1. Congenital Infections
TORCH
Toxoplasmosis
Other (syphilis)
Rubella
Cytomegalovirus (CMV)
Herpes simplex virus (HSV)

2. Varicella zoster (the chickenpox virus).
Entroviruses
Hepatitis B.
Parvovirus.
HIV (human immune deficiency virus).
Chlamydia trachomatis.
Mycoplasma.
Group B streptococcus.
Malaria

3. COMMON CLINICAL FEATURES
Low birth weight for gestational age
Prematurity
Seizures
Chorio-retinitis
Cataracts
Purpura
Cerebral calcification
Micro-ophthalmia
Jaundice
Anaemia
Hepatosplenomegaly
Pneumonitis

4. CONGENITAL CMV Caused by a DNA herpesvirus Cytomegalovirus (CMV)
Most common congenital viral infection
The majority of congenital infections are asymptomatic
severe neurologic morbidity occurs in 80 percent of survivors
sequelae appear to be more severe when infection is acquired earlier in pregnancy

5. PATHOGENESIS Neonatal Childhood Antenatal (in utero) - 80-96% of cases
Primary Maternal Infection
Recurrent Maternal Infection
Perinatal
Postnatal
Childhood
1. Horizontal Transmission
CMV excreted in saliva, urine, stool, tears
2. Organ Transplantation
kidney, marrow, heart, liver, blood (leukocytes)

6. CLINICAL FEATURES: 70% - microcephaly 60% - intellectual impairment
90% of infants with congenital CMV infection are clinically silent
CNS Manifestations
70% - microcephaly
60% - intellectual impairment
35% - sensorineural hearing loss
seizures
22% - chorioretinitis

7. Systemic Manifestations
CLINICAL FEATURES:
Systemic Manifestations
Reticuloendothelial (Liver) %
70% - hepatomegaly/splenomegaly
68% - jaundice
65% - thrombocytopenia (with petechiae and purpura)
hepatitis
Others
65% - low birth weight (< 2500 gm)
2-5% - pneumonitis

8. INVESTIGATIONS Diagnostic Serum CSF Virology Serology Others
gold standard
of urine, saliva, blood, CSF, nasopharynx
Serology
ELISA - CMV-specific IgM
of neonatal blood specimens, cord sampling
Others
PCR
Serum
CBC - anemia, thrombocytopenia
conjugated , unconjugated hyperbilirubinemia
elevated hepatic transaminases
CSF
elevated protein content

9. INVESTIGATIONS: Imaging Studies CT (Head)
periventricular calcifications
can be identified in 25-50% of symptomatic infants

10. ® Ganciclovir Prognosis 80% have long-term sequelae:
Infants with signs of congenital CMV infection
80% have long-term sequelae:
sensorineural hearing loss
neuromuscular problems
motor and intellectual retardation
seizures
chorioretinitis with visual deficits
Infants with silent congenital CMV infection
have a more favourable outcome
® Ganciclovir

11. CONGENITAL TOXOPLASMOSIS
caused by the protozoan Toxoplasma gondii
ocular, central nervous system (CNS)
incidence: 0.3-1/1000 live births

12. Routes of Transmission
Neonatal (in utero)
Primary Maternal Infection
acquired by the ingestion of raw or undercooked meat ( cattle), or of infectious oocysts in feces (cats, birds)
1st trimester - 17% - spontaneous abortion
2nd trimester - 25% - spontaneous abortion or severe disease
3rd trimester - 65% - subclinical disease

13. CLINICAL FEATURES: Ocular Manifestations (76%) chorioretinitis
70% of infants with congenital toxoplasmosis infection are asymptomatic
Ocular Manifestations (76%)
chorioretinitis
optic nerve atrophy
microphthalmias
blindness

14. CLINICAL FEATURES: CNS Manifestations (52%) Systemic Manifestations
hydrocephaly
motor and intellectual retardation
seizures
sensorineuronal hearing loss
Systemic Manifestations
classic triad of congenital toxoplasmosis : chorioretinitis, hydrocephalus, and intracranial calcifications.

15. INVESTIGATIONS: Serology Imaging Studies
Isolation of T. gondii from placenta or cord blood
Serology
measures IgG T. gondii antibody
IgM fluorescent antibody test
Imaging Studies
CT (Head)
intracranial calcifications (33%)

17. MANAGEMENT combination of : Spiramycin Prevention pyrimethamine
sulphadiazine
folinic acid is added
Spiramycin
Prevention

18. CONGENITAL RUBELLA caused by an RNA Togavirus
Vaccine-preventable disease

19. Routes of Transmission
Antenatal (in utero)
1st trimester %
2nd trimester %
3rd trimester %

20. CLINICAL FEATURES: Neonatal Manifestations Early Manifestations
IUGR low birth weight - prematurity
stillbirth - spontaneous abortion
Early Manifestations
cloudy corneas
Cataracts
microcephaly
hepatomegaly splenomegaly
jaundice
pulmonary valve stenosis
patent ductus arteriosus
thrombocytopenia purpura

21. INVESTIGATIONS: Virology Serology from urine, naspharynx, CSF
fetal rubella-specific IgM
persistence of rubella-specific IgG after 8-12 months of age