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4C > Congenital infections (TORCH) > Flashcards

Congenital infections (TORCH) Flashcards

1
Q

What are the risk factors for toxoplasmosis?

A

Cat litter
Undercooked meat
Both may contain oocysts of toxoplasma gondii

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2
Q

What is the risk of congenital toxoplasmosis infection and consequences in the first trimester?

A

Infection: 10%

Severe consequences: 70%

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3
Q

What is the risk of congenital infection and consequences in the third trimester?

A

Infection: 60%

Severe consequences: 1%

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4
Q

How does toxoplasmosis present in the pregnancy woman?

A

Asymptomatic
Lymphadenopathy
Flu-like symptoms

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5
Q

What is the clinical triad that neonates with toxoplasmosis develop?

A

Chorioretinitis
Hydrocephalus
Intracranial calcification

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6
Q

What are the clinical features of toxoplasmosis in the neonate?

A

Triad (chorioretinitis, hydrocephalus, neurological)
Seizures, microcephaly
Blueberry muffin rash, hydrops

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7
Q

What changes occur on the placenta in tocoplasmosis?

A

Granulomas in the placenta

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8
Q

After maternal diagnosis of toxopalsmosis, what is the management?

A

Antibiotic therapy
Intrauterine diagnosis for neonate: ultrasound and amniotic fluid PCR
Offer TOP if PCR positive

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9
Q

What is the management of toxoplasmosis in the neonate?

A 
12 month therapy of
- pyrimethamine
- sulphadiazine
- folic acid
Review for eye and development
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10
Q

What are the long-term sequelae of toxoplasmosis?

A 
Chorioretinitis
Developmental delay
Deafness
Seizures
Microcephaly, hydrocephalus
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11
Q

What investigations are performed for a neonate with suspected toxoplasmosis?

A 
Cord blood IgM, IgA
Maternal IgM, IgA
FBE, LFTs, culture
US, CT, MRI brain 
Eye, hearing assessment
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12
Q

What are the risk factors for congenital syphilis?

A

Maternal primary and secondary disease

Lowest in latent disease

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13
Q

What are the late features of congenital syphilis?

A 
Hutchinson's teeth
Sabre tibia
CNVIII hearing loss
Blindness, saddle nose deformity (from ulceration)
Frontal skull bossing 
Developmental delay
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14
Q

How does congenital syphilis present?

A

Asymptomatic

Disseminated disease

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15
Q

What systems does congenital syphilis involve

A 
Haem - hydrops
Mucosal - rhinitis, nose deformity
Eyes
Skin
Bone
CNS
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16
Q

What is the management of syphilis of the mother?

A

Benzathine penicillin IM single dose

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17
Q

What is the management of syphilis of the neonate?

A

IV benzylpenicillin 10 days

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18
Q

What are the long-term sequelae of congenital syphillis?

A

Fetal death, premature delivery
Neurological, deafness
Bone deformities

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19
Q

Which congenital (TORCH) infections are notifiable?

A

Listeriosis
Syphilis
Varicella zoster
Rubella

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20
Q

What are the risk factors for listeriosis?

A

Unpasteurised dairy
Soft cheeses, deli meats
Pregnancy

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21
Q

What is the rate of fetal mortality in listeriosis?

A

20-60%

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22
Q

How does listeriosis present in the mother?

A

Flu-like symptoms, fever

Gastroenteritis like symptoms

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23
Q

What is the management for listeriosis?

A

Penicillin or ampicillin and gentamicin.

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24
Q

What are the clinical features of listeriosis in the neonate?

A 
Death, preterm labour, fetal distress
Meconium-stained liquor, particularly <34 weeks
Meningitis, pneumonia, conjunctivitis
Anaemia, thrombocytopenia 
Granulomas
25
Q

What are the two broad outcomes of varicella infection in the mother?

A

<20 weeks: congenital varicella syndrome

7 days before and 2 days after delivery: neonatal chickenpox

26
Q

How does neonatal chickenpox present?

A

Prodromal fever

Pruritic rash, macular –> vesicular

27
Q

How are congenital varicella syndrome present?

A

Low birth weight
Skin lesions
Eye, brain and limb abnormalities

28
Q

How is an exposed mother managed?

