Congenital toxoplasmosis

Approximately 85 percent of women of childbearing age in the United States are susceptible to acute infection with the protozoan parasite Toxoplasma gondii. Transmission of T. gondii to the fetus can result in serious health problems, including mental retardation, seizures, blindness, and death. Some health problems may not become apparent until the second or third decade of life. An estimated 400 to 4,000 cases of congenital toxoplasmosis occur in the United States each year. Serologic tests are used to diagnose acute T. gondii infection in pregnant women. Because false-positive tests occur frequently, serologic diagnosis must be confirmed at a Toxoplasma reference laboratory before treatment with potentially toxic drugs is considered. In many instances, congenital toxoplasmosis can be prevented by educating pregnant women and other women of childbearing age about not ingesting raw or undercooked meat, using measures to avoid cross-contamination of other foods with raw or undercooked meat, and protecting themselves against exposure to cat litter or contaminated soil.     

The proteins of fast phase of inflammation in prognosis of condition of newborn in case of pregnancy complicated by hydramnion and under the risk of intrauterine infection

The content of alpha-macroglobulin associated with pregnancy, alpha2-glycoprotein, alpha1-antitripsin, and lactolerrin in blood serum of pregnant women and umbilical serum under hydramnion and risk of development of intrauterine infection of fetus is investigated. It is demonstrated that in case ofpresence in blood of pregnant woman of G-antibodies to C. trachomatis under low titers (1:20, 1:40) the increase of levels of alpha-macroglobulin, alpha2-glycoprotein, al-antitripsin and especially of lactoferrin in serum of pregnant women testifies the high risk of presence of intrauterine infection of fetus and probability of birth of child with low values on Apgar scale.     

妊娠期妇女感染HPV对产妇和胎儿的影响

目的分析妊娠期妇女感染人乳头瘤病毒(HPV)对产妇和胎儿的影响。方法选取116例感染人乳头瘤病毒的产妇作为实验组,另选取健康孕妇116例为对照组,分别对产妇分娩时羊水、胎盘组织及胎儿脐静脉血、口咽部分泌物与外阴分泌物中的HPV进行检测,分析产妇HPV的感染分型。随访1年,观察HPV感染对产妇和胎儿的影响。结果实验组中单型HPV感染及高危型HPV感染的患者所占比例较大,分别为66.38%和76.72%;患者宫颈肉眼形态异常炎症、细胞学检验呈鳞状上皮病变是感染HPV的危险因素;2组患者在分娩方式、产后出血及胎儿生长受限等方面比较,差异无统计学意义(P0.05);正常阴道分娩与剖宫产分娩的胎儿在羊水、胎盘组织及脐静脉血、口咽部分泌物、外阴分泌物或包皮分泌物中的HPV阳性检出率比较无显著差异(P0.05);胎儿HPV感染率为24.14%。结论单型HPV感染及高危型HPV感染是妊娠期妇女HPV感染的主要分型。     

Value of 2 IgG avidity commercial tests used alone or in association to date toxoplasmosis contamination

Toxoplasmosis acquired during pregnancy exposes the fetus to congenital toxoplasmosis. Avidity tests are commonly used to date time of infection to evaluate the fetal risk and to offer prenatal diagnosis. This study evaluated and compared 2 commercial avidity tests: Platelia™ Toxo IgG Avidity (Bio-Rad, Marnes la Coquette, France) and Liaison® Toxo IgG Avidity II (Diasorin, Saluggia, Italy) kits. In complement, a study of specific IgG and IgM in the 2 systems was carried out. Sensitivity and specificity of the avidity tests were 94.4% and 87.8% for the Liaison® and 91.3% and 98.5% for the Platelia™ methods, respectively. Percentages of complete discrepancies, partial discrepancies, and agreement between both tests were 1.1%, 23.6%, and 75.3%, respectively. Moreover, the combination of both avidity tests may be useful in some cases. Indeed, that strategy permitted to confirm without delay a chronic toxoplasmosis in 23 cases and avoid treatment in these pregnant women.     

