Paediatrics: Transplacental (congenital infection)

2021-03-05 12:00 AM

Causes • ‘TORCH’ infections. • Herpes zoster. • Parvovirus B19. • Syphilis. • Enterovirus.

Transplacental (congenital infection)

Causes

  • ‘TORCH’ infections.
  • Herpes zoster.
  • Parvovirus B19.
  • Syphilis.
  • Enterovirus.
  • HIV; hepatitis B.
  • Rarely bacterial, e.g. GBS, Listeria monocytogenesN. gonorrhoea.

Presentation

  • TORCH infection: SGA, jaundice, hepatitis, hepatosplenomegaly, purpura, chorioretinitis, micro-ophthalmic, cerebral calcification, micro/microcephaly, hydrocephalus.
  • Rubella and CMV: also cause deafness, cataracts, congenital heart disease, osteitis (rubella only).
  • Parvovirus B19: rubella-like rash, aplastic anaemia +/– hydrops.
  • Herpes zoster: cutaneous scarring, limb defects, multiple structural defects.
  • Congenital syphilis: SGA, jaundice, hepatomegaly, rash, rhinitis, bleeding mucous membranes, osteochondritis, meningitis.
  • Bacterial infections present with features that may be non-specific or even result in multi-organ failure. Gonorrhoea causes purulent conjunctivitis (ophthalmia). Listeriosis causes preterm labour and meconium-stained liquor.

Investigation

Consider:

  • Blood culture.
  • Pathogen-specific IgM and IgG (paired for Herpes zoster, Toxoplasma).
  • Venereal Disease Research Laboratory (test)(VDRL).
  • Maternal-specific serology.
  • Urine CMV culture.
  • Throat swab viral culture.
  • CSF culture and latex particle agglutination (GBS).
  • Stool viral culture.
  • Skin vesicle viral culture and electron microscopy.

Treatment

  • Most congenital infections have no specific treatment.
  • General treatment is supportive and involves careful follow-up to identify sequelae, e.g. deafness and CMV.
  • Toxoplasma: spiramycin (4–6wks 100mg/kg/day) alternating withpyrimethamine (3wks 1mg/kg/day) plus sulfadiazine (1yr 50–100mg/kg/ day).
  • Syphilis: benzylpenicillin 14 days 30mg/kg 12-hourly IV.
  • Symptomatic CMV: consider IV ganciclovir then oral valganciclovir.

 Prognosis 

Variable and depends on disease severity.