Congenital infections Flashcards
History suggestive of congenital infection
- Previous abortions or intra uterine fetal death
* Maternal Fever ,Skin rash or Skin vesicles during pregnancy
General features suggesting congenital infection
o Hepatosplenomegaly
o Generalized lymphadenopathy.
o Anemia
o Thrombocytopenic purpura.
o 😱😱Hepatitis (⬆️conjugated bilirubin)
- Mental retardation
- Seizures
- Microcephaly
- Chorioretinitis
Low birth weight
y Intra uterine growth restriction y Prematurity
General workup
🌝 Detection of specific IgM or rising titer of specific IgG
🌝 For clinical features e.g.
- CBC with differential WBCs count
- Fundus examination
- Liver enzymes and bilirubin
- Plain skull radiograph, CT, MRI
🌝 Isolation of the causative organism
Congenital Toxoplasmosis -Clinical pictur
y General features
y Hydrocephalus /Microphthalmia /Chorioretinitis
TOXO dx
y General workup
y Isolate of the organism from the blood
y Skull X-ray, CT: Diffuse calcifications
TOXO tx
Treatment
A. Prevention
y Food hygiene
y Spiramycin for seropositive pregnant
B. Curative
y Symptomatic treatment
y Triple therapy for up to 1 year pyrimethamine ,folonic acid, sulphadiazine
Congenital Rubella cause
Maternal german measles specially in the 1 st trimester
Congenital Rubella Syndrome(CRS) clinical picture
Even if asymptomatic infection occurs in the mother, rubella can be transmitted across the placenta to the developing fetus.
The earlier in gestation the infection occurs, the greater the injury
40% of fetuses infected during the first 8 weeks spontaneously abort
Some infants at risk are normal Some appear normal at birth but later are found to have hearing loss
Some are small for gestational age and at birth have congenital anomalies :
💔head
Catarct, glaucoma, microphthalmia Sensorineural deafness , Miningeoencephalitis, Chorioretinitis (salt and pepper appearance)
💔chest
Congenital heart disease o PDA o Pulmonary stenosis
💔abdomen
o Hepatosplenomegaly , Hepatitis
💔blood
o Lymphadenopathy o Anemia o Purpura o
💔skin
In some cases a rubelliform rash or a characteristic raised, bluish, papular eruption, termed a blueberry muffin rash, may be evident as the result of dermal erythropoiesis
Congenital Rubella Syndrome triad
PDA
Microcephaly
Cataract
Congenital Rubella: Diagnosis and Treatment
Diagnosis:
Rubella specific IgM culture: nasopharynx, blood, urine, CSF, throat
Treatment:
supportive
Congenital Syphilis: Symptoms
Asymptomatic 50%
Fever, lymphadenopathy, irritability, failure to thrive
Jaundice, hepatosplenomegaly
🌝 Mucocutaneous: palmar/plantar bullae, maculopapular rash trunk/limbs, mucosal lesions, condylomata lata
Anemia (BM arrest,hemolysis),thrombocytopenia,low/high WBCs
Meningitis
😱 “Snuffles” (serous rhinitis)
😱 Bone changes: osteochondritis of humerus, tibia
Congenital Syphilis: Diagnostic Studies
Quantitative RPR CSF exam: cell count, protein, VDRL CBC, platelets, liver enzymes Long bone radiographs Demonstration of spirochetes: tissue/fluid HIV testing
Congenital Syphilis: Treatment
Penicillin G or Procaine penicillin G
Congenital CMV Infection incidence
The commonest congenital viral infection (0.5–1 per 1000 live births)
-Cytomegalovirus: Clinical Findings In Symptomatic Infants
😱😱 Microcephaly, intracranial calcifications (Periventricular calcifications)
😱 Thrombocytopenia, petechiae, purpura-‘Blueberry muffin syndrome
Conjugated hyperbilirubinemia, elevated liverenzymes, liver failure
Interstitial pneumonitis
😱 Hearing loss
Mental retardation
Neurologic impairment, cerebral palsy
Chorioretinitis
Intestinal pseudo-obstruction like illness
Cytomegalovirus: Diagnosis
CMV titers:
IgM, IgG Acute and convalescent
Urine culture for CMV
Excretion may be intermittent
CNS imaging Eye exam
Cytomegalovirus: Treatment
Supportive
Platelet transfusion
Anti-viral treatment
Ganciclovir may reduce sequelae, but of limited efficacy
CMV hyperimmune globulin
Infectious disease consultation
Parvovirus B19
Associated with multiple disorders:
Erythema infectiosum (fifth disease)
Aplastic crisis (hemolytic disorders, sickle cell)
Chronic anemia in immunosuppressed
Acute arthritis
non immune Fetal hydrops and death due to anemia
Varicella clinical picture
Maternal varicella before 20 weeks:
congenital anomalies reported to be 1-2%
Cicatricial skin lesions Limb hypoplasia CNS, ocular, neurologic
Perinatal infection within 5 days before to 2 days after delivery varicella can cause? Tx?
fatal varicella in the infant.
Treatment for perinatal infection:
- Zoster immunoglobulin or IVIG
- If clinical varicella developed, treat with IV acyclovir
Herpes Simplex: Clinical Presentation
y Skin and mouth vesicles and ulcers y Kerato conjunctivitis y Encephalitis→ seizures y Disseminated form: (multi organ) septic shock like -Fever
Dx of congenital HSV
Diagnosis
y Isolate CMV from the vesicles or conjunctiva smears
y Skull X-ray, CT: May show diffuse calcifications
y Avoided by cesarean section for mothers with genital lesions and Acyclovir
TX of HSV
Symptomatic treatment + Acyclovir or Vidarabine