Congenital infections

Question 1

toxoplasmosis

Answer 1

trans: transplacental, primary infections from consuming raw meat or contact with cat feces

sx: hydrocephalus, intracranial calcifications, chorioretinitis, ring-enhancing lesions on MRI
d

dx: serology
tx: pyrimethamine + sulfadiazine
prevention: spiramycin prophylaxis for 3rd trimester, avoid exposures to cats

Question 2

Rubella

Answer 2

trans: transplacental in the 1st trimester
sx: purpuric “blueberry muffin” rash, cataracts, mental retardation, hearing loss, PDA
dx: serology
tx: symptomatic
prevent: immunize before pregnancy; vaccine mother after delivery if titres still neg

Question 3

CMV

Answer 3

trans: transplacental
sx: petechial rash, periventricular calcifications
dx: urine culture; PCR of amniotic fluid
tx: postpartum ganiclovir
prevent: N/a

Question 4

HSV

Answer 4

trans: intrapartum transmission if the mother has active lesions; transplacental is rare
sx: skin eye and mouth infections; life-threatening CNS/systemic infection
dx: serology
treatment: acyclovir
prevent: C-section if lesions at delivery

Question 5

HIV

Answer 5

trans: in utero, at delivery, or via breast milk

Sx: often asymptomatic; failure to thrive; bacterial infections; increase incidence of upper and lower respiratory disease

dx: ELISA, western blot
tx: HAART
prevent: AZT or nevirapine in pregnant women with HIV; C-section if viral load is > 1000. treat infants with prophylactic AZT ; avoid breastfeeding

Question 6

syphilis

Answer 6

trans: intrapartum; transplacental transmission is possible
sx: macuopapular rash, hepatomegaly; snuffles, mucopurulent rhinitis, osteitis
late congenital syphilis: saber shins, saddle nose, CNS involvement, hutchinson’s traid: peg-shaped central incisors, deafness, interstitial keratitis

dx: dark-field microscopy, VDRL/RPR, FTA-ABS

Tx: penicillin

prevent: penicillin in pregnant women who test +