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Congenital Intrauterine TORCH Infections
Deepika Deka
SECTION 1: MATERNAL FETAL SEQUELAE
ONE:
Intrauterine Infections and Congenital TORCH Syndromes
INCIDENCE
MATERNAL FETAL TRANSMISSION
CONGENITAL TORCH
APPROACH TO CLINICAL MANAGEMENT
IMPORTANT POINTS
TWO:
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
REFERENCES
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
REFERENCES
THREE:
Clinical Signs of Maternal TORCH Infections
FOUR:
Clearing Misconceptions: Pregnancy Complications and Miscarriage Due to Maternal TORCH Infections
TOXOPLASMOSIS
PREGNANCY COMPLICATIONS
RUBELLA
PREGNANCY COMPLICATIONS
Rubella Vaccination
CYTOMEGALOVIRUS
PREGNANCY COMPLICATIONS
HERPES SIMPLEX VIRUS (HSV)
PREGNANCY COMPLICATIONS
PARVOVIRUS B 19
HEPATITIS
HIV
SYPHILIS
MALARIA
VARICELLA ZOSTER
MEASLES, MUMPS
CHLAMYDIA AND CHLAMYDIA-LIKE ORGANISMS
FIVE:
Outcome of Neonates Born with Congenital TORCH Infections
OUTCOME OF THE NEONATE BORN TO A MOTHER WITH TOXOPLASMOSIS DURING PREGNANCY
SUBCLINICAL CONGENITAL TOXOPLASMA INFECTION— SEQUELAE IN INFANCY/CHILDHOOD.
SYMPTOMATIC CONGENITAL TOXOPLASMA INFECTION
PROGNOSIS: CONGENITAL TOXOPLASMA INFECTION
DIAGNOSIS OF CONGENITAL TOXOPLASMOSIS
TREATMENT
CONGENITAL CYTOMEGALOVIRUS INFECTION
SYMPTOMATIC CMV INFECTION CAN PRESENT EITHER AS ACUTE FULMINANT INFECTION OR WITHOUT LIFE THREATENING COMPLICATIONS
Acute Fulminant Infection
Symptomatic Presentation without Life Threatening Complications
Sequelae of Congenital CMV Infection
Perinatally acquired Cytomegalovirus infection
ACQUIRED NEONATAL CMV INFECTION
DIAGNOSIS OF CONGENITAL CMV INFECTION
Viral Isolation
Serologic Diagnosis
PROGNOSIS: CONGENITAL CMV INFECTION
TREATMENT
Prevention
CONGENITAL RUBELLA SYNDROME
TRANSIENT MANIFESTATIONS
PERMANENT SEQUELAE
DIAGNOSIS OF CONGENITAL RUBELLA INFECTION
TREATMENT
PREVENTION
HERPES SIMPLEX VIRUS (HSV) INFECTION
DETERMINANTS OF FETAL TRANSMISSION
CLINICAL MANIFESTATIONS: HERPES SIMPLEX VIRUS
SKIN EYE-MOUTH (SEM DISEASE)/ 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
SIX:
Congenital TORCH Infections and Mental Retardation
SEVEN:
Intrauterine TORCH Infections and Ocular Manifestations
TOXOPLASMOSIS
OCULAR MANIFESTATIONS
Course of the Disease
OTHER OCULAR FINDINGS
Visual Impairment
TREATMENT
RUBELLA
OCULAR MANIFESTATIONS
WHEN TO SUSPECT CRS
According to WHO (World Health Organization)
MANAGEMENT OF OCULAR PATHOLOGY
CYTOMEGALOVIRUS (CMV)
HSV INFECTION
EYE MANIFESTATIONS
Anterior Segment
Retina
Optic Nerve
Microphthalmia
TREATMENT
OTHERS
SYPHILIS
EYE MANIFESTATION
LYMPHOCYTIC CHORIOMENINGITIS VIRUS
EYE MANIFESTATIONS
VARICELLA-ZOSTER VIRUS
HUMAN IMMUNODEFICIENCY VIRUS
EPSTEIN-BARR VIRUS
ACKNOWLEDGEMENTS
EIGHT:
Congenital TORCH Infections and Hearing Loss
