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بسم الله الرحمن الرحيم. Transplacental infections. ( Reproductive Block , Microbiology : 2014 ). By: Dr.Malak El-Hazmi. OBJECTIVES;. Types of infant infections. Major transplacentaly transmitted pathogens causing congenital infections . Toxoplasma , Treponema pallidum ,

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slide1
بسم الله الرحمن الرحيم

Transplacentalinfections

( Reproductive Block , Microbiology : 2014 )

By: Dr.Malak El-Hazmi

objectives
OBJECTIVES;
  • Types of infant infections.
  • Major transplacentaly transmitted pathogens causing congenital infections .

Toxoplasma ,

Treponema pallidum ,

Parvovirus ,

Varicella Zoster Virus,

Rubella virus ,

Cytomegalovirus.

Their major features & epidemiology .

Manifestations of congenital infection.

Diagnosis of congenital infection.

Their Treatment and Prevention.

congenital infections
Congenital infections
  • mostly viruses
  • previously known as ( TORCH) infections:

T= Toxoplasmosis,

O=Others

(syphilis ,parvovirus &VZV),

R=Rubella V,

C=CMV,

H=Herpes( Hepatitis &HIV),

congenital infections1
Congenital infections

Risk of IUI & fetal damage ;

  • Type of org.(teratogenic)
  • Type of maternal inf.(1o,R)
  • Time of inf .(1st ,2ndor 3rd)
  • 1o Maternal infection in the first half of pregnancy
  • poses the greatest risk to the fetus
congenital infections2
Congenital infections

Common Findings

  • Intrauterine growth retardation(IUGR)
  • Hepatosplenomegaly(HSM)
  • Thrombocytopenia
  • Microcephaly

Majority of CI (“asymptomatic”) at birth

  • Preventative and therapeutic measures ;
  • possible for some of the agents
slide7
Neonatal serological Dx;
  • IgM antibody
  • Persistence of specific IgG antibody >12 ms of age

Absence of fetal IgM at birth

does not exclude infection

transplacental infections torc h
Transplacentalinfections( TORCH)

T= Toxoplasmosis

Congenital Toxoplasmosis

O=Other

(syphilis ,parvovirus &VZV)

R=RubellaV

C=CMV

slide9
Toxoplasma Gondii
  • Obligate intracellular parasite
  • Three forms:

Bradyzoites:

Oocysts;

Tachyzoites:

Immunity +

Immunity -

  • Shed in cat feces
  • rapidly dividing forms
  • ACUTE PHASE
  • slowly dividing forms
  • CHRONIC PHASE
slide10
Toxoplasma gondii,
  • Ingestion of oocyst:
  • Contaminated fingers,soil,water
  • Ingestion of cyst in undercooked meat.
  • Blood transfusion and organ transplant

TRANSMISSION:

slide11
TOXO
  • Congenital infection ;
  • Most cases, due to 10 maternal inf.
  • Rarely, reactivation of a latent inf.
congenital infection
TOXO Congenital infection ;
  • Most (70-90%) areasymptomaticat birth

but are still at high risk of developing abnormalities,

especially eye (chorioretinitis )/neurologic disease(MR) later.

  • Classic triad :
  • Other signs include ;

rash, HSM, jaundice, LAP, microcephaly, seizures, thrombocytopenia.

  • Abortion & IUD.
  • Intracranial calcifications
  • Chorioretinitis

Hydrocephalus

slide13
TOXODx
  • Pregnant mother
    • Serology;
    • IgM,
    • IgG
    • IgG avidity
    • IgG seroconversion

compared to booking blood.

