Congenital infections

infections CMV agent DNA virus Clinical in mother -self-limiting febrile illness in immunocompeten individuals - severe illness in immunocompromi sed transmission - by transplacental passage of virus - exposure to virus from birth canal / breast milk / exposure to other babies in nursery

Fetal risks congenital sensorineural deafness Hepatosplenomega ly IUGR Microcephaly, learning disability Thrombocytopenia Jaundice Haemolytic anaemia Seizures

Mx

-TOP if primary infection diagnosed in first trimester -Counsel re: fetal risks, consider invasive testing to diagnose fetal infection,detailed scans and monitor fetal growth - Clinical and serological assessment of neonate with follow-up if positive
Dietary advise to

Listeria

gram +ve,

-flu-like illness in

Trans-placental

Neonate

monocytoge nes -

betahaemo lytic facultative anaerobe

* raw food / soft cheeses / un-pasteurised milk / reheated food

Rubella

RNA virus

immunocompetent - severe disease in immunocompromi sed - chorioamnionitis and septic miscarriage or fetal death inutero - meconium stained liquor fever, rash, arthralgia, postauricular and suboccipital lymphadenopathy

respiratory droplet

symptomatic at birth or within a few days of life -disseminated granulomas (Granulomatosis infantisepticum) involving liver, placenta and other solid organs, septic shock and respiratory distress Congenital rubella syndrome
Typically affects: 1) Eyes cataract, retinopathy, glaucoma and micro-ophthalmia 2) Heart patent ductus arteriosus, pulmonary valvular and artery stenosis, coarctation of the aorta, VSD and ASD 3) Ear bilateral and

prevent infection Rx: sensitive to ampicillin / penicillin G. Aminoglycosides are also effective and are usually given in addition to penicillin

Universal vaccination Universal screening in pregnancy Screening and vaccination of all women planning pregnancy

progressive hearing loss IUGR and oligohydramnios

Neonatal hepatosplenomegaly, purpura, jaundice, meningoencephalitis and thrombocytopaenia also occur

Toxoplasma gondii

obligate intracellula rprotozoan

usually asymptomatic / produces glandular fever like illness. Lymphadenopathy involving the posterior cervical chain is commonest

Infection occurs through ingestion of contaminated food including vegetable or infected meat.

Spontaneous first trimester miscarriage Chorioretinitis IUGR Microcephaly Hydrocephalus Intra-cranial calcification Learning disability -

Prevention - Avoid contact with cat faeces / raw meat Spiramycin therapy to infected mothers - 60% reduction in the risk of fetal infection Scans / amniocentesis /

clinical manifestaton.

Hepatosplenomegaly cordocentesis to diagnose fetal Risk of fetal infection infection increases TOP / while risk of pyramethamine + affection decreases sulfonamide + with increasing folinic acid if fetal gestation age. infection helps arrest progression of fetal disease