New developments in the diagnosis of maternal and congenital CMV infection

Recent advances in the screening of pregnant women with Cytomegalovirus (CMV) IgM, CMV IgG and CMV IgG avidity serologic tests, has led to a more accurate diagnosis of CMV infection. When serologic screening is performed early in gestation, it is possible to identify those women at risk of intrauterine transmission of the virus, i.e., those women with a primary CMV infection, who should be enrolled in prenatal diagnosis. The use of quantitative PCR on amniotic fluid from pregnant women at 21-22 weeks of gestation in prenatal diagnosis is an effective diagnostic tool to distinguish between CMV infection and CMV disease in the fetus and newborn. Quantitative PCR on peripheral blood leukocytes from CMV infected newborns can be used to monitor viral load, especially during treatment with ganciclovir. These advances in serology and quantitative virology should lead to more accurate diagnosis of maternal and congenital CMV infection.     

Managing varicella zoster infection in pregnancy

Varicella zoster virus (VZV) infection can be serious for pregnant women and their babies, although it is rare. The implications of primary VZV infection vary with the gestational age at infection. For the mother, the risk of severe illness is greatest after mid-pregnancy, when she is relatively immunocompromised. For the fetus, the risk of congenital infection is greatest when maternal infection occurs in the first or second trimester. Maternal infection is preventable by preconception vaccination.     

Preconception health care

Appropriate preconception health care improves pregnancy outcomes. When started at least one month before conception, folic acid supplements can prevent neural tube defects. Targeted genetic screening and counseling should be offered on the basis of age, ethnic background, or family history. Before conception, women should be screened for human immunodeficiency virus and syphilis infection and begin treatment to prevent the transmission of disease to the fetus. Immunizations against hepatitis B, rubella, and varicella should be completed, if needed. Women should be counseled on ways to prevent infection with toxoplasmosis, cytomegalovirus, and parvovirus B19. Environmental toxins such as cigarette smoke, alcohol, and street drugs, and chemicals such as solvents and pesticides should be avoided. In women with diabetes, it is important to optimize disease control through intensive management before pregnancy. Medications for hypertension, epilepsy, thromboembolism, depression, and anxiety should be reviewed and changed, if necessary, before the patient becomes pregnant. Counseling about exercise, obesity, nutritional deficiencies, and the overuse of vitamins A and D is beneficial. Physicians may also choose to discuss occupational and financial issues related to pregnancy and to screen patients for domestic violence.     

不同孕期慢性 HBV感染孕妇疾病相关心理压力的现状分析

目的：了解慢性乙型肝炎病毒（ HBV）感染孕妇不同孕期疾病相关压力水平,探讨不同孕期慢性HBV感染孕妇疾病相关压力的主要压力源及压力特点。方法采用方便抽样法选取361例慢性HBV感染孕妇作为研究对象,使用自行设计的一般资料调查表和慢性HBV感染孕妇疾病相关压力量表对孕妇进行问卷调查。结果慢性HBV感染孕妇疾病压力在整个孕期均处于轻中度水平,部分感染孕妇达重度水平。不同孕期心理压力源均以担心母子健康为主,孕晚期感染孕妇较关注自身健康及爱人身心健康,同时渴望良好的社会接纳。结论医护人员应全面准确地了解感染孕妇的妊娠期心理压力,根据其压力特点提供有效的干预措施以确保母子健康。     

