Maternal–fetal cytomegalovirus infection: From diagnosis to therapy

Cytomegalovirus (CMV) is the most common and serious congenital infection, because it occurs after both primary and recurrent infection in pregnancy and is a major cause of childhood deafness and neurological handicap. Fetal transmission generally occurs in 30–60% of women acquiring a primary infection or in 0.5–2% of women with preconceptional immunity. Following primary maternal infection, approximately one-third of the CMV-infected infants will have disease at birth or develop severe sequelae, which include convulsive or spastic syndromes, mental retardation and auditory and visual impairment. Routine antepartum and in pregnancy serological screening should be essential for avoiding doubtful interpretations of CMV-IgM results in pregnancy. Detection of quantitative CMV DNA in the amniotic fluid and accurate ultrasound examinations are needed in pregnant women with suspected primary infection. Being not yet available a vaccine and uncertain the results of postnatal ganciclovir therapy, CMV hyperimmunoglobulin appears to be the only safe and valid approach for prevention of congenital CMV disease.     

Management of an obstetric health care provider with acute parvovirus B19 infection

We report a case of an obstetrician with acute parvovirus B19 infection and the series of exposed pregnant women. Currently, there are no established guidelines regarding management of an obstetric health care provider with acute parvovirus B19 infection. We propose a management scheme of this clinical scenario.     

婴幼儿铅中毒脑病临床特点及预后分析

目的 探讨铅中毒脑病的临床特点及预后。方法 回顾分析衡阳市中心医院儿科2002~2003年26例铅中毒脑病患儿的临床资料及随访结果。结果 26例铅中毒脑病患儿临床均表现为频繁的抽搐伴意识障碍，中度以上贫血。伴呕吐23例、腹泻21例、发热11例、肝大5例。26例患儿治疗前血铅平均为8.486μmol/L，尿铅平均为3.598μmol/L，Hb均低于90g/L，最低55g/L。血钙均低于1.86mmol/L， 最低1.03mmol/L。脑脊液蛋白均增高，22例心肌酶谱增高，提示心肌损害明显。头颅CT/MRI仅1例脑室系统轻度扩张，全部病例经驱铅治疗后无一例死亡，1年后随访,继发性癫疒间4例，脑瘫4例。结论铅中毒脑病是铅中毒的严重类型，预后不良。对不明原因的无热惊厥者应注意及时行血铅检查，以便早期诊断，防止漏诊。 Abstract Objective Study the clinical characteristics and prognosis of lead poisoning encephalopathy.Methods We reviewed and analyzed the clinical data and the results of the 26 cases of lead poisoning encephalopathy.Results All the 26 cases had frequen convulsion,accompanied by disturbance of consciousness and above middle pitch of anemia.Among the 26 cases vomit ting was found in 23 cases,diarrhea in 21 cases,fever in 11 cases,live swelling in 5 cases.Supplemental examination:before treatment,the average of blood lead level was 8.486μmol/L，urine lead level was 3.598μmol/L,Hb was lower than 90g/ L,the lowest being 5g/L.The blood calcium was all lower than 1.86 mmol/ L,the lowest being 1.03 mmol/L.Protein of cerebrospinal fluid in all cases was over normal.Myocardial enzyme of 22 cases was over normal,suggesting myocardials injured obviously.Only 1 case was found ventricle system expanding lightly in CT/MRI.All cases had no death after treatment of driving lead.The 12 month follow up result suggested that second epilepsy was found in 4 cases and cerebral palsy in 4 cases.Conclusion The lead poisoning encephalopathy is the most serious type of the lead poisoning,and prognosis is not good. The patient of convulsion with unknown reason,and no fever,should be checked the blood lead for early diagnosis in order to prevent from leaking diagnosis. Key wordsLead poisoning;Encephalopathy;Clinical characteristics;Prognosis      

Cytomegalovirus non-primary infection during pregnancy. Can serology help with diagnosis?