Infant

*Prenatal Dx;

  • PCR
  • Culture
  • Serial U/S

*Postnatal Dx;

  • Serology;
    • IgM, IgA,
    • IgG or persistently +ve >12 ms
  • PCR
  • Culture
  • Evalution of infant

(ex, neuroimaging)

slide14
TOXORx
  • Spiramycin.
  • pyrimethamine& sulfadiazine.
  • Prevention
    • Avoid exposure to cat feces;
    • Wash ;- hands with soap and water
    • - fruits/vegetables,
    • - surfaces that touched
    • fruits/vegetables/raw meat.
    • Cook all meats thoroughly
transplacental infections torc h1
Transplacentalinfections( TORCH)

T= Toxoplasmosis,

O=Other

(syphilis ,Parvovirus &VZV),

R=Rubella V

C=CMV

parvovirus b 19
Parvovirus B19

Epidemiology:

Parvoviridae

non developed V.

Icosahedral capsid

& s.s DNA genome.

  • Worldwide distribution
  • Humans are known hosts
  • Transmission
    • Respiratory route
    • Transplacental route
    • Blood transfusion
clinical presentation
ParvoClinical presentation;

1.Acquired infection;

*Immunocompetent host *Immunocompromised pts

Erythema infectiosum

2.Congenital infection;

congenital infection1
ParvoCongenital infection
  • Risk of congenital infection is greatest when inf occur in 1st20 wks
  • Inf in the 1st trimester IUD (Intrauterine death)
  • Inf in the 2 nd trimester HF(Hydrops fetalis)
  • Inf in the 3 rd trimester Lowest risk
  • Cause fetal loss through hydrops fetalis,severe anaemia,CHF, generalized oedema and fetal death
slide19
ParvoDx

Rx:

Intrauterine transfusion

  • Pregnant mother;
    • Specific IgM.
    • IgG seroconversion.
  • Prenatal Dx;
    • Not grow in c/c.
    • PCR
    • U/S (hydrops)

Prevention:

  • Hygiene practice
  • No vaccine (TRIAL)
transplacental infections torc h2
Transplacentalinfections( TORCH)

T= Toxoplasmosis,

O=Other

(syphilis ,Parvovirus &VZV),

R=Rubella V

C=CMV

v aricella z oster v irus vzv
VaricellaZosterVirusVZV
  • Herpesviridae
  • dsDNA , Enveloped , Icosahedral Virus
  • Transmission
    • Respiratory route
    • Transplacental
  • Clinical presentations
    • Acquired infection ;
      • Varicella : Chickenpox:
        • 1o illness
        • Generalized vesicular rash
      • Zoster: Shingles:
        • Recurrent form
        • Localized VR
  • Congenital infection ;
vzv infection in pregnancy
VZV infection in Pregnancy
  • Primary infection is rare Why?
  • Primary infection carries a greater risk of severe disease,

in particular pneumonia

Intrauterine infections

  • congenital varicella syndrome ;
  • 1st 20 weeks of Pregnancy
  • The incidence of congenital varicella syndrome is ~ 2%
    • Scarring of skin
    • Hypoplasia of limbs
    • CNS defects
    • eye defects
  • Neonatal varicella ;
        • < 5 days of delivery severe disease
        • > 5 days before delivery mild disease
slide23
Diagnosis

vzv

Pregnant mother

  • Direct ex:
    • Vesicular fluid for

virusisolation

    • Cellsscraping from the base of vesicles

ImmunoFluorescent test (Ag)

    • DNA-HSV by PCR
  • Serological test:

IgM AB*

  • Infant;
  • Prenatal Dx
      • VZV DNA in FB or AF or placenta villi
      • VZV IgM in FB.
      • U/S
  • B. Postnatal Dx
      • VZV IgM
      • virusisolation
      • VZVDNA in VF
      • or CSF ( CNS INF )
slide24
vzvRx
  • Acyclovir

Prevention;

Pre exposure;

live-attenuated vaccines.

