Transcript Slide 1
Congenital Toxoplasmosis Congenital toxoplasmosis usually occurs when a woman acquires primary infection while pregnant. Most often, maternal infection is asymptomatic or without specific symptoms or signs. As with other adults with acute toxoplasmosis, lymphadenopathy is the most common symptom. Congenital infection may present as a mild or severe neonatal disease or with sequelae or relapse of a previously undiagnosed and untreated infection later in infancy or even later in life. There is a wide variety of manifestations of congenital infection, ranging from hydrops fetalis and perinatal death to small size for gestational age, prematurity, peripheral retinal scars, persistent jaundice, mild thrombocytopenia, cerebrospinal fluid (CSF) pleocytosis, and the characteristic triad of chorioretinitis, hydrocephalus, and cerebral calcifications. More than 50% of congenitally infected infants are considered normal in the perinatal period, but almost all such children develop ocular involvement later in life if they are not treated during infancy. Neurologic signs such as convulsions, setting-sun sign with downward gaze, and hydrocephalus with increased head circumference may be associated with or without substantial cerebral damage or with relatively mild inflammation obstructing the aqueduct of Sylvius. If affected infants are treated promptly, signs and symptoms may resolve and development may be normal. the most severe cases, including most of those individuals who died, were not referred. therapeutic abortion was often performed when acute acquired infection of the mother was diagnosed early during pregnancy. in utero spiramycin therapy may have diminished the severity of infection. Neonatal herpes is an uncommon but potentially fatal infection of the fetus or more likely the newborn. This increase in neonatal herpes cases parallels the increase in cases of genital herpes. More than 90% of the cases are the result of maternal-fetal transmission. The risk for transmission is greatest during a primary 1st infection (30-50%) and much lower when the exposure is during a recurrent infection (<2%). Infants born to mothers dually infected with HIV and HSV-2 are also at higher risk for acquiring HIV than infants born to HIV-positive mothers who are not HSV-2 infected. HSV is a leading cause of sporadic, fatal encephalitis in children and adults. In the USA it is estimated that there are 1,250 cases annually of HSV encephalitis. Postpartum transmission may be from the mother or another adult with a nongenital (typically HSV-1) infection such as herpes labialis. Most cases of neonatal herpes result from maternal infection and transmission, usually during passage through a contaminated infected birth canal of a mother with asymptomatic genital herpes. Transmission is well documented in infants delivered by cesarean section. Neonatal HSV infection is thought to never be asymptomatic. Its clinical presentation reflects timing of infection, portal of entry, and extent of spread. Infants with intrauterine infection typically have skin vesicles or scarring, eye findings including chorioretinitis and keratoconjunctivitis, and microcephaly or hydranencephaly that are present at delivery. Infants with encephalitis typically present at 8-17 days of life with clinical findings suggestive of bacterial meningitis, including irritability, lethargy, poor feeding, poor tone, and seizures. Fever is relatively uncommon, and skin vesicles occur in only about 60% of cases . If untreated, 50% of infants with HSV encephalitis die and most survivors have severe neurologic sequelae. Acyclovir Acyclovir is a safe and effective therapy for herpes simplex virus (HSV) infections. The greatest clinical roles for acyclovir are for the treatment of primary and recurrent genital HSV infections, the management of HSV encephalitis, and all manifestations of neonatal HSV infection.