CONGENITAL

INFECTION
Dr. Zurina Zainudin
Consultant Paediatrician & Neonatologist
Faculty of Medicine and Health Sciences
University Putra Malaysia
 Learning Outcome
✓ Describe the causative agents of
congenital infection
✓ Explain epidemiology, pathogenesis and
clinical manifestations and
complications of congenital infection
✓ Discuss clinical and laboratory diagnosis
of congenital infection
✓ Discuss principle of management of
congenital infection
 Definition
Congenital infections are infection
that are transmitted from mother to
child dur ing pregnancy
( t ra n s p l a c e n t a l l y ) o r d e l ive r y
(per ipartum)
* * i n c i d e n c e i s r a r e however it is linked to
adverse pregnancy outcome worldwide particularly
in resource-limited countries
 CMV, HSV, Parvovirus B19, Enteroviruses, Hepatitis
B virus,VZV, HIV, Rubella

Treponema pallidum, Mycobacterium tuberculosis,

Aetiological Salmonella typhosa, Listeria monocytogenes,
Campylobacter fetus, Borrelia burgdorferi
Agents for
Congenital
Candida albicans
Infection

Toxoplasma gondii, Plasmodium spp, Trypanosoma

cruzi
 CMV, HSV, Parvovirus B19, Enteroviruses, Hepatitis
B virus,VZV, HIV, Rubella

Aetiological Treponema pallidum, Mycobacterium tuberculosis,

Salmonella typhosa, Listeria monocytogenes,
Agents for Campylobacter fetus, Borrelia burgdorferi

Congenital
Candida albicans
Infection

Toxoplasma gondii, Plasmodium spp, Trypanosoma cruzi

 • Toxoplasma gondii
T
• Parvovirus B19, Hepatitis B virus,VZV, HIV, Zika virus,
O Listeria monocytogenes

• Rubella
R
• Cytomegalovirus
C
• Herpes simplex 2 (HSV 2)
He
• Treponema pallidum (syphilis)
S
MECHANISM OF
TRANSMISSON
 General
Mechanism of transmisson
manifestation:
Hematogenous
Fetal loss / Prematurity route
Small for gestational age
Hepatosplenomegaly
Rash
CNS manifestation
Thrombocytopenia
Jaundice
 Additionally, some of
the aetiological agent is
transmitted sexually
which allows it to
bypass the trophoblast
layer via ascending
infection of the
amniochorionic
membrane, amniotic
fluid predisposing the
baby to sepsis,
Ascending meningitis and
pneumonia.
infection
TOXOPLASMA GONDII
 Transplacental-fetal
hematogenous route

t ox o p l a s m o s i s

Acute infection – subclinical or mild non-

specific mononucleosis like illness (fever, rash,
malaise, fatigue, myalgia, lymphadenopathy or
splenomegaly)
Infection
15% 45% 70%
risk
80%
Severe (abortion-stillbirth or 50% RARELY RESULT IN
infection severe disease with SYMPTOMATIC FETAL DAMAGE
teratogenesis)
 organ Parvovirus
stage Torches effect Toxo Rubella CMV HSV VZV Syphilis
B19
Zika
system
IUGR X X X X
Size Microcephaly X X X X X
Hepatosplenomegaly X X X X X X X

Fluid Hydrocephalus X X X
accumulation Hydrops fetalis X X
periventric
Brain calcification Diffuse X X
ular
Bony abnormalities X X X X X
Cardiac abnormalities X
Myocarditis X X
Jaundice X X X X
Skin
Rash X Blueberry Blueberry X Vesicular Palms/soles X
Snuffles X
Hearing impairment X X X
Cataracts X X
Chorioretinitis X X X X
Cardiac abnormalities X
Myocarditis X X
 CLASSIC TRIAD
O F C O N G E N I TA L
TOX O P L A S M O S I S

Hydrocephalus, Cerebral
Calcification, Chor ioretinitis
Congenital Toxoplasmosis
Diagnosis
Cerebrospinal fluid examination and IgM
Serology test
Management
Pyrimethamine – sulfadiazine/Spiramycin
 Congenital Rubella
Infection
Rubella is an acute, contagious viral
infection. While rubella virus
infection usually causes a mild fever
and rash in children and adults,
infection during pregnancy,
especially during the first trimester,
can result in miscarriage, fetal death,
stillbirth, or infants with congenital
malformations, known as congenital
rubella syndrome (CRS).
 organ Parvovirus
stage Torches effect Toxo Rubella CMV HSV VZV Syphilis
B19
Zika
system
IUGR X X X X
Size Microcephaly X X X X X
Hepatosplenomegaly X X X X X X X

Fluid Hydrocephalus X X X
accumulation Hydrops fetalis X X
periventric
Brain calcification Diffuse X X
ular
Bony abnormalities X X X X X
Cardiac abnormalities X
Myocarditis X X
Jaundice X X X X
Skin
Rash X Blueberry Blueberry X Vesicular Palms/soles X
Snuffles X
Hearing impairment X X X
Cataracts X X
Chorioretinitis X X X X
Cardiac abnormalities X
Myocarditis X X
Classic TRIAD
of Congenital
Rubella
S y n d ro m e