  • Post exposure;
  • VZIG
    • susceptible pregnant women have been exposed to VZV.
    • infants whose mothers develop V < 5 days of delivery
    • or the first 2 days after delivery.
transplacental infections torc h3
Transplacentalinfections( TORCH)

T= Toxoplasmosis

O=Other

(syphilis ,Parvovirus &VZV)

R=Rubella V

C=CMV

rubella virus
Rubella Virus

Togaviridae

  • SS RNA genome

Icosahedral capsid

Enveloped Virus

Epidemiology:

  • Humans
  • Transmission
    • Respiratory route
    • Transplacental route
  • A world wide distribution ed . ?
slide28
RV

Clinical manifestation:

  • Acquired infection ;

Ex. Maculopapular rash

(German measles)

  • Congenital infection;

Normal CRS IUD

  • Risk of acquiring congenital rubella infection varies and depends on gestational age of the fetus at the time of maternal infection.

gestational age risk to fetus

  • 0-12 wks 70%
  • 13-16 wks 20%
  • >16 wks Infrequent
congenital rubella syndrome
Congenital Rubella Syndrome

affecting eyes, ears & heart

Triad of abnormalities

  • Sensorineural hearing loss*
  • Cataracts and glaucoma
  • Cardiac malformations

( patent ductus arteriosus )

  • Neurologic defects
  • Others

growth retardation,

bone disease,

HSM, thrombocytopenia,

“blueberry muffin” lesions

“Blueberry muffin” spots

slide30
RV

Dx;

Pregnant mother

  • Serological diagnosis
  • Rubella specific IgM
  • Seroconversion compared to booking blood

Infant

  • Cell culture & RT-PCR

(aminiotic fluid, chorionic villi)fetus

(nasal secretion,throat,urine blood) newborn

  • Serological diagnosis
      • Rubella specific IgM
      • Persistance & rising titres of anti-rubella

IgGAbs in the infants serum beyond 9-12 months of age

slide31
Prevention:
  • Routine antenatal screening:

Rubella specific IgG

Non-immune  women   vaccination

( avoid pregnancy for 3 months).

  • vaccination:

- before or after pregnancy but not during pregnancy.

Why ?

transplacental infections torc h4
Transplacentalinfections( TORCH)

T= Toxoplasmosis,

O=Other

(syphilis ,Parvovirus &VZV),

R=Rubella V

C=CMV

c yto m egalo v irus cmv
Cytomegalovirus CMV*

Epidemiology

Human ,worldwide .

Transmission(tn)

1- Horizontal tn

  • Young children: saliva
  • Later in life: sexual contact
  • Blood transfusion

&organ transplant

2- Vertical tn

10 CMV inf . Recurrent CMV inf

(~40%) (~1%)

  • Herpesviridae
      • dsDNA , Enveloped ,
      • Icosahedral Virus.
  • Establishes in latent form
  • reactivation
  • Recurrent inf
slide34
CMV

Congenital Infections:

Clinically normal

Blueberry muffin” spots

15% Hearing defect mental retardation

4% Cytomegalic inclusion disease

1% death

cytomegalic inclusion disease
Cytomegalic Inclusion Disease;

Ventriculomegaly & calcifications

of congenital CMV

  • CNS abnormalities - microcephaly,

periventricular calcification.

  • Eye - chorioretinitis
  • Ear - sensorineural deafness
  • Liver – HSM and jaundice.
  • Lung - pneumonitis
  • Heart - myocarditis
  • Thrombocytopenic purpura
slide36
CMVDx.
  • Prenatal :
    • PCR .
    • culture
    • CMV specific IgM
    • Ultrasound
  • Postnatal:

by isolating CMV in first 3 wks of life.

    • Body fluid : urine, saliva, blood.
    • By
      • Standard tube culture method
      • Shell vial assay

Histology;

  • Detection of Cytomegalic Inclusion

Bodies in affected tissue

Serology; CMV IgM

  • Maternal :

Serology ;

          • CMV IgM
          • CMV IgG
          • CMV IgG avidity

Intranuclear I B [Owl’s -eye]

slide37
CMVRx
  • Symptomatic infants ? Ganciclovir .
  • Asymptomatic infants not recommended .
  • Prevention !?
    • Education about CMV
    • & how to prevent it
    • through hygiene;
    • hand washing
    • Vaccine is not available
  • (TRIAL)
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