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Y2 Clinical Pathology > Pregnancy & Childhood Infections > Flashcards

Pregnancy & Childhood Infections Flashcards

1
Q

What are the problems with infections during pregnancy?

A

Pregnancy does not alter resistance to infection

some infections during pregnancy are more severe and can affect the foetus

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2
Q

What may infections in pregnancy cause?

A
  • Miscarriage
  • congenital abnormalities
  • fetal hydrops
  • fetal death
  • preterm delivery
  • preterm rupture of the membranes
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3
Q

What is meant by “fetal hydrops”?

A

A serious fetal condition defined as an abnormal accumulation of fluid in two or more fetal compartments

this includes Ascites, pleural effusion, pericardial effusion and skin oedema

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4
Q

How can the foetus receive immunity?

A

Maternal antibodies cross the placenta and give passive immunity to the foetus

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5
Q

What is a key message during antenatal counselling?

A

Avoid exposure to infections during pregnancy

i.e. vaccination (pertussis vaccine b/w 16 - 32 weeks)

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6
Q

What screening is offered during pregnancy?

A
  • Screening for HIV and syphilis and hepatitis B occurs early in pregnancy (by 10 weeks)
  • it is reoffered before 20 weeks
  • Hepatitis B, HIV and syphilis can all be passed from mother to baby during pregnancy and birth
  • early detection aids specialist appointment and interventions/treatment to reduce the risk of transmission
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7
Q

Why is screening for rubella in pregnancy no longer offered?

A

Screening for rubella in pregnancy is no longer offered

rubella is now very rare in the UK because of the high uptake of the MMR vaccine

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8
Q

What is meant by the TORCH acronym for infections that can be transmitted from mother to baby during pregnancy (in utero)?

A
  • Toxoplasmosis
  • Others (syphilis, HIV, Coxsackie virus, Hepatitis B, Varicella zoster)
  • Rubella
  • Cytomegalovirus
  • Herpes simplex virus
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9
Q

How are the following pathogens acquired?

How are they transmitted to the baby?

A
  • Cytomegalovirus - respiratory droplets / secretions
  • Parvovirus B19 - respiratory droplets / secretions
  • toxoplasmosis - ingestion of oocytes
  • syphilis - sexually transmitted
  • varicella zoster virus - respiratory droplets / secretions
  • rubella - nasopharyngeal secretions
  • zika virus - mosquito bite
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10
Q

What do most of the TORCH infections cause?

A

They cause mild maternal morbidity, but have serious fetal consequences:

  • abortion
  • stillbirth
  • prematurity
  • IUGR
  • congenital malformations - microcephaly, intracranial calcifications
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11
Q

What is IUGR?

A

Intrauterine growth restriction

this is a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb

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12
Q

What are other perinatal infections?

A
  • Group B streptococcus
  • listeriosis
  • gonorrhoea
  • chlamydia
  • influenza
  • human immunodeficiency virus
  • hepatits b virus

HIV and HBV virus can be passed in utero and postnatal via breast milk

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13
Q

What are the risks associated with transplacental passage of the influenza virus?

A

Teratogenesis has not been confirmed

premature delivery may occur (as in any febrile maternal illness), increasing the perinatal morbidity and mortality

the clinical syndrome in the mother is self-limited unless pneumonia occurs and the newborn manifests as any form of sepsis

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14
Q

What is meant by the “perinatal period”?

A

The period immediately before and after birth

usually starts at the 20th - 28th week of gestation and ends 1 - 4 weeks after birth

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15
Q

Why is screening for Group B Streptococci not recommended in the UK?

A

Until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost-effective, routine screening is not recommended

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16
Q

What is the likelihood of maternal GBS carriage in current pregnancy if a mother has had previous GBS carriage?

What 3 options does the mother have in this situation?

