Congenital Infections TORCH Toxoplasmosis Other syphilis Rubella Cytomegalovirus

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

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

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

CONGENITAL CMV l l l 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

PATHOGENESIS l Neonatal 1. Antenatal (in utero) - 80 -96% of cases l l Primary Maternal Infection Recurrent Maternal Infection Perinatal 3. Postnatal 2. l Childhood 1. Horizontal Transmission l CMV excreted in saliva, urine, stool, tears 2. Organ Transplantation l kidney, marrow, heart, liver, blood (leukocytes)

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

CLINICAL FEATURES: l Systemic Manifestations l Reticuloendothelial (Liver) - 65 -75% l 70% - hepatomegaly/splenomegaly l 68% - jaundice l 65% - thrombocytopenia (with petechiae and purpura) l hepatitis l Others 65% - low birth weight (< 2500 gm) 2 -5% - pneumonitis

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

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

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

CONGENITAL TOXOPLASMOSIS caused by the protozoan Toxoplasma gondii l ocular, central nervous system (CNS) l incidence: 0. 3 -1/1000 live births l

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

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

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

INVESTIGATIONS: l Isolation l of T. gondii from placenta or cord blood Serology l measures Ig. G T. gondii antibody l Ig. M fluorescent antibody test l Imaging Studies l CT (Head) l intracranial calcifications (33%)

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

CONGENITAL RUBELLA caused by an RNA Togavirus l Vaccine-preventable disease l

Routes of Transmission Antenatal (in utero) 1 st trimester - 75 -90% l 2 nd trimester - 35 -40% l 3 rd trimester - 25 -50% l

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

INVESTIGATIONS: l Virology l from l urine, naspharynx, CSF Serology fetal rubella-specific Ig. M l persistence of rubella-specific Ig. G after 8 -12 months of age l