By acquiring correct prenatal and perinatal care, pregnant girls can optimize their probabilities of stopping, detecting, and treating congenital infections.
Congenital infections are brought on by pathogens transmitted from a mom to her offspring throughout being pregnant or supply. These infections may cause vital fetal and neonatal morbidity and mortality. The mnemonic “TORCH” is usually used to discuss with widespread congenital infections:
T – Toxoplasma
O – Different (Syphilis, Parvovirus B19, Varicella-Zoster, and many others)
R – Rubella
C – CMV
Congenital Toxoplasmosis
Congenital toxoplasmosis is brought on by the parasite Toxoplasma gondii. It may be acquired when a pregnant lady consumes uncooked or undercooked meat, or contacts contaminated water, soil, or cat feces (usually from outside cats that hunt.) The basic triad of congenital toxoplasmosis is 1) chorioretinitis 2) hydrocephalus and three) cerebral calcifications.
Signs usually don’t happen till months after start and should embody seizures, cognitive impairment, and cerebellar dysfunction (1). The retinal illness related to congenital toxoplasmosis is progressive. Different medical manifestations might embody fever, rash, hydrocephalus or microcephaly, sensorineural listening to loss, congenital nephrosis, hematologic abnormalities, hepatosplenomegaly, varied endocrinopathies, and myocarditis. An infection can result in spontaneous abortion, prematurity, stillbirth, and perinatal demise.
Congenital toxoplasmosis is extra extreme when acquired in early being pregnant. The incidence is highest within the Jap Mediterranean and Africa (2). Charges are estimated at 1 per 3000-10000 stay births in the USA (3) and 6.7 per 10000 stay births in Europe – with 81% of all confirmed circumstances within the EU/EEA occurring in France (4). Spiramycin can lower the danger of vertical transmission, however won’t deal with the fetus if the an infection has already occurred. Infants born with this illness might profit from pyrimethamine, sulfadiazine, and leucovorin.
To assist stop an infection, pregnant girls ought to keep away from consuming uncooked and undercooked meat, put on gloves when gardening, and keep away from altering cat litter.
Congenital Rubella
Rubella, also called “German measles,” is brought on by the Rubella virus (Togaviridae household). It’s most extreme when acquired in the course of the first trimester of being pregnant when the maternal an infection will result in fetal demise in 40-90% of circumstances (5). Congenital rubella may cause cardiac abnormalities, together with patent ductus arteriosus and pulmonary artery stenosis. It may additionally trigger ophthalmic abnormalities reminiscent of cataracts, glaucoma, retinopathy, and microphthalmia. Sensorineural deafness is widespread, and microcephaly, cognitive impairment, and meningoencephalitis might happen. Hepatosplenomegaly, hepatitis, hemolytic anemia, and thrombocytopenic purpura may be noticed.
The incidence of congenital rubella has plummeted in international locations that make use of widespread vaccination. In latest occasions, documented circumstances of rubella in the USA are nearly all imported. Circumstances and outbreaks proceed in Europe however at a really low fee. In 2008, 48% of all circumstances occurred in Southeast Asia and 38% in Africa (6). There isn’t any efficient remedy for congenital rubella.
Regional comparability of Congenital Rubella Syndrome prevalence, 1999 – 2019
Congenital CMV
Congenital cytomegalovirus (CMV) is the most typical congenital viral an infection within the developed world. Scientific manifestations embody sensorineural listening to loss, visible impairment, cerebral palsy, and cognitive issue. It may additionally trigger neonatal cholestasis, pulmonary hypertension, and epilepsy. 10-20% of all listening to impairment in kids is brought on by congenital CMV (7).
CMV is recognized in 5 to 7 per 1000 stay births within the USA, Canada, Western Europe, and Australia; and 10-30 per 1000 stay births in Latin America, Africa, and most Asian international locations (8). Symptomatic infants might profit from remedy with valganciclovir. It’s tough to forestall the acquisition of CMV, however some have recommended that pregnant girls can lower threat by avoiding contact with the saliva and urine of younger kids.
Congenital HSV
Congenital herpes simplex virus (HSV) mostly happens when an toddler is uncovered to the mom’s genital tract throughout supply. Each herpes simplex-1 and herpes simplex-2 may cause congenital HSV. The danger of transmission from mom to toddler relies upon totally on when the maternal an infection was acquired. When a mom is contaminated near the time of supply, the fetal an infection fee is estimated at 25-60%. This fee drops to lower than 2% when a mom is contaminated in the course of the first half of being pregnant or earlier (9).
Indicators of congenital HSV an infection might happen between start and 6 weeks of age. Disseminated illness might contain the liver, lung, central nervous system, and pores and skin. “SEM illness” is proscribed to the pores and skin, eyes, and/or mouth. Congenital HSV might trigger a vesicular rash, hypothermia, lethargy, seizures, respiratory misery, hepatosplenomegaly, thrombocytopenia, hepatic dysfunction, cerebrospinal fluid pleocytosis, and sepsis. Congenital HSV is deadly in 50% of circumstances (10). The incidence of congenital HSV is estimated to be between 1 in 3000-20000 stay births. All pregnant girls needs to be examined for HSV, and people who are constructive ought to obtain prophylactic acyclovir or an analogous drug on the time of supply. Contaminated infants needs to be handled as nicely.
