Congenital infections

Question 1

History suggestive of congenital infection

Answer 1

• Previous abortions or intra uterine fetal death

* Maternal Fever ,Skin rash or Skin vesicles during pregnancy

Question 2

General features suggesting congenital infection

Answer 2

o Hepatosplenomegaly
o Generalized lymphadenopathy.
o Anemia
o Thrombocytopenic purpura.

o 😱😱Hepatitis (⬆️conjugated bilirubin)

• Mental retardation
• Seizures
• Microcephaly
• Chorioretinitis

Low birth weight

y Intra uterine growth restriction y Prematurity

Question 3

General workup

Answer 3

🌝 Detection of specific IgM or rising titer of specific IgG
🌝 For clinical features e.g.

• CBC with differential WBCs count
• Fundus examination
• Liver enzymes and bilirubin
• Plain skull radiograph, CT, MRI
  🌝 Isolation of the causative organism

Question 4

Congenital Toxoplasmosis -Clinical pictur

Answer 4

y General features

y Hydrocephalus /Microphthalmia /Chorioretinitis

Question 5

TOXO dx

Answer 5

y General workup
y Isolate of the organism from the blood
y Skull X-ray, CT: Diffuse calcifications

Question 6

TOXO tx

Answer 6

Treatment

A. Prevention
y Food hygiene
y Spiramycin for seropositive pregnant

B. Curative
y Symptomatic treatment
y Triple therapy for up to 1 year pyrimethamine ,folonic acid, sulphadiazine

Question 7

Congenital Rubella cause

Answer 7

Maternal german measles specially in the 1 st trimester

Question 8

Congenital Rubella Syndrome(CRS) clinical picture

Answer 8

Even if asymptomatic infection occurs in the mother, rubella can be transmitted across the placenta to the developing fetus.

The earlier in gestation the infection occurs, the greater the injury
40% of fetuses infected during the first 8 weeks spontaneously abort
Some infants at risk are normal Some appear normal at birth but later are found to have hearing loss

Question 9

Some are small for gestational age and at birth have congenital anomalies :

Answer 9

💔head
Catarct, glaucoma, microphthalmia Sensorineural deafness , Miningeoencephalitis, Chorioretinitis (salt and pepper appearance)
💔chest
Congenital heart disease o PDA o Pulmonary stenosis
💔abdomen
o Hepatosplenomegaly , Hepatitis
💔blood
o Lymphadenopathy o Anemia o Purpura o
💔skin
In some cases a rubelliform rash or a characteristic raised, bluish, papular eruption, termed a blueberry muffin rash, may be evident as the result of dermal erythropoiesis

Question 10

Congenital Rubella Syndrome triad

Answer 10

PDA
Microcephaly
Cataract

Question 11

Congenital Rubella: Diagnosis and Treatment

Answer 11

Diagnosis:

 Rubella specific IgM  culture: nasopharynx, blood, urine, CSF, throat

 Treatment:

supportive

Question 12

Congenital Syphilis: Symptoms

Answer 12

Asymptomatic 50%
 Fever, lymphadenopathy, irritability, failure to thrive
 Jaundice, hepatosplenomegaly
🌝 Mucocutaneous: palmar/plantar bullae, maculopapular rash trunk/limbs, mucosal lesions, condylomata lata
 Anemia (BM arrest,hemolysis),thrombocytopenia,low/high WBCs
 Meningitis
😱 “Snuffles” (serous rhinitis)
😱 Bone changes: osteochondritis of humerus, tibia

Question 13

Congenital Syphilis: Diagnostic Studies

Answer 13

Quantitative RPR
  CSF exam: cell count, protein, VDRL
  CBC, platelets, liver enzymes
  Long bone radiographs
  Demonstration of spirochetes: tissue/fluid 
 HIV testing

Question 14

Congenital Syphilis: Treatment

Answer 14

Penicillin G or Procaine penicillin G

Question 15

Congenital CMV Infection incidence

Answer 15

The commonest congenital viral infection (0.5–1 per 1000 live births)

Question 16

-Cytomegalovirus: Clinical Findings In Symptomatic Infants

Answer 16

😱😱 Microcephaly, intracranial calcifications (Periventricular calcifications)
😱 Thrombocytopenia, petechiae, purpura-‘Blueberry muffin syndrome

 Conjugated hyperbilirubinemia, elevated liverenzymes, liver failure
 Interstitial pneumonitis
😱 Hearing loss
 Mental retardation
 Neurologic impairment, cerebral palsy
 Chorioretinitis
 Intestinal pseudo-obstruction like illness

Question 17

Cytomegalovirus: Diagnosis

Answer 17

 CMV titers:

 IgM, IgG  Acute and convalescent

 Urine culture for CMV

 Excretion may be intermittent

 CNS imaging  Eye exam

Question 18

Cytomegalovirus: Treatment

Answer 18

 Supportive

 Platelet transfusion

 Anti-viral treatment

 Ganciclovir may reduce sequelae, but of limited efficacy

 CMV hyperimmune globulin

 Infectious disease consultation

Question 19

Parvovirus B19

Answer 19

 Associated with multiple disorders:

 Erythema infectiosum (fifth disease)
 Aplastic crisis (hemolytic disorders, sickle cell)
 Chronic anemia in immunosuppressed
 Acute arthritis

 non immune Fetal hydrops and death due to anemia

Question 20

Varicella clinical picture

Answer 20

Maternal varicella before 20 weeks:

congenital anomalies reported to be 1-2%

 Cicatricial skin lesions  Limb hypoplasia  CNS, ocular, neurologic

Question 21

Perinatal infection within 5 days before to 2 days after delivery varicella can cause? Tx?

Answer 21

fatal varicella in the infant.
Treatment for perinatal infection:

• Zoster immunoglobulin or IVIG
• If clinical varicella developed, treat with IV acyclovir

Question 22

Herpes Simplex: Clinical Presentation

Answer 22

y Skin and mouth vesicles and ulcers 
y Kerato conjunctivitis
 y Encephalitis→ seizures
 y Disseminated form: (multi organ) septic shock like
-Fever

Question 23

Dx of congenital HSV

Answer 23

Diagnosis
y Isolate CMV from the vesicles or conjunctiva smears
y Skull X-ray, CT: May show diffuse calcifications
y Avoided by cesarean section for mothers with genital lesions and Acyclovir

Question 24

TX of HSV

Answer 24

Symptomatic treatment + Acyclovir or Vidarabine

Question 25

Hepatitis B

Answer 25

 Vertical transmission

 Blood exposure during labor and delivery
 In utero transmission: < 2% of cases

 Maternal HBsAg+ HBeAg+ 70-80%
 Maternal HBsAg+ HBeAg- 5-20%
 Chronic carrier, hepatitis, cirrhosis, hepatocellular carcinoma

Question 26

Infant born to HBsAg + mother: management

Answer 26

 Avoid skin to skin until infant bathed
 Hepatitis B vaccine within 12 hr  HBIG given at separate site

 Complete standard HBV schedule

 Preterm < 2 kg: 1st dose not counted, total 4 doses

 HBsAg and anti-HBsAg at 9-15 months of age
 Breast feeding not precluded: controversial

Question 27

Hepatitis C

Answer 27

 Prevalence in adults in U.S. - 1.8%  Vertical transmission - 5% of infants born to mothers with hepatitis C

 No specific preventive measures  Breast feeding is allowed

 Transmission not proven  Cracked or bleeding nipples: may be risk

 Test infant at 18 months:

anti-HCV

 Earlier testing with HCV RNA PCR