You are on page 1of 64

081904186380

smdnygy@gmail.com
WA 087738843377
Sumadiono

- Staf Dept IKA FK UGM

- Ketua IDAI Cabang DIY


- Komisi Evaluasi Kolegium IKA
- Ketua Peralmuni Cabang DIY

- Ketua UKK Alergi 2009-2011 & 2012-2014

- Anggota APAPARI Board


(Asa Pasific Ascociation of Pediatric Allergy,
Respirology and Immunology)
CONGENITAL TORCH
INFECTION

Sumadiono
TORCH INFECTION IN PREGNANT WOMEN and
THE CONSEQUENCIES
Infections Abortus/ Prem. SGA. Anom. Acute dis. Disease
After birth Persistent
Stillbirth

Toksoplasmpsis + + + + + +

Rubella + + + + - +

Cytomegalovirus + + + + + +

Herpes simpleks + + + + + +

Sifilis + + + + + +
In raw meat

From vegetables,
A. Hydrocephalus
A. Hydrocephalus followingfirst-trimester
following first-trimester : Dilated laterallateral
: Dilated ventricles were foundwere
ventricles
during a fetal ultrasonographic survey for a small fetal size for the
found estimatedgestational
during a fetal ultrasonographic
age of 26 weeks. survey for a small fetal size for
the B.
estimatedgestational age of 26
At birth the infant had monocular weeks.
micro-ophthalmia, chorioretinitis, and
blindness,
B. At birth in addition
the infant had to massive hydrocephalus.
monocular micro-ophthalmia, chorioretinitis,
and blindness, in addition to massive hydrocephalus.
C. Brain computed tomographic scan showing small, calcified
lesions.
D. Necrotic lesion adjacentto the lateral ventricle in an infant who
C. Brain computed tomographic scan showing small, calcified lesions.
died from causes
D. Necrotic lesion adjacentto the lateral ventricle in an infant who died from
unrelated
causes to Toxoplasma infection. Toxoplasma tissue cysts
wereidentified into Toxoplasma infection. Toxoplasma tissue cysts wereidentified
unrelated
in
microscopic sections through the lesion.
T US
FE
N T
A
IN F
Rehabilitasi

Toxoplasmosis Okular Deafness


Operative Hearing aid
Stimulasi penglihatan

Mental retardation
Physiotherapy, stimulation, special education, and training
Primary Maternal Primary Maternal
Infection (IgM Antibodi Infection (IgM Antibodi
Rubella) Rubella)

Viremia Viremia Tidak


Maternal Sangat Jarang ada Defek muncul
Viremia
( +) dikemudian hari
I gM
INFEKSI
Abortus Spontan/ Bayi atau
Lahir mati JANIN lahir
normal IgM(-)
Normal

Malformasi Penyakit yg
Cacat & timbul kemudian
penyakit & BBL
Perjalanan Penyakit & Status Imunologi Rubella Kongenital

Rubell
a + + + + + + + - - - -
Virus
infecti
on Maternal IgM IgG
IgG

IgM

1st 2nd 3rd 1 2 3 6 1 2 3

TrimesterBirth Months Age (Years)


CONGENITAL RUBELLA SYNDROME
(CRS)/SRK DIAGNOSIS CRITERIA

1. CRS CONFIRMED:
- Defects present
- & one or more of the following:
a. Rubella virus isolated
b. Rubella-specific immunoglobulin M (IgM) present
c. Infants rubella IgG antibody titer persists above & beyond &
expected from passive transfer of maternal antibody
2.CRS COMPATIBLE laboratory data
insufficient for the confirmation & any two
complications found in list A, or one in A & B.
a.Cataracs & congenital glaucoma (either or
both count as one), congenital heart
disease, loss of hearing, pigmentary
retinophaty)
b.Purpura, splenomegaly, jaundice,
microcephaly, mental retardation,
meningoencephalitis, radiolucent bone
disease.
3.CRS POSSIBLE Some compatible clinical
findings that do not fulfill the criteria for a
compatible case.
4.CONGENITAL RUBELLA INFECTION ONLYNo
defect present but laboratory evidence of
infection.
5.STILL BIRTHSStillbirths which are thought to
be secondary to maternal rubella infection

