1
|
Yadav M, Gowda M, Navya C, Deodhare K, Murugesan S. Prenatal presentation and diagnosis of a case of fetal varicella syndrome. Clin Dysmorphol 2024; 33:99-103. [PMID: 38363857 DOI: 10.1097/mcd.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Affiliation(s)
- Manisha Yadav
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Gorimedu, Pondicherry, India
| | | | | | | | | |
Collapse
|
2
|
Abstract
Varicella-zoster virus (VZV) is a human pathogen of the α-herpesvirus family. Some fetuses infected in utero around 8-20 weeks of pregnancy show signs of congenital varicella syndrome (CVS). Infants born to mothers who develop varicella within 5 days before and 2 days after delivery can experience severe disease with increased mortality. The best diagnostic modality is polymerase chain reaction (PCR), which can be done using vesicular swabs or scrapings, scabs from crusted lesions, tissue from biopsy samples, and cerebrospinal fluid. The prevention and management of varicella infections include vaccination, anti-VZV immunoglobulin, and specific antiviral drugs. In this article, we have reviewed the characteristics of VZV, clinical manifestations, management of perinatal infections, and short- and long-term prognosis.
Collapse
Affiliation(s)
- Srijan Singh
- Department of Paediatrics, Grant Government Medical College and Sir JJ Hospitals, Mumbai, Maharashtra, India
| | - Akash Sharma
- Department of Pediatrics, Sir Padampat Institute of Neonatal and Pediatric Health (SPINPH), SMS Medical College, Jaipur, Rajasthan, India
| | | | - Gangajal Kasniya
- Mount Sinai Hospital, Chicago, Illinois, United States of America
| | - Akhil Maheshwari
- Global Newborn Society, Clarksville, Maryland, United States of America
| | - Suresh B Boppana
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| |
Collapse
|
3
|
Condrat CE, Varlas VN, Duică F, Antoniadis P, Danila CA, Cretoiu D, Suciu N, Crețoiu SM, Voinea SC. Pregnancy-Related Extracellular Vesicles Revisited. Int J Mol Sci 2021; 22:3904. [PMID: 33918880 DOI: 10.3390/ijms22083904] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022] Open
Abstract
Extracellular vesicles (EVs) are small vesicles ranging from 20–200 nm to 10 μm in diameter that are discharged and taken in by many different types of cells. Depending on the nature and quantity of their content—which generally includes proteins, lipids as well as microRNAs (miRNAs), messenger-RNA (mRNA), and DNA—these particles can bring about functional modifications in the receiving cells. During pregnancy, placenta and/or fetal-derived EVs have recently been isolated, eliciting interest in discovering their clinical significance. To date, various studies have associated variations in the circulating levels of maternal and fetal EVs and their contents, with complications including gestational diabetes and preeclampsia, ultimately leading to adverse pregnancy outcomes. Furthermore, EVs have also been identified as messengers and important players in viral infections during pregnancy, as well as in various congenital malformations. Their presence can be detected in the maternal blood from the first trimester and their level increases towards term, thus acting as liquid biopsies that give invaluable insight into the status of the feto-placental unit. However, their exact roles in the metabolic and vascular adaptations associated with physiological and pathological pregnancy is still under investigation. Analyzing peer-reviewed journal articles available in online databases, the purpose of this review is to synthesize current knowledge regarding the utility of quantification of pregnancy related EVs in general and placental EVs in particular as non-invasive evidence of placental dysfunction and adverse pregnancy outcomes, and to develop the current understanding of these particles and their applicability in clinical practice.
Collapse
|
4
|
Enioutina EY, Constance JE, Stockmann C, Linakis MW, Yu T, Rower JE, Balch AH, Sherwin CM. Pharmacokinetic considerations in the use of antivirals in neonates. Expert Opin Drug Metab Toxicol 2015; 11:1861-78. [PMID: 26535960 DOI: 10.1517/17425255.2015.1108963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Neonatal patients, because of the inability of their immune system to properly respond to microbial challenge, are highly susceptible to viral infections. Immunoglobulins, monoclonal antibody and antiviral drugs are used for prophylaxis and treatment of viral diseases in neonates. Neonates and, especially, preterm infants differ in drug absorption, distribution, metabolism and excretion from adults and older children. AREAS COVERED This review will evaluate deficiencies of neonatal immune responses to microbial challenge that predispose newborns to viral infections, clinical manifestations and the treatment of viral diseases in neonates. We focus on published studies describing antiviral drug pharmacokinetics in neonates and make recommendations on the dosing of these drugs, allowing achievement of maximal clinical benefits in neonates. EXPERT OPINION While some efforts were undertaken to study pharmacokinetics and pharmacodynamics of antiviral drugs, much more needs to be done. Current data indicate that the pharmacokinetics of antiviral drugs may vary significantly depending on gestational age, maturation processes of drug-metabolizing enzymes and renal clearance. Specifics of pharmacokinetics of antiviral drugs need to be taken into consideration when they are prescribed to neonates and infants.