A

If there is history of previous GBS carriage, likelihood of maternal GBS carriage in current pregnancy is 50%

3 choices are:

  1. To NOT have intra-partum antibiotics
  2. To have intra-partum antibiotics
  3. Screening at 35-37 weeks and offer antibiotics to those who have GBS colonisation
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17
Q

When are intrapartum antibiotics administered?

A

Intra-partum refers to the time period between onset of labour and the delivery of the placenta

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18
Q

What is chorioamnionitis?

How many pregnancies are affected by this?

A

Inflammation of the umbilical cord, amniotic membranes / fluid and placenta

it is a major cause of perinatal morbidity and mortality

affects 1-2% of term pregnancies and 20-25% of pregnancies with pre-term labour

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19
Q

What are the symptoms of chorioamnionitis?

A
  • Maternal fever
  • uterine tenderness
  • tachycardia
  • purulent / foul amniotic fluid

obstetric complications + adverse outcomes for the neonate:

  • sepsis
  • pneumonia
  • long term neurodevelopment disability
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20
Q
A
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21
Q

what usually causes chorioamnionitis?

What is it associated with?

A

It is inflammation of the fetal membranes (amnion / chorion) due to a bacterial infection

it typically results from bacteria ascending from the vagina into the uterus

it is most often associated with prolonged labour

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22
Q

What are the risk factors for intra-amniotic infections?

A
  • Most common after prolonged rupture of membranes
  • amniocentesis / cordocentesis
  • cervical cerclage
  • multiple vaginal examinations
  • bacterial vaginosis
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23
Q

What is the pathogenesis of intra-amniotic infections like?

A

Bacteria present in the vagina cause infection by ascending through the cervix

Haematogenous (via blood) infection is rare e.g. Listeria monocytogenes

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24
Q

What organisms can cause intra-amniotic infections?

A
  • Group B Streptococcus
  • Escherichia coli
  • Genital Mycoplasma (Mycoplasma hominis & Ureaplasma urealyticum)

it is caused by polymicrobial infections

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25
Q

What is involved in the management of intra-amniotic infections?

A

Intrapartum antimicrobials and delivery of the foetus

antimicrobials should be administered at the time of diagnosis (not after delivery)

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26
Q

What is puerperal endometritis?

A

A uterine infection (lining of the womb) during puerperium which affects 5% of pregnancies

It is typically caused by bacteria ascending from the lower genital or GI tract

it can occur up to 6 weeks following birth

27
Q
A
28
Q

What is the major risk associated with puerperal endometritis?

A

Puerperal sepsis is a major cause of maternal death

it can cause sepsis, pelvic abscesses and peritonitis in the mother

29
Q

What are the risk factors for puerperal endometritis?

A
  • Caesarean section
  • prolonged labour
  • prolonged rupture of membranes
  • multiple vaginal examinations
30
Q

what are the clinical features of puerperal endometritis?

A
  • Fever - 38.5C in first 24h post-delivery or >38.0C for 4 hours 24+ hours after delivery
  • uterine tenderness
  • purulent, foul-smelling lochia
  • increased white cell count
  • general malaise, abdominal pain
31
Q

What are the causative organisms for puerperal endometritis?

A

The causative organisms are frequently mixed:

  • Escherichia coli
  • Beta-haemolytic Streptococci (Group B)
  • anaerobes
32
Q

What is involved in the diagnosis and treatment of puerperal endometritis?

A

Diagnosis:

  • the role of transvaginal endometrial swabs is controversial

treatment:

  • broad spectrum intravenous antimicrobials
  • these are continued until the patient has been apyrexial for 48h
  • for polymicrobial infections, clindamycin + gentamicin are used
33
Q

What are the most common infections in children?

A

Neonatal sepsis

Common childhood infections - respiratory tract infections, UTIs, meningitis

Rashes associated with systemic disease

34
Q

What are the main causes of maternal and neonatal mortality?

