This video is on infections that are vertically transmitted from mother to fetus during pregnancy, including TORCH infections and TORCH syndrome.
This presentation was created using Google Slides.
ADDITIONAL TAGS:
Infection:
Symptoms / signs / findings:
Diagnosis:
Treatment (for baby):
Risk/how did mom get it?
Maternal symptoms:
Screening / prevention:
Toxoplasmosis
Diffuse intracranial calcifications (particularly in basal ganglia), chorioretinitis, hydrocephalus / ventriculomegaly, seizures; HSM, FGR, visual disturb, developmental delay,
Toxoplasma serology or PCR
Pyrimethamine, sulfadiazine, folinic acid / leucovorin
Cat feces, cysts in soil / unwashed produce, undercooked/raw meat
Fever, malaise, cervical LAD, HSM, maculopapular rash; resolves spontaneously
Toxo antibodies in 1st trimester
Syphilis (Other)
Osteoarticular destruction (eg, Hutchinson (notched) teeth, saddle nose); maculopapular rash on palms/soles; LAD; saber shins
RPR, FTA-ABs
Darkfield (old)
Penicillin
STD
Painless chancre (1º) → rash on palms/soles, fever (2º) → neuro, tabes, AR pupils (3º)
Treat mom with penicillin (even if allergic → test IgE → desensitize)
Rubella (German measles)
Cataracts (leukocoria [white pupillary reflex]), heart defects (PDA, VSD), SNHL, extramedullary hematopoiesis (blueberry muffin baby). IUGR and abortion if in 1st trimester
Serology (+high avidity IgG)
None :(
Contacts → respiratory droplets
Fever, cephalocaudal spread maculopapular rash (like in children); + arthralgias, arthritis
1st trimester screen; MMRV vaccine (not during pregnancy)
Cytomegalovirus
(most common)
Bilateral periventricular calcifications; deafness (SNHL), thrombocytopenia, chorioretinitis petechiae; blueberry muffin; HSM; growth restriction, microcephaly; jaundice
PCR test; viral culture of urine/saliva
Valganciclovir; supportive care
Contacts → urine / saliva; work w young children (teacher, daycare)
Often asymptotic, or nonspecific mild viral illness
Avoid sick kids
Herpes
Mucocutaneous vesicles, keratoconjunctivitis (dendritic branching pattern on cornea); seizures, fever, lethargy, temporal lobe hemorrhage/edema; systemic (sepsis, pneumonia, hepatitis)
Culture of surface; PCR of blood or CSF (don’t use Tzanck anymore
Acyclovir
STD
Painful burning genital lesions (vesicles on erythematous base)
If +hx, prophylax from 36 weeks with acyclovir. If active lesions at delivery → c/section
Vertically transmitted infections
Varicella-zoster:
Transmxn: Chickenpox contacts → aerosolized droplets
Sx: Limb hypoplasia, vesicular eruption → cutaneous scars, chorioretinitis, cortical atrophy, cataracts, fever, systemic (hepatitis, pneumonia, meningitis, encephalitis
Tx: Acyclovir. + PEP: if mom exposed on DOB-5d to DOB+2d, give VZIG
Screen/prevent: 1st trimester screen; MMRV vaccine (not during pregnancy)
Listeria monocytogenes:
Transmxn: food → bacterial invasion of intestinal epithelium → transplacental to fetus
Sx: neonatal febrile gastroenteritis → invasive disease (sepsis, meningitis). Multiple abscesses and granulomas, a.k.a. Granulomatosis infantiseptica
Dx: Gram+ rods on culture
Tx: gastroenteritis gets supportive care; invasive dz gets abx
Screen/prevent: pregnant moms avoid raw meats/veggies, unpasteurized dairy, deli meats, decaying vegetation
Hemolysis → high bili → jaundice +/ kernicterus
-Extramedullary hematopoiesis → hepatosplenomegaly, lymphadenopathy, widespread purpura (blueberry muffin baby)
-Low platelets → petechiae