Abortion and sever congenital malformation in the 1 trimester Peak incidence in late winter and spring Minor importance in absence of pregnancy 3

Clinical manifestations Mild febrile illness Generalized maculopapular rash Artheralgia or arrthritis Head and neck Conjunctivitis lymphadenopathy

4 Infectiuos period Incubation period 12+13 days Viremia precede clinical signs Infectious period during viremia and 5_7 days of the rash

5 Risk of fetal infection 80% during first 12 weeks 54% during 13_14 weeks 25% during second trimester

6 Sign and symptom Eye defects:cataract,glucoma Heart disease:PDA,pul artery stenosis sensorineural deafness most common CNS defects :microcephaly,developmental

delay,mental retardation Pigmentary retionpathy Neonatal purpura Hepatosplenomegaly Radiolucent bone dz 7

Diagnosis Diagnosis made with serology Rubella isolated from :urin,CSF,nasopharenx Enzyme linked immuno assay IGM 4_5 days after clinical dz or 8 weeks

after appearance rash Peak serum titer IGG demonstrated 1_2 weeks after rash or 2_3 weeks after viremia High rubella IGG avidity in recarrent 8 Some abnormality in sono

Fetal growth retardation Ventricolomegaly Intracranial calcification Microcephaly Microphethalemia Meconium peritonitis Hepatosplenomegaly Cardiac malformation

9 Management and prevention No specific treatment for rubella Avoidance of droplets for 7 days after rash Vaccine in non pregnant women at child bearing age and hospital

personels Avoided vaccine 1 month before pregnancy and during pregnancy No evidence that vaccine induced malformation<1%> 10 11

12 13 14 15

VARICELLA ZOSTER VIRUS Dr askari 16 Varicella zoster virus Double stranded DNA herpes virus Acquired predominantely during childhood

95% of adults have serological evidence of immunity Transmitted by direct contact or respiratory transmission

Incubation period is 10_21 days Contagious from 1 day prior to the onset rash until lesion crusted over 60_95%risk of infection after exposure in non immune women 17 Clinical manifestations 1_2 days flu like sx

Pruritic vesicular lesions crusted over 3_7days Infection tend to be more sever in adult Mortality is prodominately due to varicella pnemonia perticulary in pregnancy Pnemonia :fever,tachypnea,dry

cough,pluretic pain,nodullar 18 Diagnosis Usually diagnosed clinicaly Tzank smear Tissue culture Direct fluorescent antibody testing

In fetus with nucleic acid amplification technique on amniotic fluid 19 Fetal varicella infection Chiken pox occure during first half of

pregnancy fetus may developed congenital anomaly Congenital infection after 20 weeks are uncommon 20 Congeital varicella sx

Chorioretiniris Microphethalemia Cerebral cortical atrophy Growth restriction Hydronephrosis Skin or bone defects 21

Risk of congenital infection 0.4% before 13 weeks 2% 13_20 weeks 22 Peripartum infection

Exposure before or during delivery poses a serious threat to newborn with attack rate 25_50% and mortality rate 25% IgVZV should be administered to neonate born to mother who have clinical evidence of VZV 5 days before up to 2 days after delivery

23 Exposure to virus Exposed seronegative pregnant

women need to given varizIG within 96hrs of exposure Isolated this pregnant women from other pregnant women Considered CXR Most women require only supporative care

Pneumonia managed in hospital with IV fluid and IV acyclovir 500 mg/m2 24 vaccination Live virus vaccine: Varivax<1995> in adolescents and

adults with no history of varicella with 2 doses given 4 to 8 weeks apart with 97%seroconversion Zostavax <2006> not recommended for individuals younger than 60 years 25 26

27 28 29 30

31 32 Thanks for your attention Thanks for your attention


CBC, BS, FL 100000 100

34 35

4 36

CT, BT CT , BT 37


X-RAY 39 40

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