A

Maternal mortality:

  • haemorrhage
  • indirect causes
  • hypertension
  • sepsis
  • other direct causes
  • abortion
  • embolism

neonatal mortality:

  • complications from preterm birth
  • intrapartum related
  • sepsis / meningitis
  • pneumonia
  • congeital
  • other
  • tetanus
  • diarrhoea
35
Q

What are the risks associated with early onset sepsis (EOS) in neonates?

When does this start?

A

early-onset neonatal sepsis (usually within 72 hours) is a major cause of mortality and morbidity in new-born babies

high mortality, particularly in premature and low birth weight babies

death occurs in 1 in 4 babies that develop it, even when they are given antibiotics

36
Q

What causes early onset sepsis in neonates?

Under what circumstance does it have higher mortality?

A

It is caused by organisms from the maternal genital tract

typical to have multisystem involvement / pneumonia

higher mortality, particularly in infections that are evident within the first 24 hours

37
Q

What are the major causative pathogens of neonatal late-onset sepsis?

A
  • Coagulase negative staphylococci
  • staphylococcus aureus
  • escherichia coli
  • klebsiella spp.
  • enterobacter spp.
  • pseudomonas spp.
  • candida spp.
38
Q

What are the commonest symptoms reported in early education settings?

A
  1. Respiratory symptoms
  2. fever
  3. gastroenteritis
  4. earache
  5. rash
39
Q

In which groups of children are infections more common?

Why are infections more common in children?

A

Affected groups:

  • young infants
  • children with special health care needs / impaired immune systems
  • children with long-standing prosthetic devices

Why are infections common?

  • frequent hand-to-mouth behaviours
  • still learning appropriate hygiene skills e.g. washing hands, covering coughs
  • some children are not fully immunised
  • children have close physical contact
40
Q

What are the vast majority of infections in children?

A

90% of infections are mild, self-limited and require no treatment

41
Q

What are the 3 main upper respiratory tract infections in children?

A
  • Common cold
  • acute tonisillitis
  • acute otitis media
42
Q

What is a “sore throat”?

What causes it?

A

Any of various inflammations of the tonsils, pharynx or larynx, characterised by pain on swallowing

70-80% of cases are viral

20-30% of cases are caused by Group A beta-haemolytic Streptococcus

43
Q

What is otitis media?

What are the typical symptoms?

A

Inflammation of the middle ear +/- presence of middle ear effusion

  • unusual irritability
  • difficulty sleeping
  • tugging or pulling at one or both ears
  • fever
  • fluid draining from the ear
  • loss of balance
  • unresponsive to quiet
  • sounds or other signs of hearing difficulty
44
Q

What are the bacteria that cause acute otitis media?

A
  • Streptococcus pneumoniae
  • haemophilus influenzae
  • M. Catarrhalis
  • streptococcus pyogenes
  • staphylococcus aureus
45
Q

What are the most common lower respiratory tract infections in children?

A
  • Pneumonia
  • acute bronchitis
  • bronchiolititis

respiratory viruses are the leading cause in children under 5 years

46
Q

What are the most common organisms which cause acute respiratory infections in children?

A
  • Respiratory syncytial virus
  • mycoplasma pneumoniae
  • streptococcus pneumoniae
  • adenovirus
  • haemophilius influenzae
  • influenza A and B
  • haemophilus parainfluenzae

H. Influenzae is now quite rare due to immunisation

47
Q

What is the definition of bronchiolitis?

A

Inflammation of the bronchioles / small airways in children younger than 2 years (usually 3-6 months of age)

it is a seasonal viral illness characterised by fever, nasal discharge and dry, wheezy cough

on examination there are fine inspiratory crackles and/or high-pitched expiratory wheeze

48
Q

What are the causes of bronchiolitis?

A
  1. Respiratory syncytial virus (RSV)
  2. metapneumovirus
  3. adenovirus
  4. para-influenza virus
  5. influenza
  6. rhinovirus
49
Q

What are the bacterial and viral pathogens which cause pneumonia in neonates?