Diagnosis of cytomegalovirus (CMV) primary infection is reliable, but diagnosis of CMV non-primary infection (NPI) is questionable. Our aim is to highlight the difficulties met in diagnosis of CMV NPI. We illustrate that in proven cases of CMV NPI, very different serologic and molecular patterns may be observed and that routine serologic testing may fail to help with diagnosis. These results point out that many data available in literature concerning the prevalence of NPI, materno-fetal transmission rates and consequences of NPI may be wrong. We need to know how frequently they occur, are transmitted and cause fetal damages. Diagnosis of NPI must be improved, along with our understanding of the mechanisms leading to intrauterine CMV transmission and congenital infection in babies born to women with preexisting immunity.     

妊娠期人乳头瘤病毒感染

人乳头瘤病毒(HPV)感染是一种常见的性传播感染,文章讨论了妊娠与HPV感染之间的相互影响,介绍了妊娠期尖锐湿疣的临床特点与治疗方法,以及妊娠期HPV阳性且宫颈筛查异常患者的处理原则。     

Puerperal Infections of the Genital Tract: A Clinical Review

Puerperal genital tract infections, although less common in the 21^st century, continue to affect maternal mortality and morbidity rates in the United States. Puerperal genital tract infections include endometritis as well as abdominal and perineal wound infections. These infections interrupt postpartum restoration, increase the potential for readmission to a health care facility, and can interfere with maternal‐infant bonding. In addition, unrecognized or improperly treated genital tract infection could extend to other sites via venous circulation or the lymphatic system and increase the risk of severe complications or sepsis. Midwives are leaders in education, low rates of intervention, and prompt recognition of deviation from normal. Because puerperal genital tract infection usually begins after discharge, detailed education for women will encourage preventative health care, prompt recognition, and treatment.     

Double maternal seroconversion to cytomegalovirus and Toxoplasma gondii

Background: We report the first case of a double maternal seroconversion for Toxoplasma gondii (TG) and cytomegalovirus (CMV) diagnosed during pregnancy. Case: One case is reported of a female patient referred for seroconversion in response to TG in the 27th week of gestation. A search for foetal involvement revealed signs of non-specific foetal infection without any TG-related lesions. Tests were carried out for another foeto-maternal infectious disease and maternal seroconversion in response to CMV was discovered with virus in the amniotic fluid. The foetus developed hydrocephalus and intracranial calcifications and the pregnancy was terminated at the parents' request. CMV-induced multiple organ involvement without any signs of Toxoplasma gondii-related involvement were noted in the foetus. Conclusions: This case indicates that a search should be made for another infectious disease likely to involve the foetus when non-specific signs of infection in the foetus are present, even though maternal seroconversion has been recognized.     

上海地区不同家庭环境中儿童幽门螺杆菌感染的流行病学

目的研究上海地区不同职业家庭不同年龄组的儿童幽门螺杆菌(H.pylori)感染的流行病学情况，以探讨不同经济状况下，儿童感染H.pylori的年龄阶段以及家庭H.pylori人群的分布对儿童H.pylori感染的影响。方法1119名就读于上海地区市中心与郊区学校的学生，男性568名，女性551名，年龄7~l4岁。问卷调查每位学生的居住环境、常住人口、父母职业和受教育程度、家庭的经济收入，有无消化道症状及慢性胃炎、溃疡病史等，同时采用ELISA方法检测血中H.pylori IgG抗体。结果无症状儿童中7岁年龄组的H.pylori感染率为30.91%，在7~12岁年龄阶段随着年龄的增加H.pylori感染率也逐渐上升，平均年递增3.28%；工人和农民家庭的儿童较小的年龄即有较高的H.pylori感染率；生活在父母感染H.pylori家庭中的儿童更容易感染H.pylori。结论经济水平较低的家庭中，儿童H.pylori感染率高，而且较小年龄即有感染；H.pylori感染有家庭聚集现象。     

