TORCH infections and HIV/AIDS in newborn - diagnostic, treatment and prophylaxis. - PowerPoint PPT Presentation

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TORCH infections and HIV/AIDS in newborn - diagnostic, treatment and prophylaxis.

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... R=rubella C=cytomegalovirus (CMV) H=herpes ... 11 Treatment Rubella Clinical Manifestations 14 15 Diagnosis Cytomegalovirus ... – PowerPoint PPT presentation

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Title: TORCH infections and HIV/AIDS in newborn - diagnostic, treatment and prophylaxis.


1
TORCH infections and HIV/AIDS in newborn -
diagnostic, treatment and prophylaxis.
  • Prof. Pavlyshyn H.A.

2
Index of Suspicion
TORCH Infections
Ttoxoplasmosis Oother (syphilis) Rrubella Ccyt
omegalovirus (CMV) Hherpes simplex (HSV)
  • When do you think of TORCH infections?
  • IUGR infants
  • HSM
  • Thrombocytopenia
  • Unusual rash
  • Concerning maternal
  • history
  • Classic findings of any specific infection

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4
Toxoplasmosis
  • Caused by protozoan Toxoplasma gondii
  • Domestic cat is the definitive host with
    infections via
  • Ingestion of cysts (meats, garden products)
  • Contact with oocysts in feces
  • Much higher prevalence of infection in European
    countries (ie France, Greece)
  • Acute infection usually asymptomatic
  • 1/3 risk of fetal infection with primary maternal
    infection in pregnancy
  • Infection rate higher with infxn in 3rd trimester
  • Fetal death higher with infxn in 1st trimester

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Clinical Manifestations
  • Most (70-90) are asymptomatic at birth
  • Classic triad of symptoms
  • Chorioretinitis
  • Hydrocephalus
  • Intracranial calcifications
  • Other symptoms include fever, rash, HSM,
    microcephaly, seizures, jaundice,
    thrombocytopenia, lymphadenopathy
  • Initially asymptomatic infants are still at high
    risk of developing abnormalities, especially
    chorioretinitis

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Treatment
  • Symptomatic infants
  • Pyrimethamine (with leucovorin rescue) and
    sulfadiazine
  • Treatment for 12 months total
  • Asymptomatic infants
  • Course of same medications
  • Improved neurologic and developmental outcomes
    demonstrated (compared to untreated pts or those
    treated for only one month)

10
Syphilis Clinical Manifestations
  • Early congenital (typically 1st 5 weeks)
  • Cutaneous lesions (palms/soles)
  • HSM
  • Jaundice
  • Anemia
  • Snuffles
  • Periostitis and metaphysial dystrophy
  • Funisitis (umbilical cord vasculitis)
  • Late congenital
  • Frontal bossing
  • Short maxilla
  • High palatal arch
  • Hutchinson teeth
  • 8th nerve deafness
  • Saddle nose
  • Perioral fissures
  • Can be prevented with appropriate treatment

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Treatment
  • Penicillin G is THE drug of choice for ALL
    syphilis infections
  • Maternal treatment during pregnancy very
    effective (overall 98 success)
  • Treat newborn if
  • They meet CDC diagnostic criteria
  • Mom was treated lt4wks before delivery
  • Mom treated with non-PCN med
  • Maternal titers do not show adequate response
    (less than 4-fold decline)

13
Rubella Clinical Manifestations
  • Sensorineural hearing loss (50-75)
  • Cataracts and glaucoma (20-50)
  • Cardiac malformations (20-50)
  • Neurologic (10-20)
  • Others to include growth retardation, bone
    disease, HSM, thrombocytopenia, blueberry
    muffin lesions

14
  • Blueberry muffin spots representing
  • extramedullary hematopoesis

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Diagnosis
  • Maternal IgG may represent immunization or past
    infection - Useless!
  • Can isolate virus from nasal secretions
  • Less frequently from throat, blood, urine, CSF
  • Serologic testing
  • IgM recent postnatal or congenital infection
  • Rising monthly IgG titers suggest congenital
    infection
  • Diagnosis after 1 year of age difficult to
    establish

