Infectious Diseases of Pregnancy

Infectious Diseases of Pregnancy 133 million infants are born worldwide every year (7) 5.5 million of these infants die (4) 99% occur in developing countries 33% are due to mostly preventable infections Common Congenital Infections T O R C H E S 22 year old G0 presenting for routine prenatal care, LMP was 6 weeks ago, at-home pregnancy test was positive. Patient has had one episode of Gonorrheal infection 2 years prior. What are the current infectious disease screening recommendations? Prenatal screening recommendations (2): HIV Syphilis Hepatitis B Gonorrhea/Chlamydia Rubella antibody Group B Streptococcus - 35-37 weeks High risk screening recommendations (2): HIV (Third trimester or at delivery if HIV status is unknown) Syphillis (Third trimester and at delivery) Hepatitis B (At delivery, consider vaccination) Gonorrhea/Chlamydia (Third trimester) Hepatitis C (Initial prenatal visit) HSV/Bacterial Vaginosis/Trichomonas (Symptomatic only) Toxoplasmosis Rubella HIV Herpes Syphilis CMV Prevention: Thoroughly cook all meats Clean all fruits and vegetables Wear gloves when working with soil Avoid exposure to cats that are not fed processed foods Spiramycin in HIV infected/high risk mothers Complications/Findings: Greatest risk - 3rd trimester/More severe - 1st trimester Toxoplasmosis Antibody Titers - Radiologic Severe mental retardation Chorioretinitis, Blindness Epilepsy, Intracranial calcifications Hydrocephalus Treatment: Pyrimethamine + Sulfadiazine Not proven to decrease transmission (6) http://www.tedmontgomery.com/the_eye/eyephotos/toxoplasmosischorioretinitis.html http://www.pathobio.sdu.edu.cn/sdjsc/engparabook/ch084.htm http://www.med.uc.edu/neurorad/webpage/bfa.html Prevention: Screening and antibiotic prophylaxis -High risk/Status Unknown (1) Preterm labor (<37 weeks) Preterm PROM ROM >18 hours Maternal fever Complications: -Early-onset (First week)/Late-onset (>3 Months) Septic shock Pneumonia Meningitis Treatment: Penicillin, Ampicillin prophylaxis, primary treatment Infant - [Third-generation Cephalosporin] or Aminoglycosides GBS http://richmondmidwife.com/GroupBStrepGBS.aspx Prevention: Vaccination at least 1 month prior to conception (live attenuated virus) Vaccination after delivery in pregnant women not immune Complications/Findings: Congenital heart disease - Patent ductus arteriosus Mental Retardation Deafness Cataracts Buzz phrase: "Blueberry muffin" rash Treatment: No treatment CDC CDC General: Most common congenital infection Primary maternal infection is highest risk Complications/Findings: Most are asymptomatic Petechiae Hepatosplenomegaly Jaundice Thrombocytopenia Microcephaly, periventricular calcifications Chorioretinitis Hyrops fetalis (MC) Long term - hearing loss and neurologic impairment Treatment: No treatment, ganciclovir and foscarnet (not proven effective, 1) No vaccine available http://www.asm.org/Division/c/viruses.htm http://radiographics.rsna.org/content/30/7/1779/F2.expansion.html Prevention: Screening: Dark-field microscopy, VDRL/RPR, FTA-ABS Prophylaxis - Penicillin Complications/Findings (10-14 days after delivery): Maculopapular skin rash Hepatomegaly Osteitis Mucopurulent rhinitis Saber shins Saddle nose Hutchinson's triad - interstitial keratitis, peg-shaped incisors, deafness Treatment: Penicillin (G) (8) http://www.sciencephoto.com/media/295804/view CDC CDC General: Infection occurs during or after delivery Primary Infection - no evidence of prior infection, high risk Recurrent - low risk to fetus Complications: Localized infections do well Disseminated do poorly, encephalitis Treatment: Active vaginal lesions require C/S Acyclovir - starting at 36 weeks (3) References 1. Beckman, Charles, et al. Obstetrics and Gynecology, Sixth Edition. Baltimore: Lippincott Williams and Wilkins, 2010. 2. Department of Health and Human Services, Centers for Disease Control and Prevention. "Sexually Transmitted Disease Treatment Guidelines, 2010." Morbidity and Mortality Weekly Report (2010): 8-10. 3. Hollier, Lisa M and George D Wendel. "Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection." Cochrane Database of Systemic Reviews (2008). 4. Lawn, Joy E, Simon Cousens and Jelka Zupan. "4 million neonatal deaths: When? Where? Why?" The Lancet (2005): 891-900. 5. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." 24 May 2010. AIDSinfo. 21 May 2011 <http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf>. 6. Peyron, Francois, et al. "Treatments for toxoplasmosis in pregnancy." Cochrane Database of Systemic Reviews (2010). 7. United States Central Intelligence Agency. "The World Factbook." 17 May 2011. Central Intelligency Agency. 21 May 2011 <https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html>. 8. Walker, Godfrey. "Antibiotics for syphilis diagnosed during pregnancy." Cochrane Database of Systematic Reviews (2010). Prevention: Screening and prophylaxis - ELISA (Confirmatory Western Blot) Discourage breastfeeding - linked with transmission Reduce time from ROM - Early C/S for >1000 copies/mL viral load Complications: Immunodeficiency Treatment: Combined antiretroviral therapy decreases transmission to 1% (5) - [Zidovudine], Neviparine, Lamivudine Neonatal treatment (Ziduvidine for 6 weeks if ART, combined if not) http://www.articlesbase.com/diseases-and-conditions-articles/how-to-treat-genital-herpes-2407924.html