Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Virology > Viral rash in pregnancy > Flashcards

Viral rash in pregnancy Flashcards

1
Q

Which viruses are implicated in cause of maculopapular rash in pregnancy?

Exanthema is widespread skin rash accompanying a disease or fever

A

enterovirus - Coxsackie A + B, Echovirus, Enterovirus 68-71

human herpes virus 6

human herpes virus 7

measles

parvovirus B19

rubella

varicella - discussed in separate section

EBV human herpes virus 4 and CMV human herpes 5, both are unlikely to present primarily as rash, but should be considered in differential

Measles and rubella are notifiable diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are other bacterial/ viral rarer causes of rash in pregnancy?

A

Streptococcal
meningococcal disease
syphilis

Dengue virus
Zika

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Parvovirus is smallest DNA virus (parvo=small), B19 only strain to infect humans

Infection commonly occurs between ages 3-15, with over 50% infected by this point. One attack provides lifelong immunity.

What is transmission route?

A

Vertical via placenta
Respiratory droplets
Blood transfusion
Bone marrow transplant

Infectivity rates lower than most viruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Parvovirus B19, what is incubation period, and when are they infective

50% population been infected with parvovirus at some point

A

7-14 days incubation

7-10 days before rash appears

Infective from 10 days before rash appears, until 1 day after rash

If pregnant woman has exposure on day 0, she must avoid pregnant woman/ immunocompromised either -

  • until 11 days until disease develops and non-infectious
  • until proven to be immune
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are symptoms of parvovirus B19 infection?

A 
General - 
sore throat
malaise
fatigue
abdominal pain
arthralgia

Then become symptoms free for a week, before “slapped cheek” erythema rash develops, which lasts couple of days

About 1-4 days after the facial rash appears, an erythematous macular/morbilliform rash develops on the extremities, mainly on the extensor surfaces. Can be itchy in adults

Aplastic crisis - virus has affinity for RBC precursors, so can cause significant problem if have udnerlying disease eg, sickle cell anaemia, thalassaemia, hereditary spherocytosis and iron-deficiency anaemia.

Meningoencephalitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Parvovirus B19 also called fifth disease, as fifth on childhood list of rash causing diseases.

What are the other diseases?

A 
Measles
Scarlet fever
Rubella
Duke's disease - no longer in use
Parvovirus B19
Roseola - HHV 6/7
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pregnant women who develop erythema infectiosum (parvovirus B19 infection) have a 30% chance of passing it on to their unborn baby

Maternal symptoms often short-lived.

During the first trimester the risk of fetal complications is heightened.

What are complications for unborn baby?

A 
foetal loss - 10% risk
hydrops fetalis - accumulation oedema in foetal compartments
hepatitis
severe anaemia,
myocarditis/ heart failure

Maternal asymptomatic parvovirus B19 infection is as likely to infect and damage the fetus as symptomatic infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

All pregnant women who have a non-vesicular rash, or contact with someone who has a non-vesicular rash, should be investigated for parvovirus and rubella infection - irrespective of past history, previous serology or gestation:
Contact is defined as being in the same room for >15 minutes or face-to-face contact; however, for parvovirus, this is probably over-cautious, the main risk of infection being from household contacts or prolonged occupational contact.

What tests are required for parvovirus infection?

A

Parvovirus IgG/ IgM - on booking blood

or

Parvovirus IgM on latest bloods. Needs to be within 4 weeks of exposure, but also not taken to early. If taken early, consider parvovirus DNA titre

Booking blood are usually kept for 2 years to assist with investigations in neonate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pregnant patient tests positive for parvovirus, what is management?

A

Refer fetal medicine -

  • fetal blood sampling - PCR to confirm infection
  • intrauterine transfusion
  • serial USS
  • early delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At pregnancy booking visit with midwife, what history should be documented regarding infectious diseases?

A

MMR vaccination history

Varicella vaccination history

Enquire if had rash in pregnancy, and advise if they get a rash to seek medical review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pregnant patient presenting with rash, what a key parts of history?

