Sandbox: Reddy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Historical Perspective
- In 1947, the first case of congenital varicella syndrome was reported.
Pathophysiology
Pathogenesis
- Once a pregnant women has a primary varicella infection, transplacental transmission of the virus can take place affecting the fetus in utero.
- The risk of abortion is high when the infection in the fetus occurs before 20 weeks of gestation.
Genetics
Gross Pathology
Microscopic Pathology
Epidemiology and Demographics
Natural History, Prognosis and Complications
Prognosis
Prognosis of infants with congenital varicella syndrome is poor, early death is due to gastroesophageal reflux and recurrent aspiration pneumonia and respiratory failure.
Complications
- Fetal demise
- Intrauterine growth restriction
- Hydrops
- Limb deformities
- Microcephaly
Diagnosis
History and Symptoms
Physical Examination
Clinical manifestations suggestive of Congenital varicella syndrome include:
Clinical Manifestations in congenital varicella syndrome | |
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Skin |
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Eye |
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Central Nervous System |
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Musculoskeletal system |
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Gastrointestinal |
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Systemic Manifestations |
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Urinary Tract |
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Laboratory Findings
Imaging Studies
Treatment
Medical Therapy
Surgical Therapy
Prevention
Primary Prevention
- In all pregnant women documentation of varicella infection in the past and the pre-conceptional vaccination should be be documented.
- 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.
- 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.
- 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.
Secondary Prevention
- 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.