Infectious diseases

DR.TARIG MAHMOUDMD SUDAN

HAIL UNIVERSITY

Infectious disease can cause congenital abnormalities ,increase risk of pregnancy loss and preterm birth and can lead to serious neonatal consequences.

Rubella:

is a togavirus spread by droplet transmission.

All women should be offered rubella screening early in their pregnancy, women who are antibody is not detected, rubella vaccination after pregnancy should be advised.

Vaccination during pregnancy is contra -indicated

Clinical features:a febrile rash but may be asymptomatic

in the mother in 20–50 per cent of cases.Features of congenital rubella syndrome

include 1)sensorineural deafness.2)congenital cataracts.3)blindness. 4)encephalitis .5)endocrine problems.

Management:If infection occurred prior to 16 weeks

gestation, termination of pregnancy should be offered.

If the infection occurs later in pregnancy the woman should be given appropriate information and reassured.

Toxoplasmosis:

Toxoplasma gondii is a protozoan parasite found in cat faeces, soil or uncooked meat.

Infection occurs by ingestion of the parasite from undercooked meat or from unwashed hands.

Clinical features:

Severely infected infants may have: 1)ventriculomegaly .

2)Microcephaly. 3) chorioretinitis. 4)cerebral calcifi cation.

Management:

The diagnosis of primary infection with toxoplasmosis during pregnancy is made by the Sabin-Feldman dye test .

Spiramycin treatment can be used in pregnancy(a 3-week course of 2–3 g per day).

Cytomegalovirus:

Cytomegalovirus (CMV) is a DNA herpes virus.

transmitted by respiratory droplet and is excreted in the urine.

about 60 per cent of women are already immune and the incidence of infection in pregnancy is estimated to be around 1–2 per cent

Clinical features:No symptoms or mild non-specific flu-

like symptoms in the mother.The diagnosis is made after

abnormalities are seen in the fetus on U/S. The main features seen in an affected fetus are FGR, microcephaly, ventriculomegaly, ascites or hydrops.

Or after delivery blindness, deafness or developmental delay.

The neonate can also be anaemic and thrombocytopenic,with hepatosplenomegaly, jaundice and a purpural rash.

Management:diagnosis made by demonstrating CMV

antibodies in a seronegative woman, who initially develops CMV IgM antibody, and subsequently IgG antibody.

If there is a suspicion that the fetus may be

infected, amniotic fluid can be tested.If abnormalities are detected on

ultrasound and these are felt to be due to congenital CMV infection, termination of pregnancy should be offered.

Chickenpox:is caused by the varicella zoster virus

(VZV), a herpes virus which is transmitted by droplet spread.

About 90% of adults are immune to chickenpox and approximately one in 200 women will contract chickenpox during their pregnancy.

Clinical features:pregnant women are more vulnerable to

chickenpox and may develop a serious pneumonia,hepatitis or encephalitis.

It may also cause the fetal varicella syndrome (FVS) or varicella infection of the newborn.

FVS is characterized by one or more of the following:

1) skin scarring in a dermatomal distribution;2) eye defects (microphthalmia,

chorioretinitis, cataracts).3) hypoplasia of the limbs.4) neurological abnormalities (microcephaly,

cortical atrophy, developmental delay

&dysfunction of bowel and bladder sphincters).

Management:If the pregnant woman is not immune to

VZV and she has had a significant exposure, she should be given varicella zoster immuno -globulin (VZIG) as soon as possible.

VZIG is effective when given up to 10 days after contact and may prevent or attenuate the disease.

Women who have had exposure to chickenpox should be asked to notify their doctor early if a rash develops.

oral aciclovir 800 mg five time per day for 7 days be prescribed for pregnant women with chickenpox if they present within 24 hours of the onset of the rash.

ParvovirusParvovirus is a relatively common

infection inpregnancy, and is spread by droplet

infection.Fifty per cent of women at childbearing

age are immune to PVB19 infection and therefore 50 per cent are susceptible to infection during pregnancy

Clinical features:

mild flu-like illness.

Hydrops fetalis on U/S due to fetal an aplastic anaemia.

Managementdiagnosis is made by demonstrating sero

-conversion of the mother, who develops IgM antibodies to parvovirus, having previously tested negative.

A hydropic fetus may recover spontaneously as the mother and fetus recover from the virus, or may require treatment by in utero transfusion.

Listeria Listeria monocytogenes is an aerobic

and facultatively anaerobic motile Gram-positive bacillus.

The incidence of listeria infection in pregnant women is estimated at 12 per 100 000.

Contaminated food is the usual source of infection(unpasteurized milk, ripened soft cheeses and pâté).

Clinical featuresflu-like illness with fever and general

malaise.Transmission to the via the ascending

route through the cervix, or transplacentally.

Approximately 20 per cent of affected pregnancies result in miscarriage or stillbirth.

Premature delivery occur in over 50 %.

diagnosis of listeria depends on clinical suspicion

and isolation of the organism from blood, vaginal

swabs or the placenta. Meconium staining of the amniotic fluid in

apreterm fetus increase clinical suspicion. For women with listeriosis during

pregnancy, intravenous antibiotic treatment (ampicillin 2 g given every 6 hours) is indicated.

Thank you