Infections affecting the fetus in the prenatal period

Many infections, mainly viral, can affect the fetus. In English-language scientific terminology, they are united under the abbreviation "TORCH infection: T - toxoplasmosis, O - others (for example, AIDS, syphilis), R - rubella, C - cytomegalovirus, H - herpes (and hepatitis). Fetal infection with the first five diseases occurs antenatal, herpes and hepatitis - usually postnatal. Antenatal infection with measles.

Rubella. Seventy percent of pregnant women have adversity immunity. With routine vaccination of all children, no pregnant woman will be susceptible to rubella. Routine antenatal screening identifies those who should be vaccinated in the postpartum period (after which pregnancy is avoided for three months, since the vaccine is live). Symptoms of rubella are absent in 50% of mothers. The fetus is most vulnerable in the first 16 weeks of pregnancy. Almost 33% of fetuses under 4 weeks of age will become infected with rubella if the mother is infected; 25% - at 5-8 weeks; 9% - at 9-12 weeks. Cataracts will develop in the fetus if it contracts rubella at 8-9 weeks, deafness - at 5-7 weeks, heart damage - at 5-10 weeks. Other signs of rubella include rash, jaundice, hepatosplenomegaly, thrombocytopenia, cerebral palsy, microcephaly, mental retardation, cerebral calcification, microphthalmia, retinitis, cataracts, and growth disorders. Miscarriage or stillbirth are possible. If rubella is suspected in a pregnant woman, it is necessary to compare the dynamics of antibodies in the blood taken at 10-day intervals; IgM antibodies are determined 4-5 weeks after the start of the incubation period. An infectious disease specialist should also be consulted.

Syphilis. Mothers are screened for syphilis as part of a routine examination; if an active process is detected, the mother is treated with benzylpenicillin novocaine salt, for example, 1/2 ampoule containing 1.8 g of bicillin is administered intramuscularly daily for 10 days. Signs of syphilis in newborns: rhinitis, difficulty breathing through the nose (due to syphilitic rhinitis), rash, hepatosplenomegaly, lymphadenopathy, anemia, jaundice, ascites, dropsy, nephrotic syndrome, meningitis. Nasal discharge is examined for spirochetes: perichondritis may be detected by X-ray examination; the blood has an increased content of monocytes and protein, serological reactions are positive. In such cases, benzylpenicillin novocaine salt is prescribed at a dose of 37 mg/kg per day, intramuscularly for 3 weeks.

AIDS (human immunodeficiency virus, HIV). In 86% of children with AIDS, the mother is in a high-risk group for the disease. Therefore, such women should be given early advice and education about the consequences of HIV infection for both themselves and their children, and offered diagnostic tests for HIV. Up to 15% of children born to seropositive mothers are infected in utero, but diagnosis in the postnatal period can be difficult, since most children will carry maternal antibodies to HIV by 18 months of age. Clinically, AIDS can manifest by 6 months of age with failure to thrive, recurrent fever, and persistent diarrhea. In addition, generalized lymphadenopathy, pulmonary and upper respiratory tract pathology, disseminated candidiasis, opportunistic infections, and dermatitis are possible. Death can occur quite rapidly.

Cytomegalovirus. In the UK, cytomegalovirus is a more common cause of congenital growth restriction than rubella. The infection in the mother is latent or asymptomatic. The fetus is most vulnerable in early pregnancy. Up to 5:1000 live births are infected, with 5% of these developing multiple handicaps and CMV disease early on (with non-specific manifestations resembling rubella plus choroidoretinitis syndrome). In 5%, handicaps develop later. There are no effective methods of preventing them.

Toxoplasmosis. Toxoplasma infection in the mother and fetus resembles cytomegalovirus infection but is less common. Serologic testing of pregnant women and treatment with spiramycin are possible, but there is no consensus on the appropriate intensity of treatment. Preventive measures may be more effective: gloves and hygiene products should be used when gardening and caring for cats, as well as during subsequent food preparation and consumption. Infected children (diagnosis confirmed serologically) should receive 0.25 mg/kg chloridine every 6 hours orally, 50 mg/kg sulfazine every 12 hours orally, and folic acid (since chloridine is a folate antagonist) for 21 days.

