Paediatrics: Transplacental (congenital infection)

Transplacental (congenital infection)

Causes

•   ‘TORCH’ infections.

•   Herpes zoster.

•   Parvovirus B19.

•   Syphilis.

•   Enterovirus.

•   HIV; hepatitis B.

•   Rarely bacterial, e.g. GBS, Listeria monocytogenes, N. gonorrhoeae.

Presentation

•   TORCH infection: SGA, jaundice, hepatitis, hepatosplenomegaly, purpura, chorioretinitis, micro-ophthalmos, cerebral calcification, micro/macrocephaly, hydrocephalus.

•   Rubella and CMV: also cause deafness, cataracts, congenital heart disease, osteitis (rubella only).

•   Parvovirus B19: rubella-like rash, aplastic anaemia +/– hydrops.

•   Herpes zoster: cutaneous scarring, limb defects, multiple structural defects.

•   Congenital syphilis: SGA, jaundice, hepatomegaly, rash, rhinitis, bleeding mucous membranes, osteochondritis, meningitis.

•   Bacterial infections present with features that may be non-specific or even result in multi-organ failure. Gonorrhoea causes purulent conjunctivitis (ophthalmia). Listeriosis causes preterm labour and meconium-stained liquor.

Investigation

Consider:

•   Blood culture.

•   Pathogen-specific IgM and IgG (paired for Herpes zoster, Toxoplasma).

•   Venereal Disease Research Laboratory (test)(VDRL).

•   Maternal-specific serology.

•   Urine CMV culture.

•   Throat swab viral culture.

•   CSF culture and latex particle agglutination (GBS).

•   Stool viral culture.

•   Skin vesicle viral culture and electron microscopy.

Treatment

•   Most congenital infections have no specific treatment.

•   General treatment is supportive and involves careful follow-up to identify sequelae, e.g. deafness and CMV.

•   Toxoplasma: spiramycin (4–6wks 100mg/kg/day) alternating with pyrimethamine (3wks 1mg/kg/day) plus sulfadiazine (1yr 50–100mg/kg/ day).

•   Syphilis: benzylpenicillin 14 days 30mg/kg 12-hourly IV.

•   Symptomatic CMV: consider IV ganciclovir then oral valganciclovir.

Prognosis 

Variable and depends on disease severity.