A

Date of onset

Clinical features -

  • distribution
  • vesicular or not
  • how it has evolved

Contact with people with rash

Pregnancy details - gestation

Vaccination history - beware foreign patients may have incomplete vaccination history

Recent travel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are symptoms of measles infection in children/ adults?

Measles is RNA virus

A

General - fever, malaise

Conjunctivitis

Coryza

Encephalitis

Otitis media

Koplik’s spots - reddish spots on buccal mucosa, with white dot. Prodrome, and fade when morbilliform rash develops

Rash - morbilliform (measles-like). Initially forehead/ neck. Then trunk/ limbs

Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is incubation period of measles?

When are patients with measles potentially infective?

A

7-21 days

4 days before rash appears, until 4 days after appears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Measles infection

What are risks to mother/ baby in pregnancy?

What are risks to children/ adults?

A

Baby -

  • foetal loss
  • prematurity/ LBW
  • subacute sclerosing panencephalitis SSPE

Children/ adults -

  • pneumonia
  • subacute sclerosing panencephalitis SSPE
  • acute demyelinating encephalitis
  • measles inclusion body encephalitis

Those with vitamin A deficiency are at higher risk of significant disease.

In developing countries, measles is biggest cause of vaccine preventable death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is measles transmitted?

A

Airborne via respiratory droplets

One of most highly infectious pathogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for suspected measles

A

Oral fluid swab - IgM/ RNA

Serum for measles IgM/ IgG
Needs to be taken within 6 weeks illness

17
Q

What is management of confirmed measles for mother/ baby?

Ideally should have received HNIG at time of exposure

A

Mother - no specific treatment. Monitor for signs pneumonitis. Ribavirin can be used in severe cases

Neonate - Human normal immunoglobulin (HNIG) is recommended for neonates born to mothers
who develop a measles rash 6 days before to 6 days after delivery.

18
Q

If just suspected exposure to measles (not yet confirmed), what are guidelines for post-exposure prohpylaxis? (first test for susceptibility)

Pregnant

Infant

Immunocompromised

Healthy adult

A
  • 2x doses of MMR is considered immune, and does not require HNIG
  • Pregnancy - very high proportion of pregnant women will be immune. Cannot have MMR in pregnancy. If had exposure, check immune status, and if susceptible - give human normal immunoglobulin
  • <6 months - give HNIG
  • > 9 months - give MMR within 72 hours
  • immunocompromised - HNIG if severe deficiency. If minor deficiency e.g steroid use, will likely be immune
  • Healthy adult - MMR vaccination within 72 hours of exposure. If incubating measles, mumps or rubella, the MMR vaccination will not exacerbate the symptoms.

HNIG given with 72 hours (up to 6 days)
HNIG can be given IM
Can await measles IgG result firstly

See detailed PEP guidelines PHE

19
Q

Rubella rare in UK. Cases occur in spring/ early summer. Also known as German measles

RNA virus

How is it transmitted?

What is incubation period?

A

airborne droplets between close contacts (unlike most togaviruses which are arthropod-borne)

incubation period is 14-21 days
infectious for up to seven days before and four days after symptoms appear.

20
Q

Rubella symptoms for mother

A

Usually self-limiting. 20-50% cases asymptomatic
General - fever, conjunctivitis, coryzal symptoms
Lymphadenopathy
Arthralgia
Macular rash

21
Q

Rubella symptoms for baby

A
  • Infection in weeks 8-10 of pregnancy results in damage in up to 90% of surviving infants. Multiple defects are then common.
  • risk of damage reduces to 10-20% if the infection is in weeks 11-16 of pregnancy.
  • Fetal damage is rare over 16 weeks of gestation.

Transient:
Intrauterine growth restriction

Thrombocytopenic purpura (25% - ‘blueberry skin’)

Haemolytic anaemia

Hepatosplenomegaly

Jaundice (common)

Radiolucent bone disease (20%)

Meningoencephalitis (25%) +/- neurological sequelae.
Developmental:

Sensorineural deafness (80%) - rubella is the most common cause of congenital deafness in the developed world.

General learning disability (55%).

Congenital heart disease

Eye defects including cataracts, congenital glaucoma, pigmentary retinopathy

Microcephaly

22
Q

What are tests for rubella infection?