TORCH 感染孕妇IgG 亲和力检测的临床价值

目的：通过检测TORCH感染孕妇IgG亲和力指数（AI）,探讨 TORCH感染类型与妊娠结局间关系。方法收集TORCH各型病原体IgM阳性孕妇血清,检测其IgG亲和力指数（AI）,并追踪妊娠结局。结果在TORCH各病原体近期感染的孕妇中,HSV（含1型及2型）、RUB、CMV、TOXO原发感染（AI＜30％）的比例分别为0、3．8％、9．3％、7．9％;在CMV原发感染的10例孕妇中,2例妊娠结局异常（稽留流产）,CMV疑似原发感染孕妇中发现1例为异常妊娠;TOXO原发感染孕妇发现1例为胎儿畸形（脑积水）,其余均为正常妊娠。结论在TORCH各病原体近期感染的孕妇中,以非原发性感染为主;而巨细胞及弓形虫原发感染对胎儿的侵害则远大于非原发感染。     

Parasites during pregnancy

Parasitic infection during pregnancy is common. With most parasites, primary prevention is very effective in avoiding infestation. With the exceptions of malaria, toxoplasmosis, and African trypanosomiasis, when infection does occur, treatment decisions should be based on the impact of the infection on the patient and her fetus on an individual basis. When treatment is indicated, selection of medications with the least potential to harm the mother and more particularly the developing fetus is essential.     

Diagnostic protocol of toxoplasmosis in materno-fetal infections (1981-1984 statistics)

The authors describe the most important methods in use for the laboratory diagnosis of toxoplasmosis, with special reference to the presence of IgM and to their significance in the diagnosis of acute infection. Statistics of tests carried out on pregnant women at the "Giovanni Lelli" Centre (Rome, Italy) during the years 1981-1984 are quoted. The recommended diagnostic protocol to be followed to prevent congenital infections is given.     

IgG avidity assay firms up the diagnosis of acute toxoplasmosis on the first serum sample in immunocompetent pregnant women

Rapid diagnosis of acute toxoplasmosis during pregnancy permits timely treatment and prevents or attenuates congenital toxoplasmosis. Specific IgM antibodies to Toxoplasma as marker of acute infection are often poorly informative, meaning that a complementary technique is needed to reach a diagnosis on the first sample. Here we evaluated 2 commercial kits designed to assist with the diagnosis of acute toxoplasmosis: Platelia Toxo IgG Avidity Complementary Reagents and Platelia Toxo IgA, both from BIO-RAD (Marnes La Coquette, France). We tested 2 groups of subjects: 36 patients with acute toxoplasmosis and 55 patients with chronic toxoplasmosis. The IgG avidity test had a sensitivity of 100% (36/36), a specificity of 92.7% (51/55), a positive predictive value of 90%, and a negative predictive value of 100%. Among the immunocompetent women population, the avidity test had perfect sensitivity and specificity, and positive and negative predictive values of 100%. The IgA test had a sensitivity of 88.8% (32/36) and a specificity of 85.4% (47/55), and positive and negative predictive values of 80% and 92.1%, respectively. When the 2 tests were combined, there was only 1 case in which the diagnosis of chronic toxoplasmosis could not be confirmed. The IgG avidity test can therefore be used to rapidly distinguish between chronic and acute infection on the first sample from a pregnant woman, provided there is no underlying immunodepression and no ongoing antitoxoplasmic treatment. In these 2 situations, the results must be interpreted with care, and other serologic markers, including IgA, should be tested. Determination of a pregnant woman's status on a first serum sample allows therapeutic and preventive management to be started without delay.     

Screening and treatment for sexually transmitted infections in pregnancy

Many sexually transmitted infections are associated with adverse pregnancy outcomes. The Centers for Disease Control and Prevention recommends screening all pregnant women for human immunodeficiency virus infection as early as possible. Treatment with highly active antiretroviral therapy can reduce transmission to the fetus. Chlamydia screening is recommended for all women at the onset of prenatal care, and again in the third trimester for women who are younger than 25 years or at increased risk. Azithromycin has been shown to be safe in pregnant women and is recommended as the treatment of choice for chlamydia during pregnancy. Screening for gonorrhea is recommended in early pregnancy for those who are at risk or who live in a high-prevalence area, and again in the third trimester for patients who continue to be at risk. The recommended treatment for gonorrhea is ceftriaxone 125 mg intramuscularly or cefixime 400 mg orally. Hepatitis B surface antigen and serology for syphilis should be checked at the first prenatal visit. Benzathine penicillin G remains the treatment for syphilis. Screening for genital herpes simplex virus infection is by history and examination for lesions, with diagnosis of new cases by culture or polymerase chain reaction assay from active lesions. Routine serology is not recommended for screening. The oral antivirals acyclovir and valacyclovir can be used in pregnancy. Suppressive therapy from 36 weeks' gestation reduces viral shedding at the time of delivery in patients at risk of active lesions. Screening for trichomoniasis or bacterial vaginosis is not recommended for asymptomatic women because current evidence indicates that treatment does not improve pregnancy outcomes.     

