Congenital Infections

Question 1

How are congenital infections contracted

4

Answer 1

in utero,

transplacental

Via ruptured membranes

from the birth canal during delivery (intrapartum)

Question 2

What is a TORCH and why is it important in paediatrics

Answer 2

group of diseases that cause congenital abnormalities if the fetus undergoes intrauterine exposure from maternal infection

T: Toxoplasma gondii.
O: Others= Syphilis, Parvovirus, Varicella zoster.
R: Rubella.
C: Cytomegalovirus (CMV).
H: Herpes zoster.

Question 3

name a few General characteristics of congenital infections

Answer 3

New active maternal infection is obligatory

No risk for subsequent pregnancies.

Most often affected organs: Brain and liver.

Morphologic changes: necrosis and inflammation.

Diagnostic criteria:
°IgM in umbilical blood > 0.2 g/l (first 24 hrs).
°Elevated specific IgM in the newborn.
° Elevated specific IgG in the newborn that exceeds maternal blood level

Question 4

General clinical presentation of a newborn w/ a congenital infection ( when in doubt & syphillis )

Answer 4

Intrauterine growth retardation.

Enlargement of the liver and spleen.

Jaundice especially w/ hepatomegaly and hepatitis

Rashes of different types( syphillis & aids)

Necrotizing encephalitis, intracerebral calcifications → microcephaly, hydrocephalus.

Chorioretinitis.

Hematologic manifestations: Anemia, thrombocytopenia

Question 5

Why is the Risk of contracting intrapartum and postpartum infection is inversely proportional to gestational age.

Answer 5

Although antibodies are actively transported across the placenta,

effective levels of Maternal IgG are not achieved until near term so infecti me are more likely at an early gestational age than a later one

Question 6

Consequences of congenital infections

Answer 6

depend on the agent and timing of infection in gestation

spontaneous abortion,
intrauterine growth restriction,
premature birth, stillbirth,
congenital malformation (eg, rubella),

symptomatic (eg, CMV, toxoplasmosis, syphilis) asymptomatic (eg, CMV) neonatal infection.

Question 7

How does Congenital toxoplasmosis occur

Answer 7

transplacental acquisition !!of Toxoplasma gondii parasite after the mother is infected by

1) consumption of raw or undercooked meat
2) from contact with the faeces of recently infected cats.

Although the rate of fetal transmission is higher when women are infected later during pregnancy fetuses infected earlier in gestation have more severe disease.

Question 8

Manifestation of congenital toxoplasmosis

Sx vs asx

Answer 8

Newborns can be

Symptomatic General sx of congenital infections

Asymptotic: remain at risk of developing chorioretinitis into adulthood.

Question 9

Dg of Congenital toxoplasmosis

Answer 9

serologic testing of maternal IgG
PCR of the amniotic fluid.

Neuro: Brain imaging, CSF analysis, ophthalmologic evaluation (for neonatal infection)

Question 10

Rx of Congenital toxoplasmosis

Answer 10

pyrimethamine, sulfadiazine, and leucovorin for a year.

Sometimes spiramycin is used for pregnant women yet to give birth

Question 11

How does Congenital rubella infection occu

Answer 11

primary maternal infection w/ Rubella virus which invades the upper respiratory tract, and causes subsequent viremia. Once I’m the blood Virus then disseminates to the placenta.

highest risk of developmental abnormalities when infected during the first 16 wk of gestation! particularly the first 8 to 10 wk!! As early infection increases chances of chronic uterine infection

Question 12

Sx of rubella In the pregnant women and the Fetus

Answer 12

Maternal 
URT symptoms,
mild fever, 
conjunctivitis, 
Sub occipital/ post auricular lymphadenopathy 
a maculopapular rash.

Infant 👶
No effect
Congenital rubella syndrome
Death In utero

Question 13

What is congenital rubella syndrome

Head heart hearing 👀

Answer 13

Mx abnormalities cause by congenital rubella infection consisting Of

Intrauterine growth restriction
Microcephaly!!
Meningoencephalitis!!!
Cataracts
Retinopathy
Hearing loss
Cardiac defects (PDA and pulmonary artery stenosis)
Hepatosplenomegaly

Question 14

Dg of Congenital rubella infection

Answer 14

maternal serum rubella titers,
viral detection in the mother via culture

reverse transcriptase–PCR (RT-PCR)
of amniotic fluid, nose, throat (preferred), urine, CSF, or blood specimens

infant antibody titers.

Question 15

Can congenital rubella be rx

Answer 15

No specific therapy is available for maternal or congenital rubella infection.

most pregnancies end in termination.

Prevention with the MMR (measles, mumps and rubella) vaccine is only therapeutic option

Question 16

How is Congenital CMV infection acquired

Answer 16

Prenatal(transplancental) 
perinatal acquisition ( during delivery)

Most common congenital infection

Question 17

Sx of Congenital CMV infection

Answer 17

90% are normal at birth and develop normally a

5% have general clinical features of TORCH at birth
Can be acquired in late infancy and present w/ pneumonia,
hepatosplenomegaly,
hepatitis,
thrombocytopenia,
sepsis-like syndrome,
atypical lymphocytosis.