Cataract,
C a r d i a c A b n o r m a l i t y,
Sensor ineural
deafness
 Fo l l ow i n g t h e i n t ro d u c t i o n o f r u b e l l a va c c i n e, t h e
incidence of congenital r ubella syndrome is eliminated
in at least 5 who reg ion
 Congenital CMV infection
• Most common intrauterine infection worldwide
• Majority (85% - 90%) of cases – asymptomatic
• Symptomatic congenital disease occurs most often after primary
maternal infection in pregnancy.
 Risk of transmission
Primary infection 30 – 40% 40 - 70%
Non primary
< 3%
infection

The risk of
complications to
the fetus is
greatest if a
primary infection
occurs during the
first trimester.
 organ Parvovirus
stage Torches effect Toxo Rubella CMV HSV VZV Syphilis
B19
Zika
system
IUGR X X X X
Size Microcephaly X X X X X
Hepatosplenomegaly X X X X X X X

Fluid Hydrocephalus X X X
accumulation Hydrops fetalis X X
periventric
Brain calcification Diffuse X X
ular
Bony abnormalities X X X X X
Cardiac abnormalities X
Myocarditis X X
Jaundice X X X X
Skin
Rash X Blueberry Blueberry X Vesicular Palms/soles X
Snuffles X
Hearing impairment X X X
Cataracts X X
Chorioretinitis X X X X
Cardiac abnormalities X
Myocarditis X X
Cla ssic Fea tures Of
Congenital CMV

Microcephaly

Per iventr i cul a r

calcification
 Diagnosis
detection of CMV DNA in the
urine, saliva (preferred specimens), or
blood, within three weeks after birth

Management
Ganciclovir
 Congenital syphilis results from the
transplacental, hematogenous spread of
Treponema pallidum from the mother
to the fetus. Congenital syphilis occurs
when a child is born to a mother with
secondary or tertiary syphilis. The risk
for fetal infection is greatest in the early
stages of untreated maternal syphilis

CONGENITAL
SYPHILIS
 Manifestation

The child often has rhinitis,

hepatosplenomegaly, hemolytic
anemia, jaundice, and
pseudoparalysis (i.e., immobility of
one or more extremities) as a result
of painful osteochondritis.
CONGENITAL
SYPHILIS

Typical desquamating skin lesions of both

palms and soles and punched out, pale,
blistered lesions mainly on ears and nasal
bridge
 CONGENITAL SYPHILIS
D I AG N OS I S M A N AG E ME NT
• Antenatal • Penicillin
• Maternal serology testing
(VDRL)
* Untreated increased risk of neonatal
death
• Postnatal
• Serologic testing
• CSF analysis and VDRL
Congenital Varicella
Syndrome

An extremely rare disorder in which

affected infants have distinctive
abnormalities at birth (congenital) due
to the mother’s infection with
chickenpox (maternal varicella zoster)
early during pregnancy (i.e., up to 20
weeks gestation).
 organ Parvovirus
stage Torches effect Toxo Rubella CMV HSV VZV Syphilis
B19
Zika
system
IUGR X X X X
Size Microcephaly X X X X X
Hepatosplenomegaly X X X X X X X

Fluid Hydrocephalus X X X
accumulation Hydrops fetalis X X
periventric
Brain calcification Diffuse X X
ular
Bony abnormalities X X X X X
Cardiac abnormalities X
Myocarditis X X
Jaundice X X X X
Skin
Rash X Blueberry Blueberry X Vesicular Palms/soles X
Snuffles X
Hearing impairment X X X
Cataracts X X
Chorioretinitis X X X X
Cardiac abnormalities X
Myocarditis X X
C O N G E N I TA L VA R I C E L L A Z O S T E R
Cicatr icial lesion
Listeria monocytogenes
Raw, unpasteurized DAIRY PRODUCTS (milks and
cheeses, ice cream)
Raw or processed VEGETABLES AND FRUITS,
Raw or undercooked POULTRY, SAUSAGES,
HOT DOGS, DELI MEATS
Raw or smoked FISH AND OTHER SEAFOOD
Symptoms of
Listeriosis

Asymptomatic
Fever
Headache
Dizziness
Nausea/Vomiting
Diarrhea
Lethargy/Muscle ache
 Listeria and the unborn
baby
Listeria can infect the placenta or the
amniotic fluid and result in miscarriage,
stillbirth or preterm birth (babies born
before 37 weeks). Premature babies are at
risk of multiorgans complication result
in higher morbidity and mortality.
Classical presentation is premature baby
with meconium stained amniotic fluid.
PA RVOV I RU S B 1 9
Parvovirus B19 infection in
pregnancy