CONGENITAL CYTOMEGALOVIRUS (CMV) INFECTIONS
CLINICAL FEATURES
Diagnosis
Management
CONGENITAL RUBELLA INFECTIONS
DIAGNOSIS
MANAGEMENT
CONGENITAL TOXOPLASMA INFECTION
DIAGNOSIS
Treatment
CONGENITAL HERPES INFECTION
AUDIOLOGICAL ASSESSMENT OF CHILDREN AFFECTED BY TORCH INFECTIONS
TREATMENT OF DEAFNESS
NINE:
Effects of Genital Tract Infections and Pregnancy Outcome
BACTERIAL VAGINOSIS
ETIOLOGY
PATHOGENESIS
MICROBIOLOGY
EFFECTS OF BACTERIAL VAGINOSIS ON OUTCOME OF PREGNANCY
DIAGNOSIS
GRAM STAINING
TREATMENT
TRICHOMONIASIS
IMPACT ON OUTCOME OF PREGNANCY
CLINICAL PRESENTATION
DIAGNOSIS
TREATMENT
GONORRHEA
DIAGNOSIS
MATERNAL INFECTION
TREATMENT OF UNCOMPLICATED GONORRHEA IN PREGNANCY
NEONATAL INFECTION
CHLAMYDIA TRACHOMATIS
PREVALENCE
MATERNAL INFECTIONS
DIAGNOSIS
SCREENING
TREATMENT
NEONATAL INFECTIONS
GENITAL WARTS
ETIOPATHOGENESIS OF GENITAL WARTS
DIAGNOSIS
SCREENING
TREATMENT
NEONATAL INFECTION
URINARY TRACT INFECTIONS
COMPLICATIONS OF UTI
CLINICAL PRESENTATION
Asymptomatic Bacteriuria
Cystitis
Pyelonephritis
SECTION 2: PROBLEM-BASED APPROACH TO MATERNAL-FETAL MANAGEMENT
TEN:
Avidity-Testing to Pinpoint Timing of Maternal TORCH Infections during Pregnancy
INTRODUCTION
PRINCIPLE OF ANTIBODY AFFINITY AND AVIDITY
DEVELOPMENT OF HIGH AFFINITY ANTIBODIES
THEORETICAL EXPLANATION
CLINICAL EXPLANATION
ELEVEN:
Prenatal Treatment of Toxoplasmosis
SCREENING FOR TOXOPLASMOSIS
MATERNAL-FETAL TRANSMISSION
CONGENITAL TOXOPLASMOSIS
SEROLOGICAL DIAGNOSIS
PRENATAL DIAGNOSIS
ULTRASONOGRAPHY
CORDOCENTESIS
AMNIOCENTESIS
CHORIONIC VILLUS SAMPLING
IDENTIFICATION OF PARASITE
PRENATAL TREATMENT
SPIRAMYCIN
DOSAGE SCHEDULE
TOXOPLASMOSIS
BACTERIAL INFECTIONS
SULPHONAMIDE-PYRIMETHAMINE
ADVERSE EFFECTS
SPIRAMYCIN
PYRIMETHAMINE
SULPHADIAZINE
EFFICACY OF PRENATAL TREATMENT ON CONGENITAL TOXOPLASMOSIS
EFFECT OF PRENATAL TREATMENT ON CONGENITAL TOXOPLASMOSIS
TWELVE:
Strategies for Management of Intrauterine Rubella Infection
CLINICAL DIAGNOSIS
LABORATORY DIAGNOSIS
MANAGEMENT PROTOCOLS
WOMAN PRESENTING FOR PRE-PREGNANCY COUNSELING
WOMAN PRESENTING WITH PREGNANCY
WOMAN EXPOSED / SUSPECTED TO HAVE RUBELLA DURING PREGNANCY
PRENATAL DIAGNOSIS AND MANAGEMENT DECISION
NATIONAL POLICY FOR PREVENTION
THIRTEEN:
Decision Making in Intrauterine Cytomegalovirus Infection
INTRODUCTION
THE VIRUS, ITS TRANSMISSION AND CLINICAL MANIFESTATIONS
DILEMMAS FOR THE OBSTETRICIAN
DIAGNOSIS OF PRIMARY INFECTION IN THE MOTHER
DIAGNOSIS OF INTRAUTERINE CMV
ULTRASOUND FOR DIAGNOSIS OF FETAL CMV INFECTION
TIMING OF USG FOR DETECTION OF CMV
PRENATAL DIAGNOSIS
INDICATIONS FOR PRENATAL DIAGNOSIS
TECHNIQUES OF PRENATAL DIAGNOSIS
TREATMENT OF PRIMARY CMV IN PREGNANCY
INDICATIONS FOR TERMINATION OF PREGNANCY
FOURTEEN:
Streamlining Therapy of Pregnant Women with Genital Herpes
PRESENTATION OF INFECTION