Question 18

Typical dg work up of Congenital CMV infection

Virus= PCR

Answer 18

viral detection using

1) culture using urine, saliva, or tissue
2) PCR using urine, saliva, blood, or tissue.

Question 19

Rx for Congenital CMV infection

Answer 19

Supportive rx for deteriorated hearing

Parenteral ganciclovir or oral valganciclovir given to infants with symptomatic disease identified in the neonatal period.

Question 20

What are the clinical sx of CONGENITAL SYPHILIS:

Answer 20

Same as general TORCH manifestation

Specific sx are
A characteristic rash on the soles of the feet and hands.
Bone lesions.

Question 21

Dg of congenial syphillis

Why are there two types of dg Tests

Answer 21

nontreponemal tests: detect cardiolipin. B antibody.
-Venereal Disease Research Laboratory (VDRL)
-Rapid Plasma Reagin (RPR) tests
Often false positive So require confirmation

treponemal tests: confirmation of +ve non trep test

• Fluorescent Treponemal Antibody-Absorption (FTA-ABS) test
• Microhemagglutination Assay-Treponema pallidum(MHA-TP) test.

Question 22

Principles for syphillis tests

Answer 22

Gestational syphilis is diagnosed most commonly by routine serological screening of all women during early pregnancy.

Women who are considered to be at high risk for acquiring syphilis during pregnancy should undergo repeat testing in the third trimester and at delivery.

Question 23

Describe the key clinical features of CONGENITAL HEPATITIS:

Answer 23

symptoms usually appear at 1-2 months of age.

Jaundice: Yellow eyes and skin.
Pain in the abdomen.
Dark urine.
Loss of appetite and no normal weight gain.
Nausea and vomiting.

Question 24

Dg of giant cell CONGENITAL HEPATITIS:

Answer 24

liver biopsy -
shows combo of 4-5 liver cells into a large cell that still functions, but not as well as a normal liver cell.
This type of neonatal hepatitis is called “giant cell hepatitis.”

Question 25

What are the four types of complications of congenital hepatitis depending on the type

Answer 25

Neonatal hepatitis caused by rubella or cytomegalovirus

• Increase risk of brain infection leading to mental retardation or cerebral palsy.
• increased risk of permanent liver disease from scarring (cirrhosis).

Infants with giant cell hepatitis

• usually recover (80 percent of cases) with little or no scarring to the liver.
• 20 % have jaundice lasting six months of age & require a liver transplant d/2 develop chronic liver disease/ cirrhosis

Vitamin deficiency
-Because of the blockage of the bile ducts and the damage caused to liver cells, infants with chronic neonatal hepatitis will not be able to digest fats and will not be able to absorb vitamins.
-Vitamin D def: rickets
-Vitamin A def: is also needed for normal growth and good vision.
Vitamin K def: coagulopathy = easy bruising and a tendency to bleed
-Vitamin E def: results in poor coordination.

Chronic neonatal hepatitis will lead to the inability of the liver to eliminate toxins in the bile. This causes itching, skin eruptions and irritability.

Question 26

Major and minor criteria for dg of congenital HIV Infection

Answer 26

Major

1) weight loss / failure to thrive
2) chronic diarrhoea ( over a month)
3) chronic fever (over a month)

Minor
General lymphadenopathy

Oropharyngeal candidiasis

Recurrent common infections

General dermatitis

Confirmed maternal HIV

Question 27

What are is he classifications of HIV sx

Answer 27

CNS

Respiratory System:

CVS

GI

SKIN

opportunistic infections

Malignancy

Question 28

CNS sx of aids

Answer 28

Microcephaly.
Progressive neurological deterioration.
Developmental delay/regression.
Predisposition to CNS infections.

Question 29

Resp sx of HIV

Answer 29

Recurrent infections (pneumonia, sinusitis, otitis media).
Tuberculosis.
Pneumocystis jiroveci pneumonia or lymphoid interstitial pneumonitis.

Question 30

Cvs sx of HIV

Answer 30

Cardiomyopathy with congestive cardiac failure.

Question 31

GI sx of HIV

Answer 31

AIDS enteropathy (malabsorption, infections with various pathogens) → chronic diarrhea resulting in failure to thrive.
Abdominal pain, dysphagia, chronic hepatitis or pancreatitis.
Renal.

Question 32

Renal sx of HIV

Answer 32

AIDS nephropathy: the most common presentation nephrotic syndrome.

Question 33

Skin sx of HIV

Answer 33

Eczema.
Seborrheic dermatitis.
Candida infections.
Molluscum contagiosum.
Anogenital warts.

Question 34

Opportunistic infec HIV

Answer 34

Pneumocystis jiroveci pneumonia.
Cyptosporidium.
Epstein Barr Virus.
Measles.
Cryptococcus meningitis.
Toxoplasmosis.

Question 35

Malignancies in HIV

Answer 35

Non Hodgkin’s Lymphoma.
Primary CNS lymphoma.
Kaposi sarcoma