Presentation is loading. Please wait.

Presentation is loading. Please wait.

Diagnostic, treatment and prophylaxis. TORCH infections and HIV/AIDS in newborn - diagnostic, treatment and prophylaxis. Prof. Pavlyshyn H.A.

Similar presentations


Presentation on theme: "Diagnostic, treatment and prophylaxis. TORCH infections and HIV/AIDS in newborn - diagnostic, treatment and prophylaxis. Prof. Pavlyshyn H.A."— Presentation transcript:

1 diagnostic, treatment and prophylaxis. TORCH infections and HIV/AIDS in newborn - diagnostic, treatment and prophylaxis. Prof. Pavlyshyn H.A.

2 Index of Suspicion When do you think of TORCH infections?When do you think of TORCH infections? IUGR infantsIUGR infants HSMHSM ThrombocytopeniaThrombocytopenia Unusual rashUnusual rash Concerning maternalConcerning maternalhistory “Classic” findings of any specific infection“Classic” findings of any specific infection TORCH Infections T=toxoplasmosis O=other (syphilis) R=rubella C=cytomegalovirus (CMV) H=herpes simplex (HSV)

3

4 Toxoplasmosis Caused by protozoan – Toxoplasma gondiiCaused by protozoan – Toxoplasma gondii Domestic cat is the definitive host with infections via:Domestic cat is the definitive host with infections via: Ingestion of cysts (meats, garden products)Ingestion of cysts (meats, garden products) Contact with oocysts in fecesContact with oocysts in feces Much higher prevalence of infection in European countries (ie France, Greece)Much higher prevalence of infection in European countries (ie France, Greece) Acute infection usually asymptomaticAcute infection usually asymptomatic 1/3 risk of fetal infection with primary maternal infection in pregnancy1/3 risk of fetal infection with primary maternal infection in pregnancy Infection rate higher with infxn in 3 rd trimesterInfection rate higher with infxn in 3 rd trimester Fetal death higher with infxn in 1 st trimesterFetal death higher with infxn in 1 st trimester

5

6 Clinical Manifestations Most (70-90%) are asymptomatic at birthMost (70-90%) are asymptomatic at birth Classic triad of symptoms:Classic triad of symptoms: ChorioretinitisChorioretinitis HydrocephalusHydrocephalus Intracranial calcificationsIntracranial calcifications Other symptoms include fever, rash, HSM, microcephaly, seizures, jaundice, thrombocytopenia, lymphadenopathyOther symptoms include fever, rash, HSM, microcephaly, seizures, jaundice, thrombocytopenia, lymphadenopathy Initially asymptomatic infants are still at high risk of developing abnormalities, especially chorioretinitisInitially asymptomatic infants are still at high risk of developing abnormalities, especially chorioretinitis

7

8

9 Treatment Symptomatic infantsSymptomatic infants Pyrimethamine (with leucovorin rescue) and sulfadiazinePyrimethamine (with leucovorin rescue) and sulfadiazine Treatment for 12 months totalTreatment for 12 months total Asymptomatic infantsAsymptomatic infants Course of same medicationsCourse of same medications Improved neurologic and developmental outcomes demonstrated (compared to untreated pts or those treated for only one month)Improved neurologic and developmental outcomes demonstrated (compared to untreated pts or those treated for only one month)

10 Syphilis Clinical Manifestations Syphilis Clinical Manifestations Early congenital (typically 1 st 5 weeks): Cutaneous lesions (palms/soles)Cutaneous lesions (palms/soles) HSMHSM JaundiceJaundice AnemiaAnemia SnufflesSnuffles Periostitis and metaphysial dystrophyPeriostitis and metaphysial dystrophy Funisitis (umbilical cord vasculitis)Funisitis (umbilical cord vasculitis) Late congenital: Frontal bossingFrontal bossing Short maxillaShort maxilla High palatal archHigh palatal arch Hutchinson teethHutchinson teeth 8 th nerve deafness8 th nerve deafness Saddle noseSaddle nose Perioral fissuresPerioral fissures Can be prevented with appropriate treatmentCan be prevented with appropriate treatment

