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Kat's Pathology > Viral Infections in Pregnancy > Flashcards

Viral Infections in Pregnancy Flashcards

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1
Q

What are the general consequences of viral infections during pregnancy (6)

A 
Increased morbidity/mortality/complications for the mother 
Miscarriage/stillbirth 
Teratogenicity
IUGR/prematurity
Congenital disease 
Persistent infection
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2
Q

What viral infections increase morbidity/mortality/complications for the mother (3)

A

Influenza
Varicella Zoster
Hepatitis E

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3
Q

What viral infections increase chance of miscarriage/stillbirth (2)

A

Rubella

Measles

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4
Q

What viral infections increase chance of teratogenicity (2)

A

Varicella Zoster

Zika

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5
Q

What viral infections cause IUGR/prematurity (2)

A

CMV

Herpes Simplex Virus

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6
Q

What viral infections cause increase the risk of congenital disease (2)

A

CMV

HSV

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7
Q

What viral infections cause persistent infections in the child (2)

A

HIV

Hepatitis B/C

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8
Q

What viral infections are associated with a rash illness (13)

A 
Varicella Zoster (Chickenpox)
Epstein Barr Virus
HSV
Cytomegalovirus
Parvovirus B19 (5th disease)
Enterovirus
Measles 
Rubella
Influenza 
Hepatitis A, B, C, E
HIV
HTLV
Travel-Associated Viruses - yellow fever, dengue, zika
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9
Q

What are some herpes viruses (4)

A

HSV
VZV
CMV
EBV

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10
Q

What type of viruses are herpes viruses

A

DNA viruses

Life-long infections once exposed

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11
Q

What is characteristic about herpes infections

A

Capacity to reactivate - shingles, recurrent cold sores/genital herpes

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12
Q

What are the two forms of herpes simplex viruses

A

HSV 1

HSV 2

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13
Q

How is HSV transmitted

A

Close contact

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14
Q

What is the incubation period of HSV (3)

A

Oropharyngeal and or-facial infection 2-12 days
Genital infection 4-7 days after sexual exposure
Latency established in nerve cells

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15
Q

What are the symptoms of HSV (4)

A

Asymptomatic
Painful vesicular rash
Lymphadenopathy
Fever

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16
Q

How is HSV diagnosed (2)

A

Clinical

Virus detection - culture, antigen detection, PCR, serology

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17
Q

What are the routes of infection of the foetus/neonate in pregnancy (4)

A

Ascending infection if PROM
Direct contact with infected maternal genital secretions during delivery
Oral herpes in mother post delivery (kissing baby)
Contact with relatives, hospital staff in babies born to susceptible mothers

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18
Q

What type of HSV infection poses the greatest risk to the baby

A

Primary genital infection in the 3rd trimester poses the greatest risk of transmission to the infant

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19
Q

How is a 1st clinical attack of genital herpes in pregnancy treated (4)

A

GUM clinic
Aciclovir
Type-specific HSV antibody testing
Caesarean recommended if primary HSV in final 6 weeks of pregnancy

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20
Q

How are recurrent HSV outbreaks managed in pregnancy (2)

A

Maternal Antibody offers some protection to infants in postnatal period but may not prevent transmission
Prolonged rupture of membranes and invasive fetal monitoring in labour should be avoided

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21
Q

When does neonatal herpes present

A

3 days - 6 weeks post delivery

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22
Q

How does neonatal herpes present (4)

A

Lesions of skin, eye, mouth 7-12 days
Neurological symptoms +/- SEM 2-6 weeks
Disseminated disease with/without vesicles frequently involving brain 4-11 days
Mortality in untreated cases of disseminated disease exceeds 80%

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23
Q

How is neonatal HSV diagnosed (2)

