Mi - Viral Infections in Pregnancy

Question 1

causes of a rash in pregnant women

Answer 1

VZV
EBV
HSV
CMV
parvovrius b19
enterovrius
measles
rubella

Question 2

who gets CMV

Answer 2

chemo / AI pts

Question 3

name some herpes viruses

Answer 3

HSV, VZV, CMV, EBV

Question 4

what type of virus is herpes

Answer 4

DNA

Question 5

can herpes viruses be cleared

Answer 5

no - cause lifelong latent infection reactivated under stress

Question 6

how is HSV transmitted

Answer 6

close contact

Question 7

sx of herpes

Answer 7

asymptomatic
painful vesicualr rash
lymphadenopathy
fever

Question 8

Dx for herpes

Answer 8

viral detection - lesion swab for PCR
serology

Question 9

how can foetus be infected with HSV

Answer 9

active rash in mothers genitals then PROM

Question 10

how can neonates get HSV

Answer 10

kissing baby with oral herpes
direct contact with mothers infected secretions in delivery

Question 11

3 types of HSV infection

Answer 11

primary - 1st time infected
non primary - prev infection with a type of HSV then ifnected with another
recurrent - latent reactivation

Question 12

2 risks of HSV in pregnancy

Answer 12

vertical transmission - greatest if active infection in 3rd trimester
in utero infection - primary infection causing miscarriage / congenital abnormalities

Question 13

Tx of HSV in preg

Answer 13

acyclovir suppression 6 weeks pre birth

Question 14

Ix for HSV in preg

Answer 14

GUM referral to look for other STIs
HSV AB testing
acyclovir
C section if within 6 weeks pre birth

Question 15

3 types of neonatal HSV

Answer 15

skin eye mouth (SEM)
CNS involvement
dissemninated

Question 16

Sx, time frame of occurence and prognosis of SEM (skin, eye, mouth) HSV in neonates

Answer 16

benign
first 14 days or up to 6 weeks
high risk of progression to CNS

Question 17

Sx, time frame of occurence and Ix of CNS HSV in neonates

Answer 17

seizures, lethargy, irritability, poor feeding
2-3 weeks of life, up to 6
LP

Question 18

Sx, time frame of occurence and prognosis of disseminated HSV in neonates

Answer 18

like sepsis - multi organ involvement
1st week of life
death, too late to treat here

Question 19

Tx of neonatal HSV

Answer 19

acyclovir

Question 20

incubation of VZV

Answer 20

7 to 13 days

Question 21

timeline of VZV course

Answer 21

get infection
24hrs later, rash starts
lesions crusted over 5-7 days after

Question 22

complications of maternal varicella

Answer 22

10% varicella pneumonia
encephalitis (rare)

Question 23

3 types of congenital varicella syndrome

Answer 23

in utero
perinatal
postnatal

Question 24

Sx of congenital varicella syndrome

Answer 24

neuro abnormalities
occular abnormalities
low birth weight
GI abnormalities
limb abnormalities & skin scarring

Question 25

when would you Ix a pregnant woman with VZV for ?Tx

Answer 25

if no previous chicken pox or vaccination

Question 26

when would you offer Tx to VZV pregnant woman

Answer 26

if VZV IGG <100

Question 27

Tx for VZV pregnant woman

Answer 27

oral acyclovir 800mg or oral valaciclovir 1000mg

Question 28

what % of people have CMV by 16 years old

Answer 28

40%

Question 29

transmission and incubation of CMV

Answer 29

saliva / resp secretions / urine 4-8 weeks

Question 30

Sx of CMV

Answer 30

mostly none maculopapular rash, sore throat, temp, glands

Question 31

Ix of CMV

Answer 31

PCR of urine / saliva serology +/- bronchoscopy

Question 32

when is the biggest risk to baby with CMV infection

Answer 32

3rd trimester

Question 33

Sx of CMV for foetus

Answer 33

encephalitis microcephaly ventriculomegaly --> poor development jaundice thrombocytopenia hepatosplenomegaly chroioretinitis

Question 34

when is CMV tested for in baby

Answer 34

Guthrie card in 1st week of life

Question 35

Ix for CMV for mother

Answer 35

check serology & compare to 8 week booking scan USS +/- amniocentesis

Question 36

Tx for CMV

Answer 36

NONE

Question 37

conjunctivitis, rash, cough, fever, koplik spots. Dx?

Answer 37

measles

Question 38

headache, low fever, sore throat, spots on soft palate. lymphadenopathy. Dx?

Answer 38

rubella

Question 39

contrast the rashes of measles and rubella

Answer 39

measles = rash starts at hair line / behind ears and goes to chest over 3 days rubella = rash starts on face then spreads to chest within hours

Question 40

Ix of rubella

Answer 40

buccal swab for PCR and serology

Question 41

when is rubella most a problem for foetus & what happens

Answer 41

1st trimester - pre 8 weeks = miscarriage, pre 10 weeks = 90% have foetal defects

Question 42

rubella after 20 weeks gestation. prognosis?

Answer 42

FINE

Question 43

congenital rubella syndrome Sx in neonate?

Answer 43

microcephaly cataracts retinopathy bone lesions purpura hepatosplenomegaly PDA heart

Question 44

congenital rubella syndrome Sx developing in older child?

Answer 44

panencephalitis hearing loss DM intelectual disability thyroid dysfunction

Question 45

complications for mother of measles in preg

Answer 45

secondary bacterial infections otitis media / pneumonia / GI encephalitis

Question 46

measles Sx for foetus

Answer 46

foetal loss *** main one preterm delivery no congenital abnormalities subacute sclerosing panencephalitis

Question 47

Sx of SSPE & onset

Answer 47

progressive neuro Sx and neuro degeneration 7-10 years post infection

Question 48

in whom in parvovirus b19 a particular worry and why

Answer 48

sickle cell pts - causes aplastic crisis

Question 49

Sx of parvovirus in pregnancy

Answer 49

mostly none erythema infectiosum / slapped cheek polyarthropathy

Question 50

when are you infectious in parvovirus

Answer 50

6 days post exposure to 1 week

Question 51

parvovirus Sx in foetus before 20 weeks

Answer 51

hydrops fetalis 3% - accumulation of fluid in soft tissue, leads rapidly to death foetal anomalies 1% foetal loss 7%

Question 52

parvovirus Sx in foetus after 20 weeks

Answer 52

none

Question 53

enterovirus / hand, foot, mouth prognosis in preg women

Answer 53

usually fine, no severe outcomes

Question 54

enterovirus / hand, foot, mouth prognosis/complications in neonates

Answer 54

myocarditis, hepatitis, encephalitis, bleeding, multi organ failure

Question 55

complications for neonate from zika

Answer 55

microcephaly !!! brain damage seizures limb movement issues