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CONGENITAL
INFECTION
BLOK
27
2017
Objectives
1. The
common
means
of
transmission
of
these
infections
2. The
major
manifestations
of
congenital
and
perinatal
infections
3. Diagnosis,
management
and
prevention
of
these
infections
1
8/26/17
Introduction
Congenital
infection
Acquired
in
utero
and
perinatally
Can
be
asymptomatic
in
the
newborn
period
Clincal
symptoms
complexes
2
8/26/17
Toxoplasmosis
Potential
devastating
but
preventable
Outcome
can
be
improved
with
early
diagnosis
and
treatment
Cat
as
the
denitive
host
Exposure
to
cat,
particularly
feses
Undrcooked
meat
Clymatic
condition
Infection
risk
:
1st
trimester
:
14
%
congeital
infection,
6
%
infants
severely
infected,
5%
perinatal
deaths
2nd
trimester
:
29
%
congenital
infection,
2
%
infants
severely
infecterd,
2
5
perinatal
deaths
3rd
trimester
:
59
%
congnetial
infection,
6
%
mildly
aected
3
8/26/17
Clinical
Manifestation
Other
clinical
signs
and
Classic
Triad
:
symptoms
:
Hydrocephalus
Blueberry
mun
rash
Chorioretinitis
Hepatosplenomegaly
Brain
calcication
Jaundice
Eryhtroblastosis
Hyrdops
fetalis
Non
sepcic
sign
:
fever,
lymphadenopathy,
vomiting,
diarrhea,
pneumonitis
Microcephaly
can
be
described
Diagnosis
Physical
examination
Full
neurologic
examination
Funduscopy
CT-Scan
Ultrasound
scan
Denitive
laboratory
diagnosis
:
PCR
on
CSF
T.
gondii-specic
IgM,
IgA
and
IgE
4
8/26/17
Treatment
(1
year)
Pyrimethamine
:
Loadiing
:
1
mg/kg
/12
hourly
for
2
days
1
mg/kg/day
for
2-6
months
1
mg/kg
three
times
a
week
to
total
1
year
Sulfadizine
:
50
mg/kg
12
hourly
for
1
year
Prevention
Primary
:
education
Pregnant
woman
should
avoid
risk
activities
cat
litter
and
eating
undercooked
meat
Secondary
:
maternal
screening
and
treatment
Flu-like
illness
or
maternal
screening
Termination
or
treatment
Tertiary
:
infant
screening
Screening
all
infants
???
5
8/26/17
Rubella
Defects
:
<
11
weeks
:
severe
congenital
heart
disease
and
deafness
13-16%
:
35%
deafness
alone
>
16
weeks
:
no
congenital
defects
6
8/26/17
Clinical
features
Other
:
Virus
infection
all
tissue
wide
range
of
congenital
defects
Microcephaly
neurodevelopmental
Autoimmune disease
Dental problems
Neruopyschiatirc
problems
autisme
Diagnosis
Rubella-specic
IgM
in
infantserum
Therapy
None
Prevention
Immunization
7
8/26/17
Cytomegelovirus
8
8/26/17
Clinical
manifestation
10-11%
symptomatic
Clinical
signs
:
Most
common
(at
birth
or
soon
after
birth
)
:
petechial
or
purpuric
rash,
jaundice,
hepatomegaly
50%
with
microcephaly
intracranial
calcication
classically
periventricular
50%
with
IUGR
14%
with
chorioretinitis
may
resemble
toxoplasma
retinitis
9
8/26/17
Treatment
:
Antiviral
prolonged,
parenteral,
and
toxic
Recommended
antiviral
and
dose
:
Ganciclovir
6
mg/kg/dose
IV
12
hourly
Valganciclovir
16
mg/kg/dose
orally
Duration
6
weeks
Prevention
:
Avoid
transmission
to
pregnant
women
from
suspected
CMV-infected
