Torch infections Rina Karborani - PowerPoint Presentation

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Torch infections

Rina Karborani

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T= Toxoplasmosis

O= others (

Parvovirus B-19

,

syphilis

, Varicella)

R= Rubella

C=

CMV

H=

HSV

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Parvovirus B-19

Parvo

virus B19 is a small, non-enveloped, single-stranded DNA virus that causes

1) erythema

infectiosum

fifth disease or slapped cheek disease) in children.2) papular-purpuric gloves and socks syndrome (PPGSS)3) Aplastic crisis

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Transmission

Occurs Via :

Vertical transmission

Respiratory secretions

Transfusion of blood products

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Rash & Joint symptoms occur

2-3 weeks after initial infection

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Pathogenic

sequence is as follows: maternal

primary

infection (by respiratory droplets)

transplacental

transfer of virus infection of RBC precursor cells causing arrested RBC production leading to severe anemia ( HB less than 8 g/dl) congestive HF & edema.May cause severe fetal anemia causing fetal hydrops (edema and ascites)Fetuses that survive the infection have no fetal

Defects.

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Treatment

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C

ongenital Syphilis



chronic infectious disease caused

by Treponema pallidum (spirochete)  Transmitted via sexual contact  acquired by the fetus in the uterus before birth; Placental transmission as early as 6wks gestation.

 Typically occurs during second half

of pregnancy

,

Mom

s

with primary or secondary syphilis

are

more

likely to transmit the infection than latent disease

.

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 2/3 of affected live-born infants are asymptomatic at birth



3 major

classifications of clinical manifestations:



Fetal effects  Early effects  Late effects

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Clinical Manifestations

Fetal:



Stillbirth

 Neonatal death  Hydrops fetalis Intrauterine death in 25% Perinatal mortality in 25-30% if untreated

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

Early

congenital

(typically

in

1st 5 weeks):  Cutaneous lesions (palms/soles)  HSM  Jaundice  Anemia

 Snuffles  Periostitis and metaphysial dystrophy



Funisitis (umbilical cord vasculitis)

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

Late congenital

:

 Frontal

bossing  Short maxilla  High palatal arch  Hutchinson teeth  8 th nerve deafness

 Saddle nose  Perioral fissures

(

rhagades

)

Can

be prevented with appropriate treatment

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Diagnosing Syphilis

Available

serologic

testing

: 1) RPR/VDRL: nontreponemal test  Sensitive but NOT specific  Quantitative, so can follow to determine disease activity and treatment response 2)

MHA-TP/FTA-ABS: specific treponemal test 

Used for confirmatory testing



Qualitative, once positive always

positive

Whenever a screening test (RPR, VDRL) is positive, a more specific test (FTA-ABS, TP-MHA) should be used to confirm the test and rule out a "biologic false positive."

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Presumptive diagnosis if any of

:

 Physical exam findings



CSF findings (positive VDRL)  Osteitis on long bone x-rays  Funisitis (“barber shop pole” umbilical cord)  RPR/VDRL >4 times maternal test

 Positive IgM antibody

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Treatment

 Penicillin G is THE drug of choice for ALL syphilis infections



Maternal treatment during pregnancy

is very

effective (overall 98% success)  Treat newborn if: 1)Mom treated with non-PCN medication 2) Maternal titers do not show adequate response (less than 4-fold decline)

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CMV

 Most common congenital viral infection



~40,000 infants per year in the U.S

.

 Mild, self limiting illness  Transmission can occur with primary infection or reactivation of virus 90% are asymptomatic at birth!  Up to 15% develop symptoms later, notably sensorineural hearing

loss * Symptomatic

infection

10% :

 SGA, HSM, petechiae, jaundice, chorioretinitis, periventricular calcifications, neurological

deficits

 >80%

develop long term

complications  Hearing loss, vision impairment, developmental delay

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Diagnosis

Viral isolation from urine or saliva in 1st 3weeks of life



Afterwards may represent post-natal

infection Viral load and DNA copies can be assessed by PCR  Less useful for diagnosis, but helps in following viral activity in patient

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Treatment



Ganciclovir

x6wks in symptomatic infants



Studies show improvement or no progression of hearing loss at 6mos  Neutropenia often leads to cessation of therapy Treatment not recommended in asymptomatic infants due to side effects

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Herpes Simplex (HSV)

 HSV1 or HSV2



Primarily transmitted through infected maternal genital

tract

 Rationale for C-section delivery prior to membrane rupture

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Clinical manifestations

Most are asymptomatic at

birth

3 patterns of

symptoms between birth and 4wks:  Skin, eyes, mouth (SEM)  CNS disease  Disseminated disease (present earliest)

Initial manifestations of

skin lesions

are

NOT necessarily present

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Clinical manifestations

Skin and mouth vesicles and

ulcers

Kerato conjunctivitis

Encephalitis Disseminated form: (multi organ) =septic shock like

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Diagnosis

Culture

and PCR

of maternal lesions if present at delivery Cultures in infant:  Skin lesions, oro/nasopharynx, eyes, urine, blood, rectum/stool, CSF

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Treatment

Infants with disseminated and/or CNS disease are given 20 mg/kg IV every 8 hours for

21 days

. After this regimen, infants with CNS disease are given oral acyclovir 300 mg/m

2

 3 times a day for 6 months; this long-term regimen improves neurodevelopmental outcomes at 1 year of age but may cause neutropenia.Prevention:C-section for mothers with genital lesionsAcyclovir for pregnant mothers with primary HSV.

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Thank you