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NU2101 > Infections > Flashcards

Infections Flashcards

1
Q

what is Hepatitis B?

A

HBV is a double-shelled DNA virus that affects the liver causing acute and chronic infection that can lead to liver damage. Please note that the hep B virus has different antigens that are used to diagnose active, chronic or past infection.

can be prevent via vaccination

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2
Q

how is Hepatitis B transmitted?

A

HPV is transmitted by blood and body fluids and it can live for up to 72 hours on surfaces which appear clean. Please note that the risk of transmission via breastmilk is very low, so breastfeeding is NOT contraindicated.

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3
Q

horizontal transmission of hep b?

A
  • Sex
  • IV drug users
  • Sharp injuries
    Blood transfusion
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4
Q

vertical transmission of hep b?

A
  • In utero
  • During birth
    Breastfeeding (low risk)
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5
Q

The risk of vertical transmission (mother-baby) depends on the serological result. To interpret them, midwives must pay attention to what?

A

• HBV surface antigen: it is a viral protein detected in the blood. If positive indicates current infection. If negative, indicates the person is not currently infected and has never been in the past
• HBV E antigen (HBeAg) indicates active viral replication, and is a sign of acute infection.
• Anti–HBV surface antigen antibodies are the ones produced when someone is being exposed to HBV in the past and has become immune, of if the person has been vaccinated against HBV. Levels >100 mIU/mL indicate full immunity.

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6
Q

hep b is screening at booking, what should a midwife do if there is a positive result?

A

• Refer to obstetrician. If acute infection, then she will be referred to hepatology team. If the viral load is high, the mother will be treated during the last trimester to reduce the chance of vertical transmission.
• If high risk of transmission, avoid interventions in labour where there may be contact between maternal and fetal blood. At birth, baby will be given HBV immunoglobulin IgG and HBV vaccination within 24 hours.
Advice mother that breastfeeding is safe, but if they have cracked nipples or bleeding, they should not breastfeed. They can pump to maintain supply, but the milk must be discarded.

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7
Q

what cells does HIV target?

A

CD4+ which helps immune cells communicate

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8
Q

why is HIV viewed as a chronic infection that is manageable?

A

The advent of anti-retroviral therapy (ART) has enabled the replication of HIV to be suppressed to such a level that the CD4 count can recover. HIV is therefore now viewed as a chronic infection that is manageable with medications.

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9
Q

how can HIV be transmitted?

A

• Horizontally: via sexual intercourse, blood transfusion, sharp’s injuries or IV drug users
• Vertically: from mother to child in utero, during birth or while breastfeeding.

The rate of mother-to-child transmission in the UK is now around 0.27%. The benefit of antiretroviral therapy is clear: 90% of HIV+ women on ART had undetectable viral load by the time of birth, and for these women, the risk of transmission is even lower (0.14%).

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10
Q

what is the impact of HIV on pregnancy?

A
  • Miscarriage and still birth
    • Fetal malformations
    • IUGR
    • Low birth weight
    • Preterm birth
    • Neonatal death
    • Postnatal depression
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11
Q

what does summary of care involve for HIV women?

A
  • Universal screening at booking
    • Under multidisplinary team
    • Combined anti-retroviral therapy
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12
Q

what does antenatal screening involve for HIV?

A

HIV is universally screened at booking. A new diagnoses of HIV during pregnancy are even more difficult to process that in non-pregnant women, as their diagnose have implications not only for their own health, but the health of their future babies. Lots of stigma and myths are still present in society. Because of this, every new diagnose in pregnancy should include:
• Counselling and support groups available
• An invitation for sexual health screening for other sexually transmitted infections

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13
Q

how is HIV managed during pregnancy?

A

who are on monotherapy with zidovudine may need to change their medication pre-conception to combined anti-retroviral therapy to reduce their risk of transmission. They will be cared by a multidisciplinary team and serial viral load samples will be taken regularly.

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14
Q

why does the result of the viral load will determine what options are offered antenatally and even the place of birth?

