TORCH Infections.pdf

TORCH Infections Group of infectious diseases that can be transmitted to a developing fetus or newborn during pregnancy, delivery, or after birth → fetal abnormalities TORCH infections: o Toxoplasmosis o Other (syphilis, varicella-zoster, parvovirus B19) o Rubella o CMV (cytomegalovirus) o Herpes Ma...

TORCH Infections Group of infectious diseases that can be transmitted to a developing fetus or newborn during pregnancy, delivery, or after birth → fetal abnormalities TORCH infections: o Toxoplasmosis o Other (syphilis, varicella-zoster, parvovirus B19) o Rubella o CMV (cytomegalovirus) o Herpes Maternal illness during pregnancy o Infection → fetus o Miscarriage o Stillbirth o Fetal abnormalities at birth Toxoplasma gondii Toxoplasmosis o Protozoa o Commonly lives in cats (felines) o Oocysts shed in stool o Infection from ingested oocysts (soil) o Contaminated uncooked meat (pork, lamb) Transmission: o Eating undercooked, contaminated meat o Handling contaminated meat o Eating food that was contaminated by knives, o o o o o utensils, and cutting boards Contaminated water Accidentally swallowing the parasite through contact with cat feces that contain Toxoplasma Cleaning a cat’s litter box when the cat has shed Toxoplasma in its feces Receiving an infected organ transplant or infected blood via transfusion, though this is rare Mother-to-child transmission (congenital toxoplasmosis) Congenital HSV Infection Herpes Simplex (HSV) 2 - DNA virus Genital HSV → fetus at birth via genital tract lesions o NOT transplacental Very contagious with skin-skin contact Red Flag: if the mother is experiencing her first HSV outbreak Manifestations o Cutaneous (40%) – Localized eye, mouth, and skin lesions o CNS (30%) - herpes encephalitis, apnea, seizures o Disseminated (25%) – Multiorgan disease, septic presentation o Dx: HSV PCR o Tx: Acyclovir 60mg/kg/d Congenital Toxoplasmosis Maternal 1°infection (immunocompetent mother) o 80 to 90% of infections asymptomatic o Lymphadenopathy o Fever, chills, sweats Latent infection usually does not infect the fetus Diagnosis o IgM antibodies in the first week o IgG antibodies peak 6 to 8 weeks, fall over the next two years o MRI (diffuse Intracranial calcifications) o Ophthalmologic exam (cataract) Fetal damage most likely if the infection is acquired during 2nd to 6th months of gestation Most newborns appear normal Classic triad in fetus: o Hydrocephalus o Chorioretinitis (inflammation of choroid in eye) o Intracranial calcifications Tx: o Pyrimethamine + sulfadiazine + leucovorin o Spiramycin: exposed mother, to reduce transmission = Congenital Syphilis Early Findings o Maculopapular rash Syphilis o Runny nose Treponema pallidum o Jaundice o Spirochete (bacteria) o Abnormal long-bones o Transmitted by sexual contact § More common in legs o Maternal symptoms § Many, many abnormalities reported § Primary syphilis: Chancre Late Findings abnormalities: § Secondary syphilis: Maculopapular rash (palms/soles) o Ears/nose o Findings in baby can be early or late § Saddle nose (no nasal bridge) § Early (2yrs) § Hearing loss/deafness o Teeth § Hutchinson teeth (notched, peg-shaped teeth) § Mulberry molars (maldevelopment of the molars) o Legs: Saber shins (bowed legs) o Caused by scarring and gumma formation Varicella Zoster Virus Herpes virus (DNA) Maternal infection o Primary: Chickenpox o Reactivation: Herpes Zoster (shingles) Maternal 1° first-trimester disease → fetal infection Newborn signs and symptoms o Scars in a dermatomal pattern o Microcephaly, hydrocephalus, seizures o Eye abnormalities (cataracts, nystagmusinvoluntary eye movement) o Limb atrophy and hypoplasia Long-term: learning disabilities, mental retardation Rubella (Measles) Rubella RNA virus Found in nasal/throat secretions of infected persons Maternal infection via respiratory droplets Mild, self-limited illness o Maculopapular rash o Lymphadenopathy o Joint pain Cytomegalovirus Herpes virus (DNA) Several modes of maternal infection: o Sexual contact o Close contact of infected individual o Blood/tissue exposure 1° CMV infection asymptomatic 90% cases May cause mild febrile illness “Mononucleosis-like” Nonspecific symptoms Rhinitis, pharyngitis, headache, myalgia, arthralgia Parvovirus B19 Non-enveloped, single-stranded DNA virus Found in respiratory secretions of infected persons Classic infection: Fifth disease in children o “Slapped cheek” appearance of face Adults often develop arthritis (hands, wrists, knees, ankles) Infects red cell progenitors o Mild ANEMIA in normal individuals o Severe in chronic anemia (sickle cell) Fetus especially vulnerable to B19 o Shortened RBC half-life o Expanding RBC volume o Immature immune system Miscarriage, fetal death Hydrops fetalis o Fluid accumulation in the fetus o Ascites, pleural, etc. o Often diagnosed on ultrasound o “Immune hydrops” from Rh mismatch between mom/fetus o Many non-immune causes including B19 Congenital Rubella Syndrome Sensorineural deafness Cataracts Cardiac malformations o Classically a patent ductus arteriosus (PDA) Blueberry muffin baby o Purpuric skin lesions o Congenitally missing lower incisors o Extramedullary hematopoiesis § In utero hematopoiesis occurs outside bone marrow § Normally stops prior to birth § Persists in rubella infection o May also be seen in congenital toxoplasmosis, CMV o Dx: Rubella titers, echocardiogram, ophthalmologic exam o Tx: Supportive. There is no treatment for congenital rubella Congenital CMV Infection Most infected newborns are asymptomatic Major consequence: congenital deafness o Most common consequence of congenital CMV o Many babies diagnosed based only on failed hearing screen o Most common ID cause of congenital sensorineural deafness Other potential findings o Small for gestational age, microcephaly o Intellectual disabilities o Hepatosplenomegaly o Blueberry muffin baby o Seizures Classic neuroimaging finding: o Intracranial calcifications o Usually periventricular Dx: Urine for CMV, cranial MRI (periventricular calcifications) Rx: Prolonged ganciclovir