11

12 Treatment Penicillin G is THE drug of choice for ALL syphilis infectionsPenicillin G is THE drug of choice for ALL syphilis infections Maternal treatment during pregnancy very effective (overall 98% success)Maternal treatment during pregnancy very effective (overall 98% success) Treat newborn if:Treat newborn if: They meet CDC diagnostic criteriaThey meet CDC diagnostic criteria Mom was treated <4wks before deliveryMom was treated <4wks before delivery Mom treated with non-PCN medMom treated with non-PCN med Maternal titers do not show adequate response (less than 4-fold decline)Maternal titers do not show adequate response (less than 4-fold decline)

13 Rubella Clinical Manifestations Sensorineural hearing loss (50-75%)Sensorineural hearing loss (50-75%) Cataracts and glaucoma (20-50%)Cataracts and glaucoma (20-50%) Cardiac malformations (20-50%)Cardiac malformations (20-50%) Neurologic (10-20%)Neurologic (10-20%) Others to include growth retardation, bone disease, HSM, thrombocytopenia, “blueberry muffin” lesionsOthers to include growth retardation, bone disease, HSM, thrombocytopenia, “blueberry muffin” lesions

14 “Blueberry muffin” spots representing extramedullary hematopoesis

15

16 Diagnosis Maternal IgG may represent immunization or past infection - Useless!Maternal IgG may represent immunization or past infection - Useless! Can isolate virus from nasal secretionsCan isolate virus from nasal secretions Less frequently from throat, blood, urine, CSFLess frequently from throat, blood, urine, CSF Serologic testingSerologic testing IgM = recent postnatal or congenital infectionIgM = recent postnatal or congenital infection Rising monthly IgG titers suggest congenital infectionRising monthly IgG titers suggest congenital infection Diagnosis after 1 year of age difficult to establishDiagnosis after 1 year of age difficult to establish Treatment Prevention…immunize, immunize, immunize!Prevention…immunize, immunize, immunize! Supportive care only with parent educationSupportive care only with parent education

17 Cytomegalovirus (CMV) 90% are asymptomatic at birth!90% are asymptomatic at birth! Up to 15% develop symptoms later, notably sensorineural hearing lossUp to 15% develop symptoms later, notably sensorineural hearing loss Symptomatic infectionSymptomatic infection SGA, HSM, petechiae,SGA, HSM, petechiae, jaundice, chorioretinitis,jaundice, chorioretinitis, periventricular calcifications,periventricular calcifications, neurological deficitsneurological deficits >80% develop long term>80% develop long termcomplications Hearing loss,Hearing loss, vision impairment,vision impairment, developmental delaydevelopmental delay

18

19 Ventriculomegaly and calcifications of congenital CMV

20

21 Diagnosis Maternal IgG shows only past infectionMaternal IgG shows only past infection Infection common – this is uselessInfection common – this is useless Viral isolation from urine or saliva in 1 st 3weeks of lifeViral isolation from urine or saliva in 1 st 3weeks of life Afterwards may represent post-natal infectionAfterwards may represent post-natal infection Viral load and DNA copies can be assessed by PCRViral load and DNA copies can be assessed by PCR Less useful for diagnosis, but helps in following viral activity in patientLess useful for diagnosis, but helps in following viral activity in patient Serologies not helpful given high antibody in populationSerologies not helpful given high antibody in population

22 PCR diagnostic

23

24 Treatment Ganciclovir x6wks in symptomatic infantsGanciclovir x6wks in symptomatic infants Studies show improvement or no progression of hearing loss at 6mosStudies show improvement or no progression of hearing loss at 6mos No other outcomes evaluated (development, etc.)No other outcomes evaluated (development, etc.) Neutropenia often leads to cessation of therapyNeutropenia often leads to cessation of therapy Treatment currently not recommended in asymptomatic infants due to side effectsTreatment currently not recommended in asymptomatic infants due to side effects Area of active research to include use of valgancyclovir, treating asx patients, etc.Area of active research to include use of valgancyclovir, treating asx patients, etc.

