P020A

1. P020A Lecture 5 -

2. Course Objective #30 • Identify the causative agent and the effects on the fetus in the following maternal infections: • Rubella • Toxoplasmosis • Syphilis • Cytomegalovirus

3. Development • Cephalocaudal • Proximal-distal

4. Rubella • AKA • German Measles

5. Congenital Rubella Syndrome • AKA • “Blueberry Muffin Syndrome” • 1st trimester • 85% affected • After 20 weeks • Defects rare

6. Congenital Rubella SyndromeEtiology • Intrauterine Infection • Critical Time period • 1st trimester

7. Congenital Rubella SyndromeFYI • 1941 Australian epidemic • 78 infants w/CRS • 1964-65 US epidemic • 20.5 M cases of Rubella  • 20,000 infants w/CRS

8. Congenital Rubella SyndromeS&S • Varied • ID • Normal – severe • Sensory defects • Deaf* • Blind

9. Congenital Rubella Syndrome • S&S • Cardiac defects • Microcephaly • Bone abnormalities • Purpura

10. Congenital Rubella Syndrome • Treatment • Prevention • Rubella vaccine licensed in 1969 • MMR • 2005 Rubella eradicated in US

11. Rubella Virus Eliminated in the United States • Washington Post --Monday, March 21, 2005 • The invisible "chain of transmission" of rubella virus has been broken in the United States. With it disappears a disease that a little more than a generation ago struck fear in the heart of every pregnant woman. • Fewer than 10 people a year in this country now contract the infection known popularly as German measles. Since 2002, all cases have been traceable to foreigners who carried the virus in from abroad.

12. Congenital Toxoplasmosis • Toxoplasmosis • Protozoa Parasite • “Transplacental spread”  Congenital Toxoplasmosis

13. Congenital Toxoplasmosis • Etiology • Raw, undercooked meat, • Cat feces, • Non-pasteurized milk

14. Congenital Toxoplasmosis • Incidence • 1:10,000 births • Prognosis • Many die in 1st month

15. Congenital Toxoplasmosis • S&S • Varywidely depending on period of infection

16. Congenital Toxoplasmosis • S&S • Triad • Hydrocephalus • Intracranial calcification • Chorioretinitis

17. Congenital Toxoplasmosis • Severe ID • Blindness • Epilepsy • Low birth weight • Hepatosplenomegaly • Jaundice

18. Congenital Toxoplasmosis • Tx • Antibiotics

19. Congenital Toxoplasmosis • Dx • Amniocentesis • Ultrasound

20. Congenital Syphilis • Etiology: • Spirochete bacterium • Bacteria!!!!

21. Congenital Syphilis • Mom  infant • during pregnancy or birth • Fetus vulnerable • after 18 weeks

22. Congenital Syphilis • Incidence • 1:100,000 live births (CDC, 2002) • @ 50% die in utero or shortly before or after birth

23. Congenital SyphilisS&S Early stage • Failure to thrive, • Nasal discharge • Blistery rash • No nasal bridge

24. Congenital Syphilis • Late stage • Hutchinson’s triad • Hutchinson’s teeth • Keratitis • Deaf

25. Congenital Syphilis • Late stage • ID • Bone pain • Vision/hearing loss

26. Congenital Syphilis • Treatment • Mom • Prenatal care • Antibiotics • Delivery • Cesarean

27. Congenital Cytomegalovirus • Herpes-like infection

28. Congenital Cytomegalovirus • Etiology • Transplacental spread

29. Congenital CytomegalovirusFYI • Mom may be asymptomatic • 1% all newborns test positive for CMV • 95% asymptomatic • 5% congenitally affected

30. Congenital cytomegalovirus • The mother's illness may not have symptoms, so she may be unaware that she has CMV.

31. Congenital CytomegalovirusS&S • Inflammation of the retina • Hepatosplenomegaly • Jaundice • Low birth weight • Petechiae • Seizures • Microcephaly

32. Congenital CytomegalovirusDx Tests • Antibody titer against CMV • Bilirubin level • TORCH screen

33. Congenital CytomegalovirusTx • Focus on specific problems

34. Congenital CytomegavirusPrognosis • Up to 90% of infants who have symptoms of their infection at birth will have neurologic abnormalities later in life. Only about 5 - 10% of infants without symptoms will have these problems.

35. Congenital CytomegalovirusFYI -neonatal death is common

36. Congenital CytomegalovirusPrevention • CMV is almost everywhere • Wash hands p touching diapers • ⌀ kiss kids < 6 yrs • ⌀ share food c kids • PG ⌀ work with < 2 1/2

37. Objective #31 • Describe the cause, sequence of events, pathology and preventative factors of erythroblastosisfetalis.

38. Course Objective #32 • Describe the relationship of the Rh factor disorders and kernicterus

39. ErythroblastosisFetalis • What is erythroblastosisfetalis?

40. ErythroblastosisFetalis • Hemolytic disease • ABO incompatibility • Rh incompatibility

41. ErythroblastosisFetalis • Neonate red blood cell destruction

42. ErythroblastosisFetalisS&S • Anemia • Hepatoslenomegaly • Jaundice • Hydrops

43. ErythroblastosisFetalisDx test • Complete blood count and immature red blood cell (reticulocyte) count • Bilirubin level • Blood typing

44. ErythroblastosisFetalisTreatment • Phototherapy: • bilirubin breaks down when exposed to UV light • Blood transfusion

45. Maternal-Fetal Blood Incompatibilities -Rh Incompatibility -ABO Incompatibility

46. ABO Incompatibility • Etiology • Mom blood type • O • Fetus blood type • A • B

47. ABO Incompatibility S&S • Mild • Anemia • Jaundice

48. ABO Compatibility • Severe  • Kernicterus • Brain damage d/t h bilirubin levels

49. ABO Incompatibility Treatment • Phototherapy

50. Rh incompatibility • Mom blood type • Rh- • Fetus blood type • Rh+