6.NOT CRS one or more of any of the following


inconsistent laboratory findings in child without
evidence of an immune deficiency disease
a.Rubella HI (hemagglutination inhibition) titer
absent in a child 24 months or less
b.Rubella HI titer absent in mother
c.Rubella HI titer decline in an infant consistent
with the normal decline of passively
transferred maternal antibody after birth
Gambaran klinis rubela aquisita
CMV INFECTIONS OR INCLUSION
DISEASE
IN CHILDREN
Can affect many organs.
Universal all geographic location
all socioeconomic groups , mostly low soc. Ec. Cond.

Infects 50-80% adults < years in USA the virus remains alive
Transmitted to a fetus

Recently, the incidence of CMV infections in infants & children has


been increasing
Manifestations range from slight to severe & oftenly fatal
Clinical manifestation of CMV Infection in infants &
children at Dr. Sardjito Hospital
Clinical sign N : 72 %
Prolonged fever 15 20,8
Hydrosephaly 16 22,2
Microsephaly 6 8,3
Anemia 10 13,9
Prolonged jaundice 5 6,9
Convulsion 11 15,3
Hepatomegali 5 6,9
Respiratory disturbances 2 2,8
Khorioretinitis 3 4,2
Letargis 8 11,1
Mental retardation 10 13,9
Psychomotor abn. Development 18 25,0
Speech problems 10 13,9
Deafness 4 5,6
Splenomegali 1 1,4
Pencegahan Inf. CMV pd bayi & anak
Pencegahan inf. Pd ibu hamil dg menjaga kebersihan
diri & lingkungan.
Hindari kontak dg penderita CMV akut/aktif
Pemberian infus & transfusi yg bebas CMV
Skrining TORCH bagi ibu sebelum & atau sesudah
hamil
Vaksinasi bila ada
CLINICAL
EXAMINATION
IN NEONATES
Breech
presentation

Hydrocephal
us
Feto-fetal tranfusion
syndrome
Bronze baby
syndrome
Growth retardation Harlequin
Discordant
twins
Cytomegalovirus
Multiple purpura Cranial CT scan
Hepatosplenomeg - Hydrocephalus
aly - Periventricular calcification
Miliaria

Cutis marmorata
Birth Trauma

Laceration post VE Laceration post SC


Cephalohematoma

Caput succedaneum
Facial Appearance

Pre term baby Post term baby


Facial Appearance
SGA

Infant of diabetic
mother :
macrosomia
Hypoplastic auricle

Low-set ear

Microtia
Physical Examination at the Neonatal Ward
Mouth

Symmetry
Size
Cleft (Labio-palatoschizis)

Teeth
Ranula
Cyst (Epstein,s pearls)

Oral thrush
Oral thrush

Labio-palatoschizis
Macrogloss
ia

True teeth with


roots
Goiter :
Ectopic thyroid
iodine deficiency
Umbilical hernia

Omphalocel
e
Micropenis

Undescensus testis
Ambiguous genitalia
Male (XY) Female (XX)
Testes in Clitoral enlargement
labioscrotal fold
Anal atresia
Rectovaginal
fistula

Dermatitis
Thumb
hypoplasia
Polydactil
y
Sindactily
Post-Term
Long nails, peeling
skin Simian crease
Clubbing of
fingers Sepsis
SCLEREMA

Talipes
equinovarus
Reflex
Grasp
Reflex
Plantar grasp Reflex
Rooting Reflex
Moro Reflex
Paralysis

Seventh nerve Erb palsy


palsy ; unilateral
facial paralysis
Meningoc Meningoensephalocele
el