Infections in pregnancy

Infections in pregnancy may complicate its course and harm the fetus or newborn after vertical transmission. Treatment of asymptomatic bacteriuria is mandatory in pregnant women given the high risk of secondary pyelonephritis. Intraamniotic infection usually arises by the ascending route and is associated with premature rupture of membranes. Vaginal infections promote preterm labour or premature rupture of membranes and may be transmitted to the child during labour. They must therefore be treated although they often cause little discomfort to the pregnant woman. Systemic infections due to viral, protozoal and bacterial pathogens may be transmitted transplacentally and cause embryopathies, fetopathies or neonatal infections. Depending on the responsible agent the negative impact on the course of pregnancy and on the fetus' or neonate's health can be prevented or reduced by prophylactic or therapeutic interventions.     

Regulation of Extraadrenal Steroid 21-Hydroxylase Activity: INCREASED CONVERSION OF PLASMA PROGESTERONE TO DEOXYCORTICOSTERONE DURING ESTROGEN TREATMENT OF WOMEN PREGNANT WITH A DEAD FETUS

We measured deoxycorticosterone (DOC) and progesterone (P) in plasma of 47 women pregnant with a dead fetus and sequentially throughout gestation in 35 women pregnant with a live fetus. When P levels in plasma were low, the plasma levels of DOC in women pregnant with a dead fetus varied but usually were similar to those in women pregnant with a live fetus. However, when P levels were high, the levels of DOC in some women pregnant with a dead fetus were considerably lower than those in women pregnant with a live fetus. To test whether this finding was due to loss of transfer of DOC from fetus to mother or else loss of extraadrenal steroid 21-hydroxylase activity in the mother after death of the fetus, we conducted several studies. The levels of P and DOC in plasma of one woman remained constant from 30 min after fetal death until delivery occurred 13 h later. Estrogen treatment of four women pregnant with a dead fetus brought about an increase in plasma levels of DOC in three of the women. In one woman the ratio of plasma DOC to P was 0.015, a value similar to that found before fetal death, but was 0.003 after fetal death but before estrogen treatment. In two women pregnant with a dead fetus the transfer constants of conversion of plasma P to DOC were 0.011 and 0.005 before, and 0.024 and 0.013, respectively, during estrogen treatment. In one woman pregnant with a deformed fetus with adrenal agenesis, the metabolic clearance rates of DOC before and during estrogen treatment were similar, whereas the plasma production rates of DOC were 2.75 before and 4.31 mg/24 h during estrogen treatment. We suggest that (a) the DOC in plasma of near-term pregnant women arises in part by extraadrenal 21-hydroxylation of plasma P and (b) estrogen stimulates steroid 21-hydroxylase activity in extraadrenal tissues.     

Points to Remember In Prescribing Drugs During Pregnancy

Our knowledge of possible adverse drug effects on the fetus is quite limited. The doctor must act as the fetus' first line of defence. Mothers must be educated about the dangers of self-medication. Physicians must guard against drug administration to pregnant women unless the indications are clear and the expected benefit outweighs the possible risk to the fetus.     

