Transplacental (congenital infection)
•
‘TORCH’
infections.
•
Herpes
zoster.
•
Parvovirus
B19.
•
Syphilis.
•
Enterovirus.
•
HIV;
hepatitis B.
•
Rarely
bacterial, e.g. GBS, Listeria
monocytogenes, N. gonorrhoeae.
•
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.
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.
•
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.
Variable and depends on disease
severity.
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