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• Congenital Infections


  Agents that infect the mother during labor and delivery or pregnancy may infect the fetus
• Congenital Infections


  • Can cause fetal death, early neonatal loss, multi organ dysfunction or injury to the developing brain
• Most common infecting agents


  • CMV
  • Toxoplasma gondii
  • Treponema pallidem
  • HSV
  • Rubella virus
• Toxoplasmosis


  Infections in the mothers are asymptomatic or only LAP
• Toxoplasmosis

  • Primary infections during pregnancy are associated with about 30% of fetal infections
  • Risk of transmission is higher in the third trimester but serious sequelae if in the first trimester
  • Classic triad: chorioretinitis, hydrocephalus and intracranial calcifications
  • Chorioretinitis can be a late manifestation with unilateral visual loss
• Manifestations of toxoplasmosis


  • Asymptomatic infection (70-90%)
  • Acute signs and symptoms
  • IUGR
  • Anemia, jaundice, maculopapular rash
  • Hepatosplenomegaly
  • Intracranial calcifications, hydrocephalus, seizure, microcephaly
• Toxoplasmosis


  • Long term effects: Visual impairment, blindness, seizures and mental retardation
• Diagnostics for toxoplasmosis

  1. Prenatal: Antibodies in mother and fetal amniotic fluid, IgM, IgG, PCR on amniotic fluid and placenta

  2. Postnatal: Antibodies and PCR, Careful clinical evaluation
• Prevention of toxoplasmosis


  1. Avoid risk factors for maternal infection

  2. Antibiotic treatment

  3. Treatment of the mother during acute infection - spiramycine (esp. in HIV patients, reduces risk to fetus by 50%)

  4. Treating symptomatic newborns - pyrimethamine and sulfadiazine for one year with leucovorin
• Prognosis in a newborn with overt toxoplasmosis disease is poor
• Congenital Syphilis


  Parallels with the rate of women having syphilis infection
• Congenital Syphilis


  • Adequate treatment during pregnancy prevents its development
  • In untreated women, about 40% end up with spontaneous abortion
  • About 60% are asymptomatic at birth
  • Transmission throughout the whole gestation, more commonly during the second half of pregnancy, more in Primary or secondary infections than latent infection in the mother
• Manifestations of congenital syphilis

  • Anemia, thrombocytopenia, hepatosplenomegaly, jaundice, bone abnormalities and CNS manifestations
  • Stillbirth
  • Neonatal death
  • Hydrops fetalis
  • Coetaneous lesions
  • Metaphyseal dystrophy and periostitis
• Congenital Syphilis


  • Early congenital infections variable and in the 1st weeks of life
  • Late congenital manifestations: Scarring related to early infection, prevented by treating the infant in the first three months of life
• Late congenital syphilis manifestations

  • Frontal bossing, short maxilla, high palatal arch, Hutchinson triad (Hutchinson teeth, interstitial keratitis, and eighth nerve deafness), saddle nose, and perioral fissures
• Diagnosis of congenital syphilis

  1. Direct visualization of spirochetes in overt disease from tissue or exudate

  2. MHA-TP, FTA-ABS

  3. Presumptive diagnosis if newborn has positive serologic test and compatible findings, CSF abnormalities, osteitis, placentitis or funisitis, nontreponemal test fourfold higher than maternal, positive FTA-ABS-19S IgM antibody
• Treatment of congenital syphilis

  Penicilline G
• Congenital Rubella Syndrome


  Mild self-limited illness in humans (its sole host)<|>Major impact occurs during pregnancy when rubella can have devastating effects on the developing fetus
• Presentation of Congenital Rubella Syndrome

  • Sensorineural deafness (50 to 75 percent)
  • Cataracts (20 to 50 percent)
  • Cardiac malformations - PDA (20 to 50 percent)
  • Pulmonary atrial hypoplasia (20 to 50 percent)
  • Neurologic sequelae (meningoencephalitis to behavior disorders and mental retardation) (10 to 20 percent)
• Congenital Rubella Syndrome


  • Maternal infection at early gestation interferes with critical organogenesis of the fetus
  • Cataracts, blindness, CVS anomalies, microcephaly and mental retardation
  • Prognosis with severe CRS is poor, mortality is high if diagnosed in the 1st year and survivors are with serious impairment
  • Vaccination has made it increasingly rare in developed countries
• Diagnosis and management of Congenital Rubella Syndrome

  1. Viral isolation, Serology

  2. Best management is prevention
• Congenital CMV infection


  Most common viral congenital infection, can occur with primary or reactivated maternal infection<|>Majority of newborns asymptomatic, <10% have cytomegalovirus inclusion disease - only 5-20% have mental retardation above 30% in these patients
• Manifestations of symptomatic congenital CMV infection

  • Jaundice (67 percent)
  • Hepatosplenomegaly (60 percent)
  • Petechial rash (76 percent)
  • Multiorgan involvement (eg, microcephaly, motor disability, chorioretinitis, cerebral calcifications, lethargy, respiratory distress, seizures)
• Congenital CMV infection


  • 90% of symptomatic and 5-10% of asymptomatic infants at birth develop complications
  • Greatest risk to the developing fetus
  • Maternal disease is asymptomatic
  • Transmission risk with primary maternal infection is 24-75%
  • Less severe presentation if there are maternal antibodies
  • 0.5-2.5 of infants infected during delivery
• Diagnostics for congenital CMV infection

  1. Abnormal blood counts (especially thrombocytopenia), hemolytic anemia, elevated transaminases, and elevated direct and indirect serum bilirubin

  2. Isolating the virus from saliva or urine samples collected within the first three weeks

  3. Culture yields the virus within one to three days of inoculation
• Complications of congenital CMV infection

  • Sensorineural hearing loss
  • Speech abnormalities
  • Chorioretinities
  • Optic atrophy
  • Microcephaly
  • Mental retardation
• Prevention of congenital CMV infection


  Using safe and effective vaccine
• HSV Infections


  Can be HSV 1/2, and can be transmitted during pregnancy (rare), during delivery (most common), and postnatal<|>Neonatal HSV infection is a life threatening condition manifesting with isolated CNS disease, disseminated disease with CNS involvement, isolated eye, skin, and/or mouth infection
• HSV Infections


  • IV acyclovir treatment reduces the risk of death
  • Long term sequelae include microcephaly, chorioretinitis, mental retardation, blindness, spasticity
  • Mortality can further be reduced by early initiation of iv acyclovir