A

Neonatal swabs - oral, rectal, mucosal, umbilical

+/- EDTA blood for HSV PCR

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24
Q

What is the treatment for neonatal HSV

A

Aciclovir

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25
What are the two presentations of VZV
Chickenpox | Shingles
26
How is VZV transmitted
Respiratory 70% attack rate in susceptible individuals Infectious from 48hrs before onset of rash until all lesions have crusted over
27
What is the incubation period for VZV
7-23 days (mean 2 weeks)
28
What are the symptoms of VZV infection (3)
prodromal fever, malaise, myalgia (adults>children) Centripetal maculopapular rash mainly in areas that are not exposed to pressure Vesicular rash appearing in crops
29
How is VZV diagnosed (3)
Clinical vesicle fluid for VZV PCR, (electron microscopy) NOT serology
30
What are the foetal complications if the mother catches VZV during early pregnancy
Congenital varicella syndrome 0.4% for maternal infection between 0-12/40 2% for maternal infection between 12-20/40
31
What does congenital varicella syndrome consist of (8)
``` Skin scarring Limb hypoplasia Muscular atrophy Rudimentary digits Cortical atrophy Psychomotor retardation Choreoretinitis Cataracts ```
32
What is the pathogenesis of congenital varicella syndrome
fetal zoster following initial VZV infection (Short latency due to poorly developed fetal cell-mediated immunity)
33
What occurs if primary varicella is caught in the 3rd trimester (2)
Severe disseminated haemorrhagic neonatal VZV -purpura fulminans 30% case fatality in untreated cases
34
How is neonatal varicella contracted if the mother is infected in the 3rd trimester (3)
The route of infection could be transplacental, ascending vaginal or result from direct contact with lesions during or after delivery
35
What is meant be primary varicella in the 3rd trimester
7 days prior to delivery - 7 days postpartum.
36
What are the complications of VZV for the mother (2)
Pneumonia | Encephalitis (rare complication - mortality 5-10%)
37
What increases the risk of pneumonia as a complication in primary VZV in the mother (5) Mortality?
``` Smoke cigarettes, Have chronic obstructive lung disease, Are immunosuppressed Have extensive or haemorrhagic rash 2nd half of pregnancy ``` 20-40% case fatality in untreated cases
38
How is VZV treated in pregnant women (3)
VZV Immunoglobulin - All pregnant women susceptible to VZV ( irrespective of gestation) with a significant exposure to VZV within 10d - Infants exposed to chickenpox when <7 days old only if mother VZV IgG negative Treatment of confirmed VZV - Aciclovir Vaccination - Ideally pre-conception counselling should cover varicella Hx if non-immune could delay pregnancy for 2 doses of vaccine. - Can also vaccinate post-partum if not identified pre-conception.
39
What proportion of infants are infected with CMV worldwide
2-6% by 6 months
40
What is the prevalence of CMV in the UK
40% infected by 16 years old | In adults seroprevalance increases by 1% PA
41
What is the natural history of CMV
Virus persists lifelong in individual, reactivation leads to further transmission (vertical & horizontal) via bodily fluids (eg. nappy-changing)
42
What are the symptoms of CMV (2)
Most asymptomatic | Rarely maculopapular rash, Infectious mononucleosis-like illness
43
How is CMV diagnosed (2)
Detection of virus- urine, saliva, amniotic fluid, tissue | Detection of immune response- CMV IgG and IgM
44
How is CMV transmitted to the foetus in pregnancy (3)
Transplacental Perinatally- infected genital secretions Postnatal- saliva, breastmilk
45
What are the features of congenital CMV infection
Commonest cause of viral congenital infection Birth prevalence 3/1,000 in the UK 85-90% asymptomatic at birth, but later risk of hearing defects and impaired intellectual performance
46
What are the main two worries regarding neonatal CMV infection (2)
Hearing defects | Impaired intellectual performance
47
In symptomatic infants with CMV, what are the features (8)
``` IUGR Jaundice Hepatosplenomegaly Chorioretinitis Thrombocytopenia Encephalitis Microcephaly/ventriculomegaly/calcifications ```
48
How is CMV infection diagnosed
If maternal CMV infection suspected check serology (compare with booking bloods) If suspected seroconversion during pregnancy refer to fetal medicine unit for USS +/- amnio Investigating neonates: Urine/saliva for CMV PCR within 1st 21d
49
How can we prevent CMV transmission from mother to child
No available treatment
50
What type of virus is rubella
Togavirus RNA virus
51
How is rubella transmitted
Respiratory
52
What is the incubation period for rubella
12-21 days
53
What are the symptoms of rubella (4)
20-50% subclinical infection Fine macular rash Lymphadenopathy Prodrome may be seen in adult infection