Collapse
Affiliation(s)
- Elena Yu Enioutina
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA.,b Division of Microbiology and Immunology, Department of Pathology , University of Utah School of Medicine , 15 North Medical Drive East, Salt Lake City , UT 84112 , USA
| | - Jonathan E Constance
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA
| | - Chris Stockmann
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA
| | - Matthew W Linakis
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA
| | - Tian Yu
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA
| | - Joseph E Rower
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA
| | - Alfred H Balch
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA
| | - Catherine M Sherwin
- a Division of Clinical Pharmacology, Department of Pediatrics , University of Utah School of Medicine , 295 Chipeta Way, Salt Lake City , UT 84108 , USA
| |
Collapse
|
5
|
Abstract
Viral infections during pregnancy have long been considered benign conditions with a few notable exceptions, such as herpes virus. The recent Ebola outbreak and other viral epidemics and pandemics show how pregnant women suffer worse outcomes (such as preterm labor and adverse fetal outcomes) than the general population and non-pregnant women. New knowledge about the ways the maternal-fetal interface and placenta interact with the maternal immune system may explain these findings. Once thought to be 'immunosuppressed', the pregnant woman actually undergoes an immunological transformation, where the immune system is necessary to promote and support the pregnancy and growing fetus. When this protection is breached, as in a viral infection, this security is weakened and infection with other microorganisms can then propagate and lead to outcomes, such as preterm labor. In this manuscript, we review the major viral infections relevant to pregnancy and offer potential mechanisms for the associated adverse pregnancy outcomes.
Collapse
MESH Headings
- Animals
- Coinfection
- Congenital Abnormalities/etiology
- Female
- Fetal Diseases/immunology
- HIV Infections/congenital
- HIV Infections/embryology
- HIV Infections/immunology
- HIV Infections/transmission
- Hepatitis, Viral, Human/embryology
- Hepatitis, Viral, Human/immunology
- Hepatitis, Viral, Human/transmission
- Herpesviridae Infections/embryology
- Herpesviridae Infections/immunology
- Herpesviridae Infections/transmission
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Influenza, Human/embryology
- Influenza, Human/immunology
- Maternal-Fetal Exchange/immunology
- Obstetric Labor, Premature/etiology
- Placenta/immunology
- Placenta/virology
- Pregnancy
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/virology
- Pregnancy Outcome
- Risk
- Rubella/embryology
- Rubella/immunology
- Rubella/transmission
- Virus Diseases/immunology
- Virus Diseases/transmission
Collapse
Affiliation(s)
- Michelle Silasi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | | |
Collapse
|
6
|
|
7
|
Abstract
Varicella (chickenpox) in pregnancy is unusual because most women of childbearing age are immune. It can, however, cause significant morbidity for the pregnant woman and in rare cases cause congenital varicella syndrome. The incidence of congenital varicella syndrome after maternal varicella during the first two trimesters is <1% across multiple cohort studies. Maternal infection in the third trimester is not associated with congenital varicella syndrome, but the infant may develop herpes zoster during the first one or two years. Maternal infection just before or after delivery presents a high risk for disseminated varicella in the infant. Serious infection can be prevented with passive antibody prophylaxis and antiviral therapy. Maternal herpes zoster does not result in adverse fetal or neonatal outcomes.