EFFECT OF HSV INFECTION ON PREGNANCY
DIAGNOSIS OF HERPES SIMPLEX INFECTION
ROUTES AND RISK OF TRANSMISSION OF HERPES TO CHILD
NEONATAL HERPES
ANTIVIRAL MEDICATION
MANAGEMENT OF PREGNANT WOMEN WITH FIRST EPISODE OF GENITAL HERPES
COUNSELLING THE PATIENT WITH GENITAL HERPES
ROLE OF CESAREAN SECTION
MANAGEMENT OF WOMEN PRESENTING WITH A RECURRENT EPISODE OF GENITAL HERPES DURING PREGNANCY
WOMEN WITH NONGENITAL HERPES
PATIENTS WITH ACTIVE HSV INFECTION AND RUPTURED MEMBRANES
PATIENTS WITH ACTIVE HSV AND PRETERM PREMATURE RUPTURE OF MEMBRANES
INVASIVE PROCEDURES IN WOMEN WITH HSV
PREVENTION OF POSTNATAL HSV TRANSMISSION TO THE NEONATE
ROLE OF UNIVERSAL SCREENING DURING PREGNANCY OR AT DELIVERY
FIFTEEN:
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
CORDBLOOD SAMPLING
PROCEDURE
TOXOPLASMOSIS
RUBELLA
CMV
HSV
SIXTEEN:
Minimizing Risk of HIV Transmission to Fetus and Newborn
INTRODUCTION
FACTORS INFLUENCING MTCT
MATERNAL FACTORS
OBSTETRICAL FACTORS
FETAL/INFANT FACTORS
PRECONCEPTION CARE
ANTENATAL CARE
REDUCING MTCT RISK IN WOMEN WITH UNKNOWN HIV STATUS
ARV PROPHYLAXIS
DIFFERENT REGIMENS OF ARV
ZDV REGIMEN
BENEFITS/RISKS OF ZDV
NEVIRAPINE
BENEFITS/RISKS OF NVP
Nevirapine Resistance
INTRAPARTUM CARE
DELIVERY: CESAREAN VS VAGINAL BIRTH
POSTNATAL CARE
COUNSELLING AND SUPPORT FOR SAFE INFANT FEEDING
Infant Age
Pattern of Breastfeeding
Breastfeeding Duration
CONCLUSION AND RECOMMENDATIONS
SEVENTEEN:
Sexually Transmitted Disease in Pregnancy: Saving the Fetus
MATERNAL-PERINATAL IMPACT OF STDs
SPONTANEOUS ABORTION
PRETERM LABOR AND CHORIOAMNIONITIS
INTRAUTERINE DEATH
POSTABORTAL, INTRAPARTUM AND POSTPARTUM COMPLICATIONS
CONGENITAL INFECTION
GONORRHEA
Maternal and Fetal Risks
Laboratory Diagnosis
Treatment
SYPHILIS
Clinical Manifestations
Laboratory Diagnosis
Maternal and Fetal Risks
CHLAMYDIAL INFECTIONS
MATERNAL AND FETAL RISKS
LABORATORY DIAGNOSIS
HUMAN PAPILLOMAVIRUS
TRICHOMONAS VAGINALIS
DIAGNOSIS
PERINATAL RISK
TREATMENT
BACTERIAL VAGINOSIS
DIAGNOSIS
SYSTEMIC THERAPY
SECTION 3: PRENATAL DIAGNOSIS OF CONGENITAL INFECTION
EIGHTEEN:
Laboratory Techniques for Prenatal Diagnosis of Maternal-Fetal TORCH Infections
INTRODUCTION
GENERAL APPROACH FOR THE DIAGNOSIS OF CONGENITAL TORCH INFECTIONS
SYSTEMIC APPROACH FOR THE INDIVIDUAL INFECTIONS
1. TOXOPLASMOSIS
Laboratory Diagnosis
Antigen Detection
2. RUBELLA INFECTION (GERMAN OR THREE-DAY MEASLES)
Laboratory Diagnosis
Molecular Methods
Virus Isolation
3. CYTOMEGALOVIRUS INFECTION
Laboratory Diagnosis
Antigen Detection
Other Tests
4. HERPES SIMPLEX VIRUS INFECTION
Diagnostic Aids
Specific
NINETEEN:
Role of Ultrasound in Prenatal Diagnosis of Congenital Infections
ROLE OF ULTRASOUND IN THE MANAGEMENT OF CONGENITAL INFECTIONS
SONOGRAPHIC FINDINGS IN CONGENITAL INFECTION
BRAIN
a. Hydrocephalus/Ventriculomegaly
