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MRCOG Antenatal Part 2 Revision - Hay > Infectious diseases - Vaccination, influenza, TB, Zica and COVID > Flashcards

Infectious diseases - Vaccination, influenza, TB, Zica and COVID Flashcards

1
Q

What are the 4 main types of vaccine?

A

Killed organisms
Live-attanuated - replicate of host
Sub-unit vaccines - use antigen subunit
Toxoid - bacterial exotoxin

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2
Q

Which vaccines are live attenuated

A

Bacterial
- BCG, tuberculous

Viral
- MMR
- Polio
- Varicella zoster
- Adenovirus
- Yellow fever

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3
Q

What 2 vaccines are offered in pregnancy?

A

Whooping cough, offered between 16-32 weeks.
Most deaths occur in children before they can be vaccinated, vaccinating the mother protects the baby

Influenza
- Risk higher in pregnancy, also risk to baby, offered Sep-Feb

Rubella offered pre-pregnancy if not already vaccinated.

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4
Q

What antivirals can be give in the treatment of influenza? When should they be commenced?

A

Oseltamivir (tamiflu) 75mg OD- 48hrs
Zanamivir (relenza) 10mg inhaled OD - 36hr

Can still be given with 7 days

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5
Q

Which antiviral for influenza is preferred in pregnancy +/- breastfeeding.

A

Pregnancy - Zanamivir, oseltamivir if severe/zanamivir not available

Oseltamivir if breastfeeding

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6
Q

If pregnant women are in close contacting with H1N1 influenza, what should occur?

A

1) Zanamivir (10 mg inhaled daily) or oseltamivir (75 mg daily by mouth) for 10 days after exposure

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7
Q

When are people infectious with influenza?

A

1 day before symptoms up tp 5-7 days after becoming sick.

Children and people with weakened immune system may be unwell for longer than 7 days.

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8
Q

How long is protection conferred after influenza vaccine?

A

2 weeks

Note H1N1 vaccine is different - Pandemrix

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9
Q

What type of pathogen is malaria

A

Protozoa called plasmodium. There are 4 types that effect humans - P. falciparum, viva, oval and malariae

Primary host - female anopheles mosquito

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10
Q

Which parasite causes the most severe infection?

A

P falciparum (cerebral complications)

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11
Q

What % of malaria infection in UK are due to P.falciparum?

A

80%

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12
Q

Which trimester is highest risk of severe infection with malaria?

A

2nd

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13
Q

What are the maternal complications of malaria in pregnancy?

A

Anaemia

Severe cerebral malaria

Acute pulmonary oedema / ARDS

Hypoglycaemia – commoner in pregnancy and may be worsened by treatment with iv quinine

Renal failure with haemoglobinuria

DIC

Maternal mortality

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14
Q

What are the fetal complications of malaria in pregnancy?

A

Miscarriage

Pre-term delivery

Stillbirth

Low birth weight

Fetal anaemia

Neonatal death

Neonatal anaemia

Congenital malaria - evidence of placental infection at delivery in up to 25% of cases. P falciparum infection in pregnancy is typically has parasites sequestered in the placenta

Increased susceptibility to other infections

Failure to thrive

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15
Q

Prevention of malaria using ABCD Mnemonic?

A

Awareness - avoid endemic area, avoidance strategies, can sitill present within 1 year of visit

Bite prevention - Dusk til dawn, 50% DEET, bed nets, clothing

Chemoprophyalxsis - Take until 7 days after leaving area, should not become pregnancy during this time and need to await the clearance time of those drugs.

Diagnose & treat

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16
Q

Drug excretion time of
- Mefloquine

A

3 months

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17
Q

Drug excretion time of
- Atovaquone and proguanil (Malarone®)

A

2 weeks

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18
Q

Drug excretion time of
- Doxycycline and proguanil

A

1 week

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19
Q

Which is the prophylaxis of choice if 2nd/3rd trimester or breastfeeding?

When is it contraindicated?

A

Mefloquine

CI Hx depression, Neuro-psychiatric disorder, epilepsy, hypersentivity to mefloquine/quinine

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20
Q

What investigation should be performed to Ix malaria.

A

Thick and thin blood films - need 3 negative films 12-24hrs apart to exclude malaria.

FBC, glucose, ABD, U+E, LFT, CRP, urine, CXR, stool culture, blood culture. Consider LP
Obs USS

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21
Q

Where should pregnancy women with malaria be treated?

A

Uncomplicated - admit to hospital
Complicated - ITU

22
Q

What is the treatment of choice for severe falciparum malaria?

A

IV artesunate

or
IV quinine + clindamycin

23
Q

What is the treatment of choice for uncomplicated falciparum malaria?