A

• If amniocentesis is needed, viral load needs to be below 50.
• External cephalic version can be offered if viral load is below 50
• At 36 weeks, mode of birth will be discussed:
○ If <50 copies/mL: vaginal birth is recommended
○ If >400 or on zidovudine monotherapy: csection recommended (38-39 weeks)
○ If >1000: IV zidovudine infusion should be given during csection

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15
Q

what does neonatal care involve for mums with HIV?

A
  • Baby will start of prophylactic zidovudine therapy at birth
    • Baby immunisations should be given as per guidelines
    • Breastfeeding is contraindicated in the UK
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16
Q

breastfeeding is contraindicated for women with HIV but if they choose to Bf what do you do?

A
  • Undetectable viral load
    • No vomiting or diarrhoea in neither mum or baby
      No injury or infection in breast
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17
Q

what does intrapartum care for women with HIV involve?

A

vaginal birth, then minimise interventions (including fetal scalp electrode or fetal scalp blood sampling!). Birth does not need to be in the obstetric unit, it can also be in a co-located midwifery unit with access to paediatric care.

• Because the duration of rupture membranes is related with a higher risk of transmission, ARM should be avoided. If spontaneous rupture of membranes, then aim for birth within 24 hours. 
• IV antibiotics should be considered to reduce the risk of infection, however, this is controversial
• Once the baby is born, will start on prophylactic zidovudine therapy at birth, and viral load will be monitored after birth.
• Breastfeeding as a general rule, is not recommended in the UK, but if the woman chooses to breastfeed, she needs to be counselled about the risk of transmission (1-2 in 100 babies). As long as the mother continues breastfeeding, viral load will be measured in the baby once a month. She should also be advised about the 3 conditions in the yellow box below that will reduce the risk of transmitting HIV to the baby.
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18
Q

what is syphilis transmitted?

A
  1. Acquired syphilis - T pallidum enter via body fluids
    - Cuts in skin or mucous membranes
    - Sexual contact
    - Contaminated needles
    - Direct contact with skin lesions
  2. Congenital syphilis - mother has syphilis and T pallidum infects baby in utero or during birth .
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19
Q

what are the three stages of acquired syphilis?

A

primary, secondary, tertiary

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20
Q

what is primary syphilis?

A
  1. Primary (early localised)
    - 1-3 weeks after T pallidum lands on skin or mucous membrane
    - Painless
    - Can spread to other part of body and people
    - Sexual contact - external genitals
    - Physical contact - hands or other part of body
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21
Q

what is secondary syphilis?

A
  • 6-12 weeks after infection
  • Enters bloods and infected epithermal skin cells causing non-itchy maculopapular rash
  • Starts trunk -> arms and legs -> palm and soles and genitals.
  • The rash can be pustular (filled with white fluid) or papulosquamous (scaly and hard) or condyloma lata (smooth, white, painless, wart like lesions).
  • Most infectious stage
  • Usually resolves in a few weeks to months
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22
Q

what are latent syphilis?

A
  • Dormont, asymptomatic
  • Enters in capillaries in organs and tissues
  • Early phase - within a year of infection, can circulate in blood causing symptoms like in secondary syphilis.
  • Late phase - after a year of infection, stay within the capillaries or organs and tissues.

There is only a few spirochetes in the capillaries but it causes a severe immune response which damaged the cell.

This triggers tertiary syphilis

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23
Q

what is teriary syphilis?

A
  • Type 4 hypersensitive reaction - immune response led by t cells, they recruit macrophages to cause the release of tumour necrosis factor, IL 1 and IL 6.
  • This leads to swelling, oedema, redness, warmth and fever.
  • Organs get damaged in tertiary syphilis.
  • Heart - cardiovascular syphilis
  • Neurosyphilis
  • Liver, joint and testes.
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24
Q

what is cardiovascular syphilis?

A
  • Endarteritis
  • Aorta is damaged
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25
Q

what is neurosyphilis?

A
  • Result in wasting of back of spinal cord.
  • Results in weakness or loss of sensation
  • Can called slurred speech
  • Memory loss
  • Difficulty coordinating
  • Paralysis
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26
Q

how is congenital syphilis transmitted?

