Question 1.1

Administration of medication via nebulisation
As per the current guideline following procedures are considered likely to generate aerosols capable of transmitting respiratory pathogens:

  • intubation, extubation and related procedures; for example, manual ventilation
    and open suctioning
  • cardiopulmonary resuscitation
  • bronchoscopy (unless carried out through a closed-circuit ventilation system)
  • surgery and post-mortem procedures in which high-speed devices are used
  • dental procedures
  • non-invasive ventilation (NIV) eg bilevel positive airway pressure ventilation
    (BiPAP)
  • continuous positive airway pressure ventilation (CPAP)
  • high-frequency oscillatory ventilation (HFOV)
  • induction of sputum

Some procedures generate aerosols, but not from the patient’s secretion and thus NOT considered to represent a significant infectious risk:

  • obtaining diagnostic nose and throat swabs
  • administration of pressurised humidified 02
  • administration of medication via nebulisation

Ref: Infection control precautions to minimise transmission of acute respiratory tract infections in healthcare settings (Version 2 – October 2016)

A rapid review of the evidence (01/04/2020)

Question 1.2

Reston Ebola virus

Six species of ebolavirus has been identified – 

Four species are known to infect humans – Zaïre ebolavirus (EBOV), Sudan ebolavirus (SUDV), Bundibugyo ebolavirus (BDBV), and Tai Forest (TAFV) /Ebola Ivory Coast).

No human infection reported from other two ebolavirus – Reston Ebolavirus (affect primates) and Bombali ebolavirus (affect bats).

Question 1.4

HHV6

1st disease – Measles

2nd disease – Scarlet fever (group A Strep)

3rd disease – Rubella

4th disease – Staphylococcal Scalded Skin Syndrome

5th disease – Erythema infectiosum, Parvovirus B19

6th disease – Erythema sabitum/Roseola Infantum, HHV6/ HHV 7

Question 1.5

The EBV serological profile may reflect distant past infection, however recent infection cannot be excluded. Repeat in 4-6 weeks if recent EBV infection is suspected

EBV serology interpretation (Source: UK Standards for Microbiology Investigations
Epstein-Barr virus serology)

EBV VCA IgMEBV VCA IgGEBNAComment
Not detectedNot detectedNot detectedNo serological evidence of EBV infection at any time.
Not detectedDetectedDetectedConsistent with past EBV infection. Consider testing for HIV
if at risk
DetectedDetectedNot detectedConsistent with recent acute EBV infection
DetectedNot detectedNot detectedConsistent with but not diagnostic of early acute EBV infection. Repeat to confirm in 4-6 weeks.
Not detectedDetectedNot detectedThe EBV serological profile may reflect distant past infection, however recent infection cannot be excluded. Repeat in 4-6 weeks if recent EBV infection is suspected
DetectedDetectedDetectedEvidence of EBV infection at some time, but this profile is difficult to interpret. Although the IgM reactivity might be false, late primary infection or recent EBV reactivation cannot be excluded

Question 1.6

Temporal lobe

The neuropathological picture of HSE is characteristic, consisting of acute necrotising encephalitis that almost always localises, often asymmetrically, to the orbitofrontal and temporal lobes with the involvement of the cingulate and insular cortex; neonatal HSE tends to produce a more diffuse pathology.

Question 1.7

Serotype 40 and 41.

Question 1.8

Answer EBV

Virus, that can cause congenital infection: (Infection – may not necessarily mean abnormality)

HIV:
The transmission rate is 20-30%, higher in patients not on antiretroviral treatment. Most transmission occurs during delivery.
Abnormalities: wide-set eyes, short nose, patulous lips, ‘box’ forehead and growth failure.
[https://gpnotebook.com/simplepage.cfm?ID=-2113535973]

LCM:
Manifestation is similar to toxoplasmosis.
Chorioretinitis, hydrocephalus, microcephaly, intracranial calcification.
A large number of infected infants (up to 40%) dies. Severe neurodevelopmental abnormality has been reported.
[Anderson et al, Congenital Lymphocytic Choriomeningitis Virus: When to consider the diagnosis, J Child Neurol. 2014 Jun; 29(6): 837–842.]

