Y2 Infections and immunity

Question 1

Viral

Answer 1

Hep B, HIV, Chicken pox, CMV, Rubella

Question 2

Bacterial

Answer 2

Syphilis, Listeria, Toxoplasmosis (parasite), GBS

Question 3

Hep B

Answer 3

Viral bloodborne, causes liver damage, very infectious (low in BM), can be vaccinated against, common in Africa/Western pacific/Mediterranean/Middle east.
Care: referral to obstetrician, avoid scalp electrode in labour, vaccinate baby after birth, no BF if cracked nipples

Question 4

HIV

Answer 4

Viral bloodborne, impaired immune response, prevalent in Africa, commonly transmitted sexually/via placenta/during birth/ in BM. No vaccination, treat with ART. With treatment, mother-child transmission is only 0.14%
Care: red pathway, ART. risk for miscarriage, stillbirth, IUGR, SGA, preterm birth, neonatal death, PN depression. If viral load<50 vaginal birth (ok for MWU, water, no ARM), >400 section, >1000 section with IV zidovudine. Baby on prophylactic zidovudine therapy.

Question 5

Syphilis

Answer 5

Bacterial, sexually transmitted (body fluids) or in utero/at birth, untreated women with primary disease will 70-100% transmit to baby. Can lead to miscarriage, stillbirth, preterm birth, Polyhydramnios, Hydrops, congenital syphilis.
Care: red pathway, shared care. Penicillin IM, Paediatric review.
After treatment= low risk, MWU

Question 6

Listeria

Answer 6

Bacterial, food acquired: soft/blue cheese, smoked salmon, cooked sliced meats, prepacked sandwiches, unpasteurized milk. Symptoms are unspecific, up to 90 days past initial infection, flu/aches and pains/fever/gastroenteritis. Crosses placenta, 50-100% fetal/neonatal mortality (meningitis/sepsis).
Care: health promotion, post infection a spectrum of antibiotics.

Question 7

Toxoplasmosis

Answer 7

Parasite, infection caused by exposure to cat faeces/ undercooked meat/unwashed raw vegetables. Unspecific symptoms, flu like for 4-6 weeks. Risk of fetal infection is small but can lead to birth defects/still birth.

Question 8

Chicken pox

Answer 8

Viral, relatively harmless in children but can be severe in adults. Immunity after first infection. During pregnancy it can develop into sepsis, meningitis or pneumonia. parity is a risk factor. Can cause preterm birth and neonatal infection. Vaccination available.

Question 9

Citomegalovirus CMV

Answer 9

Viral (part of herpes family), spreads via body fluids/saliva. Common amongst nursery aged children. Unspecific flulike symptoms, can lead to IUGR, neonatal hearing loss, birth defects, 3% fetal mortality.

Question 10

Rubella

Answer 10

Viral, part of MMR vaccine. Respiratory droplet acquired. 90% fetal transmission in early pregnancy, goes down with gestation. Can cause fetal deafness, cardiac abnormalities, congenital cataracts, microcephaly and learning impairments.

Question 11

GBS

Answer 11

Bacterial, from digestive tract/sometimes vagina. Ca 18% of women are carriers. High risk: black african, high BMI, health care workers. Can lead to miscarriage or premature birth. In infants it destroys red blood cells and can cause pneumonia/sepsis and can be mortal. Vertical transmission, early onset(50%)- fever, grunting, tachycardia, irritability, lethargy, cyanosis, reluctant feeder, hypoglycemia. Risks much greater
horizontal, late onset.
Care: Antibiotics, benzyl penicillin in labour if risk factors present. baby obs 24 hrs post birth.

Question 12

If someone has IgG antibodies that means they

Answer 12

have had an infection that has subdued, IgG are the long term memory defence of the body.

Question 13

If someone has IgM antibodies that means that they

Answer 13

have a current or recent infection, IgM are the first antibodies the body makes when there is an infection.