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30 Cards in this Set

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Congenital Rubella Syndrome:

- transmission
- outcome of transmission?
viremia to fetus

CRS or stillbirth
Describe the cytolytic effects of congenital rubella virus.
NO cytolytic,

but does affect growth mitosis and chromosomal structure
Severity of fetal birth in CRS is dependent on what?
Time of infection in terms of gestational stage
Describe the manifestations seen for the times of infection:

- 1st month
- 1st trimester
- 2nd trimester
- after 2nd trimester
All infected, >80% pathology

70-85% pathology

25-35% infected

Usually no damage
Four months into pregnancy, a maternal infection would do what in terms of CRS probablility?

If maternal infection occured in the last 10 weeks, what are the chances for severe defects?
After four months, probability reduced

Only a few
What are the five outcomes seen in fetuses after a maternal rubella infection?
If transmission, then

Miscarriage
Infant born with CRS
Stillbirth
Therapeutic abortion

No transmission -> normal infant
Rubella diagnosis in pregnant women:

If HI titer < 1/8

Then repeat HI titer increases 4-fold
Rubella infection
Rubella diagnosis in pregnant women:

If HI titer = 1/8, what are the steps to ensure immunity?
Repeat HI in 4 weeks.

If HI titer = 1/8, then repeat

If HI titer = 1/8,

The patient is IMMUNE
Rubella diagnosis in pregnant women:

If HI titer <1/8,

Then, repeat HI titer is the same value
Susceptible

Vaccinate postpartum
Rubella diagnosis in pregnant women:

If HI titer > 1/8,

Then repeat HI titer is >1/8.
Do again weeks later.

If no increase, then the patient is IMMUNE
What are the 3 categories of clinical manifestations seen in CRS?

Include time frame associated.
Transient: newborn + infants

Permanent: birth + early life (1 yr)

Developmental: later in childhood
What are the major defects associated with CRS? x4
Deafness & Cataracts

Cardiac problems

Microcephaly & hepatosplenomegaly

Thrombocytopenia purpura
(blueberry muffin)
What percent of CRS babies have neural involvement?
80%
What is a rubella baby?
One that excretes virus from many sites
What are some common transient manifestation of CRS?
Low birth wt (due to intrauterine growth retardation)

Thrombocytopenia purpura
(blueberry muffin)

Hepatosplenomegaly

Meningoencephalitis

Large anterior fontanelle

Bone lesions:
(striated, linear refractions in long bone)
What are some uncommon transient manifestations of CRS? x6
Generalized adenopathy
Cloudy cornea
Hepatitis
(Hemolytic) anemia
(rubella) myocarditis
(rubella) pneumonia
What are the permanent manifestation of CRS? x8
Glaucoma (if early in pregnancy)
Permanent retinopathy

Micropthalmia
Cataracts

Mental retardation
Deafness (organ of corti)

Congenital heart disease
Central language defect
List conditions associated with congenital heart disease as a manifestation of CRS. x3
Patent Ductus arteriosus
Pulmonary artery stenosis
Pulmonary valve stenosis
List common late manifestations of CRS. x4
Behavior Disorder

Mental retardation
IDDM
Autoimmunity (certain HLA types)
List some very rare late manifestation of CRS
Progressive Rubella Panencephalitis (PRPE)
- 20 years

Behavior changes
(ataxia, intellectual decline)

Spasticity
(Perivascular cuffing,
Loss of white matter
Always fatal in 8 years,
Demyelination)
What are the lab diagnosis for CRS in infants? x2

Where do you look?
HI titer is high and increases

Can isolate virus from newborn

IgM in cord blood or infant serum
What are the lab diagnosis for CRS in mother?
Increase in HI titer (IgM)

Isolate virus
T/F - Diagnosis for CRS can be done based on symptoms.
False

Not definitive
T/F - CRS immunity is permanent.
True
T/F - IgM crosses placenta.
False
Presence of IgM indicates what?
Recent or current infection
T/F - IgG crosses placenta.
True if maternal
Describe what happens to maternal IgG during pregnancy.
Declines 2 fold dilution per month
What are the treatment modalities for CRS.
None
CRS vaccine

- name
- given when?
- given how?
- contraindicated?
RA27/3

@ 15 months
booster given at kindergarten

SubQ

For pregnant mothers