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YR5 Microbiology > Viral Infection in Pregnancy > Flashcards

Viral Infection in Pregnancy Flashcards

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1
Q

List 6 broad consequences of viral infections during pregnancy

A

Maternal complications
Miscarriage/ stillbirth
Teratogenicity
IUGR/ prematurity
Congenital disease
Persistent infection

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2
Q

List 3 viral infections that increase risk of maternal complications

A

Influenza
Varicella Zoster
Hep E

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3
Q

List 3 viral infections that increase risk of miscarriage/ stillbirth

A

Rubella
Measles
Hep E

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4
Q

Give 2 viral infections that increase risk of teratogenicity

A

Varicella Zoster
Zika

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5
Q

Give 2 viral infections that cause IUGR/ prematurity

A

Rubella
CMV

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6
Q

Give 2 viral infections that increase the risk of congenital disease

A

CMV
HSV

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7
Q

Give 2 viral infections that cause persistent infection in the child

A

HIV
Hep B/C

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8
Q

Which 12 viral infections are associated with rashes?

A

VZV (Chickenpox/ shingles)
EBV
HSV
Cytomegalovirus
Parvovirus B19
Enterovirus
Measles
Rubella
Influenza
Hep A-E
HIV
HTLV

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9
Q

List 3 travel associated viral infections that a pregnant woman may present with

A

Dengue
Zika
Yellow fever

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10
Q

List the first 5 human herpes viruses

A

HHV1+2: Herpes Simplex Virus
HHV3: Varicella Zoster virus
HHV4: Epstein Barr Virus (EBV)
HHV5: Cytomegalovirus (CMV)

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11
Q

List 3 features of herpes viruses

A

DNA viruses
Once exposed, cause lifelong infection (often latent)
Have capacity to reactivate under stress/ immunosuppression

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12
Q

Describe the transmission, incubation and latency of HSV 1+2

A

T: close contact
I: Oropharyngeal 2-12d. Genital 4-7d
L: established in dorsal route ganglion

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13
Q

Give 4 presentations of HSV 1+2

A

Asymptomatic
Painful vesicular rash
Lymphadenopathy
Fever

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14
Q

What investigations should be sent for HSV 1 + 2?

A

Swab lesion - PCR
Serology in immunosuppressed

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15
Q

What 3 forms of HSV may occur in pregnancy?

A

Primary: 1st exposure
Non-primary: Previous HSV1, contract HSV2 during pregnancy
Recurrent: Same HSV as previous infection

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16
Q

How can a foetus contract HSV from its mother?

A

Ascending infection in PROM (active infection in genital area)
V rare

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17
Q

How can neonates contract HSV?

A

Direct contact with infected maternal secretions during delivery
Active infection + kissing baby
Non-familial: other relatives/ hospital staff

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18
Q

When is the risk of maternal to foetus HSV transmission highest? What is advised to reduce risk?

A

Primary genital infection in 3rd trimester
If active HSV in final 6w: C-section

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19
Q

List 4 complications of primary genital HSV infection

A

Miscarriage
Congenital abnormalities (Ventriculomegaly, CNS abnormalities)
Preterm birth
IUGR

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20
Q

How should a first presentation of genital herpes in pregnancy be managed?

A

Refer to GUM clinic
Aciclovir 5d
HSV antibody testing
Consider C-section if <6w to delivery

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21
Q

How should recurrent genital herpes in pregnancy be managed?

A

Often self resolving
Consider suppressive therapy from 36w
Maternal antibody offers some protection (though may not prevent transmission)
Avoid prolonged ROM/ invasive foetal monitoring

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22
Q

Describe the skin, eye and mouth presentation of HSV in a neonate

A

45% of cases
Initially benign, high risk progression to CNS
Must be treated
Usually occurs in first 14d
May last up to 6w

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23
Q

Describe the CNS involvement (+/- SEM) in neonatal HSV

A

30% of cases
Usually occurs at 2-3w (up to 6)
Seizures
Lethargy
Irritability
Poor feeding
Fevers
Needs CSF

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24
Q

Describe disseminated HSV in neonates

A

Presents like Sepsis
Often in 1st week of life
Multi-organ involvement: Liver, Lungs, Heart, CNS, GIT, Renal tract, BM