Congenital cytomegalovirus infection in pregnancy: a case report of fetal death in a CMV-infected woman

Objectives The human cytomegalovirus (CMV) is universally distributed among human populations as one of the most common cause of congenital infection with an incidence of about 0.15–2.0% in developed countries. However, controversial data concerning intrauterine fetal death caused by CMV infection exist. Method A case report. Results In this case report we present a stillbirth in the 18th week of pregnancy, caused by a maternal serological and fetal histological congenital CMV infection. Conclusion Every attending physician and obstetrician should be aware of the possibility of a primary or even recurrent congenital CMV infection that could be a reason for sudden unknown congenital fetal death.     

Maternal infection and risk of preeclampsia: systematic review and metaanalysis

There are lingering questions regarding the association between maternal infection and preeclampsia. Systematic review and metaanalysis was conducted of observational studies that examined the relationship between maternal infection and preeclampsia. Forty-nine studies met the inclusion criteria. The risk of preeclampsia was increased in pregnant women with urinary tract infection (pooled odds ratio, 1.57; 95% CI, 1.45-1.70) and periodontal disease (pooled odds ratio, 1.76; 95% CI, 1.43-2.18). There were no associations between preeclampsia and presence of antibodies to Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus, treated and nontreated HIV infection, and malaria. Individual studies did not find a relationship between herpes simplex virus type 2, bacterial vaginosis, and Mycoplasma hominis and preeclampsia. Urinary tract infection and periodontal disease during pregnancy are associated with an increased risk of preeclampsia. More studies are required to verify this as well as to explore whether or not such relationships are causal and, if so, the mechanisms involved.     

Seroepidemiologic study of human cytomegalovirus in pregnant women in Valiasr Hospital of Kazeroon,Fars, Iran

Background. Cytomegalovirus (CMV) is a common opportunistic infection among HIV-infected individuals, a major source of serious complications among organ-transplant recipients, and a leading cause of hearing loss, vision loss, and mental retardation among congenitally infected children. Women infected for the first time during pregnancy are especially likely to transmit CMV to their fetuses.

Objective. In this study, it was aimed to determine the rate of CMV seroprevalence in pregnant women, the prevalence of maternal CMV infection and also the incidence of congenital CMV infection in their newborns in the Kazeroon, south of Iran.

Methods. Between January 2007 and July 2007, all (n = 1472) pregnant women who attended the obstetric ward of Valiasr hospital in Kazeroon for delivery, were enrolled in this study, and according to the presence or absence of anti CMV-IgM and CMV-IgG, were classified as seropositive, seronegative and having active maternal CMV infection. Differentiation of primary and recurrent CMV infection in women with both CMV-IgM (+) and CMV-IgG (+) antibody was determined by the avidity index (AI) of anti-CMV IgG.

Results. The rate of seropositivity was found as 97.69% and the rate of seronegativity as 2.31% in pregnant women. The prevalence of active maternal CMV infection was found as 4.35% and among these pregnant women, the incidence of primary and recurrent maternal CMV infection was 34.4% and 65.6% respectively.

Conclusion. Seroprevalence rate of CMV in pregnant women is high and most infections are recurrent. Thus, it does not seem to be cost-effective to screen all pregnant women for CMV infection, as in the other countries with high seropositivity rate.     