Collapse
Affiliation(s)
- Candice K Smith
- Stanford University School of Medicine, 300 Pasteur Drive, G322, Stanford, CA 94305, USA.
| | | |
Collapse
|
8
|
Alfonsi V, Montomoli E, Manini I, Alberini I, Gentile C, Rota MC, Ciofi degli Atti ML. Susceptibility to varicella in childbearing age women, Central Italy: is there a need for vaccinating this population group? Vaccine 2007; 25:6086-8. [PMID: 17629374 DOI: 10.1016/j.vaccine.2007.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 05/07/2007] [Accepted: 05/12/2007] [Indexed: 11/24/2022]
Abstract
We conducted a cross-sectional seroprevalence study of varicella-zoster virus (VZV) antibodies in childbearing age women aged 17-42 years. Sera were collected in Central Italy in years 2001-2002 and were tested by a commercial VZV IgG enzyme immunoassay. Overall VZV seroprevalence was 80.9% and it showed a significant increase by age, confirming a considerable circulation of VZV also in the older age groups not commonly considered at high risk. This study further supports the importance of vaccinating susceptible adolescents and women of childbearing age in order to reduce both maternal and foetal complications associated with varicella in pregnancy.
Collapse
Affiliation(s)
- Valeria Alfonsi
- Istituto Superiore di Sanità, National Center for Epidemiology Surveillance and Health Promotion, Italy
| | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
OBJECTIVE Historically, pneumonia during pregnancy has been associated with increased morbidity and mortality compared with nonpregnant women. The goal of this article is to review current literature describing pneumonia in pregnancy. This review will identify maternal risk factors, potential complications, and prenatal outcomes associated with pneumonia and describe the contemporary management of the varied causes of pneumonia in pregnancy. RESULTS Coexisting maternal disease, including asthma and anemia, increase the risk of contracting pneumonia in pregnancy. Neonatal effects of pneumonia in pregnancy include low birth weight and increased risk of preterm birth, and serious maternal complications include respiratory failure. Community-acquired pneumonia is the most common form of pneumonia in pregnancy, with Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae accounting for most identified bacterial organisms. Beta-lactam and macrolide antibiotics are considered safe in pregnancy and are effective for most community-acquired pneumonia in pregnancy. Viral respiratory infections, including varicella, influenza, and severe acute respiratory syndrome, can be associated with maternal pneumonia. Current antiviral and respiratory therapies can reduce maternal morbidity and mortality from viral pneumonia. Influenza vaccination can reduce the prevalence of respiratory hospitalizations among pregnant women during influenza season. Pneumocystis pneumonia continues to carry significant maternal risk to an immunocompromised population. Prevention and treatment of Pneumocystis pneumonia with trimethoprim/sulfamethoxazole is effective in reducing this risk. CONCLUSIONS Prompt diagnosis and treatment with contemporary antimicrobial therapy and intensive care unit management of respiratory compromise has reduced the maternal morbidity and mortality due to pneumonia in pregnancy. Prevention with vaccination in at-risk populations may reduce the prevalence and severity of pneumonia in pregnant women.
Collapse
Affiliation(s)
- William H Goodnight
- Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
10
|
Greenberg DE, Greenberg SB. Viral Infections in ICU Patients. Tropical and Parasitic Infections in the Intensive Care Unit 2005. [DOI: 10.1007/0-387-23380-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
Bruel H, Chabrolle JP, El Khoury E, Poinsot J, Amusini P, Beurrier J. À propos de deux cas de varicelle congénitale : plaidoyer pour la vaccination des femmes en âge de procréer. Arch Pediatr 2004; 11:216-8. [PMID: 14992768 DOI: 10.1016/j.arcped.2003.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Accepted: 12/06/2003] [Indexed: 02/01/2023]
Abstract
We describe two cases of congenital varicella. The first presented with cutaneous aplasia and scars; the second with skin abnormalities, limb atrophy, limb paresis, Horner's syndrome and liver calcifications: prognosis was poor in this case. After reviewing the published cases of congenital varicella, we advocate the use of varicella vaccine in seronegative women before pregnancy.