A

Bacterial pathogens:

  • ​group B streptococcus
  • gram negative bacilli ( E. coli, K. Pneumoniae, Proteus spp.)
  • staphylococcus aureus

Viral pathogens:

  • RSV
  • herpes simplex virus
  • cytomegalovirus
  • adenovirus
50
Q

What are the main pathogens which cause pneumonia in children aged 1-3 months?

A

Bacterial pathogens:

  • s. Pneumoniae
  • h. Influenzae type B

viral pathogens:

  • RSV

other:

  • C. Trachomatis
51
Q

What are the main pathogens which cause pneumonia in children aged 4 months - 5 years?

A

Bacterial pathogens:

  • s. Pneumoniae
  • h. Influenzae type b

viral pathogens:

  • parainfluenza virus 1 and 3
  • adenovirus
  • influenza virus A and B
52
Q

What are the pathogens that cause pneumonia in children aged 5 years and older?

A

Bacterial pathogens:

  • s. Pneumoniae

others:

  • M. Pneumoniae
  • C. Pneumoniae
53
Q

What is the presentation of pneumonia in children?

A

Acute febrile illness, possibly preceded by typical viral upper respiratory tract infection

younger children rarely cough and may present with grunting tachypnoea and chest retractions

54
Q

What are the symptoms of pneumonia in children?

A
  • Breathlessness (poor feeding)
  • irritability
  • sleeplessness
  • cough, chest or abdominal pain in older patients
  • audible wheezing is rare in LRTI, but can occur
55
Q

What is pertussis (whooping cough)?

A

A highly contagious respiratory disease caused by Bordetella pertussis bacteria

it is known for uncontrollable, violent coughing which often makes it hard to breathe

56
Q

What are the 3 stages of clinical illness in pertussis?

A

Catarrhal phase:

  • cold-like - coryza, conjunctival irritation, occasional slight cough
  • lasts 7-10 days

Paroxysmal phase:

  • long duration (2-6 weeks) with no fever
  • series of rapid, forced expirations followed by gasping inhalation (whooping sound)
  • post-tussive vomiting
  • very young infants may present with apnea or cyanosis in the absence of cough

convalescent phase

57
Q

How is pertussis transmitted?

How is it diagnosed?

A

It is transmitted person-to-person through aerosolised respiratory droplets

humans are the sole reservoir

Diagnosis:

  • culture & PCR in early stages
  • serology if illness > 3 weeks
58
Q

How does meningitis present in children?

A

There is a non-specific clinical presentation in newborn & infants

  • fever
  • irritability
  • lethargy
  • poor feeding
  • high pitched cry, bulging AF
  • convulsions, opisthotonus
59
Q

What organisms cause meningitis in neonates and young children?

A

Neonates:

  • Group B streptococcus
  • escherichia coli
  • Listeria monocytogenes

> 1 month - 5 years:

  • Streptococcus pneumoniae
  • Neisseria meningitidis
60
Q

What is viral meningitis?

What is it caused by?

A

It is the most common infection of the CNS especially in < 1 year

caused by enteroviruses, HSV, influenza, EBV, adenovirus and CMV

there are mononuclear lymphocytes in CSF

61
Q

What is the morbidity and mortality involved in meningococcemia?

A

Mortality - 5-10% (90% if DIC)

Morbidity - 10% (deafness, neurological problems, amputations)

Peak incidence < 4 years

62
Q

What are the symptoms of meningococcaemia?

A
  • Fever
  • non-specific malaise
  • lethargy
  • vomiting
  • meningism
  • respiratory distress
  • irritability
  • seizures
  • maculopapular rash common in early disease
63
Q

what is meningococcaemia?

A

A severe form of blood poisoning that affects the entire body

the hallmark sign of meningococcaemia is a rash that does not fade under pressure

the rash can appear anywhere on the body due to damaged blood vessels allowing blood to leak into the skin

64
Q
A

Y2 Clinical Pathology (76 decks)

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