Congenital Syphilis
Congenital syphilis happens when the bacterium Treponema pallidum is transmitted transplacentally or by way of the start canal. The speed of vertical transmission will increase because the being pregnant advances and transmission is extra possible when the mom is experiencing early illness (11). Congenital syphilis can generally be detected by the looks of nonimmune hydrops fetalis on ultrasound examination.
Congenital syphilis could also be divided into two medical syndromes: early congenital syphilis and late congenital syphilis. The early illness manifests throughout the first two years of life and is characterised by rash, adenopathy, and hepatosplenomegaly. Mucous patches and condylomata lata could also be seen. The eyes could also be affected, and cranial nerve palsy and seizures might happen. Thrombocytopenia with petechiae and purpura are sometimes famous. Different manifestations can embody anemia, myocarditis, pancreatitis, nephrotic syndrome, and malabsorption. Osteochondritis is usually seen on imaging.
Late congenital syphilis manifests after two years of age. Dental findings embody “Hutchinson’s tooth” and “mulberry molars.” Interstitial keratitis and eighth cranial nerve deafness can happen. Rhagades could also be seen. Bone and joint abnormalities might embody frontal bossing, saddle nostril deformity, protuberant mandible, quick maxilla, excessive palatal arch, sternoclavicular joint thickening (Higouménakis signal), saber shin, and Clutton’s joints. Central nervous system involvement can embody cognitive impairment, hydrocephalus, seizures, cranial nerve palsy, paralysis, and optic nerve atrophy.
Congenital infections, Syphilis in the USA, 1941 – 2019
The WHO estimates that there have been roughly 661,000 whole circumstances of congenital syphilis in 2016, leading to over 200,000 stillbirths and neonatal deaths (12) – with most circumstances occurring in South America and Africa. The CDC studies that congenital syphilis is on the rise in the USA, with the variety of circumstances in 2018 being highest since 1998 (13).
All pregnant girls needs to be examined for syphilis at their first prenatal go to. Penicillin is the one recognized efficient antimicrobial agent for the prevention of vertical transmission and remedy of fetal and neonatal an infection.
Congenital Parvovirus B19
Parvovirus B19 is estimated to contaminate 1-5% of pregnant girls. Most infections are with out consequence to the fetus, however in uncommon circumstances, critical fetal illness can come up (14). In contaminated fetuses, ultrasound might present nonimmune hydrops fetalis.
Congenital parvovirus B19 usually causes extreme anemia and may trigger thrombocytopenia. Neurological manifestations embody hydrocephalus, cerebellar hemorrhage, and polymicrogyria. Cardiac issues can embody Ebstein’s anomaly, ventricular septal defect, cardiomyopathy, second‐diploma coronary heart block, and myocarditis. Ocular involvement might embody corneal opacification, aphakia, and microphthalmia. Gastrointestinal manifestations embody meconium peritonitis, fetal liver calcifications, portal tract fibrosis, and hypoplasia of the belly muscle tissue. Congenital parvovirus B19 can even trigger cleft lip and palate, micrognathia, bifid scrotum, Secundum atrial septal defect, and micropenis with perineoscrotal hypospadias.
Intrauterine fetal blood transfusion can be utilized to deal with the extreme fetal anemia related to congenital parvovirus B19 an infection.
Congenital Varicella-Zoster
Varicella-zoster congenital infections are brought on by the virus that causes chickenpox and shingles. An infection could also be characterised by low start weight, hypoplasia of the extremities, dermal scarring, focal muscular atrophy, encephalitis, cortical atrophy, chorioretinitis, and microcephaly. Neonatal varicella zoster might happen when a mom contracts varicella virus between 5 days earlier than supply – to 48 hours after supply. Neonatal varicella has a fatality fee of as much as 30% (15). Congenital Varicella-Zoster virus an infection is uncommon since most girls are immune by childbearing age – having both been contaminated throughout childhood or vaccinated. Infants born with congenital varicella zoster might enhance with acyclovir.
Extra Congenital Infections
Extra viral brokers of fetal and neonatal morbidity and mortality embody HIV, Hepatitis B and C, measles, enteroviruses, adenovirus, lymphocytic choriomeningitis virus, West Nile virus, Zika virus, and Chikungunya virus. Extra bacterial causes embody Group B Streptococcus, Chlamydia trachomatis, Neisseria gonorrhoeae, Escherichia coli, Mycobacterium tuberculosis, and Coxiella burnetii. A parasite, Plasmodium falciparum (the causative agent of malaria) can be related to congenital an infection.
By acquiring correct prenatal and perinatal care, pregnant girls can optimize their probabilities of stopping, detecting, and treating congenital infections.
References
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