2. Definition and Aetiology
Congenital infections are infections acquired in utero.
Common causes of congenital infection include:
Congenital Toxoplasmosis gondii
Congenital Rubella
Congenital Cytomegalovirus infection
congenital Herpes
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3. Aetiology cont.
Congenital syphilis
Congenital hepatitis
You may also have
Congenital varicella infection.
The TORCH Infections include some of these namely:
Toxoplasmosis, Others (syphilis), Rubella,
Cytomegalovirus, Herpes
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4. Pathogenesis
These infections are acquired in utero by
transplacental route or by direct infection from the
genital tract.
The mother has usually acquired infection usually
during pregnancy ( has a primary infection)
However reactivation may occur in those who are
immunocompromised
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5. i
Microorganism
Clinical infection Bloodstream Placenta
Mother Fetus
Subclinical infection Direct infection from genital
Death – Subclinical infection Clinical infection Congenital malformations
Abortion, apparently normal
still birth infant
Persistent infection Recovery
Recovery without sequele Death Late sequele
organ system dysfuction
psychomotor retardation
Developmental disabilities
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6. Infection acquired in utero may result in resorption of
the embryo, abortion, stillbirth, congenital
malformation, intrauterine growth retardation,
premature birth, acute disease in neonatal period or
asymptomatic infection.
The asymptomatic infection can present many years
later with deafness
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7. Clinical Presentation
Congenital Rubella, Cytomegalovirus and
Toxoplasmosis
These three infections present with similar clinical
findings in their severe form:
Low birth weight for gestational age
Jaundice
Hepatosplenomegaly
Thrombocytopenia and purpura
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8. Clinical manifestations
Cataract
Chorioretinitis
Abnormalities of head growth/intracranial
calcification – microcephaly or macrocephaly
Osteitis
Congenital heart disease
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9. Congenital Rubella infection
Congenital Rubella infection may result in abortion of
the fetus
Symptomatic neonatal infection can cause low birth
weight, hepatosplenomegaly, petechiae, osteitis,
retinitis
Congenital defects include heart defect; Patent ductus
arteriosus, microcephaly, cataracts, micropthalmia
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10. Late sequele include Deafness, mental retardation,
thyroid disorders, diabetes, degenerative brain tissue,
autism
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11. Diagnosis - rubella
Confirmed by by isolation of virus from throat
washings or urine
Serology – IgM in neonate within 3 months of birth
Infants with congenital rubella may continue to
excrete virus form pharynx and kidney for up 2 years
Prevention - Vaccination
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12. Treatment - rubella
Prevention – vaccination of infants. Will prevent
infection in later life
Treatment is symptomatic
PDA should be closed
Cataracts extracted
Hearing tests done to identify and treat those who are
deaf.
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13. Congenital cytomegalovirus
infection
Congenital CMV infection causes symptomatic
anemia, thrombocytopenia, hepatosplenomegaly,
jaundice, encephalitis
Congenital defects include; Microcephaly,
micropthalmia, retinopathy- chorioretinitis
Late sequele include deafness, cerebral palsy -
psychomotor retardation, cerebral calcification.
Infections which are subclinical at birth may cause
later damage to the central nervous system.
Sensorineural deafness may occur as late as six years of
age
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14. Other delayed sequele are clumsiness, visual defects,
mental retardation and convulsions.
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15. Diagnosis - CMV
Primary infection in mother usually asymptomatic
Diagnosis most reliably made by virus culture from
urine, saliva, throat washings and CSF
Serological assay: IgM levels for CMV in baby
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16. Treatment – congenital cmv
Treatment by antiviral drugs – Gancicyclovir has
suppressed the excretion of virus but has not affected
clinical course of disease
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17. Congenital Toxoplasmosis gondii
Toxoplasmosis is caused by a protozoa called
Toxoplasmosis gondii.
Infection my cause abortion of fetus
Neonatal disease causes low birth weight,
hepatosplenomegaly, jaudice, anemia
Congenital defects occurring are Hydrocephalus,
microcephaly
Late sequele iclude Chorioretinitis, mental
retardation, epilepsy, Cerebral calcification, cerebral
palsy
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18. Diagnosis - toxoplasmosis
Xray of the skull may show calcification
Serological assays for Toxoplasma IgM in neonate for
active infection
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19. Treatment - toxoplasmosis
For congenital infection infection: spiramycin 100
mg/kg/day for 4-6 weeks alternating with
pyrimethamine (1mg/kg/day) plus sulphadiazine
(50mg/kg/day) for 3 weeks for a whole year
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20. Congenital syphilis
Caused by a spirochaete Treponema pallidum. Mother
herself infected. Infection acquired by placental
transfer, occurring mainly in second half of pregnancy.
Recent infections in mother would result in worse
prognosis; abortion, stillbirth or early congenital
syphilis.
