Micro - 4th Asessment - Intrauterine And Perinatal Viral Infections - 2007
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Intrauterine and Perinatal Viral Infections
Fourth Medical, 2007 Prof. Widad Al-Nakib, FRCPath.
Congenital and Prenatal Infections Time of infection Prenatal (transplacental)
Virus
Disease
Rubella Cytomegalovirus Varicella
Congenital rubella syndrome Cytomegalic inclusion disease Congenital varicella
Intrapartum
Herpes simplex Coxsackie B Varicella Cytomegalovirus
Herpes neonatorum Myocarditis of newborn Disseminated varicella-zoster Subclinical or pneumonia
Postnatal
Hepatitis B HIV-1, HIV-2 HTLV-1
Hepatitis B carrier state AIDS Subclinical or leukemia
syndrome
Modes of Intrauterine and Perinatal Viral Infections Virus Rubella Cytomagalovirus Herpes simplex Varicella-zoster Parvovirus Enterovirus Human immunodeficiency virus Hepatitis B Human papillomaviruses
Transplacental
During birth
Shortly after birth
++ + + ++ ++ +(late)
– ++ ++ + – ++
– ++ (BM) + + – ++
+
++
+ (BM)
+ _
++ ++
++ –
Most frequent physical signs of severe congenital rubella, cytomegalic inclusion disease, herpes simplex, and toxoplasmosis Defects
Expanded rubella syndrome
Cytomegalic inclusion disease
Low birth weight
+
+
Hepatosplenomegaly
+
+
Thrombocytopenia, petechiae, purpura
+
+
Skin vesicle Microcephaly
Generalized herpes simplex
+ +
+
+ +
Intracranial calcifications
+ +
+
Hydrocephalus
+
Meningitis, encephalitis
+
Pneumonitis
+
Cataracts
+
Choriodoretinitis
+
Patent ductus arteriosis, lesions of pulmonary artery and aorta
+
Bone defects
+
Sensorineural deafness, speech defects, mental retardation
+
Insulin-dependent diabetes mellitus
Toxoplasmosis
+
+
+
Congenital Rubella Cataract
Hemorrhagic Rash in Congenital Rubella
Rash in Congenital Rubella
Hepatosplenomegaly in Congenital CMV
“Blueberry Muffin” Lesions
Chickenpox in a Newborn
Laboratory Diagnosis 1) Virus-Specific IgM- in Cord and /or Neonatal Blood • Cytomegalovirus (CMV) • Rubella virus • Herpes simplex virus (HSV) • Parvovirus B19
Serologic Profile of Intrauterine Viral Infections
Laboratory Diagnosis 2) Electron Microscopy (EM)Vesicular fluids • Herpes simplex virus (HSV) • Varicella –zoster virus (VZV) Show typical herpes virus particles
Laboratory Diagnosis 3) PCR- In Blood (and vesicular fluids in HSV & VZV infections) • HIV • HBV • CMV • HSV • VZV • Enterovirus • HTLV • Papilloma virus
Laboratory Diagnosis 4) Antibody and Antigen Detection- In Neonatal Blood • HIV • HBV
Management • • • •
HSV & VZV- Acyclovir CMV- ?Ganciclovir HIV- AZT HBV- Specific Immunoglobulins / Vaccination
Measles, Mumps, Rubella (MMR) Vaccine • Contains live, attenuated virus • 12 months is recommended and minimum age for MMR (younger in some countries) • If child younger than 9 months, maternal antibody may interfere • Revaccinate in 6 months to 5 years (school entry age)
Fourth Medical, 2007 Prof. Widad Al-Nakib, FRCPath.
Congenital and Prenatal Infections Time of infection Prenatal (transplacental)
Virus
Disease
Rubella Cytomegalovirus Varicella
Congenital rubella syndrome Cytomegalic inclusion disease Congenital varicella
Intrapartum
Herpes simplex Coxsackie B Varicella Cytomegalovirus
Herpes neonatorum Myocarditis of newborn Disseminated varicella-zoster Subclinical or pneumonia
Postnatal
Hepatitis B HIV-1, HIV-2 HTLV-1
Hepatitis B carrier state AIDS Subclinical or leukemia
syndrome
Modes of Intrauterine and Perinatal Viral Infections Virus Rubella Cytomagalovirus Herpes simplex Varicella-zoster Parvovirus Enterovirus Human immunodeficiency virus Hepatitis B Human papillomaviruses
Transplacental
During birth
Shortly after birth
++ + + ++ ++ +(late)
– ++ ++ + – ++
– ++ (BM) + + – ++
+
++
+ (BM)
+ _
++ ++
++ –
Most frequent physical signs of severe congenital rubella, cytomegalic inclusion disease, herpes simplex, and toxoplasmosis Defects
Expanded rubella syndrome
Cytomegalic inclusion disease
Low birth weight
+
+
Hepatosplenomegaly
+
+
Thrombocytopenia, petechiae, purpura
+
+
Skin vesicle Microcephaly
Generalized herpes simplex
+ +
+
+ +
Intracranial calcifications
+ +
+
Hydrocephalus
+
Meningitis, encephalitis
+
Pneumonitis
+
Cataracts
+
Choriodoretinitis
+
Patent ductus arteriosis, lesions of pulmonary artery and aorta
+
Bone defects
+
Sensorineural deafness, speech defects, mental retardation
+
Insulin-dependent diabetes mellitus
Toxoplasmosis
+
+
+
Congenital Rubella Cataract
Hemorrhagic Rash in Congenital Rubella
Rash in Congenital Rubella
Hepatosplenomegaly in Congenital CMV
“Blueberry Muffin” Lesions
Chickenpox in a Newborn
Laboratory Diagnosis 1) Virus-Specific IgM- in Cord and /or Neonatal Blood • Cytomegalovirus (CMV) • Rubella virus • Herpes simplex virus (HSV) • Parvovirus B19
Serologic Profile of Intrauterine Viral Infections
Laboratory Diagnosis 2) Electron Microscopy (EM)Vesicular fluids • Herpes simplex virus (HSV) • Varicella –zoster virus (VZV) Show typical herpes virus particles
Laboratory Diagnosis 3) PCR- In Blood (and vesicular fluids in HSV & VZV infections) • HIV • HBV • CMV • HSV • VZV • Enterovirus • HTLV • Papilloma virus
Laboratory Diagnosis 4) Antibody and Antigen Detection- In Neonatal Blood • HIV • HBV
Management • • • •
HSV & VZV- Acyclovir CMV- ?Ganciclovir HIV- AZT HBV- Specific Immunoglobulins / Vaccination
Measles, Mumps, Rubella (MMR) Vaccine • Contains live, attenuated virus • 12 months is recommended and minimum age for MMR (younger in some countries) • If child younger than 9 months, maternal antibody may interfere • Revaccinate in 6 months to 5 years (school entry age)
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