永州地区2283例孕产妇传染性标志物检测结果分析

目的 了解永州地区孕产妇血清传染性标志物感染情况及发展趋势.方法 对永州市中心医院妇产科住院的孕产妇进行血清传染性标志物乙型肝炎病毒(HBV)、丙型肝炎病毒抗体(抗-HCV)、人类免疫缺陷病毒抗体(抗-HIV)、梅毒螺旋体抗体(抗-TP)进行检测,及乙型肝炎血清标志物的检测.结果 2283例孕产妇血清传染性标志物乙型肝炎病毒表面抗原(HBsAg)、抗-HCV、抗-HIV、抗-TP的阳性率分别为10.73％、0.04％、0.00％、0.48％,2283例孕产妇的HBV标志物模式乙型肝炎病毒表面抗原(HBsAg)(+)、乙型肝炎病毒e抗原(HBeAg)(+)、乙型肝炎病毒核心抗体(抗-HBc)(+),HBsAg(+)、乙型肝炎病毒e抗原(抗-HBe)(+)、抗-HBc(+)的比例分别为2.98％、2.31％.结论 孕产妇血清传染性标志物检测,对预防医院感染,预防血液传播性疾病,控制母耍传播,规范医疗行为,降低手术风险,具有重要意义,并建议孕龄妇女在孕前、孕期、产前进行HBV、抗-HCV、抗-HIV、抗-TP的检测,就可及早发现、及早治疗,有利于优生优育.     

Screening for disease in pregnancy.

Screening during pregnancy is unlike screening any other population, because two entities are involved and potentially affected by the disease: the pregnant woman and the fetus. A number of serum screening tests can be performed as part of prenatal care. Some are routinely done on all pregnant women, some are offered to women thought to be at risk for a particular disease, and some are offered according to the woman's age, country of origin or other criterion.     

PHARMACOKINETICS OF TOBRAMYCIN IN PREGNANT WOMEN. SAFETY AND EFFICACY OF A ONCE-DAILY DOSE REGIMEN

The pharmacokinetics of tobramycin, an aminoglycoside antibiotic, was investigated after a short intravenous infusion and once-daily dose regimen in two groups of nine pregnant women during the second (Group 1) and the third (Group 2) trimester of pregnancy. During these periods, the risk of infectious diseases is increased. Plasma concentrations of tobramycin were measured by fluorescence polarization immunoassay. The decrease in clearance (21%), at 28 weeks and more of gestation leads to an increase in half-life and the mean residence time (MRT) in the second group (33 and 29% respectively). The volume of distribution was unchanged in the two groups. No accumulation of the drug was observed in pregnant women. Pharmacokinetic disorders are correlated with the term and moreover with the weight deviation of women, i.e. the growth of the fetus. These findings suggest accumulation of the aminoglycoside antibiotic in the fetus. Moreover, the efficacy and the safety of this therapeutic regimen were excellent. To limit the potential nephrotoxicity and ototoxicity of tobramycin for the mother and the fetus, a once-daily dose regimen seems to be acceptable for the treatment of non-neutropenic pregnant women.     

Toxoplasmosis surveillance during pregnancy and quality assurance of methods in Hungary

In Hungary, screening programs have been performed for the early detection of toxoplasmosis in pregnant women in three different counties. The results of a screening program performed in the town of Szeged are discussed in details. The pregnant women are screened by serological and molecular biological methods (anti-Toxoplasma CFT, IgG, IgM, anti-P30 IgA ELISA, IgG avidity test, PCR amplification). The women are first screened within the first 16 weeks of gestation. Seronegative cases are retested for seroconversion in every second month. Appropriate treatment is immediately started both in the mothers suspicious of acute toxoplasmosis and in their offspring. The urine samples of the babies are examined by nested PCR specific to B1 gene of Toxoplasma gondii. No cases of congenital toxoplasmosis have been detected among the screened and treated children so far. Thus, we consider the program as highly successful for screening of congenital toxoplasmosis. To insure the quality of the applied laboratory diagnostic methods, the QualiCont Company organizes two quality control investigations yearly in the laboratories involved.