Untreated syphilis in mother having baby 2-5 years
after original infection causes late congenital syphilis
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21. Clinical manifestation
Manifestation of congenital syphilis divided into the
early signs which occur during the first 3 months and
correspond to secondary syphilis and later signs
(juvenile congenital syphilis ) which correspond to
tertiary syphilis.
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22. Early congenital syphilis
Infant commonly born prematurely
Usually appears normal at birth
Signs of infection develop from 2 weeks to 3 months,
sometimes earlier
The earlier the onset of signs the worse the prognosis
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23. Early signs - syphilis
Child fails to thrive
Oedema
Skin rash – symmetrical, non-irritating and copper
coloured. Lesions maybe maculopapular, bullous,
pustular or ulcerative.
There maybe desquamation on the palms and soles
Fissures occur around the mouth which on healing
leave radiating scars called rhagades
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24. Early signs - syphilis
Ulceration of buccal mucous membrane may occur
Snuffles – due to ulceration of the nasal mucous
membrane, subsequently leading to the saddle shaped
deformity of the nasal bridge from erosion of the
cartilage
Condylomata may appear around the anus and vulva
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25. In the liver, a fine pericellular cirrhosis occurs resulting
in hepatomegaly and jaundice
Splenomegaly in almost all cases
Orchitis maybe found
Bone Lesions: Can be diagnosed before clinical signs
appear.
There is widespread and usually symmetrical
periostitis causing new bone formation and double
contour to the shaft
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26. i
The periostitis may result in parrot’s nodes which is
bossing on the parietal bones
Osteochondritis results from erosion of the bone and
occurs mainly at the ends of the long bones especially
in the metaphysis.
- the upper limbs are more affected. The associated
tenderness may prevent a baby from moving the arm
and this is called syphilitic pseudoparalysis
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27. In osteochondritis, x-rays show a clear band of
decalcification in the metaphysis near the end of the
shaft with a narrow dense line between this and the
epiphysis
- the eiphysis maybe widened
- symmetrical decalcification at the medial upper ends
of both tibia may result in an apparent bites of the
tibia. This sign is called Wimberger’s sign.
Syphilitic dactylitis may occur – painless fusiform
swelling of digits – hands or toes
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28. In the eye, choroidits, iritis and optic neuritis
Involvment of CNS results in rise in CSF cells and
protein.
- occassionally , uncommonly may cause clinical
manifestation of meningitis. This indicates very severe
disease and serious prognosis.
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29. Late congenital syphilis
The child is poorly grown – small for age, poorly
nourished and usually has poor complexion
There maybe depressed nasal bridge, rhagades,
bossing but these may not indicate active disease
Hutchinson’s teeth – this is peg-shaped deformity of
upper central incisors of the permanent dentition. The
teeth are wider at the alveolar margin than at the
cutting margin and the crown maybe notched.
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30. Sabre tibia occurs after the third year of life. This is a
smooth fusiform cortical thickening of uniform
density affecting a length of the shaft resulting from
periosteal new bone formation and causing pain
particularly at night.
Perforation of nasal septum or palate may occur
Painless symmetrical effusion into knee joints called
clutton’s joints
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31. Spleen maybe enlarged
Nephritis may occur
Interstitial keratitis – commonly occurs; between 6
and 12 years of age. It initially causes clouding of
cornea with conjunctivitis with lacrimation and
photophobia. Cornea may become completely opaque
resulting in total blindness
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32. CNS manifestation; meningo-vascular syphilis
Causes mental retardation, convulsions, paralyses,
hydrocephalus, and optic atrophy
CSF – increase in cells and proteins
Deafness may occur
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33. Diagnosis
Most sensitive test is Fluorescent treponemal antibody
absorption test
IgM against the spirochaete
Direct examination in child of material from skin or
mucous membranes
RPR in mother and child
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34. Treatment
Crystalline penicillin – 100,000 iu/kg/24 hrs in 4
divided doses X 10 days.
Prevention – Weekly injections of Benzanthine
penicillin in mother for 3 weeks
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36. •Hepatitis B
Infants of women who are serum HBsAg positive in
third trimester of pregnancy especially if also positive
for hepatitis Be (marker of infectivity) should receive
0.5ml of hepatitis B immune globulin and 0.5ml of
hepatitis B vaccine at birth, 1 month and 6 months of
age.
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37. Herpes simplex virus
Neonatal disease – Tends to cause disseminated
disease with multiple organ involvment (lung, liver,
CNS) vesicular skin lesions, retinopathy
Congenital defects; possible microcephaly,
retinopathy, intracranial calcifications
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38. diagnosis
Fluid from superficial lesions should be examined by
electron microscopy
Culture of fluid for viruses including CSF
Treatment
Deliver by caeserean section women with overt genital
herpes
In any baby for whom herpes is suspected Acyclovir
should be given: 30mg/kg/24hrs) for at least 14 days
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