Medical Fun Facts Episode 68: Congenital infections

It’s Monday 29 May 2017.

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Tonight, I’m talking about congenital infections

What is a congenital infection? What causes them? How are they diagnosed? How are they treated?

Congenital infections affect the fetus and neonate.

They’re often caused by viruses but bacteria and some parasites can also cause congenital infections.

The infection can occur at any period during a pregnancy.

The best described infections are caused by:

Parasites like Toxoplasma gondii

Some spirochætes infections like Treponema pallidum subsp. pallidum and Leptospira species

Viruses like Rubella virus, Zika virus, Cytomegalovirus, Herpes simplex virus, Varicella zoster virus, Parvovirus, and Hepatitis B virus to name the common ones.

In addition, Hepatitis C virus and Human immunodeficiency virus can also infect the fetus.

Clinically, congenital infections can cause many different types of signs and symptoms.

In general, congenital infections can cause babies to be small for their gestational age and some can be responsible for spontaneous abortion or intrauterine fetal death

Most body systems and organ systems can also be affected

Common examples include infection and inflammation of the heart muscle, pneumonitis of the lungs, enlargement of the liver and spleen with jaundice, hæmolytic anæmia, skin rashes, a small brain, hydrocephaly or water on the brain, infection of the brain and meninges, infection of the back of the eye, infection of the front of the eye with cataract formation and glaucoma.

The diagnosis of congenital infections can be complicated and for some of the causative microorganisms, it’s important to test the pregnant patient as a precaution as part of a screening protocol.

Screening before 20 weeks is generally recommended for rubella, Hepatitis B infection, Hepatitis C infection, HIV infection, and syphilis.

In woman with risk behaviour, a second syphilis test should be considered later in the pregnancy along with tests for gonorrhoea, and Chlamydia infection. Depending on the risk profile testing for Cytomegalovirus infection, toxoplasmosis and Zika virus infection may be warranted.

Treatment of congenital infections is mostly possible for bacterial infections like syphilis. For most of the viral causes, there are no readily available treatments and expectant mothers can have a tough time along with their obstetricians in understanding the severity of infection and the possible outcomes.

The recent revelation that Zika virus infection can cause fetal malformations in congenital infections has reignited interest in this field of endeavour.

Closer to home there is a growing interest in the role of Cytomegalovirus in congenital infection.

It would be unethical for a podcast to presume to give advice on how to handle individual circumstances.

What’s critical is ensuring expectant mothers have a good relationship with their obstetrician and the obstetrician has a good working relationship with specialist microbiologists and infectious diseases physicians with an interest in fetal and early childhood infections.

We now live in an era where so much can be done in medicine and while poor outcomes still exist, more options are now available. If you’re expecting a baby and worried about congenital infections, you need to speak with your attending medical practitioner. Some midwives also have a good knowledge-base, but when it comes to the specifics, I recommend ensuring a medical specialist with microbiology and infectious diseases knowledge is involved.

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Medical Fun Facts Episode 68: Congenital Infections

Medical Fun Facts Episode 68: Congenital Infections