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Congenital Intrauterine TORCH Infections
Deepika Deka
INTRODUCTION
1:
Intrauterine Infections and Congenital TORCH Syndromes
INCIDENCE
MATERNAL FETAL TRANSMISSION
CONGENITAL TORCH
APPROACH TO CLINICAL MANAGEMENT
IMPORTANT POINTS
BASIC CONSIDERATIONS OF MATERNAL TORCH INFECTIONS
2:
Epidemiology, Transmission, Pathogenesis and Laboratory Diagnosis of Maternal Infection
EPIDEMIOLOGY
TRANSMISSION TO FETUS
PATHOGENESIS
METHODS OF LABORATORY DIAGNOSIS OF MATERNAL INFECTION
Serology
Virus Isolation
Viral Antigen Detection
Diagnosis of Maternal Rubella After Exposure
Management
Vaccination
HUMAN CYTOMEGALOVIRUS
CMV Infection of the Mother
Outcome of Congenital CMV Infection
Pathogenesis
DIAGNOSIS OF HCMV INFECTION
Diagnosis in Mother
Primary Infection
Serology
Detection of Virus
Secondary Infection
Serology
Detection of Virus
Detection of CMV by Shell Vial Culture
Prenatal Diagnosis of CMV Infection
HERPES SIMPLEX VIRUS INFECTION OF MOTHER
Pathogenesis
Neonatal Transmission
Diagnosis of HSV Infection in Mother
3:
Clinical Signs of Maternal TORCH Infections
4:
Avidity-testing to Pinpoint Timing of Maternal TORCH Infections during Pregnancy
INTRODUCTION
Principle of Antibody Affinity and Avidity
Development of High Affinity Antibodies
IgG-avidity Assays in Infectious Diseases
Theoretical Justification
Clinical Justification
CONCLUSIONS
IMPORTANT POINTS
TORCH SYNDROMES
5:
Pregnancy Complications and Miscarriage Due to Maternal TORCH Infections
TOXOPLASMOSIS
RUBELLA
CYTOMEGALOVIRUS
HERPES SIMPLEX VIRUS (HSV)
IMPORTANT POINTS
6:
Outcome of Neonates Born with Vertically Transmitted TORCH Infections
OUTCOME OF NEONATES BORN WITH CONGENITAL RUBELLA SYNDROME
Transient Manifestations
Permanent Manifestations
Diagnosis of Congenital Rubella Infection
Treatment
Prevention
Outcome of Neonate Born to Mother with Herpes Simplex Virus (HSV) Infection during Pregnancy
Determinants of Fetal Transmission
Clinical Manifestations
Skin Eye-mouth/Mucocutaneous Disease
CNS Infection in Absence of Disseminated Disease
Disseminated Infection
Diagnosis of Neonatal HSV Infection
Treatment
Management of Newborn to a Mother with Active Genital HSV Infections17
Clinical Spectrum TORCH Infections—Indian Experience18, 19
7:
TORCH Infections and Mental Retardation
8:
TORCH Infections—Ocular Manifestations
TOXOPLASMA GONDII
Investigations
Ocular Manifestations
RUBELLA
Investigations
Ocular Manifestations
CYTOMEGALOVIRUS (CMV)
Investigations
Ocular Manifestations
HERPES SIMPLEX (HSV)
Investigation
Ocular Manifestations
IMPORTANT POINTS
9:
Congenital TORCH Infection and Hearing Loss
INTRODUCTION
CONGENITAL CYTOMEGALOVIRUS (CMV) INFECTIONS
CONGENITAL RUBELLA INFECTIONS
CONGENITAL TOXOPLASMA INFECTION
CONGENITAL HERPES INFECTION
AUDIOLOGICAL ASSESSMENT
10:
Problems of Neurological Sequelae Due to Intrauterine Infections
RUBELLA
The Indian Scene
Clinical Features
Transient Manifestations
Meningoencephalitis
Permanent Manifestations
Delayed CRS
Progressive Rubella Panencephalitis (PRP)
Other Neuropsychiatric Problems
Long-term Prognosis of those with Neurological Problems
HERPES SIMPLEX
Intrauterine Infection
Cutaneous Disease
Disseminated Infection
Encephalitis
Treatment and Prognosis
TOXOPLASMOSIS
Clinically Apparent Disease
CNS Findings
Hydrocephalus
Intracranial Calcification
Microcephaly
Mental Retardation
Treatment and Prognosis
CYTOMEGALOVIRUS INFECTION
Pathogenesis and Pathology of CNS Involvement
Asymptomatic Infection
CNS Manifestations
Symptomatic Infection
Acute Manifestations
Microcephaly
Treatment and Prognosis
Causes of Death
Perinatal and Early Postnatal Infection
CONCLUSIONS
IMPORTANT POINTS
APPROACH TO CLINICAL MANAGEMENT OF PREGNANCY WITH INTRAUTERINE INFECTIONS
11:
Role of Ultrasound in TORCH Infections
SONOGRAPHIC FINDINGS IN TORCH INFECTION
BRAIN
Hydrocephalus/Ventriculomegaly
Hydranencephaly
Intracranial Calcification
Microcephaly
ABDOMEN
Hepatosplenomegaly (Fig. 11.2)
Intra-abdominal Calcification (Fig. 11.3)
Hyperechoic Bowel (Fig. 11.4)
HYDROPS FETALS (Fig. 11.5)