54
How is rubella diagnosed (2)
Virus isolation | serology
55
What are the complications of rubella infection in the first trimester (4)
Up to 20% spontaneous abortion if infection before 8/40 90% incidence of fetal defects if infection before 10/40 CRS: cataracts, congenital glaucoma, congenital heart disease, loss of hearing, pigmentary retinopathy, purpura, splenomegaly, microcephaly, mental retardation, meningoencephalitis CRI: infants without CRS clinical signs but with positive rubella specific IgM
56
In infants with congenital rubella syndrome, how long are they infective for
Up to and over 1 year
57
What is CRI
Congenital Rubella Infection
58
What is CRS
Congenital Rubella Syndrome
59
What are the consequences of rubella infection after the 1st trimester (2)
13-18/40 hearing defects and retinopathy | Maternal infection after 20 weeks carries no documented risk
60
When is rubella vaccinated for in the UK
MMR x 2 (13 months and pre-school booster)
61
What causes the majority of the causes of rubella in the UK now
Most cases are imported
62
What viruses are associated with a rash (8)
``` Varicella Zoster Virus (chickenpox) Epstein Barr virus HSV Cytomegalovirus Parvovirus B19 ( 5th disease) Enterovirus Measles Rubella ```
63
How is measles transmitted (2)
Respiratory | Conjunctiva
64
What is the incubation period for measles
7-18 days (typically 10 days)
65
What are the symptoms of measles (2)
prodrome 2-4 days- fever, malaise, congestion, conjuctivitis, koplik’s spots Rash classically starts behind ears & on forehead then spreads
66
Where does the measles rash typically start
Rash classically starts behind ears & on forehead then spreads
67
What are the complications of measles (3)
Opportunistic bacterial infections (otitis media, pneumonia, bronchitis) Encephalitis SSPE
68
What are the consequences of measles infection in pregnancy (4)
Fetal loss (miscarriage, IUD) Preterm delivery Increased maternal morbidity No congenital abnormalities to fetus
69
What is the treatment in susceptible pregnant women is contact with suspected/confirmed measles (2)
Measles Immunoglobulin attenuates illness | No evidence it prevents IUD or preterm delivery
70
How is parvovirus B19 transmitted (2)
Respiratory | Blood Products
71
What is the incubation period for parvovirus B19
6-8 days
72
What are the symptoms of parvovorius B19 (4)
Asymptomatic | Erythema infectiosum/ slapped cheek/ 5th disease
73
How is parvovoris B19 diagnosed (2)
Serology | Molecular tests
74
When during pregnancy are there increased risks to maternal infection with B19
Before 20/40 | No documented risk after 20/40
75
What are the risks of parvovorus B19 infection before 20/40 (4)
Transplacental transmission estimated at 33% 9% risk of infection overall 3% risk of hydrops fetalis if infection from 9-20/40 Risk of foetal anomalies less than 1%
76
What is the management of maternal infection with parvovirus B19 during pregnancy (2)
Refer to foetal medicine for monitoring | Intrauterine transfusion improves foetal outcome
77
What are some human enteroviruses (3)
Polio Coxasackie A and B Echovirus
78
What RNA do enteroviruses have
Pocornaviridae
79
How is enterovirus transmitted (2)
Respiratory | Fecal
80
What is the incubation period for enterovirus
2-40 days
81
What are the symptoms of enterovirus infection (4)
Hand, foot and mouth disease Rash illness Encephalitis Myocarditis
82
What is coxasackie infection in pregnancy associated with (5)
Early onset neonatal hepatitis Congenital Myocarditis Early onset childhood IDDM Abortion or intrauterine death
83
What type of virus is zika virus
Flaviviridae RNA
84
Is Zika always symptomatic
No, 8/10 are asymptomatic
85
How is Zika transmitted (4)
Mostly from mosquitos Pregnancy Sexual intercourse Blood transfusions
86
Where is Zika virus most prevalent
South America
87
What neurological condition can Zika cause
Guillain Barre Syndrome
88
What are the symptoms of Zika virus (6)
``` Red eyes Fever Joint pain Headache Rash Muscle pain ```
89
What are the consequences of zika infection during pregnancy (2)
Miscarriage/stillborn/microcephaly | Congenital Zika syndrome
90
What does congenital zika syndrome consist of (5)
``` Severe microcephaly + skull deformity Decreased brain tissue, seizures Retinopathy, deafness Talipes Hypertonia ```
91
What are the top travel locations associated with zika infection (3)
Caribbean | Central/South America
92
what advice is given to people to prevent zika (4)
All travellers – bite avoidance Pregnant women – avoid travel to areas with current transmission Avoid conception for 2 – 6 months after travel (prolonged viral shedding in semen) Testing only if symptomatic or abnormalities identified on antenatal USS

Kat's Pathology (105 decks)

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