Congenital/Perinatal Infections Flashcards
What does TORCH stand for?
- Toxoplasmosis
- Other
- Rubella
- CMV
- HSV
What are the “Other” pathogens?
- Syphilis
- Hepatitis B
- Varicella-zoster
- Parvovirus B19
- HIV
- HTLV-1
What determines the severity of congenital infections?
The earlier the mother is infected the greater the risk to the fetus; Acute maternal infection is worse than reactivation of the fetus (higher infectious dose causes more harm)
Routes of transmission of perinatal infections
- Exchange of maternal/fetal blood
- Fetal monitors that break skin
- Vaginal/skin flora
- Breastmilk
- Relatives and visitors
Usual route of congenital infection?
Maternal viremia
Serious manifestations of congenital infection?
- Microcephaly
- Hearing loss
- Blindness
- Rash
Strategies used to identify risk/existence of congenital/neonatal infection?
- Recognize maternal exposure
- Detect IgM or rising IgG in maternal serum
- Sample body fluids
What is the method for definitive Dx of congenital infections?
Isolate pathogen from infant using urine, saliva, CSF, nasopharyngeal swabs
What is CMV?
- Herpes virus
- Ubiquitous
Histo findings of a person w/ CMV?
Giant cells form giving “owl eye” appearance
General Px in people who get CMV infection?
Generally asymptomatic mononucleosis with essentially no sequelae
Where does CMV likely lie latent?
Bone marrow
Risk factors for congenital CMV?
- Mother has no prior infection
- Pregnancy at young age
- First pregnancy
- New sex partner during pregnancy
- Frequent contact w/ babies and toddlers (daycare)
- Mother’s illness may be subclinical
At what point in the pregnancy is Px for congenital CMV the worst?
During early pregnancy
Describe transmission and pathogenesis of CMV
- CMV passes thru maternal blood thru placenta (NOTE: Primary infection much higher viral load than reactivation)
- Virus spreads thru fetus
What is the most common congenital abnormality caused by CMV?
Hearing loss
Tx and Prevention for CMV?
- Tx: Ganciclovir
- Prevention: NONE
Which HSV has a worse outcome?
HSV2
What type of HSV infection is worse? Primary or reactivation?
Primary
What is worse? Visible lesions on the mother with HSV or subclinical reactivaiton?
Visible lesions
What type of HSV infection of the child would be worse? Perinatal or intrauterine?
Intrauterine
What is the worst manifestation of HSV in a neonate?
Dissemination > Encephalaitis > skin lesions
Most frequent scenario in which neonatal HSV occurs?
Mother has recurrence of HSV2 at the time of birth, and neonate acquires virus at full term
Typical Px for neonatal HSV?
Good outcome
Severe scenario of HSV infection?
Mother has primary HSV2 infection during pregnancy and fetus is born w/ disseminated virus, severe mental impairment, death
Tx and Px of HSV at birth?
Acyclovir (well-tolerated)
C-section, antiviral prophylaxis
Scenario in which neonatal varicella syndrome occurs?
Mother contracts primary varicella
Prevention for congenital varicella?
Vaccination of all seronegative women and advise seronegative women to avoid children w/ chickenpox or anyone w/ shingles
What is the pathogenesis of congenital rubella?
Virus spreads from blood, to placenta, to fetus
Classic abnormality of congenital rubella?
Hearing loss and congenital heart defects (patent ductus arteriosus)
What group is at serious risk of parvovirus B19 death?
Seronegative pregnant women
Tx and prevention for Parvovirus B19?
NONE!
What are the two retroviruses that are of concern for congenital spread?
Human T-lymphotropic virus type I and HIV types 1 and 2
Strategy to prevent transmission of HIV to baby?
Antiviral medications (zidovudine) before during and after pregnancy
Maximally suppress viral load, minimize the risk of developing resistant virus, reduce the risk of perinatal transmission
What is the Tx strategy for HBV+ mother and baby? HBV- mom and baby?
- HBV+ - counsel mother to avoid high risk behaviors and give the child HBIg at birh and vaccine
- HBV- - treat mother with HBV vaccine during pregnancy
