Rubella virus Unimmunized seronegative mother; fever ± rash Detectable defects with infection: by 8 wk, 85% 9–12 wk, 50% 13–20 wk, 16% Virus may be present in infant’s throat for 1 yr Prevention: vaccine Intrauterine growth restriction, microcephaly, microphthalmia, cataracts, glaucoma, “salt and pepper” chorioretinitis, hepatosplenomegaly, jaundice, PDA, deafness, blueberry muffin rash, anemia, thrombocytopenia, leukopenia, metaphyseal lucencies, B-cell and T-cell deficiency Infant may be asymptomatic at birth
CMV Sexually transmitted disease: primary genital infection may be asymptomatic Heterophil-negative mononucleosis; infant may have viruria for 1–6 yr Sepsis, intrauterine growth restriction, chorioretinitis, microcephaly, periventricular calcifications, blueberry muffin rash, anemia, thrombocytopenia, neutropenia, hepatosplenomegaly, jaundice, deafness, pneumonia Many asymptomatic at birth Prevention: CMV-negative blood products Possible treatment: ganciclovir (syphilis) asymptomatic: painless “hidden” chancre Penicillin, not erythromycin, prevents fetal infection
Presentation at birth as nonimmune hydrops, prematurity, anemia, neutropenia, thrombocytopenia, pneumonia, hepatosplenomegaly Late neonatal as snuffles (rhinitis), rash, hepatosplenomegaly, condylomata lata, metaphysitis, cerebrospinal fluid pleocytosis, keratitis, periosteal new bone, lymphocytosis, hepatitis Late onset: teeth, eye, bone, skin, central nervous system, ear Treatment: penicillin
Parvovirus Etiology of fifth disease; fever, rash, arthralgia in Nonimmune hydrops, fetal anemia adults Treatment: in utero transfusion
Trypanosoma cruzi Central South American native, immigrant, travel Failure to thrive, heart failure, achalasia (Chagas disease) Chronic disease in mother Treatment: nifurtimox
AZT, Zidovudine (azidothymidine); BCG, bacille Calmette-Guerin; CMV, cytomegalovirus; HBIG, hepatitis B immune globulin; INH, isoniazid; PDA, patent ductus arteriosus; PPD, purified protein derivative; TB, tuberculosis; VZIG, varicella-zoster immune globulin.
With the widespread use of vaccination, congenital rubella is rare in developed countries. Acquired in utero during early gestation, rubella can cause severe neonatal consequences. The occurrence of congenital defects approaches 85% if infection is acquired during the first 4 weeks of gestation; close to 40% spontaneously abort or are stillborn. If infection occurs during weeks 13 to 16, 35% of infants can have abnormalities. Infection after 4 months’ gestation does not seem to cause disease.