TORCH

Toxoplasmosis

• Toxoplasma gondii in cat feces, raw meat, unpasteurized milk

  • First trimester infection ➔ ↑ risk of preterm/spontaneous abortion

    • Triad: Chorioretinitis (posterior uveitis), intracranial calcifications (with ring-enhancement), hydrocephalus

  • Second trimester infection ➔ dz later in life (epilepsy, ID, vision dz, sensorineural HL

• DX with PCR

• TX mom with spiramycin to ↓ transmission (doesn't tx fetus)

  • • Once confirmed: pyrimethamine AND sulfadiazine AND folinic acid

Other

Syphilis

• In utero syphilis ➔ miscarriage/hydrops fetalis

• Early congenital syphilis (onset of sx before 2yo)

  • Hepatomegaly/jaundice

  • White/bloody rhinorrhea "snuffles”

  • Maculopapular rash - palms and soles

• Late congenital syphilis (onset of sx after 2yo)

  • Saddle nose, frontal bossing, short maxilla (from skeletal abnormalities)

  • Notched, wide spaced teeth (Hutchinson's) and poorly developed molars

  • Interstitial keratitis, sensorineural HL, cranial nerve palsies

• DX with RPR/VDRL, confirmed with dark-field microscopy

• TX with IV PCN G

Listeriosis

• Listeria monocytogenes in contaminated food ➔ granulomatosis infantiseptica

  • Newborn develops systemic infection with disseminated abscesses in any organ system

    • Can develop listeria meningitis/encephalitis 5d - 3wks after birth

• DX with blood/CSF cultures

• TX with IV ampicillin AND gentamicin (mom and newborn)

Varicella

• Infection during first and second trimester ➔ limb, eye, CNS defects

• Maternal exanthem <5d before birth: pneumonia, hemorrhagic exanthem, encephalitis

• TX with acyclovir and give newborn varicella-zoster immune globulin

  • C-section if lesions present at delivery

Parvo B19

• Parvovirus B19 (Fifth dz aka slapped cheek) ➔ fetal anemia, miscarriage/hydrops fetalis

• DX with PCR

• TX severe fetal anemia with intrauterine blood transfusion

Rubella

• Rubella virus infection ➔ miscarriage, preterm birth, IUGR (↑ risk in first trimester infection)

• Congenital rubella syndrome (can be asx at birth)

  • Triad: Cardiac (PDA, pulmonary artery stenosis), cataracts, cochlear (b/l sensorineural HL)

  • Early SSX: Hemolytic anemia, jaundice, thrombocytopenia, PNA, meningitis/encephalitis, petechiae/purpura (blueberry muffin rash)

  • Late SSX: Microcephaly, ID, encephalitis

• DX with PCR (mom and newborn)

  • DX fetus (chorionic villi, amniotic fluid) IgM antibody serology or PCR

• TX

  • PREGNANT WOMEN DO NOT GET MMR VACCINE

  • Consider termination discussion for intrauterine rubella infection < 16wks

  • >16wks: Reassure and monitor for complications

Cytomegaly (CMV)

• Cytomegalovirus infection ➔ ↑ risk of fetal demise, IUGR, placental abnormalities

• Most are subclinical infections but can develop b/l sensorineural HL later in life

• Newborn infection resembles rubella infection

  • Hydrocephalus, periventricular calcifications (without ring enhancement) intraventricular hemorrhage

• DX with CMV IgM antibodies or or PCR (mom and newborn)

• TX severe fetal anemia with intrauterine blood transfusion

  • TX newborn with ganciclovir OR valganciclovir OR foscarnet

  • TX mom with valacyclovir (only approved tx during pregnancy)

Herpes simplex virus (HSV)

• HSV-2 (MC), HSV-1 (rare)

• Intrauterine infection ➔ low birth weight, microcephaly, small orbits, vesicular skin lesions

• Peri/postnatal transmission

  • Skin, eye, mouth disease

  • CNS (meningoencephalitis)

  • Disseminated resembles sepsis

• DX newborn with viral culture

• TX with IV valacyclovir (mom and newborn)

Neonatal Group-B Streptococcal Infection

GBS

• Risk factors

  • Maternal GBS colonization (GBS bacteriuria/rectovaginal cultures during pregnancy)

  • Delivery of an infant with GBS disease

  • Delivery at <37wks

  • PPROM or prolonged ROM (≥18hrs before delivery)

  • Chorioamnionitis

  • Intrapartum fever

• Swab at 36wks

• SSX of early onset (birth - 6d) neonatal GBS infection

  • Sepsis (MC), PNA, meningitis

• SSX of late onset (1wk-5wks) neonatal GBS infection

  • Bacteremia ➔ fever, URI, irritability, lethargy, poor feeding, tachypnea

  • Meningitis (more common in late onset)

  • Bone/joint infection ➔ ↓ movement of affected extremity

  • Cellulitis/adenitis ➔ face/submandibular swelling

• DX with blood cultures

• TX empirically until cultures comeback then switch to PCN G IV