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25
What is this? How should it be treated until results exclude/ confirm diagnosis?
Skin, eye, mouth HSV Treat with Aciclovir Looks like Staphylococcal eye infection- SWAB!
26
Describe the transmission, infection rate and incubation period of VZV
Transmission: Respiratory 70% infection rate in those susceptible Incubation: 7-13d Infectious 24h before rash develops
27
Describe the presentation of VZV
Prodromal fever, malaise, myalgia Centripetal maculopapular rash Vesicular rash appears in crops Pruritic
28
Describe the susceptibility of pregnant women to varicella zoster
10-20% childbearing age suscebtible 10-20% of those contracting VZV develop varicella pneumonia Varicella encephalitis is rare but mortality 5-10%
29
What are the 3 stages at which a congenital infection can be transmitted?
In utero: Crossing placenta Perinatal: during childbirth Postnatally: after birth
30
What are the risks of congenital varicella syndrome depending on timing?
0-12w: 0.4% 12-20w: 2%
31
List 6 complications of congenital varicella syndrome
Neurological abnormalities Occular abnormalities Skin scarring Limb abnormalities GI abnormalities LBW
32
In which cases post exposure is a women considered to have sufficient evidence of immunity against VZV?
Hx of previous chickenpox or shingles 2 doses of varicella vaccine
33
What treatment is required if a pregnant woman is exposed to VZV with no previous infection or immunisation?
Urgent antibody testing on recent blood sample If VZV IgG <100, offer PEP
33
What treatment is required if a pregnant woman is exposed to VZV with no previous infection or immunisation?
Urgent antibody testing on recent blood sample If VZV IgG <100, offer PEP
34
What PEP is required for women presenting within 7d exposure of VZV?
Oral aciclovir 800mg or Oral Valaciclovir 1000mg TDS from day 7-14 after exposire
35
What PEP is required for women presenting after 7d from exposure of VZV?
Oral aciclovir 800mg QDS or Oral valaciclovir 1000mg TDS up until 14d post exposure
36
What drug should be used in active infection with VZV in pregnancy?
Aciclovir
37
Describe the epidemiology, transmission and incubation of cytomegalovirus
Common early childhood infection: 2-6% infants by 6m, 40% by16y T: Saliva, Resp. secretions, Urine I: 4-8w
38
Give 2 presentations of CMV
Mostly asymptomatic Maculopapular rash, infectious-mononucleosis like illness
39
What investigations are used for CMV?
PCR urine/ saliva, amniotic fluid Serology
40
When is the biggest risk of CMV transmission during pregnancy?
3rd trimester
41
List 7 complications of maternal CMV for the infant
Encephalitis Microcephaly Ventriculomegaly Chorioretinitis Jaundice Thrombocytopenia Hepatosplenomegaly
42
How do most congenitally infected newborns with CMV present?
Initially asymptomatic 15-25% go on to develop neurodevelopmental abnormalities- sensorineural hearing loss within 3y
43
What happens if maternal CMV infection is suspected?
Test booking bloods for CMV IgG If had no IgG, but has IgM now= primary infection
44
What testing is performed on the baby if maternal CMV is suspected?
USS +/- amniocentesis At birth: Guthrie card Urine + saliva PCR within 21d
45
The child of a 35w pregnant woman develops a vesicular rash. What should you do first?
Ask if she has had chickenpox before
46
What is this rash?
Most likely Measles or Rubella Flat, Maculopapular (not vesicular/ blistering like chickenpox)
47
Describe the spread of the rash in rubeola
Appears at HAIRLINE/ behind ears Spreads cephaocaudally over 3d
48
Give 5 signs/ symptoms of rubeola
Conjunctivitis Cough Coryza Fever Koplik spots on buccal mucosa
49
What are the alternative names for rubeola and rubella?
Rubeola: Common Measles Rubella: German measles
50
Describe the spread and nature of the rash in rubella
Begins on the FACE Spreads cephalocaudally within hours Fine, macular rash Mildly pruritic
51
Give 6 signs/ symptoms of rubella
Headache Low grade fever Sore throat Coryza FORCHHEIMER spots on soft palate Lymphadenopathy- tender
52
Describe the spread of the rash in roseola infantum
After fever subsides, rash develops Starts on NECK + TRUNK Spreads to the face + extremities
53
Give 3 features of roseola infantum
