Congenital Infections: Risks, Impact, and Prevention

Congenital infections are infections that are vertically transmitted from mother to fetus during pregnancy, birth, or breastfeeding. These infections are responsible for perinatal morbidity and mortality. These infections are Toxoplasmosis, HIV, Hepatitis B, Syphilis, and CMV.

1. Congenital Toxoplasmosis
   • It occurs in a baby when the mother acquires a primary toxoplasma infection during pregnancy.
   • The chances of the fetus getting this infection increases with each trimester of pregnancy. The third-trimester infection has a 60% chance of getting past the placenta.
   • However, the severity of fetal infection is greater, if the fetus is affected early in pregnancy.
   • The clinical features are:
     • Chorioretinitis
     • Hydrocephalus
     • Cerebral calcification can be detected by a noncontrast CT head.
     • Small for gestational age baby.
     • Prematurity
     • Hydrops fetalis
     • Persistence jaundice
     • Low platelets.
   • Treatment
     • It is very important to diagnose the infection early and the treatment to the mother provided is Sulfadiazine.
2. Congenital Tuberculosis
   • It is very important to note that in congenital tuberculosis, the primary lesion or Ghon focus is in the liver.
   • The most common mode of transmission to the baby is through the mother. Even postnatally, the disease can spread to the baby via aerosol transmission.
   • Clinical features
     • Hepatomegaly
     • Conjugated hyperbilirubinemia
     • Pulmonary involvement may or may not be present.
     • Disseminated tuberculosis if the situation becomes severe.
3. Congenital Syphilis
   • It is caused by a microbe called Treponema pallidum.
   • The mode of transmission is mainly transplacental during pregnancy. However during birth, if there is contact with the infectious lesion, it can lead to transmission to the baby.
   • Transmission during the early stages of pregnancy can lead to the following problems:
     • Stillbirths
     • Fetus loss
     • Low birth weight
     •  Natural death
     • Prematurity
   • Early signs of congenital syphilis are:
     • Hepatosplenomegaly and jaundice
     • Diffuse lymphadenopathy
     • Painful osteochondritis and periostitis can lead to pseudo-paralysis.
     • Skin lesions like mucocutaneous erythematous maculopapular or vesicular bullous lesions. These involve the head and feet. These vascular lesions are followed by desquamation.
   • Late signs of congenital syphilis are:
     • Prominent Forehead also called Olympian brow.
     • Saddle nose
     • Hutchinson’s triad consists of Hutchinson’s teeth, interstitial keratitis, and sensory neural deafness.
     • Thickening of the medial 1/3 of the sternal end of the clavicle is also called Higoumenaki’s sign.
     • Clutton joints involving the knee. This is a painless situation.
     • Anterior bowing of the tibia also called Sabre shins.
   • Prevention
     • There should be prenatal screening for syphilis by VDRL test for every mother.
     • Proper screening for lesions should be done.
     • In untreated cases, there is a 100% chance of transmission.
4. Congenital Rubella
   • The risk of transmission of infection and frequency of congenital infection is high before 11 weeks of gestation.
   • The clinical features are:
     • Sensory neural hearing loss or deafness.
     • Congenital bilateral cataract
     • Congenital heart diseases like patent ductus arteriosus, atrial septal defect, and VSD.
     • There is the development of bluish-red nodular lesions called blueberry muffin lesions which is a characteristic feature of congenital rubella.
     • Microcephaly and intrauterine growth retardation.
     • Glaucoma
     • Splenomegaly
     • Jaundice
     • Congenital CMV infection
     • There is no importance of routine screening because 90% of infected babies with congenital cytomegalovirus infection are asymptomatic.
   • Clinical Features are:
     • Chorioretinitis
     • Microcephaly
     • Splenomegaly
     • Jaundice
     • The most important long-term effect of congenital CMV infection is sensory neural hearing loss
   • Diagnosis
     • Within the first 3-4 weeks, viruses should be demonstrated in any of these samples from the baby.
     • The best sample is a urine sample and the virus should be grown using PCR and viral culture.
     • The IgM antibody can also provide some indirect clue about whether the baby is infected or not.
   • Treatment
     •  Gancyclovir is given to symptomatic patients.
5. Congenital Varicella Infection
   • It is a congenital infection that has more chances of getting spread in 2^nd trimester.
   • Clinical features of Congenital Varicella Infection
     • imb hypoplasia
     • Low birth weight
     • Cicatricial scarring
     • CNS involvement: microcephaly, developmental delay, intellectual disability, and seizures
     • The eyes of the baby can also get involved leading to cataracts, Chorioretinitis, and Microstia.
     • If the kidneys of the patient are involved that can lead to hydronephrosis.
     • The patient can develop features of autonomic dysfunction. These symptoms are difficulty in swallowing and neurogenic bladder.
   • Diagnosis of Congenital Varicella Infection
     • Mother with a history of varicella infection during pregnancy.
     • The clinical features of the baby suggestive of congenital varicella infection.
     • Increase in anti-varicella IgM antibodies in a baby.

Also Read: Bed Wetting: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

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