NURO 671 TEST 1 - MODULE 10 (PERINATAL INFECTION) |145 QUESTIONS AND ANSWERS

diseases with mother to child transmission HIV hepatitis HSV diseases with congenital versions of syndromes syphilis rubella what is fetal hydrops? fluid accumulation in 2+ compartments - pleural effusion - ascites - pericardial effusion what are long-term fetal physical/mental outcomes of pregnancy infections? - blindness/deafness - neuro and learning deficits - congenital anomalies what diseases do you screen teachers and daycare workers for? what diseases do you screen parents and young children in school/daycare for? what diseases do you screen health care workers for? what diseases do you screen individuals with high-risk sexual behaviors for? for prevention of what disease do you want to avoid raw meat? for prevention of what disease do you want to avoid cat feces, gardening soil, and sandboxes? toxoplasmosis for prevention of what disease do you want to avoid small children, if possible? for prevention of what disease do you want to avoid anyone with active diseases? TORCH? tests for antibodies T: toxoplasmosis O: other viruses (syphilis) R: rubella C: cytomegalovirus H: HSV interpreting results: - IgM+ in mom - IgM+ in newborns - IgG+ in mom - IgG+ in newborns IgM + in mom: likely acute infection IgM + in newborn: does not cross placenta, so likely active infection IgG + in mom: likely past infection but should prove with redraw in 2 weeks to ensure not increasing value IgG + in newborn: crosses placenta, so + in newborn without IgM may show passive immunity passed by mom why is TORCH out of fashion? explain... now more commonly use... slow result time (weeks) - use only if mom or newborn baby have symptoms - Mom: will review sx shortly - Newborn: SGA, anomalies, seizures, severe jaundice, etc. now more commonly use: 1. titres for IgG Ab (show immunity, since most are exposed as children); often standard at new OB visit: - RPR - Rubella - HIV - Optional: varicella if unsure of vaccine or previous disease 2. antigen testing - HbsAg (hep B) 3. cultures to grow organism - CMV cx in symptomatic newborn common sx of perinatal infections? 1. cold or mono-like sx - fever/chills - fatigue/malaise - myalgias/arthralgias - lymphadenopathy - sore throat 2. with or without N/V 3. often rash 4. lesions (with some STIs) **the problem is that these sx occur with almost ALL perinatal infections GI symptoms with the other common sx of perinatal infections increase suspicion for... - Hep A, B, C - CMV - HIV which lesion is single, PAINLESS syphilis which lesion is blistered, usually clustered, and PAINFUL herpes describe: - macule - papule - patch - plaque - wheal - nodule - tumor - vesicle - bulla - pustule - cyst Macule: flat, circumscribed change in color, 1 cm Papule: elevated, firm, circumscribed, 1 cm Patch: flat, nonpalpable, irregular-shaped macule, 1 cm Plaque: elevated, firm, rough with flat top, 1 cm Wheal: elevated, irregular-shaped swelling Nodule: elevated, firm, circumscribed, deep, 1-2 cm Tumor: elevated, solid, deeper, 2 cm Vesicle: elevated, circumscribed, superficial, filled with serous fluid, 1 cm Bulla: vesicle 1 cm Pustule: elevated, superficial lesion, filled with purulent fluid Cyst: elevated, circumscribed encapsulated lesion below epidermis filled with liquid of semisolid material what does each mean when describing a rash: - discrete - indistinct - irregular - advancing Discrete: well defined Indistinct: poorly defined Irregular: notched margin Advancing: expanding at the margins how do you test for toxoplasmosis? IgM and IgG testing, repeat in 3 weeks if she has N/V, what do you test for? - Hep A, B, C - CMV - consider others if she has a rash, what do you do? TORCH or similar if she has a lesion, what do you do? do confirmatory testing, as needed what do you if there is strong suspicion of perinatal infection? 1. treat prophylactically, if appropriate - syphilis - influenza 2. send to MFM or other high-level sonographer to evaluate for possible anomalies or fetal effects to: - possibly aid in diagnosis - allow for timely options counseling with PT what are the viral infections? 1. influenza 2. hep A, B, C 3. HIV 4. herpes viruses - HSV 1 and 2 - CMV - varicella 5. rubella 6. parvovirus (5th disease) what are the bacterial infections? 1. TB 2. syphilis 3. GC/CT 4. GBS what are the protozoan infections? toxoplasmosis what are the parasitic infections? malaria rash starts at face, spreads to trunk rubella german measles rubella begins with fever, sore throat, cough rubella fatigue 3-5 days before rash appears rubella often includes swollen lymph nodes behind ears or on back of head rubella resolves in 7-10 days, rapidly fading rash rubella when is rubella most dangerous to neonates? in 1st trimester - 50% chance of congenital rubella syndrome "maculopapular" - mixed flat macules and raised papules rubella diffuse, erythematous, no exudate, usually itchy/pruritic rubella what kind of rash is varicella? maculopapular, pruritic, central rash with individual spots stages of varicella rash 1. vesicular (blistering) 2. bursting 3. drying 4. crusting over (noninfectious at this stage) how does varicella start? fever, chills, malaise, myalgia, and pruritic/vesicular rash primarily on face and trunk with only a few on extremities varicella when is varicella most dangerous to fetus? neonate? Most dangerous to fetus if exposed prior to 20 weeks Most dangerous to newborn if infection is 6 days before or 2 days after delivery pruritic, bright red facial maculopapular rash parvovirus (5th disease) slapped face rash parvovirus (5th disease) reticulate (lacy), pink, slightly elevated wheals throughout trunk parvovirus (5th disease) how does parvovirus (5th disease) start? mild fever, HA, myalgias, and fatigue how is parvovirus (5th disease) different in adults? no "slapped cheek" rash some have arthralgias spreads from face to trunk, then to arms, buttocks, and thighs parvovirus (5th disease)