Abstract
Nonspecificity of clinical, laboratory and instrumental manifestations of congenital infectious diseases, including viral infections, and the diversity of methods for etiological verification of pathogens define both the need to choose the optimal approaches to the diagnosis of this pathology, and the feasibility of testing for a broad range of etiologic agents in case of suspected congenital viral infection. The analysis of current guidelines, international consensus documents issued by specialists, and published results of some studies has shown that identification of the genetic material of the pathogen with the use of amniocentesis/ cordocentesis (for cytomegalovirus and parvovirus infections) or in the birth canal (for herpes simplex infection) is the key method for antenatal etiological verification of the widespread viral infections. During the postnatal period, molecular genetic testing is combined with serological diagnosis involving determining specific immunoglobulins M and G, as well as their avidity index.
Highlights
Vasilyev VV1,4, Grineva AA1, Rogozina NV1,3, Ivanova RA1,2, Ushakova GM1 1 Pediatric Research and Clinical Center for Infectious Diseases, Saint-Petersburg, Russia 2 Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russia 3 St
The analysis of current guidelines, international consensus documents issued by specialists, and published results of some studies has shown that identification of the genetic material of the pathogen with the use of amniocentesis/ cordocentesis or in the birth canal is the key method for antenatal etiological verification of the widespread viral infections
The review does not include any guidelines and consensus documents, related to perinatal aspects of HIV infection, viral hepatitis, and other viral infections, the diagnostic approach to which is reported in the SanPin Sanitary Rules and Regulations 3.3686-21 “Sanitary and Epidemiological Requirements for Communicable Diseases Prevention” [20]; the papers, related to perinatal aspects of Congenital viral diseases (CVDs), the guidelines on which are temporary or non-legislative (COVID-19 and Zika virus disease), and the papers, substantiating the choice of the methods and instruments, included in the guidelines
Summary
The review includes the current foreign guidelines and the international consensus documents issued by professional communities, as well as the basic (according to the authors) review papers, systematic reviews and meta-analyses. The indications for laboratory and instrumental examination, aimed to exclude/verify congenital CMVI in the newborn, are as follows: the baby showing clinical signs of congenital infection regardless of their possible etiology (including leukopenia, thrombocytopenia, elevated of hepatic transaminases and direct bilirubin); failure to pass the hearing screen; the documented primary maternal CMVI during pregnancy regardless of the presence or absence of clinical manifestations in the baby; subfebrile temperature, maternal influenza-like illness during the first 20 weeks of gestation; threatened preterm labour; preterm birth, intrauterine growth restriction; genetic material of the pathogen identified in the afterbirth by PCR; signs of intrauterine infection detected during the radiological examination [36, 38, 39]. Simultaneous quantification of the CMV IgM and IgG levels in the blood serum, obtained from neonates, is a more affordable, but a less informative method: specific IgM in the first days of life should indicate the primary infection These are not always found in babies with congenital CMVI; false positive results occur [45]. Other clinical and laboratory tests are performed when clinically indicated
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