CARDIAC ABNORMALITIES (Fig. 11.6)
LIMB DEFECTS (Fig. 11.7)
PLACENTOMEGALY (Fig. 11.8)
AMNIOTIC FLUID VOLUME
IUGR
SPECIFIC FINDINGS IN TORCH INFECTIONS: (Table 11.2)
Rubella
Toxoplasmosis
Cytomegalovirus
INTERVENTIONAL ULTRASOUND IN TORCH INFECTIONS
Diagnosis
Amniocentesis
Cordocentesis
Therapy
Intrauterine Transfusion
Aspiration of Ascitis, Pericardial and Pleural Effusions; Tapping of a Hydrocephalus and Placement of Shunts
In utero Drug Therapy
DOPPLER ULTRASOUND IN TORCH INFECTIONS
Evaluating Fetal Heart Disease
To Study the Evolution of Hydrops, to Determine the Need of Treatment and Assess the Response to Treatment
Prediction, Diagnosis and Management or IUGR
3-D ULTRASOUND IN TORCH INFECTIONS
ANOMALIES DETECTED IN RELATION TO TORCH INFECTION40
CONCLUSION
12:
Prenatal Diagnosis of Fetal TORCH Infections
FETAL TORCH SYNDROMES
Fetal Toxoplasmosis
Fetal Cytomegalovirus (CMV) Infection
Fetal Rubella Syndrome
Fetal Herpes Simplex Virus (HSV) Infection
PRENATAL DIAGNOSIS
ULTRASOUND GUIDED PROCEDURES
Amniocentesis
Chorionic Villus Sampling (CVS)
Transcervical CVS
Transabdominal CVS
Cord-blood Sampling
Procedure
TOXOPLASMOSIS
RUBELLA
CMV
HSV
13:
Laboratory Diagnosis of Congenital Fetal/Neonatal TORCH Infection
INTRODUCTION
FACTORS INVOLVED IN RECURRENT EARLY PREGNANCY LOSS
GENERAL APPROACH FOR THE DIAGNOSIS OF CONGENITAL TORCH INFECTIONS
SYSTEMIC APPROACH FOR THE INDIVIDUAL INFECTION
Toxoplasmosis
Laboratory Diagnosis
Serodiagnosis1–8
IMPORTANT FACTS TO NOTE
Antigen Detection
Prevention
RUBELLA INFECTION (GERMAN OR THREE-DAY MEASLES)
Laboratory Diagnosis
Serodiagnosis
Molecular Methods
Virus Isolation
Prevention
CYTOMEGALOVIRUS INFECTION
Laboratory Diagnosis
Serodiagnosis
Molecular Methods
Antigen Detection
Other Tests
Prognosis
Prevention
HERPES SIMPLEX VIRUS INFECTION
Diagnostic Aids
General
Specific
Management
Prognosis
Prevention
14:
Prenatal Treatment of Toxoplasmosis
INTRODUCTION
SCREENING FOR TOXOPLASMOSIS
MATERNAL FETAL TRANSMISSION
CONGENITAL TOXOPLASMOSIS
PRENATAL DIAGNOSIS
Ultrasonography
Cordocentesis
Amniocentesis
Chorionic Villus Sampling (CVS)
PRENATAL TREATMENT
Spiramycin
Sulfonamide-pyrimethamine
ADVERSE EFFECTS
EFFICACY OF PRENATAL TREATMENT OF CONGENITAL TOXOPLASMOSIS
CONCLUSION
IMPORTANT POINTS
15:
Strategies for Management of Intrauterine Rubella Infection
MANAGEMENT PROTOCOLS
Woman Presenting for Pre-pregnancy Counseling
Woman Diagnosed to have Rubella during Pregnancy
Prenatal Diagnosis and Management Decision
IMPORTANT POINTS
16:
Decision Making in Intrauterine Cytomegalovirus Infection
INTRODUCTION
MANAGEMENT OF CMV INFECTION IN PREGNANCY
Congenital CMV Infection
Amniocentesis
Primary CMV infection
Recurrent Infection
Is there treatment for CMV during pregnancy?
IMPORTANT POINTS
17:
Streamlining Therapy of Pregnant Patient with Genital Herpes
IMPORTANT POINTS
18:
TORCH Infection in the Immunocompromised Pregnant Women
IMPORTANT POINTS
CONSENSUS OPINION
19:
Guidelines for Screening of TORCH Infections in Pregnancy in India
INTRODUCTION
TOXOPLASMOSIS
Disease Characteristics
Magnitude of Problem
Diagnosis
Fetal Testing
Prenatal Therapy
Role of Screening
Limitations in Recommendation of Routine Screening
RUBELLA
Disease Characteristics
Role of Screening
CYTOMEGALOVIRUS (CMV)
Disease Characteristics
Role of Screening
HERPES SIMPLEX VIRUS
Disease Characteristics
Role of Screening
20:
Impact of Health Education and Counseling in Prevention of Congenital TORCH Infection
TOXOPLASMOSIS
Types of Prevention of Toxoplasmosis (Fig. 20.1)
Center of Disease Control (CDC) in 19973 have Delineated Practices to Reduce Risk of Congenital Infection
RUBELLA
CYTOMEGALOVIRUS
Prevention
HERPES SIMPLEX
GENERAL ISSUES IS PREVENTION OF TORCH INFECTIONS
RECOMMENDATIONS FOR EDUCATION AND HEALTH POLICY
General
Specific to Particular Organisms
Herpes Virus
Cytomegalovirus
ILLUSTRATIVE CASES
21:
TORCH Infections in Pregnancy
CASE 1
CASE 2
CASE 3
CASE 4
CASE 5
CASE 6
CASE 7
CASE 8
CASE 9
CASE 10
CASE 11
CASE 12
CASE 13
INDEX
TOC
Index
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