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30 Cards in this Set
- Front
- Back
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Congenital Rubella Syndrome:
- transmission - outcome of transmission? |
viremia to fetus
CRS or stillbirth |
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Describe the cytolytic effects of congenital rubella virus.
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NO cytolytic,
but does affect growth mitosis and chromosomal structure |
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Severity of fetal birth in CRS is dependent on what?
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Time of infection in terms of gestational stage
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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 |
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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 |
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What are the five outcomes seen in fetuses after a maternal rubella infection?
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If transmission, then
Miscarriage Infant born with CRS Stillbirth Therapeutic abortion No transmission -> normal infant |
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Rubella diagnosis in pregnant women:
If HI titer < 1/8 Then repeat HI titer increases 4-fold |
Rubella infection
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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 |
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Rubella diagnosis in pregnant women:
If HI titer <1/8, Then, repeat HI titer is the same value |
Susceptible
Vaccinate postpartum |
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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 |
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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 |
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What are the major defects associated with CRS? x4
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Deafness & Cataracts
Cardiac problems Microcephaly & hepatosplenomegaly Thrombocytopenia purpura (blueberry muffin) |
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What percent of CRS babies have neural involvement?
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80%
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What is a rubella baby?
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One that excretes virus from many sites
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What are some common transient manifestation of CRS?
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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) |
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What are some uncommon transient manifestations of CRS? x6
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Generalized adenopathy
Cloudy cornea Hepatitis (Hemolytic) anemia (rubella) myocarditis (rubella) pneumonia |
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What are the permanent manifestation of CRS? x8
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Glaucoma (if early in pregnancy)
Permanent retinopathy Micropthalmia Cataracts Mental retardation Deafness (organ of corti) Congenital heart disease Central language defect |
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List conditions associated with congenital heart disease as a manifestation of CRS. x3
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Patent Ductus arteriosus
Pulmonary artery stenosis Pulmonary valve stenosis |
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List common late manifestations of CRS. x4
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Behavior Disorder
Mental retardation IDDM Autoimmunity (certain HLA types) |
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List some very rare late manifestation of CRS
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Progressive Rubella Panencephalitis (PRPE)
- 20 years Behavior changes (ataxia, intellectual decline) Spasticity (Perivascular cuffing, Loss of white matter Always fatal in 8 years, Demyelination) |
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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 |
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What are the lab diagnosis for CRS in mother?
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Increase in HI titer (IgM)
Isolate virus |
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T/F - Diagnosis for CRS can be done based on symptoms.
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False
Not definitive |
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T/F - CRS immunity is permanent.
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True
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T/F - IgM crosses placenta.
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False
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Presence of IgM indicates what?
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Recent or current infection
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T/F - IgG crosses placenta.
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True if maternal
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Describe what happens to maternal IgG during pregnancy.
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Declines 2 fold dilution per month
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What are the treatment modalities for CRS.
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None
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CRS vaccine
- name - given when? - given how? - contraindicated? |
RA27/3
@ 15 months booster given at kindergarten SubQ For pregnant mothers |
