Congenital Infections Flashcards
What are TORCH Infections?
Congenital viral infections T - Toxoplasmosis R - Rubella C - CMV H - HSV
Characteristics of congenital viral infections (in-utero):
- Microcephaly
- Intracranial calcifications
- Rash
- Intrauterine growth restriction (IUGR)
- Jaundice
- Hepatosplenomegaly
- Elevated transaminases
- Thrombocytopenia
What causes Toxoplasmosis and what is the route of infection?
Toxoplasma gondii
Route:
- Fecal oral route
- Ingested oocysts in cat feces (liter box), water, soil, or inappropriately prepared meat
- Cysts viable in soil for up to 18 hours
Presentation of Toxoplasmosis?
Acute infection is usually asymptomatic
33% risk of fetal infection with primary maternal infection in pregnancy
- Infection rate higher in 3rd trimester
- Symptomatic really only in second trimester
What are the detailed clinical manifestations of toxoplasmosis in each trimester?
First
- Death
- CNS/Opthamologic findings
Second
- Hydrocephalus
- Intracranial calcifications
- Chorioretinitis (May develop late)
- May have classic congenital infection issues like jaundice from hepatosplenomegaly, anemia, small head, visual/hearing issues
Third
- Asymptomatic
How do we diagnose toxoplasmosis?
Gold standard - Isolation of the organism from placenta, serum, or CSF.
Classic triad (hydrocephalus, intracranial calcifications, chorioretinitis) on PE
Serologies that support toxoplamosis (hard to use and hard to interpret due to bad standards)
Maternal enzyme-linked imunosorbent assay suggestiveInfant IgG persisting beyond 6 months
Treating toxoplasmosis
Pregnant mothers with acute toxo:
- Daily spiramycin to reduce congenital transmission up to 50%
If infant diagnosed prenatally, treat mom
- Spiramycin, pyrimethamine with leucovorin rescue, sulfadiazine
Symptomatic infants
- pyrimethamine with leucovorin rescue, sulfadiazine for 12 months
If asymptomatic infant, same idea but perhaps not 12 months of it.
What type of virus is Rubella and how bad is it?
This is a single stranded RNA Toga virus.
Vaccine preventable and mild, self limiting in nature.
How can rubella manifest clinically?
Eyes
- Cataracts, glaucoma (leucocoria on exam)
Cardiac
- PDA, peripheral pulmonary artery stenosis
Auditory
- Sensorineural hearing impairment
Neurologic
- Behavioral d/o, meningoencephalitis
Other
- Growth retardation
- Big liver and spleen
- Thrombocytopenia
- Purpuric skin lesions
Clinical manifestations of CMV
- Low birth weight
- petechiae
- Thrombocytopenia
- Hepatosplenomegaly
- Direct hyperbilirubinemia
- Elevated transaminases
CT scan of CMV vs. Toxoplasmosis
CMV gives this peripheral outline calcification pattern around the ventricles and brain mass
Toxo makes nodules within the brain parenchyma
Two big defects caused down the road from CMV
- Hearing loss after 6 months
- Most frequently identified viral cause of developmental delay in developed countries
CMV retinitis is a little different than the others. What dos it present with?
- Chorioretinitis (same)
- Retinal scars
- Optic atrophy
- Central vision loss
How often do symptoms present for CMV?
- 90% asymptomatic at birth, with up to 15% developing symptoms later on, notably the sensorineural hearing loss