Treatment
  • Preventionimmunize, immunize, immunize!
  • Supportive care only with parent education

17
Cytomegalovirus (CMV)
  • 90 are asymptomatic at birth!
  • Up to 15 develop symptoms later, notably
    sensorineural hearing loss
  • Symptomatic infection
  • SGA, HSM, petechiae,
  • jaundice, chorioretinitis,
  • periventricular calcifications,
  • neurological deficits
  • gt80 develop long term
  • complications
  • Hearing loss,
  • vision impairment,
  • developmental delay

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  • Ventriculomegaly and calcifications of congenital
    CMV

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Diagnosis
  • Maternal IgG shows only past infection
  • Infection common this is useless
  • Viral isolation from urine or saliva in 1st
    3weeks of life
  • Afterwards may represent post-natal infection
  • Viral load and DNA copies can be assessed by PCR
  • Less useful for diagnosis, but helps in following
    viral activity in patient
  • Serologies not helpful given high antibody in
    population

22
PCR diagnostic
23
PCR diagnostic
24
Treatment
  • Ganciclovir x6wks in symptomatic infants
  • Studies show improvement or no progression of
    hearing loss at 6mos
  • No other outcomes evaluated (development, etc.)
  • Neutropenia often leads to cessation of therapy
  • Treatment currently not recommended in
    asymptomatic infants due to side effects
  • Area of active research to include use of
    valgancyclovir, treating asx patients, etc.

25
Clinical Manifestations
Herpes Simplex (HSV)
  • Most are asymptomatic at birth
  • 3 patterns of equal frequency with symptoms
    between birth and 4wks
  • Skin, eyes, mouth (SEM)
  • CNS disease
  • Disseminated disease (present earliest)
  • Initial manifestations very nonspecific with
  • skin lesions NOT necessarily present

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Diagnosis
  • Culture of maternal lesions if present at
    delivery
  • Cultures in infant
  • Skin lesions, oro/nasopharynx, eyes, urine,
    blood, rectum/stool, CSF
  • CSF PCR
  • Serologies again not helpful given high
    prevalence of HSV antibodies in population

Treatment
  • High dose acyclovir 60mg/kg/day divided q8hrs
  • X21days for disseminated, CNS disease
  • X14days for SEM
  • Ocular involvement requires topical therapy as
    well

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What is HIV?
  • Human immunodeficiency virus is the virus that
    causes AIDS.
  • The human immunodeficiency virus (HIV) infects
    cells of the immune system - (CD4) T cells,
    destroying or impairing their function.
  • Infection with the virus results in the
    progressive deterioration of the immune system,
    leading to "immune deficiency."
  • Infections associated with severe
    immunodeficiency are known as "opportunistic
    infections", because they take advantage of a
    weakened immune system.

30
Symptoms of HIV/AIDS in Children
  • CNS microcephaly
  • - progressive neurological deterioration
  • or spastic encephalopathy
  • - developmental delay/regression
  • - predisposition to CNS infections
  • Respiratory System
  • - Recurrent infections (pneumonia, sinusitis,
    otitis media)
  • - Tuberculosis
  • - Pneumocystis carinii pneumonia (PCP) or
    lymphoid interstitial pneumonitis (LIP)

31
Clinical Features
  • CVS cardiomyopathy with congestive cardiac
    failure
  • GIT- AIDS enteropathy (malabsorption, infections
    with various pathogens) leads to chronic
    diarrhoea resulting in failure to thrive
  • - Abdominal pains, dysphagia, chronic
    hepatitis, pancreatitis
  • Renal AIDS nephropathy the most common
    presentation being nephrotic syndrome
  • Skin Eczema, seborrheic dermatitis, candida
    infections, molluscum contagiosum, anogenital
    warts
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