A

placenta or birth canal

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27
Q

what is early disease syphilis?

A
  • Still born
  • IUD
  • Maculopapular rashes in palms of hand or feet
  • Snuffles - blocked nose
  • Organ damaged to liver and spleen
  • Damaged to eyes

(first 2 years)

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28
Q

what is late disease syphilis?

A

(>2 years)

  • Saddle nose - bony disstructure of the nose
  • Saber - tibia is bent
  • Hutchinson teeth - teeth developed little notches
  • Hearing loss
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29
Q

how and why is syphilis screened?

A

Syphilis is the last of the infectious diseases universally screened at booking because we know that 70-100% of babies will be infected if the woman has untreated primary syphilis and one third of these babies will die in utero.

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30
Q

what does a positive result at booking mean for syphilis?

A

A positive result at booking does not necessarily means that she has an active syphilis infection because this tests are non-specific for syphilis (non-treponemal). The positive result needs to be confirmed with a treponemal test, a specific test that looks directly into the presence of T.pallidum in blood.

31
Q

how is syphilis treated?

A

Syphilis is treated with the administration of antibiotics, mainly penicillin IM.

32
Q

what does after treatment mean for pregnancy?

A

After treatment, pregnancy can be then managed as low risk. Birth can still happen in a midwifery unit, as long as is co-located in a hospital with access to paediatric care.
After birth, the baby will need paediatric review to screen for signs of congenital syphilis.

33
Q

what is the impact of syphilis on pregnancy?

A
  • Miscarriage and stillbirth
  • Preterm birth
  • Polyhydramnios
  • Hydrops
    Congenital syphilis
34
Q

what is the summary of care when having syphilis?

A
  • Universal screening at booking
  • Under multidisplainary team
  • Penicillin IM
  • Paediatric review
35
Q

what is Listeria monocytogenes and where is it found?

A

gram positive bacteria that is capable of growing in a wide range of temperatures, including refrigeration ones.

It is found in the environment, in soil, vegetation and faeces of many animals and birds. When food is contaminated, the only way of avoiding getting infected is by cooking food thoroughly and pasteurization of milk-derived products. T

36
Q

what foods can you get listeria from?

A
  • Soft cheese (brie, camembert, goat, chèvre)
  • Blue cheese (danish blue, gorgonzola, Roquefort)
  • Smoked salmon
  • Cooked sliced meat
  • Prepacked sandwiches
    Unpasteurized milk
37
Q

what are the symptoms of listeria?

A

Symptoms are unspecific and women may experience them up to 90 days after the initial infection: flu, gastroenteritis, muscle aches and pains and fever. In rare cases, the infection becomes severe and may need hospital admission in intensive care.

38
Q

how do you diagnose listeria?

A

The only way to confirm this infection is from blood and urine cultures at time of symptoms. If past infection is suspected in the baby, amniocentesis may be required.

39
Q

how is listeria transmitted to baby?

A

the placenta

40
Q

what is the fetal impact of listeria?

A

Fetal and neonatal infection causes meningitis or sepsis, with a 50-100% mortality. It can also cause miscarriage, stillbirth, chorioamnionitis and pre-term birth.

41
Q

what is care in pregnancy of listeria?

A

Care in pregnancy involves routine universal food safety advice, including cleaning of preparation areas and hand washing. Once the mother is infected, she will be given broad spectrum antibiotics and treatment of the symptoms.

42
Q

what is toxoplasmosis?

A

This parasite is found in animals and birds but it is the cat which acts as a host and passes it out in its faeces for several weeks after it has become infected. This is the typical example of toxoplasmosis infection: when a woman emptying the litter tray or doing some gardening, may have got in contact with cat faeces.

toxoplasmosis by eating undercooked, raw or cured meat or unwashed raw vegetables. Any other food that has been in contact with contaminated knives, chopping boards or cooking utensils can potentially be contaminated too.

43
Q

what are the symptoms of toxoplasmosis?

A

they are mild flulike unspecific symptoms that can last 4-6 weeks. or none at all

44
Q

how does toxoplasmosis impact baby?

