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Congenital infections (TORCH) Flashcards

1
Q

What are the risk factors for toxoplasmosis?

A

Cat litter
Undercooked meat
Both may contain oocysts of toxoplasma gondii

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2
Q

What is the risk of congenital toxoplasmosis infection and consequences in the first trimester?

A

Infection: 10%

Severe consequences: 70%

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3
Q

What is the risk of congenital infection and consequences in the third trimester?

A

Infection: 60%

Severe consequences: 1%

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4
Q

How does toxoplasmosis present in the pregnancy woman?

A

Asymptomatic
Lymphadenopathy
Flu-like symptoms

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5
Q

What is the clinical triad that neonates with toxoplasmosis develop?

A

Chorioretinitis
Hydrocephalus
Intracranial calcification

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6
Q

What are the clinical features of toxoplasmosis in the neonate?

A

Triad (chorioretinitis, hydrocephalus, neurological)
Seizures, microcephaly
Blueberry muffin rash, hydrops

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7
Q

What changes occur on the placenta in tocoplasmosis?

A

Granulomas in the placenta

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8
Q

After maternal diagnosis of toxopalsmosis, what is the management?

A

Antibiotic therapy
Intrauterine diagnosis for neonate: ultrasound and amniotic fluid PCR
Offer TOP if PCR positive

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9
Q

What is the management of toxoplasmosis in the neonate?

A 
12 month therapy of
- pyrimethamine
- sulphadiazine
- folic acid
Review for eye and development
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10
Q

What are the long-term sequelae of toxoplasmosis?

A 
Chorioretinitis
Developmental delay
Deafness
Seizures
Microcephaly, hydrocephalus
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11
Q

What investigations are performed for a neonate with suspected toxoplasmosis?

A 
Cord blood IgM, IgA
Maternal IgM, IgA
FBE, LFTs, culture
US, CT, MRI brain 
Eye, hearing assessment
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12
Q

What are the risk factors for congenital syphilis?

A

Maternal primary and secondary disease

Lowest in latent disease

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13
Q

What are the late features of congenital syphilis?

A 
Hutchinson's teeth
Sabre tibia
CNVIII hearing loss
Blindness, saddle nose deformity (from ulceration)
Frontal skull bossing 
Developmental delay
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14
Q

How does congenital syphilis present?

A

Asymptomatic

Disseminated disease

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15
Q

What systems does congenital syphilis involve

A 
Haem - hydrops
Mucosal - rhinitis, nose deformity
Eyes
Skin
Bone
CNS
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16
Q

What is the management of syphilis of the mother?

A

Benzathine penicillin IM single dose

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17
Q

What is the management of syphilis of the neonate?

A

IV benzylpenicillin 10 days

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18
Q

What are the long-term sequelae of congenital syphillis?

A

Fetal death, premature delivery
Neurological, deafness
Bone deformities

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19
Q

Which congenital (TORCH) infections are notifiable?

A

Listeriosis
Syphilis
Varicella zoster
Rubella

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20
Q

What are the risk factors for listeriosis?

A

Unpasteurised dairy
Soft cheeses, deli meats
Pregnancy

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21
Q

What is the rate of fetal mortality in listeriosis?

A

20-60%

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22
Q

How does listeriosis present in the mother?

A

Flu-like symptoms, fever

Gastroenteritis like symptoms

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23
Q

What is the management for listeriosis?

A

Penicillin or ampicillin and gentamicin.

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24
Q

What are the clinical features of listeriosis in the neonate?

A 
Death, preterm labour, fetal distress
Meconium-stained liquor, particularly <34 weeks
Meningitis, pneumonia, conjunctivitis
Anaemia, thrombocytopenia 
Granulomas
25
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
26
How does neonatal chickenpox present?
Prodromal fever | Pruritic rash, macular --> vesicular
27
How are congenital varicella syndrome present?
Low birth weight Skin lesions Eye, brain and limb abnormalities
28
How is an exposed mother managed?
Seropositive: no action Seronegative, <96 h: ZIG Seronegative, >96h: IV aciclovir
29
How is an infected mother managed?
<24 h: oral aciclovir + regular US | Complicated infection: IV aciclovir
30
How is the exposed infant managed?
ZIG
31
How is the infected infant managed?
IV aciclovir
32
How is parvovirus B19 transmitted?
Aerosol droplets
33
What are the risk factors for parvovirus B19 infection in mothers?
Not exposed as children
34
What is the risk of vertical transmission of parvovirus B19?
50%
35
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 ```
36
How is parvovirus B19 managed?
IVIG for mothers | Intrauterine transfusion for neonates with Hb<50
37
Which congenital infection cause hydrops fetalis?
Toxoplasmosis Syphilis Parvovirus B19 <20 weeks gestation
38
What are the 3 major outcomes of rubella infection?
<12 weeks: congenital rubella syndrome 12-18 weeks: sensorineural deafness >18 weeks: rare
39
What is the transmission route of rubella?
Droplet and contact with nasopharyngeal secretions
40
What is the rate of vertical transmission and congenital abnormalities for rubella <10 weeks
Infection: 80% Abnormalities: 90%
41
For how long are infected infants infectious?
12+ months after birth
42
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 ```
43
Which congenital infection cause blueberry muffin appearance?
Toxoplasmosis | Rubella
44
How is rubella infection prevented?
MMR vaccine for all children 12+ months
45
How is congenital rubella managed?
No pharmacological Mx Offer TOP in first trimester Supportive management and regular assessments
46
Maternal CMV infection can be primary or reactivated. Which is more likely to lead to neonatal sequelae?
Maternal primary infection
47
How is neonatal CMV diagnosed?
Urine culture for CMV Cerebral ultrasound, MRI brain Serial audiology and developmental assessment
48
How is neonatal CMV managed?
IV ganciclovir Supportive Long-term follow up
49
What are the long term sequelae of congenital CMV?
Neurological Hearing Ophthalmological
50
Which HSV type is most likely to cause congenital infection?
HSV2
51
What are the long-term sequelae of congenital HSC?
Long-term neurological sequelae (10%) | Recurrent skin and eye eruptions, monitoring essential
52
Maternal HSV infection can be primary or reactivated. Which is more likely to lead to neonatal sequelae?
Primary infection (30%)
53
When are most neonates infected with HSV?
90% infected during passage through the birth canal or through ascending infection.
54
What are they ways in which congenital HSV presents?
Skin, eye, mouth localised disease Disseminated disease Pneumonitis Meningoencephalitis
55
How does disseminated HSV present?
Unexplained sepsis Fever, lethargy DIC
56
How is HSV-caused meningoencephalitis present?
Absent gag reflex Seizures Cerebral atrophy and calcifications
57
What investigations are performed for congenital HSV?
Swab of vesicle, eye and throat Lumbar puncture FBE, LFT EEG, CT/MRI brain
58
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
59
How is congenital HSV managed?
``` Full investigation Education of family to look out for recurrence Antivirals - Acyclovir - Topical for eyes ```

4C (15 decks)

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