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11 Cards in this Set
- Front
- Back
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TORCH INFECTIONS
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Toxoplasma
Other Rubella CMV Herpes |
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Toxoplasmosis – Toxoplasma gondii
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Intracellular parasite
Widely distributed Cat only definitive host Human infection acquired by ingestion of uncooked or under cooked meat or by contact with oocysts from the feces of an infected cat. Primary toxo during pregnancy carries a 1/3 chance of fetal infection fetal infection higher in third trimester severity of fetal infection higher with first trimester infections Associated with abortion, prematurity, and growth retardation First trimester infection associated with 15% risk of major congenital anomalies Flu-like symptoms. Mild self-limited. If immunocompromised may lead to serious pulmonary and CNS involvement. |
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CMV – DNA virus of the herpesvirus group
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0.2 to 2.5% of all babies delivered are infected
50% of females in USA are susceptible. 2% of susceptible females acquire the disease during pregnancy Congenital infection generally the result of transplacental transmission Primary infection of the mother has more severe effects on the infant when compared to a recurrent infection of the mother 10% of infected neonates are asymptomatic Prematurity, LBW, microcephaly, chorioretinitis, hepatosplenomegaly, jaundice, and thrombotic thrombocytopenic purpura Prognosis is poor Maternal infection manifests as a heterophile negative mononucleosis syndrome No treatment available for mother Gancyclovir in neonate |
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Herpes
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Incidence in prenatal patients is 0.02% to 1.0%
Consider initiation of treatment with acylovir starting at 36 weeks 400 mg TID |
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Rubella- RNA Toga virus
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Spread by droplets
Peak incidence between ages 5 – 9 Virus can be isolated in bloodstream 7 – 10 days after exposure. The rash presents 16 to 18 days after exposure Placenta is vulnerable during the viremia stage Rash is not characteristic Acute and Convalescent titers required Rubella Syndrome: Cataracts Patent Ductus Arteriosus Deafness |
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GBS
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5% to 30% of women colonized
Transmission from mother to baby is 75% 16% to 45% of nursery staff are carriers. Nosocomial acquisition in newborn is common Attack rate is 0.6 to 4/1000 births Risk Factors Prematurity Low Birthweight Maternal Fever PROM >12 to 18 hours Previous child affected by Beta Strep Group B Prenatal prophylaxis is not effective in eradicating the carrier state tx: PEN |
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Parvovirus B-19 (Fifth Disease)
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Winter to Spring seasonality
60 to 80% of susceptible household contacts will become infected when exposed Predilection to erythroid progenitor cells May cause fetal hydrops secondary to aplastic anemia If woman is positive for IgG then she is immune. Hydrops usually occurs in 4-6 weeks after infection. Hydrops may resolve spontaneously. Cordocentesis may be indicated in fetuses less than 22 weeks because of immaturity of immune system of the fetus. Fetal loss before 20 weeks = 11% Fetal loss after 20 weeks = <1% |
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UTIs
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Greater than 100,000 pure colonies/cc of urine
Asymptomatic Bacteriuria 2 to 10% of all pregnant women Pyelonephritis risk of 30% in untreated Bacteria E. coli Proteus mirabilis Klebsiella pneumoniae Beta Strep Group B Urine Culture CCMS urine Cath urine Dipstick Nitrates to Nitrites Leucocyte Esterase Presence of Blood |
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Gonorrhea
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Males – 20% to 30% chance of contracting disease from a single exposure.
Females – 60% to 90% of acquiring an infection during a single exposure |
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Syphilis in Pregnancy
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Manifestation of syphilis is the same as in the non-pregnant
Early diagnosis and treatment important Jarisch-Herxheimer reaction begins 2-8 hours post therapy and subsides in 16 to 24 hours. Liberation of endotoxins from dying Treponemes Large placenta – suspicious Stillborn – collapsed skull with protruberant abdomen Heptosplenomegaly Vasculitis Can infect fetus as early as 6 weeks. Liveborn –disease 50% mortality in severely infected neonates despite adequate therapy Hydrops/hepatosplenomegaly/ syphilitic pemphigus Snuffles – persistent rhinitis Generalized lymphadenopathy Osteochondritis/Periostitis – 70% to 80% have radiographic evidence. Radiographs show alternating increased density with rarefaction. Diagnosed after 2 years old Stigmata – secondary to prior inflammation at a critical developmental stage Hutchinson Triad – Hutchinson’s teeth, interstitial keratitis, and 8th nerve damage Tx" Pen G |
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HIV
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HIV Antibody – present 22 to 27 days after acute infection
Western Blot test confirmatory HIV not equal to AIDS The presence of a defining opportunistic infection or a CD4 count less than 200 mm3 confirms the diagnosis of AIDS TX: Antepartum Screening – Counseling Initiate AZT after the first trimester Prophylaxis of Pneumocystis carinii Give Pneumovax, Influenza vaccine, & hepatitis vaccine Screen for all STD’s Treat all infections Intrapartum -- IV AZT Cesearean Section PP: AZT to infant No breast feeding With above algorithm the vertical transmission of HIV is <2% in USA/Europe |