Rubella:
Cardiovascular abnormality (PDA, Pulm artery stenosis), bilateral hearing loss, Ocular abnormality (cataract, glaucoma, retinitis), transient meningoencephalitis, hypotonia, mental disability, purpura, SFD/growth delay, hepatosplenomegaly etc.
Transmission rate –
<12 weeks – >80%, highest risk of congenital abnormality (>80%)
13-16 weeks – 54%, Some risk of congenital abnormality (>30%)
17-30 weeks – 30-35%, minimal risk of congenital abnormality after 20 weeks.
>31 weeks – >60%
last week of pregnancy – 100%
[Storch, Essentials of diagnostic virology;
CDC surveillance manual]

Enterovirus:
Reported association (Coxsackie, Echo) – congenital heart disease, urogenital abnormality, digestive system abnormality, fetal death. These associations need confirmation. It could be an underreported disease.
[https://virologyj.biomedcentral.com/articles/10.1186/s12985-018-0978-7;
https://academic.oup.com/aje/article-abstract/95/3/207/182205?redirectedFrom=fulltext]

Adenovirus:
Case reports of small for date, foetal death, thrombocytopenia,  anasarca, ascites, pericardial and pleural effusion.
[https://journals.lww.com/pidj/Citation/1994/07000/Congenital_Adenoviral_Infection.19.aspx;

https://content.iospress.com/articles/journal-of-neonatal-perinatal-medicine/npm17129; 

 

Parvovirus B19:
Miscarriage, nonimmune hydrops details.
Foetal myocarditis, endothelial lesions, and foetal cerebral damages.
Thrombocytopenia, anaemia.
Meconium peritonitis, congenital heart disease, fetal hepatic calcifications, and bilateral opacification of the cornea.

[https://www.aafp.org/afp/1999/1001/p1455.html;

https://jcm.asm.org/content/49/10/3514;
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/821550/viral_rash_in_pregnancy_guidance.pdf]

HSV:
Congenital transmission: Skin scarring (facial, scalp, face etc), bullae, vesicle. Microcephaly, hydranencephaly, brain atrophy.Chorioretinitis, microphthalmia. Hepatic involvement, pulmonary and adrenal calcification.
Perinatal transmission:
Disseminated disease involving multiple organs, most prominently liver and lungs (25%).
Localized central nervous system (CNS) disease, with or without skin involvement (30%).
Disease limited to the skin, eyes, and/or mouth (SEM disease) (45%).

[https://www.ncbi.nlm.nih.gov/books/NBK507897/ ]

VZV:
Cicatricial skin lesion, hypopigmentation. Microphthalmia, cataract, chorioretinitis, optic atrophy. Microcephaly, hydrocephalus, intracranial calcification, hydranencephaly. Motor and sensory deficit, lower limb hypoplasia, Horner syndrome, absent stretch reflex, sphincter dysfunction.
[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/821550/viral_rash_in_pregnancy_guidance.pdf ]
[https://www.rcog.org.uk/globalassets/documents/guidelines/gtg13.pdf ]

Hepatitis B:
Most transmission is during delivery but transplacental spread can occur (2%).
Persistent HBsAg antigenemia, low birth weight, increased transaminase,  acute hepatitis B, hepatomegaly, death.
[https://www.msdmanuals.com/professional/pediatrics/infections-in-neonates/neonatal-hepatitis-b-virus-hbv-infection]

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062549/ ]
[https://www.gov.uk/government/publications/infectious-diseases-in-pregnancy-screening-programme-standards ]
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/858618/Immunisation_Policy_HBIG23.pdf ]
[https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/737746/Hepatitis_B_babies_resource_flyer_.pdf ]

Hepatitis C:
Both intrauterine and perinatal. Rate is 4-22% (higher in HIV coinfection). Spontaneous clearance may occur (up to 30%). Many cases are asymptomatic. Hepatomegaly, abnormal liver enzyme. Persistent liver inflammation, fibrosis.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082901/ ]

CMV:
Risk is higher in a primary infection (>30%) compared to recurrence (<1.5%).
The highest risk of congenital infection is in the first trimester but may occur at any time during pregnancy.
Cardiac – cardiomegaly (ventricle), cardiac calcification.
CNS – microcephaly, seizure, sensory-neural hearing loss, brain migration abnormality (polymicrogyria, pachygyria), chorioretinitis.
GI – Jaundice, hepatosplenomegaly, echogenic bowel, ascites.
Lung – Pneumonia, pl effusion.
Blood – petechiae, haemolytic anaemia
General – SFD, hypotonia, lethargy.
[https://www.cdc.gov/cmv/congenital-infection.html#:~:text=Some%20babies%20with%20congenital%20CMV,Rash ]
[https://ijponline.biomedcentral.com/articles/10.1186/s13052-017-0358-8 ]

Lassa fever:
Anasarca, abdominal distension, bleeding.

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