A

Seropositive: no action
Seronegative, <96 h: ZIG
Seronegative, >96h: IV aciclovir

29
Q

How is an infected mother managed?

A

<24 h: oral aciclovir + regular US

Complicated infection: IV aciclovir

30
Q

How is the exposed infant managed?

A

ZIG

31
Q

How is the infected infant managed?

A

IV aciclovir

32
Q

How is parvovirus B19 transmitted?

A

Aerosol droplets

33
Q

What are the risk factors for parvovirus B19 infection in mothers?

A

Not exposed as children

34
Q

What is the risk of vertical transmission of parvovirus B19?

A

50%

35
Q

What are the clinical features of congenital parvovirus B19?

A 
Hydrops fetalis and fetal death (infection <20 weeks gestation)
Anaemia (infection >18 weeks gestation)
Myocarditis
Hepatitis
Erythema infectiosum
36
Q

How is parvovirus B19 managed?

A

IVIG for mothers

Intrauterine transfusion for neonates with Hb<50

37
Q

Which congenital infection cause hydrops fetalis?

A

Toxoplasmosis
Syphilis
Parvovirus B19 <20 weeks gestation

38
Q

What are the 3 major outcomes of rubella infection?

A

<12 weeks: congenital rubella syndrome
12-18 weeks: sensorineural deafness
>18 weeks: rare

39
Q

What is the transmission route of rubella?

A

Droplet and contact with nasopharyngeal secretions

40
Q

What is the rate of vertical transmission and congenital abnormalities for rubella <10 weeks

A

Infection: 80%
Abnormalities: 90%

41
Q

For how long are infected infants infectious?

A

12+ months after birth

42
Q

What are the clinical features of congenital rubella?

A 
Eye disorders
Sensorineural deafness 
CVS issues (pulmonary stenosis and PDA)
Haematological, including blueberry muffin appearance
CNS issues
Inflammatory lesions 
So many others
43
Q

Which congenital infection cause blueberry muffin appearance?

A

Toxoplasmosis

Rubella

44
Q

How is rubella infection prevented?

A

MMR vaccine for all children 12+ months

45
Q

How is congenital rubella managed?

A

No pharmacological Mx
Offer TOP in first trimester
Supportive management and regular assessments

46
Q

Maternal CMV infection can be primary or reactivated. Which is more likely to lead to neonatal sequelae?

A

Maternal primary infection

47
Q

How is neonatal CMV diagnosed?

A

Urine culture for CMV
Cerebral ultrasound, MRI brain
Serial audiology and developmental assessment

48
Q

How is neonatal CMV managed?

A

IV ganciclovir
Supportive
Long-term follow up

49
Q

What are the long term sequelae of congenital CMV?

A

Neurological
Hearing
Ophthalmological

50
Q

Which HSV type is most likely to cause congenital infection?

A

HSV2

51
Q

What are the long-term sequelae of congenital HSC?

A

Long-term neurological sequelae (10%)

Recurrent skin and eye eruptions, monitoring essential

52
Q

Maternal HSV infection can be primary or reactivated. Which is more likely to lead to neonatal sequelae?

A

Primary infection (30%)

53
Q

When are most neonates infected with HSV?

A

90% infected during passage through the birth canal or through ascending infection.

54
Q

What are they ways in which congenital HSV presents?

A

Skin, eye, mouth localised disease
Disseminated disease
Pneumonitis
Meningoencephalitis

55
Q

How does disseminated HSV present?

A

Unexplained sepsis
Fever, lethargy
DIC

56
Q

How is HSV-caused meningoencephalitis present?

A

Absent gag reflex
Seizures
Cerebral atrophy and calcifications

57
Q

What investigations are performed for congenital HSV?

A

Swab of vesicle, eye and throat
Lumbar puncture
FBE, LFT
EEG, CT/MRI brain

58
Q

How can congenital HSV be prevented?

A

Avoiding scalp electrodes in active maternal lesions
Delivery by caesarean section if the first genital HSV is diagnosed during labour
Oral acyclovir from 36 weeks for mother

59
Q

How is congenital HSV managed?

A 
Full investigation
Education of family to look out for recurrence
Antivirals
- Acyclovir
- Topical for eyes

4C (15 decks)

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