美罗培南治疗机械通气新生儿下呼吸道细菌感染的疗效

目的探讨美罗培南在治疗机械通气新生儿下呼吸道细菌感染中的疗效。 方法对应用机械通气的新生儿下呼吸道细菌感染患儿37例采用美罗培南静脉注射治疗，美洛培南治疗方法和剂量为20~30mg/kg,每日2次，静脉滴注。临床疗效评价分为痊愈、显效、进步和无效。痊愈和显效作为有效统计。 结果除1例嗜麦芽窄食单胞菌对美罗培南耐药外，其余22例革兰阴性细菌均为敏感，达95.7%。在治疗结束时，痊愈19例，显效7例，进步2例，无效9例。总有效率为70.3%。无不良反应发生。 结论美罗培南适用于机械通气的新生儿下呼吸道细菌感染，值得临床进一步研究。     

继发不孕患者阴道常见致病菌及耐药性分析

目的:分析继发不孕患者下生殖道的致病菌感染及耐药情况,明确导致女性下生殖道感染的主要致病菌及其对常用抗菌素的敏感状况,以有效指导临床抗感染用药。方法:收集确诊为继发不孕且阴道分泌物培养菌阳性的606例患者的临床资料,回顾分析其致病菌分布及抗菌素耐药情况,研究从该人群中病原体的高分离率与女性生殖道的并发症是否存在联系。结果:继发不孕患者中,引起生殖道炎症的病原菌排名前三者为大肠埃希菌、粪肠球菌和白色念珠菌,支原体培养阳性率为48.8%。大肠埃希菌、肺炎克雷伯菌等肠杆菌科细菌对氨苄西林、头孢噻肟、头孢他啶、复方新诺明等耐药率较高,而对亚胺培南、美洛培南、阿米卡星等耐药率低。革兰阳性球菌等对万古霉素、呋喃妥因、利奈唑烷等有较高的敏感性,粪肠球菌对氨苄西林的敏感性较高,解脲支原体对多西环素/强力霉素和美满霉素等敏感性高。结论:万古霉素、呋喃妥因、利奈唑烷等可作为革兰阳性菌球菌治疗的首选;氨苄西林可作为粪肠球菌治疗的首选;多西环素/强力霉素和美满霉素可作为治疗支原体感染的一线药物。     

Chlamydia Infection Among Adolescent Long-Acting Reversible Contraceptive and Shorter-Acting Hormonal Contraceptive Users Receiving Services at New York City School-Based Health Centers

Study ObjectiveOne concern regarding long-acting reversible contraceptive (LARC) use among female adolescents is the potential for sexually transmitted infection acquisition. Few studies investigate chlamydia infection among adolescent LARC users compared with other hormonal contraceptive method (non-LARC) users. We hypothesized that incident chlamydia infection would be similar in these 2 groups and that it would not be associated with adolescent LARC use.Design, Setting, and ParticipantsSecondary data analysis of electronic health records of adolescents who started using LARC (n = 152) and non-LARC methods (n = 297) at 6 New York City school-based health centers between March 2015 and March 2017.Interventions and Main Outcome MeasuresDemographic characteristics, sexual risk factors, and occurrence of chlamydia infection over a period of 1 year were compared in the 2 groups using χ² tests and t tests. Multivariable logistic regression was used to test the association between LARC use and chlamydia infection adjusting for relevant covariates.ResultsAmong 422 adolescent patients tested the year after method initiation, 48 (11.4%) had at least 1 positive chlamydia test. The proportions of LARC users and non-LARC users with chlamydia infection were not statistically significantly different (10.9% vs 11.6%; P = .82). Multivariable analysis showed that LARC use was not associated with greater chlamydia risk (adjusted odds ratio, 0.84; 95% confidence interval, 0.41-1.43).ConclusionAdolescent LARC users did not have significantly higher chlamydia infection occurrence compared with non-LARC users the year after method initiation. Concern for chlamydial infection should prompt recommending condom use but should not be a barrier to recommending adolescent LARC use.     

Amniotic fluid Interleukin-8 as a marker for intraamniotic infection

Summary We measured the amniotic fluid Interleukin-8 (AF IL-8) levels of 80 women to see whether or not AF IL-8 levels were of value in the diagnosis of intraamniotic infection. Of twelve patients developing conventional signs of infection, 9 had an AF IL-8 concentration above 10.000 pg/ml serum. In two patients, whose baby had a serious neonatal infection, AF IL-8 concentration also exceeded 10.000 pg/ml. Only one out of 66 apparently uninfected patients had an AF IL-8 level above 10.000 pg/ml. We therefore suggest that measuring the AF IL-8 levels is of value in cases of suspected intraamniotic infection.     

