Congenital Infections

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Congenital Infections

• TORCH

Toxoplasmosis Other (syphilis) Rubella
Cytomegalovirus (CMV) Herpes simplex virus
(HSV)
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• Varicella zoster (the chickenpox virus).
• Entroviruses
• Hepatitis B.
• Parvovirus.
• HIV (human immune deficiency virus).
• Chlamydia trachomatis.
• Mycoplasma.
• Group B streptococcus.
• Malaria

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COMMON CLINICAL FEATURES

• Low birth weight for gestational age
• Prematurity
• Seizures
• Chorio-retinitis
• Cataracts
• Purpura

• Cerebral calcification
• Micro-ophthalmia
• Jaundice
• Anaemia
• Hepatosplenomegaly
• Pneumonitis

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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

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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)

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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

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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 (lt 2500 gm)
• 2-5 - pneumonitis

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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

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INVESTIGATIONS

• Imaging Studies
• CT (Head)
• periventricular calcifications
• can be identified in 25-50 of symptomatic
  infants

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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

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CONGENITAL TOXOPLASMOSIS

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

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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

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CLINICAL FEATURES

• 70 of infants with congenital toxoplasmosis
  infection are asymptomatic
• Ocular Manifestations (76)
• chorioretinitis
• optic nerve atrophy
• microphthalmias
• blindness

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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.

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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)

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MANAGEMENT

• combination of
• pyrimethamine
• sulphadiazine
• folinic acid is added
• Spiramycin
• Prevention

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CONGENITAL RUBELLA

• caused by an RNA Togavirus
• Vaccine-preventable disease

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Routes of Transmission

• Antenatal (in utero)
• 1st trimester - 75-90
• 2nd trimester - 35-40
• 3rd trimester - 25-50

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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

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INVESTIGATIONS

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