A

Qunine and clindamycin

24
Q

What is the treatment of choice for P. vivax, P. ovale or P. malariae.

A

Chloroquine

25
Q

What signs are of severe falciparum infection?

A
  • Impaired GCS
  • Hypoglyceamia
  • Pulmonary oedema or ARDS
  • Hyperparasitaemia >2% parasite RBC
  • Severe anaemia <80
  • Abnormal bleeding/DIC
  • Haemglobinuira
  • Renal impairment/electrolyte, acidosis <7.3
    Hyperlactaemia
    Shick
26
Q

Placental parasitaemia is asssocaitewd with congenital malaria and increased mortality.

how should this be tested for?

A

Cord blood film + weekly blood films from neonate for 28 days
Send placenta to histology

27
Q

Incidence of TB in pregnancy women?

A

4.2/100 000

28
Q

Risk factors of TB

A

Close contact with infectious cases
Travel to or receiving visitors from places where TB is endemic
Living in ethnic minority communities originating from places where TB is endemic
Immune compromise – HIV positive, the very young / elderly
Chronic poor health and mal-nutrition, drug abuse or alcoholism
Living in over-crowded housing conditions

29
Q

How to IX TB

A

Microbiology of sputum, CSF - acid-fast bacilli
Mantous test - not effect by pregnancy, but +ve if previous BCG

Bloods/CXR +/- MRI

30
Q

Treatment of TB

A

Isoniazid, rifampicin and ethambutol for 6 months.

31
Q

What is a common side effect of isoniazid? How is it prevented?

A

Isoniazide-induced neuropathy - pyridoxine 10mg OD
Monthly LFT

32
Q

Side effect of ethambutol?

A

Retrobulbar neuritis - blurred vision and mental scotomata

33
Q

Can you breastfeed with TB?

A

Anti-TB drugs cross into breastmilk but not contraindicated

34
Q

What contact tracing should occur with TB

A

All close contacts based on history, examination, tuberculin testing and chest X-ray.
TB is a notifiable disease

35
Q

Can the BCG vaccine be given in pregnancy?

A

No, live vaccine so contraindicated
Should be offered to neonates & infants in areas where annual TB incidence > 40 per 100,000/ Fax TB in last 5 years, parent/grandparternt from country with high incidence
Do not give to babies who mothers are HIV +ve until shown to be HIV -ve

36
Q

How is Zica virus transmitted?

A

Infected Aedes species of mosquito (same as dengue, yellow fever)

37
Q

Can maternal - fetal transmission of zica occur?

A

Yes via placental barrier
Not though breastmilk

38
Q

When to screen for Zica infection in pregnancy

A

At booking ask re travel history
- If area with active zica, present with zica symptoms or symptoms within 2 weeks of travel should be tested

39
Q

If woman test +ve for Zica virus infection, What should be done?

A

Redere to FMU for 4 weekly USS and consider MRI

If +ve travel Hx offer baseline fetal USS

40
Q

If travelled to Zica area but does not have symptoms of the infections

A

Offer baseline USS then 4 weekly USS

41
Q

How long should conception be avoided if travelled to Zica country?

A

3 months if both travelled or male partner travelled
2 month if female travelled

From date left area or sexual contact with a potential infectious partner
If women develops symptoms compatible with Zica should avoid pregnancy for 2 month

42
Q

At what gestation can a Dx of microcephalic be given?

A

Until 28 weeks but not possible to given definitive Dx at all.

Consider amniocentesis for zica virus if microcephaly

43
Q

If person has zica virus, when can they try to concieve/donate gametes/fertility treatment?

A

6 months

44
Q

When can a sperm donor donate sperm after visiting a zica country?

A

Asymptomatic sperm donors should be deferred for six months after return unless the semen tests negative for Zika virus by NAT

45
Q

Which covid variant is associated with the most severe disease?

A

Delta varient

46
Q

Effects of COVID 19 on foetus?

A

Double risk of stillbirth
?Increased SGA

  • no congenital abnormality, vertical transmission is rare
47
Q

Can breastfeeding or pregnant women receive the covid 19 vaccine?

A

Yes both can, do not need to stop breast-feeding.

48
Q

If a patient has COVID 19 and is on aspirin?

A

Should be discontinued, duration of infection as may increase risk of thrombocytopenia and bleeding

49
Q

What treatments can be given for COVID 19 following MDT discussion?

A

Steroids - PO preg 40mg PD or IV hydrocortisone 80mg BD for 10 days or until discharge

Tocilizumab if evidence of systemic infection CRP >75

50
Q

According to UKOSS, what % of hospitalised women required ITU care?

A

5%
Maternal mortality of hospitalised pregnancy women 2.4/100 000

MRCOG Antenatal Part 2 Revision - Hay (72 decks)

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