, tissue

Detection of immune response- CMV IgG and IgM

44
Q

How is CMV transmitted to the foetus in pregnancy (3)

A

Transplacental
Perinatally- infected genital secretions
Postnatal- saliva, breastmilk

45
Q

What are the features of congenital CMV infection

A

Commonest cause of viral congenital infection

Birth prevalence 3/1,000 in the UK

85-90% asymptomatic at birth, but later risk of hearing defects and impaired intellectual performance

46
Q

What are the main two worries regarding neonatal CMV infection (2)

A

Hearing defects

Impaired intellectual performance

47
Q

In symptomatic infants with CMV, what are the features (8)

A 
IUGR
Jaundice
Hepatosplenomegaly
Chorioretinitis
Thrombocytopenia
Encephalitis
Microcephaly/ventriculomegaly/calcifications
48
Q

How is CMV infection diagnosed

A

If maternal CMV infection suspected check serology (compare with booking bloods)

If suspected seroconversion during pregnancy refer to fetal medicine unit for USS +/- amnio

Investigating neonates:
Urine/saliva for CMV PCR within 1st 21d

49
Q

How can we prevent CMV transmission from mother to child

A

No available treatment

50
Q

What type of virus is rubella

A

Togavirus RNA virus

51
Q

How is rubella transmitted

A

Respiratory

52
Q

What is the incubation period for rubella

A

12-21 days

53
Q

What are the symptoms of rubella (4)

A

20-50% subclinical infection
Fine macular rash
Lymphadenopathy
Prodrome may be seen in adult infection

54
Q

How is rubella diagnosed (2)

A

Virus isolation

serology

55
Q

What are the complications of rubella infection in the first trimester (4)

A

Up to 20% spontaneous abortion if infection before 8/40
90% incidence of fetal defects if infection before 10/40
CRS: cataracts, congenital glaucoma, congenital heart disease, loss of hearing, pigmentary retinopathy, purpura, splenomegaly, microcephaly, mental retardation, meningoencephalitis
CRI: infants without CRS clinical signs but with positive rubella specific IgM

56
Q

In infants with congenital rubella syndrome, how long are they infective for

A

Up to and over 1 year

57
Q

What is CRI

A

Congenital Rubella Infection

58
Q

What is CRS

A

Congenital Rubella Syndrome

59
Q

What are the consequences of rubella infection after the 1st trimester (2)

A

13-18/40 hearing defects and retinopathy

Maternal infection after 20 weeks carries no documented risk

60
Q

When is rubella vaccinated for in the UK

A

MMR x 2 (13 months and pre-school booster)

61
Q

What causes the majority of the causes of rubella in the UK now

A

Most cases are imported

62
Q

What viruses are associated with a rash (8)

A 
Varicella Zoster Virus (chickenpox)
Epstein Barr virus
HSV
Cytomegalovirus
Parvovirus B19 ( 5th disease) 
Enterovirus
Measles
Rubella
63
Q

How is measles transmitted (2)

A

Respiratory

Conjunctiva

64
Q

What is the incubation period for measles

A

7-18 days (typically 10 days)

65
Q

What are the symptoms of measles (2)

A

prodrome 2-4 days- fever, malaise, congestion, conjuctivitis, koplik’s spots
Rash classically starts behind ears & on forehead then spreads

66
Q

Where does the measles rash typically start

A

Rash classically starts behind ears & on forehead then spreads

67
Q

What are the complications of measles (3)

A

Opportunistic bacterial infections (otitis media, pneumonia, bronchitis)
Encephalitis
SSPE

68
Q

What are the consequences of measles infection in pregnancy (4)

A

Fetal loss (miscarriage, IUD)
Preterm delivery
Increased maternal morbidity
No congenital abnormalities to fetus

69
Q

What is the treatment in susceptible pregnant women is contact with suspected/confirmed measles (2)

A

Measles Immunoglobulin attenuates illness

No evidence it prevents IUD or preterm delivery

70
Q

How is parvovirus B19 transmitted (2)

A

Respiratory

Blood Products

71
Q

What is the incubation period for parvovirus B19

A

6-8 days

72
Q

What are the symptoms of parvovorius B19 (4)

A

Asymptomatic

Erythema infectiosum/ slapped cheek/ 5th disease

73
Q

How is parvovoris B19 diagnosed (2)

A

Serology

Molecular tests

74
Q

When during pregnancy are there increased risks to maternal infection with B19

A

Before 20/40

No documented risk after 20/40

75
Q

What are the risks of parvovorus B19 infection before 20/40 (4)

A

Transplacental transmission estimated at 33%
9% risk of infection overall
3% risk of hydrops fetalis if infection from 9-20/40
Risk of foetal anomalies less than 1%

76
Q

What is the management of maternal infection with parvovirus B19 during pregnancy (2)

A

Refer to foetal medicine for monitoring

Intrauterine transfusion improves foetal outcome

77
Q

What are some human enteroviruses (3)

A

Polio
Coxasackie A and B
Echovirus

78
Q

What RNA do enteroviruses have

A

Pocornaviridae

79
Q

How is enterovirus transmitted (2)

A

Respiratory

Fecal

80
Q

What is the incubation period for enterovirus

A

2-40 days

81
Q

What are the symptoms of enterovirus infection (4)

A

Hand, foot and mouth disease
Rash illness
Encephalitis
Myocarditis

82
Q

What is coxasackie infection in pregnancy associated with (5)

A

Early onset neonatal hepatitis
Congenital Myocarditis
Early onset childhood IDDM
Abortion or intrauterine death

83
Q

What type of virus is zika virus

A

Flaviviridae RNA

84
Q

Is Zika always symptomatic

A

No, 8/10 are asymptomatic

85
Q

How is Zika transmitted (4)

A

Mostly from mosquitos
Pregnancy
Sexual intercourse
Blood transfusions

86
Q

Where is Zika virus most prevalent

A

South America

87
Q

What neurological condition can Zika cause

A

Guillain Barre Syndrome

88
Q

What are the symptoms of Zika virus (6)

A 
Red eyes 
Fever
Joint pain 
Headache 
Rash 
Muscle pain
89
Q

What are the consequences of zika infection during pregnancy (2)

A

Miscarriage/stillborn/microcephaly

Congenital Zika syndrome

90
Q

What does congenital zika syndrome consist of (5)

A 
Severe microcephaly + skull deformity 
Decreased brain tissue, seizures
Retinopathy, deafness
Talipes 
Hypertonia
91
Q

What are the top travel locations associated with zika infection (3)

A

Caribbean

Central/South America

92
Q

what advice is given to people to prevent zika (4)

A

All travellers – bite avoidance
Pregnant women – avoid travel to areas with current transmission
Avoid conception for 2 – 6 months after
travel (prolonged viral shedding in semen)
Testing only if symptomatic or abnormalities identified on antenatal USS

Kat's Pathology (105 decks)

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