Congenital infections (TORCH) Flashcards
What are the risk factors for toxoplasmosis?
Cat litter
Undercooked meat
Both may contain oocysts of toxoplasma gondii
What is the risk of congenital toxoplasmosis infection and consequences in the first trimester?
Infection: 10%
Severe consequences: 70%
What is the risk of congenital infection and consequences in the third trimester?
Infection: 60%
Severe consequences: 1%
How does toxoplasmosis present in the pregnancy woman?
Asymptomatic
Lymphadenopathy
Flu-like symptoms
What is the clinical triad that neonates with toxoplasmosis develop?
Chorioretinitis
Hydrocephalus
Intracranial calcification
What are the clinical features of toxoplasmosis in the neonate?
Triad (chorioretinitis, hydrocephalus, neurological)
Seizures, microcephaly
Blueberry muffin rash, hydrops
What changes occur on the placenta in tocoplasmosis?
Granulomas in the placenta
After maternal diagnosis of toxopalsmosis, what is the management?
Antibiotic therapy
Intrauterine diagnosis for neonate: ultrasound and amniotic fluid PCR
Offer TOP if PCR positive
What is the management of toxoplasmosis in the neonate?
12 month therapy of - pyrimethamine - sulphadiazine - folic acid Review for eye and development
What are the long-term sequelae of toxoplasmosis?
Chorioretinitis Developmental delay Deafness Seizures Microcephaly, hydrocephalus
What investigations are performed for a neonate with suspected toxoplasmosis?
Cord blood IgM, IgA Maternal IgM, IgA FBE, LFTs, culture US, CT, MRI brain Eye, hearing assessment
What are the risk factors for congenital syphilis?
Maternal primary and secondary disease
Lowest in latent disease
What are the late features of congenital syphilis?
Hutchinson's teeth Sabre tibia CNVIII hearing loss Blindness, saddle nose deformity (from ulceration) Frontal skull bossing Developmental delay
How does congenital syphilis present?
Asymptomatic
Disseminated disease
What systems does congenital syphilis involve
Haem - hydrops Mucosal - rhinitis, nose deformity Eyes Skin Bone CNS
What is the management of syphilis of the mother?
Benzathine penicillin IM single dose
What is the management of syphilis of the neonate?
IV benzylpenicillin 10 days
What are the long-term sequelae of congenital syphillis?
Fetal death, premature delivery
Neurological, deafness
Bone deformities
Which congenital (TORCH) infections are notifiable?
Listeriosis
Syphilis
Varicella zoster
Rubella
What are the risk factors for listeriosis?
Unpasteurised dairy
Soft cheeses, deli meats
Pregnancy
What is the rate of fetal mortality in listeriosis?
20-60%
How does listeriosis present in the mother?
Flu-like symptoms, fever
Gastroenteritis like symptoms
What is the management for listeriosis?
Penicillin or ampicillin and gentamicin.
What are the clinical features of listeriosis in the neonate?
Death, preterm labour, fetal distress Meconium-stained liquor, particularly <34 weeks Meningitis, pneumonia, conjunctivitis Anaemia, thrombocytopenia Granulomas
What are the two broad outcomes of varicella infection in the mother?
<20 weeks: congenital varicella syndrome
7 days before and 2 days after delivery: neonatal chickenpox
How does neonatal chickenpox present?
Prodromal fever
Pruritic rash, macular –> vesicular
How are congenital varicella syndrome present?
Low birth weight
Skin lesions
Eye, brain and limb abnormalities
How is an exposed mother managed?
Seropositive: no action
Seronegative, <96 h: ZIG
Seronegative, >96h: IV aciclovir
How is an infected mother managed?
<24 h: oral aciclovir + regular US
Complicated infection: IV aciclovir
How is the exposed infant managed?
ZIG
How is the infected infant managed?
IV aciclovir
How is parvovirus B19 transmitted?
Aerosol droplets
What are the risk factors for parvovirus B19 infection in mothers?
Not exposed as children
What is the risk of vertical transmission of parvovirus B19?
50%
What are the clinical features of congenital parvovirus B19?
Hydrops fetalis and fetal death (infection <20 weeks gestation) Anaemia (infection >18 weeks gestation) Myocarditis Hepatitis Erythema infectiosum
How is parvovirus B19 managed?
IVIG for mothers
Intrauterine transfusion for neonates with Hb<50
Which congenital infection cause hydrops fetalis?
Toxoplasmosis
Syphilis
Parvovirus B19 <20 weeks gestation
What are the 3 major outcomes of rubella infection?
<12 weeks: congenital rubella syndrome
12-18 weeks: sensorineural deafness
>18 weeks: rare
What is the transmission route of rubella?
Droplet and contact with nasopharyngeal secretions
What is the rate of vertical transmission and congenital abnormalities for rubella <10 weeks
Infection: 80%
Abnormalities: 90%
For how long are infected infants infectious?
12+ months after birth
What are the clinical features of congenital rubella?
Eye disorders Sensorineural deafness CVS issues (pulmonary stenosis and PDA) Haematological, including blueberry muffin appearance CNS issues Inflammatory lesions So many others
Which congenital infection cause blueberry muffin appearance?
Toxoplasmosis
Rubella
How is rubella infection prevented?
MMR vaccine for all children 12+ months
How is congenital rubella managed?
No pharmacological Mx
Offer TOP in first trimester
Supportive management and regular assessments
Maternal CMV infection can be primary or reactivated. Which is more likely to lead to neonatal sequelae?
Maternal primary infection
How is neonatal CMV diagnosed?
Urine culture for CMV
Cerebral ultrasound, MRI brain
Serial audiology and developmental assessment
How is neonatal CMV managed?
IV ganciclovir
Supportive
Long-term follow up
What are the long term sequelae of congenital CMV?
Neurological
Hearing
Ophthalmological
Which HSV type is most likely to cause congenital infection?
HSV2
What are the long-term sequelae of congenital HSC?
Long-term neurological sequelae (10%)
Recurrent skin and eye eruptions, monitoring essential
Maternal HSV infection can be primary or reactivated. Which is more likely to lead to neonatal sequelae?
Primary infection (30%)
When are most neonates infected with HSV?
90% infected during passage through the birth canal or through ascending infection.
What are they ways in which congenital HSV presents?
Skin, eye, mouth localised disease
Disseminated disease
Pneumonitis
Meningoencephalitis
How does disseminated HSV present?
Unexplained sepsis
Fever, lethargy
DIC
How is HSV-caused meningoencephalitis present?
Absent gag reflex
Seizures
Cerebral atrophy and calcifications
What investigations are performed for congenital HSV?
Swab of vesicle, eye and throat
Lumbar puncture
FBE, LFT
EEG, CT/MRI brain
How can congenital HSV be prevented?
Avoiding scalp electrodes in active maternal lesions
Delivery by caesarean section if the first genital HSV is diagnosed during labour
Oral acyclovir from 36 weeks for mother
How is congenital HSV managed?
Full investigation Education of family to look out for recurrence Antivirals - Acyclovir - Topical for eyes