Collapse
Affiliation(s)
- H Bruel
- Service de médecine néonatale, hôpital Flaubert, groupe hospitalier du Havre, 76083 Le Havre cedex, France.
| | | | | | | | | | | |
Collapse
|
12
|
Verstraelen H, Vanzieleghem B, Defoort P, Vanhaesebrouck P, Temmerman M. Prenatal ultrasound and magnetic resonance imaging in fetal varicella syndrome: correlation with pathology findings. Prenat Diagn 2003; 23:705-9. [PMID: 12975778 DOI: 10.1002/pd.669] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess the diagnostic value of prenatal magnetic resonance imaging (MRI) in addition to prenatal ultrasound in a case of fetal varicella syndrome. METHODS Comparison of prenatal ultrasound and MRI features obtained at 26 and 32 weeks, respectively, with neonatal imaging (ultrasound, MRI and CT) and macroscopic and microscopic pathology findings in a fatal case of varicella embryopathy. RESULTS Prenatal ultrasound correlated fairly well with neonatal imaging and pathology findings. Most lesions of thoracic, abdominal and retroperitoneal viscera, limb involvement and even dermatologic features were apparent on ultrasonography. Involvement of the CNS, including cerebellar hypoplasia, was not apparent on ultrasound examination, but was clearly demonstrated by prenatal MRI. CONCLUSION If maternal seroconversion for the varicella-zoster virus is suspected, combining prenatal ultrasound and magnetic resonance imaging may document the extent of tissue damage in fetal varicella syndrome to a larger extent than has been reported until now and therefore contribute to due counselling following maternal varicella exposure.
Collapse
Affiliation(s)
- Hans Verstraelen
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | | | | | | |
Collapse
|
13
|
Abstract
Varicella-zoster virus (VZV) is the etiologic agent of varicella (primary infection) and herpes zoster (reactivation of latent infection). Although varicella is most often a relatively benign and self-limited childhood illness, the disease can be associated with a variety of serious and potentially lethal complications in both immunocompetent and immunocompromised persons. One complication of varicella that appears to be increasing in frequency is serious bacterial soft tissue infections caused by group A streptococci. Issues related to management of varicella become especially complex when varicella involves pregnant women or susceptible neonates. Herpes zoster can be associated with a variety of neurologic complications, including a syndrome of delayed contralateral hemiparesis. Neurologic complications of herpes zoster, including chronic encephalitis, occur with increased frequency in AIDS patients. VZV retinitis is a potentially sight-threatening complication that occurs in both immunocompetent and immunocompromised persons. Current knowledge regarding pathogenesis and antiviral therapy is reviewed.
Collapse
Affiliation(s)
- John W Gnann
- University of Alabama at Birmingham and Birmingham VA Medical Center, Birmingham, Alabama 35294-2170, USA
| |
Collapse
|
14
|
Bellini C, Mazzella M, Arioni C, Serra G. A Newborn with Rash and Chorioretinitis. Clin Infect Dis 2002. [DOI: 10.1086/341905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Abstract
Viral diseases in children can present with characteristic mucocutaneous manifestations. This article focuses, from a practical clinical point of view, on the laboratory and clinical diagnoses, and treatment of pediatric dermatological diseases that have specific antiviral therapies: herpes virus infections (including varicella), papillomavirus infections and molluscum contagiosum. Special issues, such as viral infections in pregnancy, therapy of viral infections in immunosuppressed children, as well as special problems associated with the epidemiology of genital herpes and papillomavirus infections in adolescents are discussed. The antivirals discussed in detail include: aciclovir, valaciclovir, famciclovir, penciclovir, cidofovir, foscarnet and the immune response modulator, imiquimod. Since these antiviral drugs generally have not been evaluated in children, caution should be exercised with their usage.
Collapse
Affiliation(s)
- Zoltan Trizna
- Department of Dermatology, Health Sciences Center, Texas Tech University, Mail Drop #9400, 3601 4th Street, Lubbock, TX 79416, USA.
| |
Collapse
|
16
|
Affiliation(s)
- Robert T Maupin
- Department of OB/GYN, Louisiana State University School of Medicine, New Orleans, Louisiana 70112, USA.
| |
Collapse
|
17
|
Affiliation(s)
- K W Kerkering
- Virginia Commonwealth University, Medical College of Virginia, Box 980276, Richmond, VA 23298, USA
| |
Collapse
|
18
|
Abstract
An understanding of the common infections that occur during pregnancy is crucial for prenatal care providers. This article discusses specific screening and diagnostic tests, along with appropriate treatment regimens for common bacterial, viral, protozoal, and fungal infections that occur during pregnancy. Additionally, methods to reduce the likelihood of infection, such as preconception immunization, are reviewed.
Collapse
Affiliation(s)
- M K Cline
- Anderson Family Practice Residency, and Assistant Clinical Professor, Department of Family Medicine, Medical University of South Carolina, Anderson, SC 29621, USA.
| | | | | |
Collapse
|