Theme 6: Clinical infections in childhood and pregnancy Flashcards
(50 cards)
Which 3 conditions do you want to screen early in pregnancy? ideally by 10 weeks
HIV, syphilis and hepB
Which infections can be transmitted from mother to baby during pregnancy?
TORCH Taxoplasmosis Others (syphilis, HIV, coxsackie virus, HepB, varicella-zoster) Rubella Cytomegalovirus disease Herpes simplex disease
How do TORCH infections spread from mother to baby?
haematogenous spread
What are the fetal consequences of TORCH infections?
- abortion
- still birth
- prematurity
- IUGR
- congenital malformations (microcephaly, intracranial calcifications)
What are other perinatal infections (other than TORCH) that can be passed onto the foetus?
- group B streptococcus
- listeriosis
- gonorrhoea
- chlamydia
- HIV
- HepB
Does the UK recommend screening for group B streptococci?
no as it is not clear that screening does more good than harm and is cost effective
What condition can arise in a neonate if their mother is infected with group B streptococci?
neonatal sepsis
If a women has had a previous GBS carriage, what is the likelihood of maternal GBS carriage in current pregnancy?
50%
What 3 options does a previous GBS carrier have in their current pregnancy?
- to not have intra-partum antibiotics
- to have intra-partum antibiotics
- screening at 35-37 weeks and offer antibiotics to those who have GBS colonisation
what is chorioamnionitis?
-inflammation of umbilical cord, amniotic membranes/fluid, placenta -major cause of perinatal morbidity and mortality
What are the symptoms of chorioamnionitis?
- maternal fever
- uterine tenderness
- tachycardia
- purulent/foul amniotic fluid
- neonatal sepsis/pneumonia/neurodevelopment disability
What are the risk factors for intra-amniotic infections?
- most common after prolonged rupture of membranes
- amniocentisis
- cordocentesis
- multiple vaginal examinations
What is the pathogenesis behind intra-amniotic infections?
- bacteria present in the vagina cause infection by ascending through the cervix
- haematogenous infection is is rare
What are the 3 causative organisms of intra-amniotic infections?
- Group B strep
- E. coli
- genital mycoplasma
How do we treat intra-amniotic infections?
- intra-partum antimicrobials and delivery of the foetus
- antimicrobials should be administered at the time of diagnosis (not after delivery)
What is puerperal endometritis?
uterine infection (lining of the wall) during pueperium (6 weeks after childbirth)
What are the risk factors for puerperal endometritis?
- caesarean section
- prolonged labour
- prolonged rupture of membranes
- multiple vaginal examinations
- sepsis, pelvic abscess and peritonitis in moter
What are the clinical features of puerperal endometritis?
- fever
- uterine tenderness
- purulent, foul-smelling lochia (post-partum bleeding)
- increased white cell count
- general malaise, abdominal pain
What are the causative organisms in puerperal endometritis?
- E.coli
- group B strep
- anaerobes
How do we treat puerperal endometritis?
broad spectrum intravenous antimicrobials - continued until the patient has been apyrexial for 48 hr
What is EOS?
- early onset neonatal sepsis
- usually within 72hrs
- major cause of mortality
What are the major causative pathogens in neonatal late-onset sepsis?
- coagulase-negative staphylococci
- staphylococcus aureus
- e.coli
- klebsiella spp
- pseudomonas spp
- candida spp
Who is at risk of childhood infections?
- young infants –> frequent hand-to-mouth behaviours, not fully immunised
- children with special health care needs
- children with impaired immune systems
- children with long standing prosthetic devices
What are 3 main upper respiratory tract infections in children?
- common cold
- acute tonsilitis
- acute otitis media