childrens
nasopharyngeal
secretion,
urine,
tears,
or
genital
secretion
Hyperimmunoglobulin
10
8/26/17
Transmission
Classic
transplasental
infection
>>
perinatally
Clinical
presentation
Classical
triad
:
Skin
involvement
(vesicular
or
bullous
skin
lesion)
Eye
(chorioretintitis
and/or
keratoconjuctivitis)
CNS
(microcephaly)
Other
:
Hepatomegaly
Cytopenia
(two
or
more
cell
line)
11
8/26/17
HSV
encephalitis
Present
in
second
week
of
life
Seizures,
fever,
lethargy,
poor
feeding,
- HSV
pneumonitis
irritability,
jitterness,
and
rigidity
12
8/26/17
Hemophagocytic
Disseminated
HSV
infection
lymphohistiocytosis
Overlapping
with
severe
bacterial
Hepato
and/or
splenomegaly
sepsis
Fever
Hepatitis
and
features
of
DIC
Lympadenopathy
Jaundice,
iritability,
seizure
and
Respiratory
failure
shock
Seizure
Cytopaenia
of
two
or
more
cell
line
Elevated
ferritin
Dicult
to
prove
biopsy
from
bone
marro,
lymph
node
or
spleen
Treatment
Diagnosis
Intravenous
acyclovir
20
Rapid
virologic
techniques
mg/kg/dose
8
hourly
Nucleic
acid
amplication
Localized
14
days
by
PCR
Disseminated
and
antigen
detection
by
Elisa
encephalitis
21
days
Immunouorescence
Monitoring
HSV
culture
not
timely
Neutrophil
count
<
500/
mm3b
decrease
acyclovir
dose
or
give
G-CSF
13
8/26/17
Prevention
Prognosis
No
eective
vaccine
Prior
antiviral
Antiviral
prophylaxis
Mortality
85%
Caesarean
section
for
Encephalitis
50%
symptomatic
mother
After
antiviral
Reduce
the
use
of
invasive
Mortality
29%
monitor
at
the
time
of
Encephalitis
4%
labour
Syphilis
14
8/26/17
Clinical
Prematurity
IUGR
Classic
rash
:
Pink
or
copper
coloured
oval
macular
eruption
on
buttock
or
trunk
often
develop
to
vesicobullous
pemphiguissy
Desquamated
and
red
of
soles
and
palm
Hepatosplenomegaly
often
associated
with
ascites
Pot
belly
and
withered
skin
Generalized
painless
lympadenopathy
charactersiticcaly
epitrocheal
lymphadenopathy
15
8/26/17
Treatment
Diagnosis
Proven
or
probable
:
Dicult
Penicillin
G
50.000
units/kg/IV
Methods
12
hourly
in
the
rst
week
8
Serology
hourly
after
10
days
PCR
Or
Microscopy
Procain
penicillin
(50.000
Lumbar
puncture
is
units/kg
IM
once
daily)
recommended
Prevention
Maternal
screening
Varicella
(Chickenpox)
Acute
infection
:
varicella
Reactivation
:
zoster
or
herpes
zoster
Etiology
:
varicella
herpes
zoster
Importancy
Maternal
VZV
primary
infection
Life
threatening
Cause
congenital
varicella
syndrome
16
8/26/17
Neonatal
varicella
Mother
developed
chickenpox
4
days
prior
to
delivery
until
2
days
after
delivery
newborn
pneumonitis
high
mortalitiy
Management
VZIG
shortly
after
birth
Alternative
IVIG
Still
develop
varicella
acyclovir
intravenously
17
8/26/17
Parvovirus
B19
Common
viral
illness
Rash,
fever,
and
athralgia
or
arthritis
Maternal
infection
Foetus
severe
anemia
and
non-
immune
hydrops
Severe
developmental
delay
Diverse
CNS
abnormalities
No
consistent
syndrome
- Early
detection
- Intrauterine
tranfussion
18