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| __NOTOC__ | | __NOTOC__ |
| {{CMG}} {{AE}} {{AKI}}
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| | {{Roseola}} |
| | {{CMG}}:{{AE}}{{DAMI}} |
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| ==Overview==
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| ==Historical Perspective== | | ==[[Roseola overview|Overview]]== |
| *In 1947, the first case of congenital varicella syndrome was reported.
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| ==Pathophysiology== | | ==[[Roseola historical perspective|Historical Perspective]]== |
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| ===Pathogenesis=== | | ==[[Roseola classification|Classification]]== |
| '''Primary infection during the period of gestation:'''
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| *Once a pregnant women has a primary varicella infection, transplacental transmission of the virus can take place affecting the fetus in utero.
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| *The risk of abortion is high when the infection in the fetus occurs before 20 weeks of gestation.
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| ==Epidemiology and Demographics== | | ==[[Roseola pathophysiology|Pathophysiology]]== |
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| ==Natural History, Prognosis and Complications== | | ==[[Roseola causes|Causes]]== |
| ===Prognosis===
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| Prognosis of infants with congenital varicella syndrome is poor. Infants die at a early age due to recurrent aspiration pneumonia and respiratory failure.
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| ===Complications=== | | ==[[Roseola differential diagnosis|Differentiating Any Disease from other Diseases]]== |
| *Fetal demise
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| *Intrauterine growth restriction
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| *Hydrops
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| *Limb deformities
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| *Microcephaly
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| ==Diagnosis== | | ==[[Roseola epidemiology and demographics|Epidemiology and Demographics]]== |
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| ===History and Symptoms=== | | ==[[Roseola risk factors|Risk Factors]]== |
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| ===Physical Examination=== | | ==[[Roseola screening|Screening]]== |
| Clinical manifestations suggestive of Congenital varicella syndrome include:
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| {| border="1"
| | ==[[Roseola natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| !'''Clinical Manifestations in congenital varicella syndrome'''
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| !'''Skin'''
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| *Cicatricial lesions
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| *Hypopigmentation
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| !'''Eye'''
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| *Chorioretinitis
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| *Cataracts
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| *Micropthalmia
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| *Anisocoria
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| !'''Central Nervous System'''
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| *Intrauterine encephalitis
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| *Cortical atrophy/porencephaly
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| *Seizures
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| *Mental retardation
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| *Autonomic instability
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| !'''Musculoskeletal system'''
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| *Limb hypoplasia
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| *Muscle hypoplasia
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| !'''Gastrointestinal'''
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| *Gastrointestinal reflux
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| !'''Systemic Manifestations'''
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| *Intrauterine growth retardation
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| *Developmental delay
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| !'''Urinary Tract'''
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| *Hydroureter
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| *Hydronephrosis
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| |}
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| ===Laboratory Findings=== | | ==Diagnosis== |
| '''Diagnosis of primary infection in the mother :''' In pregnant women diagnosis of a primary infection requires a combination of clinical manifestations and series of diagnostic tests. The tests are performed on the samples from the vesicular skin lesions and include the following:
| | [[Roseola history and symptoms|History and Symptoms]] | [[Roseola physical examination|Physical Examination]] | [[Roseola laboratory findings|Laboratory Findings]] | [[Roseola electrocardiogram|Electrocardiogram]] | [[Roseola chest x ray|Chest X Ray]] | [[Roseola CT|CT]] | [[Roseola MRI|MRI]] | [[Roseola echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Roseola other imaging findings|Other Imaging Findings]] | [[Roseola other diagnostic studies|Other Diagnostic Studies]] |
| *Culture of sampled skin lesion can be done, but results take 10 to 12 days.
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| *Direct fluroscent antigen staining with monoclonal antibodies detects the VZV glycoproteins in the cells from the skin lesion.
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| *PCR for the VZV
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| *Serological tests are not useful for the dectection of primary infection as it takes time for the IgG antibodies to be produced aganist VZV.
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| '''Prenatal Diagnosis'''
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| *Sequential ultrasound of the fetus is helpful to establish the presence of varicella infection and assess the severity of intrauterine infection.
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| *Amniocentesis should be performed 4 weeks after the primary infection in the mother, positive amniotic PCR for VZV can establish the presence of infection but does not provide information regarding the infection status and severity in the fetus.
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| ===Imaging Studies===
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| ====Ultrasound====
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| *Sequential ultrasound in during the period of gestation helps in identifying fetal anomalies as a result of varicella infection. Features suggestive of congenital varicella syndrome include limb deformities, microcephaly and hydrops. The following is a list of features that can be present in the fetus with varicella fetopathy.
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| **Cutaneous scars
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| **Musculoskeletal deformities include limb hypoplasia and contractures
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| **Cerebral anomalies include ventriculomegaly, microcephaly with polymicrogyria, and porencephaly
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| **Ocular anomalies include micropthalmia and congenital cataracts
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| **Intestinal and hepatic echogenic foci suggestive of the presence of liver calcifications
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| **Hydrops fetalis features such as skin edema, hepatosplenomegaly can be present
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| **Intrauterine growth restriction
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| **Polyhydramnios
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| ==Treatment== | | ==Treatment== |
| | [[Roseola medical therapy|Medical Therapy]] | [[Roseola surgery|Surgery]] | [[Roseola primary prevention|Primary Prevention]] | [[Roseola secondary prevention|Secondary Prevention]] | [[Roseola cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Roseola future or investigational therapies|Future or Investigational Therapies]] |
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| ===Medical Therapy=== | | ==Case Studies== |
| | | [[Roseola case study one|Case #1]] |
| ===Surgical Therapy===
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| ==Prevention==
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| ===Primary Prevention===
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| *In all pregnant women documentation of varicella infection in the past and the pre-conceptional vaccination should be be documented.
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| *If the pregnant women has no previous infection or is not vaccinated, VZV IgG antibody testing must be done to determine the maternal immune status. These patients must be counseled regarding the risks of varicella infection as vaccination aganist VZV is contraindicated during the pregnancy.
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| *Vaccination is the best preventive measure, women who are seronegative should recieve two doses of the vaccine during the postpartum period 4 to 8 weeks apart, without any effect on breast feeding.
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| *Women can also be vaccinated during the preconception period, but are adviced to avoid conceiving for a month after the last dose of the vaccine.
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| ===Secondary Prevention===
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| *In pregnant women with exposure to varicella, passive immunization with varicella zoster virus antibodies (VZV IgG) should be administered after 72-96hours of exposure. Passive immnuniaztion with immmunoglobulins decreases the risk of severe disease in the mother, but its efficacy in preventing the disease to the fetus is not established.
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| ==References==
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| {{reflist|2}}
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