b. Hydranencephaly
c. Intracranial Calcification
d. Microcephaly
ABDOMEN
a. Hepatosplenomegaly
b. Intra-abdominal Calcification
c. Hyperechoic Bowel
HYDROPS FETALIS
CARDIAC ABNORMALITIES
LIMB DEFECTS
PLACENTOMEGALY
AMNIOTIC FLUID VOLUME
IUGR
SPECIFIC FINDINGS IN TORCH INFECTIONS (Table 19.1)
VIRAL INFECTIONS
1. Cytomegalovirus (Figs 19.1 and 19.2)
2. Rubella (Fig. 19.3)
3. Herpes Simplex Virus (HSV)
4. Human Immunodeficiency Virus
5. Varicella Zoster (Figs 19.4 and 19.5)
6. Parvovirus B19 (Figs 19.6A to D)
BACTERIAL INFECTIONS
7. Syphilis
8. Intra-amniotic Infection (Chorioamnionitis)
PARASITIC INFECTIONS
9. Toxoplasmosis (Figs 19.7 and 19.8)
INTERVENTIONAL ULTRASOUND IN CONGENITAL INFECTIONS
DIAGNOSIS
a. Amniocentesis
b. Cordocentesis
THERAPY
a. Intrauterine Transfusion
b. Aspiration of Ascites, Pericardial and Pleural Effusions; Tapping of Hydrocephalus and Placement of Shunt
c. In Utero Drug Therapy
DOPPLER ULTRASOUND IN CONGENITAL INFECTIONS
a. Evaluating Fetal Heart Disease
b. To Study the Evolution of Hydrops, to Determine the Need of Treatment and Assess the Response to Treatment
c. Prediction, Diagnosis and Management or IUGR
3-D ULTRASOUND IN CONGENITAL INFECTIONS
ANOMALIES DETECTED IN RELATION TO CONGENITAL INFECTION48
CONCLUSION
TWENTY:
Ultrasound Guided Procedures in Prenatal Diagnosis of Congenital TORCH Infections
PRENATAL DIAGNOSIS OF SPECIFIC INFECTION
TOXOPLASMOSIS
Amniotic Fluid
RUBELLA
CYTOMEGALOVIRUS
HERPES SIMPLEX
VARICELLA-ZOSTER
ULTRASOUND GUIDED PROCEDURES
AMNIOCENTESIS
CHORIONIC VILLUS SAMPLING (CVS)
TRANSCERVICAL CVS
TRANSABDOMINAL CVS
CORD BLOOD SAMPLING
Procedure
SECTION 4: CONSENSUS OPINION
TWENTY ONE:
Screening Guidelines for Intrauterine Infections during Pregnancy in Pregnant Women
TOXOPLASMOSIS
SCREENING RECOMMENDATION
CYTOMEGALOVIRUS
SCREENING RECOMMENDATION
RUBELLA
SCREENING RECOMMENDATION
GENITAL HERPES
SCREENING RECOMMENDATION
SYPHILIS
SCREENING RECOMMENDATION
HEPATITIS B VIRUS INFECTION
SCREENING RECOMMENDATION
TWENTY TWO:
Impact of Health Education and Counseling in Prevention of Congenital TORCH Infections
TOXOPLASMOSIS
TYPES OF PREVENTION OF TOXOPLASMOSIS
RUBELLA
CYTOMEGALOVIRUS (CMV)
PREVENTION
HERPES SIMPLEX
PREVENTION OF NEONATAL HERPES
GENERAL ISSUES IS PREVENTION OF TORCH INFECTIONS
RECOMMENDATIONS FOR EDUCATION AND HEALTH POLICY
GENERAL
SPECIFIC TO PARTICULAR ORGANISMS
SECTION 5: ILLUSTRATIVE CASES
Illustrative Cases—TORCH Infections
CASE 1
PROBLEM
ADVICE
COMMENT
CASE 2
PROBLEM
MANAGEMENT
COMMENT
CASE 3
COMMENT
CASE 4
COMMENT
CASE 5
COMMENT
CASE 6
COMMENT
CASE 7
COMMENT
CASE 8
COMMENT
CASE 9
MANAGEMENT
COMMENT
CASE 10
COMMENT
CASE 11
CASE 12
CASE 13
COMMENT
CASE 14
CASE 15
CASE 16
COMMENT
ADVISED
INDEX
TOC
Index
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