Vertically transmitted infections (TORCH infections)

This video is on infections that are vertically transmitted from mother to fetus during pregnancy, including TORCH infections and TORCH syndrome.

This presentation was created using Google Slides.

ADDITIONAL TAGS:
Infection:
Symptoms / signs / findings:
Diagnosis:
Treatment (for baby):
Risk/how did mom get it?
Maternal symptoms:
Screening / prevention:
Toxoplasmosis
Diffuse intracranial calcifications (particularly in basal ganglia), chorioretinitis, hydrocephalus / ventriculomegaly, seizures; HSM, FGR, visual disturb, developmental delay,
Toxoplasma serology or PCR
Pyrimethamine, sulfadiazine, folinic acid / leucovorin
Cat feces, cysts in soil / unwashed produce, undercooked/raw meat
Fever, malaise, cervical LAD, HSM, maculopapular rash; resolves spontaneously
Toxo antibodies in 1st trimester
Syphilis (Other)
Osteoarticular destruction (eg, Hutchinson (notched) teeth, saddle nose); maculopapular rash on palms/soles; LAD; saber shins
RPR, FTA-ABs
Darkfield (old)
Penicillin
STD
Painless chancre (1º) → rash on palms/soles, fever (2º) → neuro, tabes, AR pupils (3º)
Treat mom with penicillin (even if allergic → test IgE → desensitize)
Rubella (German measles)
Cataracts (leukocoria [white pupillary reflex]), heart defects (PDA, VSD), SNHL, extramedullary hematopoiesis (blueberry muffin baby). IUGR and abortion if in 1st trimester
Serology (+high avidity IgG)
None :(
Contacts → respiratory droplets
Fever, cephalocaudal spread maculopapular rash (like in children); + arthralgias, arthritis
1st trimester screen; MMRV vaccine (not during pregnancy)
Cytomegalovirus
(most common)
Bilateral periventricular calcifications; deafness (SNHL), thrombocytopenia, chorioretinitis petechiae; blueberry muffin; HSM; growth restriction, microcephaly; jaundice
PCR test; viral culture of urine/saliva
Valganciclovir; supportive care
Contacts → urine / saliva; work w young children (teacher, daycare)
Often asymptotic, or nonspecific mild viral illness
Avoid sick kids
Herpes
Mucocutaneous vesicles, keratoconjunctivitis (dendritic branching pattern on cornea); seizures, fever, lethargy, temporal lobe hemorrhage/edema; systemic (sepsis, pneumonia, hepatitis)
Culture of surface; PCR of blood or CSF (don’t use Tzanck anymore
Acyclovir
STD
Painful burning genital lesions (vesicles on erythematous base)
If +hx, prophylax from 36 weeks with acyclovir. If active lesions at delivery → c/section
Vertically transmitted infections
Varicella-zoster:
Transmxn: Chickenpox contacts → aerosolized droplets
Sx: Limb hypoplasia, vesicular eruption → cutaneous scars, chorioretinitis, cortical atrophy, cataracts, fever, systemic (hepatitis, pneumonia, meningitis, encephalitis
Tx: Acyclovir. + PEP: if mom exposed on DOB-5d to DOB+2d, give VZIG
Screen/prevent: 1st trimester screen; MMRV vaccine (not during pregnancy)
Listeria monocytogenes:
Transmxn: food → bacterial invasion of intestinal epithelium → transplacental to fetus
Sx: neonatal febrile gastroenteritis → invasive disease (sepsis, meningitis). Multiple abscesses and granulomas, a.k.a. Granulomatosis infantiseptica
Dx: Gram+ rods on culture
Tx: gastroenteritis gets supportive care; invasive dz gets abx
Screen/prevent: pregnant moms avoid raw meats/veggies, unpasteurized dairy, deli meats, decaying vegetation
Hemolysis → high bili → jaundice +/ kernicterus
-Extramedullary hematopoiesis → hepatosplenomegaly, lymphadenopathy, widespread purpura (blueberry muffin baby)
-Low platelets → petechiae