A

If the infection happens in early pregnancy, the chances of the baby to be affected are small, but if they are affected, the consequences will be more severe, including miscarriage and ophthalmic and cranial birth defects. However, the only way of confirming fetal infection is through amniocentesis and this is only accurate after 20 weeks.

45
Q

what is chickenpox?

A

Chickenpox is a viral infection caused by varicella zoster virus, that cause varicella in children and shingles, when the dormant virus is reactivated in adults. By respiratory droplets in contact with vesicle fluid.

Most women in the UK have been exposed to the virus in childhood and are immune.

46
Q

how does chicken pox present?

A

Chickenpox usually starts with itchy red sports that can appear anywhere on the body. This spots fill with fluid and become blisters. The fluid in those blisters is highly contagious. Eventually, the blisters scab over. It is common to have fever and flu-like symptoms. Chickenpox is infectious from 2 days before the spots appear to until they have crusted over.

47
Q

how does non-immune pregnant women get impact with chickenpox?

A

Non-immune pregnant women are more vulnerable to severe chickenpox infection, that can develop into pneumonia, meningitis or sepsis. Women with previous children are at higher risk. In later stages of pregnancy, chickenpox is associated with pre-term birth or neonatal chickenpox infection if the woman has chickenpox 7 days before the birth.
In non-pregnant women, treatment is symptomatic, but in pregnant women, varicella zoster immunoglobulin (VZIG) should be administered.

48
Q

what does IgM and IgG mean in terms of chickenpox results?

A

IgG antibodies - immune
IgM antibodies - recent

49
Q

what is CMV?

A

Citomegalovirus (CMV)

CMV is a common virus that is part of the herpes family. Many people are exposed during childhood and become immune.

50
Q

how is CMV spread?

A

CMV is spread by contact with bodily fluids, such as saliva, urine, semen, cervical secretions or breastmilk.

51
Q

what do you reduce the risks of CMV?

A

The risk of CMV can be reduced by hand washing regularly, especially after changing nappies. Women are also advised to avoid sharing food, eating utensils or drinking glasses with children, or any other activity where there may be contact with saliva.
As other viral infections, diagnosis is made by measuring antibodies.

52
Q

what is CMV associated with?

A

CMV associated congenital defects are related with IUGR, microcephaly and neurodevelopmental delays. Hearing loss is the most frequent long term consequence in around 20% of affected children. However, most babies wil be normal at birth. Only 10% will be symptomatic and of these, up to 1/3 will die.

53
Q

what is IgG and IgM mean for CMV?

A

IgG antibodies - passed infection
IgM antibodies - recent

54
Q

what is rubella?

A

MMR vaccine.

People are the only known host and they transmit the infection by respiratory droplets.

55
Q

what happens if an unvaccinated when is in contact with rubella?

A

unvaccinated woman gets in contact with rubella, detection of IgM in saliva can help diagnose the infection.

• If she is less than 11 weeks, the risk of vertical transmission is more than 90%. This risk decreases to only 20% by 11-16 weeks, and after 20 weeks, the risk of Congenital rubella syndrome is non-increased.
56
Q

what can congenital rubella cause?

A

Congenital rubella cause deafness, cardiac abnormalities, congenital cataracts, microcephaly and learning impairments.

57
Q

what is the meaning of IgG and IgM for rubella?

A

IgG antibodies - immune
IgM antibodies - recent

58
Q

what women are higher risk of GBS?

A
  • Black African women
  • High BMI
    Health care workers
59
Q

when do problems arise with GBS?

A
  • Weakened immune systems
  • Newborns
  • Pregnant women
  • Adults with underlying disease
  • Pre-existing infection such as HIV
  • People with their spleen removed
  • Functional asplenia <- sickles cell disease
    (The spleen is important for immunity against encapsulated bacteria)
60
Q

why can having GBS in pregnancy be dangerous?

A

In pregnant women, GBS can travel through the vaginal and into the uterus damaging the chorion and amnion. This causes chorioamnionitis which can cause the membranes to rupture. It can also travel to the fetus and can cause IUD.