Affects 3-36m Caused by HHV6 Abrupt high fever
54
Describe the nature, transmission and incubation period of rubella
RNA virus T: Respiratory I: 12-21d
55
What investigations are used when suspecting rubella?
Buccal swab for PCR Serology
56
In which population is congenital rubella syndrome more prevalent?
Immigrants from countries with high burden of CRS Lots circulating Sparse vaccination programes/ avoidance
57
When is risk of CRS highest? What consequences correlate with the time of infection?
Greatest risk: 1st trimester <8w: 20% spontaneous abortion <10w: 90% fetal defects >18w: hearing defects + retinopathy >20w: risk much lower
58
List 8 complications of congenital rubella syndrome for the infant at time of birth
Microcephaly Meningioencephalitis Cataracts Retinopathy Bone lesions Cardiac defects in 50%: PDA, PS Purpura Hepatosplenomegaly
59
List 5 late manifestations of CRS
Pancephalitis Hearing loss: bilateral SNHL Intellectual disability DM Thyroid dysfunction
60
What is seen here? What condition is this associated with?
Severe cataracts at birth Congenital Rubella Syndrome
61
Describe the nature, transmission and incubation period of measles (rubeola)
RNA virus T: Respiratory, Conjunctiva I: 7-18d
62
Describe the prodrome in rubella and rubeola
Rubella: 1-5d pre-rash Rubeola: 2-4d
63
What complication for the mother may arise if they contract measles in pregnancy?
Secondary bacterial infection Otitis media/ pneumonia/ GI/ Encephalitis
64
List 3 complications for the baby from measles during pregnancy
Foetal loss Preterm delivery Subacute sclerosis panencephalitis (SSPE)
65
What is SSPE?
Occurs 7-10y after natural infection Fatal, progressive degenerative disease of CNS
66
What is this rash?
Parvovirus B19 "Slap cheek syndrome"
67
Describe the nature, transmission, incubation and infectious period of parvovirus B19
DNA virus T: Respiratory, blood products I: 6-8d Infectious 6d post exposure- 1w after Sx onset
68
Give 4 symptoms/ presentations of parvovirus B19
Mostly asymptomatic Erythema infectiosum/ slapped cheek/ 5ths disease Polyarthropathy Transient aplastic crisis (vulnerable pop. e.g. sickle cell)
69
What investigations are used for parvovirus B19?
Virus detection PCR Serology
70
What are the statistics of complications from parvovirus in pregnancy?
Transmission in 33% 9% of which get infected Of those infected 3% develop Hydrops fetalis 1% foetal abnormalities 7% foetal loss
71
How does parvovirus B19 cause hydrops fetalis?
Cytotoxic to foetal red blood precursor cells Severe anaemia Accumulation of fluid in soft tissues + serous cavities: ascites, pleural effusion, pericardial effusion, cardiomegaly
72
What should be done if parvovirus B19 is suspected in pregnancy?
Refer to foetal med for monitoring If develops Hydrops: Intrauterine transfusion Test booking + current bloods for IgG + IgM to parvovirus
73
What is this rash?
Hand foot and mouth disease (HFM) Cocksackie enterovirus
74
Describe the transmission and incubation of enterovirus
T: Respiratory +/- faecal I: 2-40d
75
List 4 symptoms/ presentations of enterovirus
Hand, foot + mouth disease Rash Encephalitis Myocarditis
76
Of all enteroviruses, which poses the main risk during pregnancy?
Cocksackie virus Perinatal newborn infection can occur in last week of pregnancy
77
List 5 complications of neonatal cocksackie infection
Myocarditis Fulminant hepatitis Encephalitis Bleeding Multi-organ failure
78
List 7 important topics to cover in a pregnant woman presenting with a rash
Gestation: date of LMP, due date by scan Date of onset, clinical features, type + distribution of rash, associated features Past hx infection Past hx of antibody testing Past immunisation hx Known contacts with rash Travel hx
79
What should be investigated for a pregnant woman presenting with rash?
Antenatal booking bloods: antibody test to determine immunity/ susceptibility Swab/ scrape rash if vesicular Blood sample: antibody +/- PCR
80
List 3 ways in which Zika virus can spread
Mosquito bite STI Blood transfusion
81
List 4 complications of Zika for the baby
Microcephaly Severe cranial abnormalities Seizures Problems with feeding, limb movement, vision + hearing

YR5 Microbiology (23 decks)

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