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Congenital Infections

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Presentation on theme: "Congenital Infections"— Presentation transcript:

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

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

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

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