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Congenital Infections

Congenital Infections . TORCH. T oxoplasmosis O ther (syphilis) R ubella C ytomegalovirus (CMV) H erpes simplex virus (HSV) . Varicella zoster (the chickenpox virus). Entroviruses Hepatitis B. Parvovirus. HIV (human immune deficiency virus). Chlamydia trachomatis .

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Congenital Infections

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  1. Congenital Infections TORCH Toxoplasmosis Other (syphilis) Rubella Cytomegalovirus (CMV) Herpes simplex virus (HSV)

  2. Varicella zoster (the chickenpox virus). Entroviruses Hepatitis B. Parvovirus. HIV (human immune deficiency virus). Chlamydia trachomatis. Mycoplasma. Group B streptococcus. Malaria

  3. COMMON CLINICAL FEATURES • Low birth weight for gestational age • Prematurity • Seizures • Chorio-retinitis • Cataracts • Purpura • Cerebral calcification • Micro-ophthalmia • Jaundice • Anaemia • Hepatosplenomegaly • Pneumonitis

  4. CONGENITAL CMV • Caused by a DNA herpesvirus Cytomegalovirus (CMV) • Most common congenital viral infection • The majority of congenital infections are asymptomatic • severe neurologic morbidity occurs in 80 percent of survivors • sequelae appear to be more severe when infection is acquired earlier in pregnancy

  5. PATHOGENESIS • Neonatal • Antenatal (in utero) - 80-96% of cases • Primary Maternal Infection • Recurrent Maternal Infection • Perinatal • Postnatal • Childhood 1. Horizontal Transmission • CMV excreted in saliva, urine, stool, tears 2. Organ Transplantation • kidney, marrow, heart, liver, blood (leukocytes)

  6. CLINICAL FEATURES: 90% of infants with congenital CMV infection are clinically silent • CNS Manifestations • 70% - microcephaly • 60% - intellectual impairment • 35% - sensorineural hearing loss • seizures • 22% - chorioretinitis

  7. CLINICAL FEATURES: • Systemic Manifestations • Reticuloendothelial (Liver) - 65-75% • 70% - hepatomegaly/splenomegaly • 68% - jaundice • 65% - thrombocytopenia (with petechiae and purpura) • hepatitis • Others 65% - low birth weight (< 2500 gm) 2-5% - pneumonitis

  8. INVESTIGATIONS • Diagnostic • Virology • gold standard • of urine, saliva, blood, CSF, nasopharynx • Serology • ELISA - CMV-specific IgM • of neonatal blood specimens, cord sampling • Others • PCR • Serum • CBC - anemia, thrombocytopenia • conjugated , unconjugated hyperbilirubinemia • elevated hepatic transaminases • CSF • elevated protein content

  9. INVESTIGATIONS: • Imaging Studies CT (Head) • periventricular calcifications • can be identified in 25-50% of symptomatic infants

  10. Prognosis • Infants with signs of congenital CMV infection 80% have long-term sequelae: • sensorineural hearing loss • neuromuscular problems • motor and intellectual retardation • seizures • chorioretinitis with visual deficits • Infants with silent congenital CMV infection have a more favourable outcome ®Ganciclovir

  11. CONGENITAL TOXOPLASMOSIS • caused by the protozoan Toxoplasma gondii • ocular, central nervous system (CNS) • incidence: 0.3-1/1000 live births

  12. Routes of Transmission Neonatal (in utero) Primary Maternal Infection • acquired by the ingestion of raw or undercooked meat ( cattle), or of infectious oocysts in feces (cats, birds) • 1st trimester - 17% - spontaneous abortion • 2nd trimester - 25% - spontaneous abortion or severe disease • 3rd trimester - 65% - subclinical disease

  13. CLINICAL FEATURES: 70% of infants with congenital toxoplasmosis infection are asymptomatic • Ocular Manifestations (76%) • chorioretinitis • optic nerve atrophy • microphthalmias • blindness

  14. CLINICAL FEATURES: • CNS Manifestations (52%) • hydrocephaly • motor and intellectual retardation • seizures • sensorineuronal hearing loss • Systemic Manifestations • classic triad of congenital toxoplasmosis :chorioretinitis, hydrocephalus, and intracranial calcifications.

  15. INVESTIGATIONS: • Isolation of T. gondii from placenta or cord blood • Serology • measures IgG T. gondii antibody • IgM fluorescent antibody test • Imaging Studies • CT (Head) • intracranial calcifications (33%)

  16. MANAGEMENT • combination of : • pyrimethamine • sulphadiazine • folinic acid is added • Spiramycin Prevention

  17. CONGENITAL RUBELLA • caused by an RNA Togavirus • Vaccine-preventable disease

  18. Routes of Transmission Antenatal (in utero) • 1st trimester - 75-90% • 2nd trimester - 35-40% • 3rd trimester - 25-50%

  19. CLINICAL FEATURES: • Neonatal Manifestations • IUGR low birth weight - prematurity • stillbirth - spontaneous abortion • Early Manifestations • cloudy corneas • Cataracts • microcephaly • hepatomegaly splenomegaly • jaundice • pulmonary valve stenosis • patent ductus arteriosus • thrombocytopenia purpura

  20. INVESTIGATIONS: • Virology • from urine, naspharynx, CSF • Serology • fetal rubella-specific IgM • persistence of rubella-specific IgG after 8-12 months of age

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