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80 Cards in this Set

  • Front
  • Back

What type of virus is CMV?

beta herpes virus

CMV method of transmission?

saliva


urine


breastmilk


sexual contact


vertical transmission at birth


blood transfusion

what to do if patient is CMV positive?


(eg IgM positive, IgG positive)

repeat test in 2-4 weeks, to check if


- rise in IgG


- change of negative to positive IgG



how long can you have a positive IgM for CMV infection?

2-3 years

how to check fetus for CMV infection

amniocentnesis


- 45% accurate if <20 weeks


- 90% accurate if >20 weeks: do viral load

does a positive CMV IgM indicate the degree that the baby will be affected?

no

what symptoms does the baby have if they get congenital CMV infection?

1. hepatomegaly


2. poly or oligohydramnios


3. microcephaly


4. IUGR


5. pseudomeconium ileus


6. increased fluid: hydrocephalus, ascites, pleural / pericardial effusion,


7. intracranial calcifications

risk of transmission of primary CMV infection to the fetus?

50%




- 10% are symptomatic

risk of transmission of reactivation of CMV infection to the fetus?

<1%

what percentage of adults / children infected with rubella will be symptomatic?

50%

rubella route of transmission?

droplet & contact with nasopharyngeal secretions

risk of baby being affected if mother infected with rubella in first 10 weeks?

90%

features of congenital rubella syndrome

1. CNS


2. Eyes


3. sensorineural deafness


4. cardiac abnormalities


5. IUGR


6. inflammatory lesions (brain, bone, liver, lungs)

risk to baby if mother reinfected with rubella during pregnancy?

<10%

risk of rubella transmission to baby if >20weeks when maternal primary infection?

30% but almost no risk of congenital defects

when to give rubella vaccine to non-immune woman if she's pregnant?

give postpartum

how long is a baby with congenital rubella infection infectious for?

1 year after birth




(unless nasopharyngeal or urine cultures negative after 3 months)

Is EBV infection during pregnancy dangerous to the baby?

unclear - may lead to premature birth & low for birth weight baby

what is the risk of transmission of EBV from mother to baby?

low, even if mother symptomatic

how is EBV transmitted?

saliva

which vaccines are contraindicated in pregnancy (2)?

live ones


- varicella


- MMR

which vaccines should be given in pregnancy and when (2)?

1. influenze - early as possible


2. pertussis - around 30 weeks / third trimester

how is toxo transmitted?

1. eating raw / uncooked meat


2. not washing hands after handling:


- raw meat


- dirt that may be contaminated with cat feces


- cat litter




very rare through direct cat contact

what type of bug is toxo?

toxoplasmosis gondii - a parasite




once infected it remains latent until reactivated if very immunosuppressed

is a baby at risk if mother has latent toxo infection?

no

what is the risk of transmission of toxo from mother to fetus in primary maternal infection?

first trimester: 15%


second trimester: 40%


third trimester: 75%

what is the risk of the baby having defects if they get toxo in utero?

first trimester: 80%


second trimester: 25%


third trimester: 10%

how do you treat toxo?

spiramycin


or atovaquone


or aciclovir

what serology in the mother shows possible active infection with toxo, and what further serology will confirm it is primary infection?

IgM & IgG positive




additional: repeat IgM & IgG still positive, positive IgA, low IgG avidity




(need to re-check as IgM can be positive for months to years)

what are the features of varicella zoster syndrome (6)?

1. skin scarring


2. eye abnormalities


3. limb abnormalities


4. intellectual disability


5. preterm birth, low birth weight & mortality


6. poor sphincter control

method of VZV transmission?

1. droplets (respiratory)


2. contact with fluid from vesicle

when is VZV infection contagious?

48 prior to rash until all lesions are crusted over

what to do if a non-immune pregnant woman is exposed to VZV?

1. Zoster Immunoglobulin if <96hr since exposure




2. aciclovir if >96hr since exposure & in second half of pregnancy or immunocompromised

what to do if a woman has primary VZV infection in pregnancy?


what is the main risk to the mother?

give aciclovir if <24 of rash starting, otherwise nothing



risk of VZV pneumonia (10% risk)

risk of VZV transmission from mother to fetus?

20 - 30%

period of maximum risk of VZV fetal syndrome if mother infected during pregnancy? what is this risk?

