Congenital and Perinatal Infections

Question 1

according to the timing baby infections can be classified as

Answer 1

Prenatal
Perinatal
Postnatal

Question 2

what are the main type of modes for congenital infections?

Answer 2

Vertical (transplacental, breast milk)
Horizontal
Ascending

Question 3

Varicella is caused by

Answer 3

Varicella Zoster Virus

Question 4

some characteristics of VZV?

Answer 4

herpes virus
dsDNA linear
capsule and envelope

Question 5

what is the difference between exanthems and enanthems?

Answer 5

Exanthems are rashes outside of the body

Enanthems are lesions inside the body in the mucosal surfaces

Question 6

what are the main findings after 14 days of a person with VZV infection?

Answer 6

Fever, lethargy, pruritic vesicular rash

(rash clear fluid first then becomes turbid and explodes) rash develops ~48 hours after symptoms onset

Question 7

what is the most common complication of VZV infection?

Answer 7

secondary bacteremia (strep pyogenes [GAS] and staph aureus)

Question 8

congenital varicella syndrome consists in? when is the foetus most at risk for severe consequences?

Answer 8

limb hypoplasia
cicatricial scarring 
mycrocephally, cataracts
mental retardation
GIT and GUrinary tract abnormalities
First Trimester PRIMARY INFECTION

Question 9

if the mom gets varicella during the last 2 trimester of pregnancy it is most likely that?

Answer 9

the child will develop shingles without having had varicella in the first year of life

Question 10

what happens if the mom develops primary varicella during the -7,+2 days of delivery?

Answer 10

the mom would lack the specific antibodies for the protection of the foetus and the baby in (30% of cases) will develop varicella as the virus will be present in higher [] in the mother fluids

Question 11

if the baby gets infected in uterus previous to delivery or during delivery

Answer 11

Hemorrhagic Varicella

Question 12

what is the main way of avoiding perinatal infection after the mother develops primary varicella?

Answer 12

Prophylactic VZIG

Varicella Zoster Immunoglobulin

Question 13

prophylactic antibodies for varicella should be given 96 hours post-exposure T/F

Answer 13

T

Question 14

treatment for acute varicella is?

Answer 14

Oral acyclovir if rash but no systemic symptoms

IV if pneumonitis, neurological symptoms, organ involvement and hemorrhagic rash

Question 15

vaccine against varicella gives?

Answer 15

100% protection against severe disease

Question 16

what type of vaccine is Varicella vaccine?

Answer 16

Live attenuated virus (also rubella)
given at 18 months of life
if never given 2 doses for >12yo

Question 17

Cytomegalovirus is what type of virus

Answer 17

Herpes Like Virus

Question 18

where does cytomegalovirus remains silent?

Answer 18

lymphocytes

Question 19

transmission of cytomegalovirus happens via?

Answer 19

all bodily fluids

10% of adults shedding virus at any one time

Question 20

congenital CMV is more prevalent in

Answer 20

developed countries

people encounter the virus later on in life

Question 21

most commonly CMV is given to the baby by

Answer 21

breastmilk

Question 22

of the infected population of babies (1%) how many are symptomatic

Answer 22

10% [deafness]

Question 23

What is the most common cause of CMV infection in babies?

Answer 23

primary infections (20-50% of foetal infections)

Question 24

of the symptomatic infections how many develop long term sequelae

Answer 24

90%

Asymptotic (only 15%)

Question 25

what is the main form of diagnosis for CMV?

Answer 25

IgG avidity IgM detection Nucleic Acid Detection PCR of amniotic fluid

Question 26

if the baby is infected it will also be affected?

Answer 26

F | ultrasound required to determine if abnormalities present

Question 27

if the baby is symptomatic at birth what is required?

Answer 27

multidisciplinary approach to management, Ganciclovir

Question 28

how many people will have asymptomatic infections with rubella virus?

Answer 28

25-50% | virus shed in nasopharyngeal secretions

Question 29

the clinical presentation of rubella infection include

Answer 29

lymphoadenopathy (posterior cervical) Exanthem Polyarthralgia

Question 30

congenital rubella syndrome causes the most amount of damage in

Answer 30

first trimester of pregnancy (first month specially)

Question 31

what is the outcome of congenital rubella syndrome

Answer 31

1/3 normal life 1/3 live with parents 1/3 institutionalised

Question 32

what is the classic triad of congenital rubella syndrome

Answer 32

Ophthalmological (catarcts, glaucoma, retinopathy) Cardiac (pulmonary artery stenosis, patent ductus arteriosum) Auditory

Question 33

what is the main way of testing for rubella?

Answer 33

serovonversion amniotic fluid, cord blood foetal IgM

Question 34

one of the main characteristics of infection by parvovirus B19(erythrovirus) in children

Answer 34

Slapped Cheek

Question 35

in adults erythrovirus can cause anaemia?

Answer 35

not because of the long live of normal RBCs (120 days)

Question 36

why does erythrovirus causes hydrops fetalis

Answer 36

because of the rapid death of RBCs there is water retention anaemia

Question 37

what is the risk of foetal loss in infection by erythroparvovirus?

Answer 37

10% in the first 10 weeks

Question 38

diagnosis of parvovirus?

Answer 38

rising titre of IgG IgM nucleic acid detection if infected weekly ultrasound is recommended and blood transfusion according to findings

Question 39

if there is a first infection during pregancy with herpes virus what is recommended?

Answer 39

acyclovir and suppression of viral load until delivery

Question 40

if there recurrent infections during pregancy with herpes virus what is recommended?

Answer 40

acyclovir and suppression careful examination at time of delivery investigation of the baby

Question 41

some of the problems HSV can cause are?

Answer 41

preterm labour, IUGR | near delivery --> ulcers, encephalitis

Question 42

what are some of the problems with syphilis infection?

Answer 42

30-40% still born | snuffles (clear, copious secretions from the nose)

Question 43

congenital syphilis has a high risk of foetal transmission?

Answer 43

T

Question 44

prenatal testing for infections MUST be done for the following

Answer 44

``` Varicella Zooster Rubella Syphilis HBV HCV HIV GBS ```

Question 45

prenatal testing for infections should be done for the following

Answer 45

Cytomegalovirus | Toxoplasma gondii