61
Q

what is the risk of passing GBS to newborn in childbirth?

A

if baby inhales this, they can develop pneumonia
they can develop neonatal sepsis
septic arthritis
neonatal meningitis

62
Q

how can GBS be transmitted?

A

• Vertical: this is usually when the GBS bacteria is transmitted from the mother to the baby when he/she passes through the vagina. It is also considered possible that the GBS may ascend through the vagina and cause infection of the membranes, especially if membranes are broken. Cases of babies born via csection with GBS infection are thought to be related with this second cause.
Horizontal: GBS can also be transmitted with direct contact with hands (p.e. health care workers who handle the baby) or direct contact with contaminated surfaces, including medical devices and furniture (like a hospital cot), where the GBS bacteria can survive.

63
Q

what is vertical transmission of GBS frequently associated with?

A

The vertical transmission is more frequently associated with early onset GBS disease, while the horizontal one is thought to cause late onset GBS.

64
Q

what is late onset GBS?

A

Late onset GBS infection is the infection that occurs between 7 days and up to 3 months of age. As it is not related with pregnancy, but with an encounter with the GBS bacteria after birth, late onset GBS is not preventable by any intervention during pregnancy or birth. Late onset GBS is more likely in non-white babies and those born preterm.

65
Q

what is early onset GBS?

A

EOGBS disease happens in the first 7 days of life, although 90% of cases will begin within the first 24 hours of life. GBS can develop very quickly and get complicated with septicaemia, pneumonia or meningitis.

66
Q

what are risk factors for early GBS?

A
  • Preterm
  • Small for gestation age
  • ROM > 12-24hrs
  • GBS in urine
  • Previous baby affected
    Intrapartum fever
67
Q

what are the early symptoms of the early onset of GBS?

A
  • Fever
  • Grunting and breathing difficulties
  • Tachycardia
  • Irritability
  • Lethargy
  • Cyanosis or pale
    Feeding difficulties
68
Q

does the UK recommend routine GBS screening and why?

A

NO,

Current test are not accurate: We do not know what factors may make it disappear and which factors may it stay. good chances of a woman being offered antibiotics in labour when in reality she does not need them.

• Timing of screening may not be adequate: many of the babies severely affected from GBS are born premature, which means, before the suggested time for screening.
	○ If screening were to be offered earlier, this may reduce even further its accuracy.

There are concerns about the widely used of antibiotics in labour: All women at risk of GBS or with a GBS+ result will be offered antibiotics in labour, even if they do not have any other risk factors
○ If screening were to be offered at onset of labour, it may be too late, as it takes around 48 hours for the results to be available
○ Sometimes GBS can be found incidentally when the woman has a swab for any other reason. However, this incidental finding in pregnancy greater than 5 weeks before labour is unreliable and may result in unnecessary interventions.

69
Q

what are the currently guidelines of GBS intrapartum antibiotics?

A

Current guidelines recommend at least 4 hours of worth of antibiotics before the baby is born.

70
Q

what is the impacts of GBS antibiotics on baby?

A

Antibiotics during birth have an impact on the microbiome of the baby and there is a potential risk of anaphylaxis, increased incidence of later bacterial infections in infants and increasing rates of diseases such as asthma, allergy, obesity, eczema and even obsessive compulsive disorder.

71
Q

what is the recommended GBS antibiotic?

A

The recommended antibiotic is benzyl penicillin.

72
Q

what does having GBS in pervious pregnancy mean?

A

Please note that having GBS in a previous pregnancy with a non-affected baby is not considered to be at risk. However, they do have 40-50% chances of being GBS carriers again. These women are given the option to be screened in late pregnancy and being offered antibiotics if positive.

73
Q

what is the care for GBS women and babies?

A

If risk factors:

  • Offer antibiotics in labour
  • Monitor mother and baby for signs of infections during labour ( as per normal care guidelines)

If PROM

  • Offer antibiotics and discuss early induction

Neonatal care

  • Observations for 24 hours
  • Neonatal review

NU2101 (33 decks)

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