12 - 28 weeks


1.4%




(0.5% when <12 weeks, negligible risk after 28 weeks)

when to give Zoster Immunoglobulin to a baby whose mother had VZV?

if mother developed VZV from 7 days prior to 28 days after birth (otherwise just monitor baby)

can babies breastfeed if mother has had / develops VZV?

yes

can shingles transmit to a baby from a pregnant mother?

no

period of infectivity for syphilis?

from initial infection to 4 years after




non infectious 48 hours after starting ABx

body systems affected in tertiary syphilis?

1. neuro


2. cardiovascular


3. bones & joints


4. liver

what bug causes syphilis?

bacterial sphirochete: triponema pallidum

how is syphilis transmitted?

sexual


congenital

what three tests are there for syphilis:


- screening


- confirmation of infection


- disease activity

- treponemal specific enzyme immunoassay


-TPPA


- RPR

how to treat a pregnant woman who has had syphilis for <2 years?

1. IM benzylpenicillin


(if in third trimester, then repeat dose 1 week later)

what is the risk of maternal syphilis to the newborn?

preterm labour / birth


miscarriage* / neonatal death /


congenital syphilis syndrome



*most common outcomes, esp in mid trimester

what is the risk of syphilis transmission to the baby if it is primary, secondary or early latent syphilis? (<2 years since first infected)

30 - 60%

what is the risk of transmission to the baby in late latent syphilis? (>2 years since infection)

10%

what are the features of congenital syphilis?

1. deafness


2. neurologic impediment


3. bone deformities

when to treat a baby for syphilis?

if the mother hasn't been treated or if she was only treated in the last 4 weeks of the pregnancy

what causes slapped cheek syndrome?


what other name does it have?

parvovirus b19


fifth disease

what is the main risk of parvovirus in pregnancy?

anemia (aplastic crisis or chronic anemia)




esp if woman has sickle cell disease, thalassemia, or is immunocompromised

how is parvovirus transmitted?

respiratory secretions


hand-mouth contact

what is the risk of parvovirus transmission from mother to fetus?

50%

what are the risks to the baby of fetus parvovirus infection?

anemia & myocarditis


lead to: fetal hydrops & death




(often 5 weeks after maternal infection)

what treatment is used for HIV during vaginal birth / after birth for for baby with HIV positive mother?

zidovudine

what to do if a mother is HIV negative but is high risk with a recent exposure?

re-check in 4 weeks

can a mother who is HIV positive breastfeed?

not recommended

risks of malaria during pregnancy?

anemia (mother & baby)


miscarriage


premature birth


low birthweight

what is the risk of Hep C transmission from mother to baby?

very small esp if undetectable viral load

when to do LUCS for Hep C positive woman?

no indication for this - risk of transmission is the same for LUCS & vaginal birth



do instrumental delivery if possible for difficult delivery

can you breastfeed if the mother has Hep C?

yes, just not if nipples bleeding




(small amount of Hep C in breastmilk, but is negligible)

what does the results below mean?




HCV antibody positive


HCV RNA PCR negative

past exposure




NOT immunity

what is the risk of HCV transmission from mother to baby? when is this risk highest in the pregnancy?

5%




highest risk is at birth

risk of HCV infection progressing to chronic infection?

75 - 80%

what type of birth is recommended for mothers with Hep B?

no particular recommendations

what should be done for every baby with a mother who has Hep B?

Hep B immunoglobulin at birth




Hep B vaccination: at birth, 6-8 weeks, 4months, 6 months

transmission method of Hep B?

secretions: saliva, breast milk, semen, vagina


mucous membranes


blood

risk of transmission for ACUTE Hep B:


- in first trimester


- in third trimester

10%


75%

Hep B surface antigen shows?

exposure to Hep B

anti-HBc means?

chronic infection

anti-HBs means?

immune!

should women with Hep B breastfeed?

yes

how much is the risk of babies getting Hep B infection reduced by treating babies with Hep B vaccine & Hep B immunoglobulin at birth?

95% reduction in risk




5% who still get Hep B often have incomplete vaccine schedule or mothers with high viral loads

what bug causes listeria?

bacteria: listeria monocytogenes

what is the risk of mother to baby transmission of listeria?

small

what are the risks to the baby if they are infected with listeria?

very high mortality (miscarriage/ still birth / infant death) ~50%

how to test for listeria?

blood cultures

treatment of listeria?

amoxycillin

how can mothers avoid listeria infection?

wash hands


don't eat:


- pate / cold meats / cold seafood


- raw vegetables (e.g. old salad)


- unpasturised milk


- soft cheeses




eg: eat recently well cooked food