Listeriosis. The mother usually suffers from a mild form of the disease, without specific manifestations. Transplacental transmission of the disease in 5% of pregnant women causes miscarriages or premature births and induces polyorgan pathology in newborns with the formation of granulomas of the skin and pharynx. Treatment: ampicillin and gentamicin intravenously. Listeria can be isolated from blood or amniotic fluid (it is a gram-positive coccal bacterium). Listeria is widespread. Prevention of infection is simple: do not eat softened cheese, pate, and food that has been inadequately reheated; as well as cold-cooked food.

Hepatitis B. Although chronic carriage of hepatitis B virus was previously rare in the UK, with the rise in drug use and the expansion of the emshrants population, the problem has become more acute and some experts even suggest appropriate virological testing of all mothers. If the mother develops acute hepatitis B in the second or third trimester of pregnancy, there is a high risk of developing perinatal infection. Infection is most likely to occur at the time of birth, so children born to mothers already infected or carriers of the hepatitis B virus should be given antiviral immunoglobulin (0.5 ml intramuscularly within 12 hours of birth) and hepatitis B vaccine (0.5 ml within 7 days of birth and at 1 and 6 months).

Human herpes. About 80% of cases of infection or carriage are caused by the type II virus. Almost 50% of children are infected at birth if the mother had obvious damage (changes) to the cervix. From the cervical canal of pregnant women with a history of herpes infection, smears are taken weekly (starting from the 36th week) to cultivate the virus. If the virus is detected, the question of cesarean section arises. In case of spontaneous discharge of amniotic fluid, they try to perform a cesarean section within the next 4 hours. The development of neonatal infection usually occurs in the first 5-21 days with the appearance of vesiculopustular elements, often on the presenting parts of the body or places of minor trauma (for example, the place where electrodes are applied to the head). Periocular lesions with the involvement of the conjunctiva may be observed. In the generalized form, encephalitis (including individual paroxysms and neurological signs), jaundice, hepatosplenomegaly, collapse and DIC syndrome may develop. Infected newborns should be isolated and treated with acyclovir. If necessary, seek help from specialists.

Conjunctiva neonatorum. This is a condition characterized by purulent discharge from the eyes of neonates less than 21 days old. Neisseria gonorrhoea should be ruled out first, but in many cases the causative organisms are Chlamydiae, herpes virus, staphylococcus, streptococcus and pneumococcus, E. coli and other gram-negative organisms. In infants with adhesive eyelids, smears are taken to determine the bacterial and viral flora, microscopy (examined for the presence of intracellular gonococci) and identification of Chlamydia (e.g., by immunofluorescence).

Gonococcal conjunctivitis. The infection usually develops in the first 4 days after birth. Purulent discharge is usually accompanied by swelling of the eyelids. Clouding of the cornea may be observed, there is a risk of corneal perforation and panophthalmitis. Children born to mothers with established gonorrhea should be given penicillin G intramuscularly at an initial dose of 30 mg / kg within 1 hour after birth, and eye drops containing 0.5% chloramphenicol (levomycetin) solution should be instilled into the eyes. If there are signs of active infection, penicillin G is administered intramuscularly at a dose of 15 mg / kg every 12 hours for 7 days, and 0.5% chloramphenicol solution is instilled into the eyes every 3 hours. The infant is isolated.

Chlamydia (Chlamydia trachomatis). Approximately 30-40% of infected mothers will have infected children. Conjunctivitis develops 5-14 days after birth and may present as minimal inflammation or purulent discharge. The cornea is usually spared. Chlamydial pneumonia may also occur. Diagnosis is by immunofluorescence or culture. Treatment is with 1% tetracycline eye ointment or drops every 6 hours for 3 weeks. Erythromycin 10 mg/kg orally every 8 hours should also be given to eliminate the pathogen from the respiratory tract. Both parents should be treated with tetracycline or erythromycin.

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