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Paediatrics: Transplacental (congenital infection)

Causes • ‘TORCH’ infections. • Herpes zoster. • Parvovirus B19. • Syphilis. • Enterovirus.

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.

 

 

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Paediatrics: Neonatology


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