A

serology - IgM/ IgG

IgM dose not cross placenta. So check neonate for IgM, and PCR of blood

23
Q

What is management of rubella infection in pregnancy?

A

No specific treatment available

If within first 16 weeks - offer termination

cochlear implants

cardiac surgery

No evidence of immunoglobulin being effective

24
Q

HHV-6 and HHV-7 are universal infections.

What problems can they cause in pregnancy?

A

Can cause rash - roseola. Most people have as children

Not implicated in any serious conditions with congenital infection

25
Q

Which enteroviruses can cause congenital infection?

A

Coxsackie A + B

Echovirus

Enterovirus 68-71

Poliovirus

26
Q

What conditions can enteroviruses cause in mother?

all spread via faecal-oral route

all RNA viruses

A

Febrile illness

Rash

Myocarditis

Bornholm disease - viral illness with lower chest/ upper abdominal pain. Coxsackie B

Hand, foot and mouth disease - coxsackie A16/ enterovirus 71. Vesicular rash on hands/ feet/ mouth. No adverse features for foetus

27
Q

What conditions can enteroviruses cause in foetus?

A
  • congenital myocarditis
  • congenital hepatitis
  • insulin dependent diabetes mellitus

These features have been seen, but no definite clear link between enterovirus infection and these symptoms

28
Q

EBV may present as infectious mononucleosis with maculopapular rash, fever, lymphadenopathy. Particularly if recently had amoxicillin.

What are risks to foetus?

CMV is most common congenital infection. It may present as rash only in rare cases, so not discussed further here

A

No risk to foetus

29
Q

If there is outbreak of parvovirus B19, measles, rubella , chickenpox in school/ nursery etc, should pregnant women avoid these areas?

A

Do not need to routinely avoid, as equal risk of wider exposure in the community.

However, will need individual risk assessment. If not immunised, or other risk factors, may need to avoid.

30
Q

Which vaccines should be avoided in pregnancy?

A

Live vaccine -

  • MMR
  • Varicella
  • BCG

Inactivated -
- HPV

If accidentally administered in pregnancy, then no need for termination, just close monitoring.

Other vaccines do not have enough information available, so avoid. But if high risk exposure, may need to vaccinate as benefits outweigh risks -

Anthrax
Hepatitis A
Japanese encephalitis
Pneumococcal
Polio (IPV)
Typhoid (parenteral and Ty21a*)
Vaccinia*
Yellow fever*
31
Q

Not pregnancy related

How does kawasaki disease present?

A

Fever

strawberry tongue

extremity desquamation

32
Q

6 month old presents with tonic-clonic seizure, after two day history of fever and coryzal symtoms. Infant drowsy, and generalised non-blanching maculopapular rash

What is next step?

Administer aciclovir
Administer ceftriaxone
Administer antipyretic
Administer anti-epileptic
Perform LP
A

Ceftriaxone

Could be viral illness, but maculopapular rash is concerning for bacterial infection such as meningococcal disease.

Maculopapular rash evolves into petechiae and purpura

33
Q

14 month old child presents with mother who is pregnant, to ED. 4 day history of fever, coryzal symptoms, conjuncitivitis, maculopapular rash.

What are important management steps?

A

Isolate patient

oral fluid for measles RNA

Check baby MMR status - should have 1 vaccination

Check mother MMR history - if susceptible then give human normal immunoglobulin within six days of contact

34
Q

Which diseases present with strawberry tongue?

A

Measles

GAS

Kawasakis

35
Q

Pregnant patient presents with vesicular rash.

What investigations are required?

A

HSV - swab lesion PCR

VZV - swab lesion PCR, IgG/ IgM

Enterovirus - swab throat/ rectum PCR/ CFT

36
Q

Pregnant patient presents with non- vesicular rash.

What investigations are required?

A

Parvovirus B19 IgM/ IgG

Enterovirus - swab throat/ rectum PCR, CFT

HIV - check booking

Syphilis - check booking

  • If not had MMR -

Rubella IgM/ IgG

Measles IgG

Virology (56 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions