Neonatology - TORCH Infections

Question 1

Toxoplasmosis gondii

Answer 1

Defintion:
- Parasitic infection
- Primary spread by contamination with faeces from a cat that is a host of the parasite
- Consumption of undercooked meats
Classical triad of features:
- Intracranial clacification
- Hydrocephalus
- Chorioretinitis (inflammation of the choid and retina in the eye)
Diagnosis:
- Blood test for IgG/IgM
Management:
- Pyrimethamine-sulphonamide or Spiramycin
Consequences:
- 1st tri-infection - spontaneous miscarriage
- Stillbirth
- Other abnormalities and mental retardation are possible

Question 2

Other agents (Syphilis)

Answer 2

Syphilis
- Antenatal screening
- T.pallidum has the potential to cross the placenta or infect the baby during delivery
- Can cause miscarriage, stillbirth, pre-term labour, or congenital syphilis

Question 3

Other agents (Parovirus)

Answer 3

Parovirus b19
- Definition
= Nonenveloped single-strand DNA virus, respiratory infection
= slapped cheek syndrome
- Symptoms
= Rash, Arthropathy
= Parvovirus infection starts with non-specific viral symptoms. After 2 – 5 days, the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks”. A few days later areticularmildly erythematous rash affecting the trunk and limbs appears, which can be raised and itchy. Reticular means net-like.
- Complications
= Miscarriage, Stillbirth, Hydrops fetalis, Anaemia, Pleural and pericardial effusions
- Antenatal testing = 8-10 weeks after maternal infection to monitory signs for hydrops, if MCA positive doppler findings + if infant has incipitant hydrops, then percutaneous umbilical blood sampling with fetal transfusion should be performed.

Question 4

Other agents (Varicella zoster virus)

Answer 4

Definition: DNA herpes virus, close contact with an infected person
Signs and symptoms: vesicular rash, fever, headache, sore throat
Treatment:
- Test VZV IgG levels = if positive they’re safe
- When they are not immune = can be treated with IV varicella immunoglobulins as prophylaxis against developing chickenpox. This should be given within ten days of exposure.
- When the chickenpox rash starts in pregnancy, they may be treated with oral aciclovir if they present within 24 hours and are more than 20 weeks gestation

Question 5

Listeria

Answer 5

• gram postive bacteria
• Infection in the mother may be ASx = cause flu like illness, or less commonly cause pneumonia or meningoencephalitis
• Listeriosis in pregnant women has a high rate of miscarriage or fetal death. It can also cause severe neonatal infection
• Listeria is typically transmitted by unpasteurised dairy products, processed meats, and contaminated foods. Pregnant women are advised to avoid high-risk foods (blue cheese) and practice good food hygiene

Question 6

Rubella

Answer 6

• German measles
• Congenital rubella syndrome = caused by maternal infection with the rubella virus during the first 20 weeks of pregnancy. The risk is highest 10 weeks gestation.
• Signs and symptoms:
  = congenital deafness
  = congenital cataracts
  = congenital heart disease (PDA and pulmonary stenosis)
  = learning disability

Question 7

Congenital cytomegalovirus

Answer 7

Blood test for IgG
Often asymptomatic
- Complications:
Stillbirth,
Growth restrictions,
Neurological disability,
Hearing loss,
Chorioretinitis,
Periventricular calcifications,
Microcephaly,

Question 8

Herpes simplex type 2

Answer 8

Usually transmitted during delivery
Signs and symptoms
- Mucocutaneous vesicles.
- Sepsis-like illness (fever or hypothermia, irritability, lethargy, respiratory distress, apnea, abdominal distension, hepatomegaly, ascites)
- CSF pleocytosis.
Tx: IV Aciclovir
Complications
- can cause encephalitis