25 Clinical Manifestations Most are asymptomatic at birthMost are asymptomatic at birth 3 patterns of ~ equal frequency with symptoms between birth and 4wks:3 patterns of ~ equal frequency with symptoms between birth and 4wks: Skin, eyes, mouth (SEM)Skin, eyes, mouth (SEM) CNS diseaseCNS disease Disseminated disease (present earliest)Disseminated disease (present earliest) Initial manifestations very nonspecific withInitial manifestations very nonspecific with skin lesions NOT necessarily present Herpes Simplex (HSV)

26

27 Diagnosis Culture of maternal lesions if present at deliveryCulture of maternal lesions if present at delivery Cultures in infant:Cultures in infant: Skin lesions, oro/nasopharynx, eyes, urine, blood, rectum/stool, CSFSkin lesions, oro/nasopharynx, eyes, urine, blood, rectum/stool, CSF CSF PCRCSF PCR Serologies again not helpful given high prevalence of HSV antibodies in populationSerologies again not helpful given high prevalence of HSV antibodies in population Treatment High dose acyclovir 60mg/kg/day divided q8hrsHigh dose acyclovir 60mg/kg/day divided q8hrs X21days for disseminated, CNS disease X21days for disseminated, CNS disease X14days for SEM X14days for SEM Ocular involvement requires topical therapy as wellOcular involvement requires topical therapy as well

28

29 What is HIV? Human immunodeficiency virus is the virus that causes AIDS.Human immunodeficiency virus is the virus that causes AIDS. The human immunodeficiency virus (HIV) infects cells of the immune system - (CD4+) T cells, destroying or impairing their function.The human immunodeficiency virus (HIV) infects cells of the immune system - (CD4+) T cells, destroying or impairing their function. Infection with the virus results in the progressive deterioration of the immune system, leading to "immune deficiency."Infection with the virus results in the progressive deterioration of the immune system, leading to "immune deficiency." Infections associated with severe immunodeficiency are known as "opportunistic infections", because they take advantage of a weakened immune system.Infections associated with severe immunodeficiency are known as "opportunistic infections", because they take advantage of a weakened immune system.

30 Symptoms of HIV/AIDS in Children CNS – microcephaly - progressive neurological deterioration or spastic encephalopathy or spastic encephalopathy - developmental delay/regression - predisposition to CNS infections Respiratory System - Recurrent infections (pneumonia, sinusitis, otitis media) - Tuberculosis - Pneumocystis carinii pneumonia (PCP) or lymphoid interstitial pneumonitis (LIP)

31 Clinical Features CVS – cardiomyopathy with congestive cardiac failureCVS – cardiomyopathy with congestive cardiac failure GIT- AIDS enteropathy (malabsorption, infections with various pathogens) leads to chronic diarrhoea resulting in failure to thriveGIT- AIDS enteropathy (malabsorption, infections with various pathogens) leads to chronic diarrhoea resulting in failure to thrive - Abdominal pains, dysphagia, chronic hepatitis, pancreatitis - Abdominal pains, dysphagia, chronic hepatitis, pancreatitis Renal – AIDS nephropathy: the most common presentation being nephrotic syndromeRenal – AIDS nephropathy: the most common presentation being nephrotic syndrome Skin – Eczema, seborrheic dermatitis, candida infections, molluscum contagiosum, anogenital wartsSkin – Eczema, seborrheic dermatitis, candida infections, molluscum contagiosum, anogenital warts


Download ppt "Diagnostic, treatment and prophylaxis. TORCH infections and HIV/AIDS in newborn - diagnostic, treatment and prophylaxis. Prof. Pavlyshyn H.A."

Similar presentations


Ads by Google