Congenital and Perinatal Infections

Question 1

What is perinatal infection?

Answer 1

Infectious during time of delivery

Question 2

When is ascending infection most common?

Answer 2

When the placenta has ruptured

Question 3

How does maternal infection lead to premature delivery or fetal death

Answer 3

Direct end-organ damage, chronic infection

non-specific effect. Mum is too weak to have baby

Question 4

When is the Varicella virus vaccine given?

Answer 4

at 18 months, with the MMRV vaccine

Question 5

Why is MMR given at 12 months?

Answer 5

Prevent cross reaction with maternal antibody

Question 6

What is anthem and enanthem?

Answer 6

anthem = rash on surface of the body 
enanthem = rash on mouth

Question 7

What are the common herpes virus that affect humans

Answer 7

CMV
HSV type 1 + 2
Varicella Zoster
EBV

Question 8

What is chicken pox?

Answer 8

Primary VZV infection

Question 9

Where does VZV become dormant? What is it called if it reactivates?

Answer 9

DRG

Shingles

Question 10

What is the typical presentation of VZV?

Answer 10

fever, lethargy, rash in 24 hours
Pruritic vesicular rash with ulcerated areas

Vesicles shed virus

Question 11

What are the complication of VZV infection?

Answer 11

Secondary bacterial infection due to skin lesions
Pneumonitis
Acute cerebellar ataxia

Question 12

At what stage of pregnancy is immune-suppression most obvious?

Answer 12

third trimester, so primary infection here is most dangerous as baby is most unprotected

Question 13

T/F Smoking is an independent variable to fetal defect

Answer 13

True, it increases the risk of pneumonitis specifically

Question 14

When is the fetus most susceptible to mental retardation and developmental abnormalities if the mother gets infected by VZV?

Answer 14

Primary infection in the first trimester

Question 15

When will VZV infection cause perinatal varicella

Answer 15

Primary infection within 7 days before delivery, as mum doesn’t have the time to mount immune response

Question 16

What is VZIG?

Answer 16

Concentrated preformed immunoglobulin given prophylactically within 96 hours post-exposure

Question 17

what is the management of acute chicken pox in mothers

Answer 17

Acyclovir + negative pressure chamber to limit the spread

Question 18

T/F We can clear cytomegalovirus

Answer 18

False, the infection is life-long

Question 19

What kind of cell is produced when infected with CMV?

Answer 19

multinuclear giant cell

Question 20

Where does CMV stay latent in?

Answer 20

White blood cells

Question 21

T/F Reactivated CMV is much more infectious

Answer 21

False, primary infection is more infectious

Question 22

What is the mode of transmission for CMV?

Answer 22

via any body liquid

Question 23

T/F Most of the CMV exposures occur in adults of the developed world

Answer 23

True, and most exposures in the developing world are in children

Question 24

What are the common ways for babies to get CMV?

Answer 24

horizontal transmission (in day-care centre), or breast milk from mum postnatally

Question 25

2% of the live births will have congenital CMV. How much of the infected will be symptomatic? What are the symptoms?

Answer 25

10% | calcification around brain, microcephaly, significant long term sequelae

Question 26

Can asymptomatic babies develop long term sequelae

Answer 26

Yes, 10-15% will have long term sequelae such as unilateral sensory deafness

Question 27

How do we determine whether CMV infection is early or late?

Answer 27

IgG avidity test for how strongly the antibody binds. Late infection will test for higher avidity

Question 28

T/F IgM is a good diagnosis for acute CMV infection

Answer 28

False, IgM for CMV can persist for a long time, up to 18 months Reactivated CMV can also cause rise of IgM

Question 29

Why is it important to retest for infections

Answer 29

To detect for rising titres of antibody

Question 30

How do we confirm fetal CMV infection?

Answer 30

amniotic fluid testing 6-8 weeks after primary infection, or at 20 weeks gestation

Question 31

If the foetus is symptomatic, what is the management option?

Answer 31

ultrasound to check for microcephaly or calcification

Question 32

Can we assume the baby is safe if the baby has asymptomatic congenital CMV?

Answer 32

No, we need to follow them up, as deafness can take five years to develop

Question 33

What is the treatment of CMV?

Answer 33

Ganciclovir IV for 6 weeks to half the rate of deafness Valganiciclovir can also be added

Question 34

T/F Rubella viral infection can be infectious before symptoms are present

Answer 34

True, virus is shed is large amount in nasopharyngeal secretion

Question 35

What are the typical signs of rubella?

Answer 35

fever, lymphadenopathy in the occipital nodes

Question 36

What is the classic triad of congenital rubella syndrome?

Answer 36

ophthalmological, | cardiac and auditory abnormalities

Question 37

T/F Rubella infection is linked to diabetes and thyroid illness

Answer 37

True, they are the rarer presentations

Question 38

T/F Risk of congenital damage is highest in the third trimester

Answer 38

False, it's in the first trimester when all the organs are forming

Question 39

How do we diagnose congenital rubella syndrome?

Answer 39

fetal amniotic fluid test for rising IgG and IgM (acute infection)

Question 40

Which virus causes "slapped cheek" syndrome?

Answer 40

Parvovirus

Question 41

T/F Parvovirus is self-limiting

Answer 41

True

Question 42

What are the presentations of parvovirus infection?

Answer 42

fine reticular rash on body, cheeck | circum-oral pallor

Question 43

What is Hydrops foetalis?

Answer 43

Parvovirus with haematological abnormalities (sickled cell) that reduce RBC lifespan. HF is a significant anaemia

Question 44

What is the treatment of Hydrops foetalis?

Answer 44

Intrauterine transfusion until the virus is cleared

Question 45

T/F HSV-1 is genital specific

Answer 45

False, HSV-2 is typically genital specific

Question 46

How will HSV be transmitted from the mother to baby?

Answer 46

perinatally during delivery if there is primary infection or reactivation

Question 47

What are the symptoms of congenital HSV infection

Answer 47

skin-eye-mouth disease skin vesicle delayed encephalitis disseminated intravascular coagulation

Question 48

What is the management of herpes?

Answer 48

acyclovir

Question 49

What is the causative agent of syphilis?

Answer 49

Treponema pallidum

Question 50

What are the diagnostic tests for syphilis?

Answer 50

EIA and RPR

Question 51

What symptom can the baby develop if there is congenital Toxoplasma gondii infection?

Answer 51

delayed retinopathy