Characteristics and serology of pregnant women with cytomegalovirus immunoglobulin G seroconversion during pregnancy in Japan

ObjectiveInvestigate the characteristics and serology of pregnant women with cytomegalovirus (CMV) immunoglobulin (Ig)G seroconversion during pregnancy to understand the risk factors associated with primary CMV infection and the occurrence of fetal congenital CMV infection.Materials and methodsWe retrospectively studied 3202 pregnant women who were CMV IgG-negative in early pregnancy and were retested for IgG in late pregnancy. Characteristics were compared between participants with and without IgG seroconversion, and serological parameters were compared between participants with and without fetal congenital CMV infection.ResultsTwenty-six participants showed CMV IgG seroconversion and fifteen showed fetal congenital CMV infection. Seroconversion rates were significantly higher in teens (5.0%) than in older women (20s: 0.8%; 30s and over: 0.6%) (p < 0.001). Titers of CMV IgM at IgG seroconversion were higher in women without (median 8.66) than with (median 6.54) congenital infection (p = 0.045). The congenital infection rate was high when IgM titers at IgG seroconversion were low (47.1% with 4.00–12.00 titers and 100% with 1.21–3.99 IgM titers) (p = 0.048).ConclusionsNulliparous pregnant teenagers have a high risk of CMV IgG seroconversion and the CMV IgM titer at IgG seroconversion may help predict the occurrence of fetal congenital CMV infection.     

Surgical site infection after cesarean delivery: incidence and risk factors at a US academic institution

Purpose: To identify the rate of surgical site infection (SSI) after Cesarean delivery (CD) and determine risk factors predictive for infection at a large academic institution.

Methods: This was a retrospective cohort study in women undergoing CD during 2013. SSIs were defined by Centers for Disease Control (CDC) criteria. Chi square and t-tests were used for bivariate analysis and multivariate logistic regression was used to identify SSI risk factors.

Results: In 2419 patients, the rate of SSI was 5.5% (n?=?133) with cellulitis in 4.9% (n?=?118), deep incisional infection in 0.6% (n?=?15) and intra-abdominal infection in 0.3% (n?=?7). On multivariate analysis, SSI was higher among CD for labor arrest (OR 2.4; 95%CI 1.6–3.5; p?<.001). Preterm labor (OR 2.8; 95%CI 1.3–6.0; p?=?.01) and general anesthesia (OR 4.4; 95%CI 2.0–9.8; p?=?.003) were predictive for SSI. Increasing BMI (OR 1.1; 95%CI 1.05–1.09; p?=?.02), asthma (OR 1.9; 95%CI 1.1–3.2; p?=?.02) and smoking (OR 1.9; 95%CI 1.1–3.2; p?=?.02) were associated with increased SSI.

Conclusions: Several patient and surgical variables are associated with increased rate of SSI after CD. Identification of risk factors for SSI after CD is important for targeted implementation of quality improvement measures and infection control interventions.     

Congenital Cytomegalovirus and Hearing Loss

Congenital cytomegalovirus (cCMV) is the most common cause of nongenetic, sensorineural hearing loss and neurodevelopmental disorders in newborns, infants, and children. Current cCMV screening procedures for pregnant women and newborns are not standardized, which may be attributed to the lack of knowledge about the consequences of infection among clinicians and the general public and the lack of effective treatments. The purpose of this article is to provide a review and update on cCMV infection epidemiology, diagnostic tests, clinical manifestations, prevention, treatment, and nursing implications. Hearing loss is emphasized because this is a common sequela of cCMV infection for which diagnostic modalities and treatments are available.