ENTEROVIRALES AS A REASON OF INTRAUTERINE INFECTIONS OF FETUS AND NEONATAL DISEASES

Abstract

Introduction. Intrauterine infections remain an urgent issue of modern Perinatology and belong to the group of diseases diagnosis of which is associated with some difficulties. The number of causative agents of intrauterine infections in case of ante-, intra- and perinatal infectionis practically unlimited. However, one of the first places belongs to pathogens of viral infections with enteroviruses being of the most interest, as a transplacental (vertical) way of infection the fetus and neonates was proved. The significance of enteroviruses in the pathology of the fetus and neonate is unknown, since there is no verification ofserotypes of enteroviruses in pregnant women and neonates.The objective is to determine the effect of enteroviruses on the fetus and neonate based on the verification of circulating enteroviruses serotypes, the definition of risk factors of the perinatal anamnesis, clinical course ofintrauterine enteroviral infection.Materials and methods. Clinical and laboratory examination of 834 mothers and their sick neonates with suspected intrauterine infections in the first 3 days of life was conducted. The subject of the study was a group of 224 infants with congenital viral infections. Intrauterineenteroviral infection was verified in 108 cases. General clinical and special methods of research were used. Specific diagnosis of intrauterine enteroviral infection was made using the cultural method, polymerase chain reaction and the modified reaction of complement binding withthe use of poly- and monovalent enteroviral diagnostic sera on the enzyme-immunoassay analyzer. Material for examination of children and mothers was the blood taken from the umbilical and peripheral veins and feces. Statistical processing was carried out with the computation of parametric and nonparametric criteria. The results of the research. In 224 children with congenital viral infections during verification of an etiological pathogen, prenatal enteroviral infections was diagnosed in 108 cases (48.2%), including 54 (50,0%) mature and 54 (50.0%) premature ones. In most casesenteroviruses were verified in association with other intrauterine enteroviral infection pathogens (mixed forms) in 91 (84,3%): in association with respiratory vi ruses in 33 (36,3%), with the causative agents of TORCH-group in 27 (29,7%), with bacterial pathogens in 31 (34,0%) and in the form of monoinfection in 17 (15,7%) neonates. On the basis of laboratory examinations the role of various serologicaltypes of enteroviruses in the structure of congenital viral infections in neonates was identified for the first time, with serotypes of entero 68-71 – in 67 (62,0%), echo – in 32 (29,6%) and Coxsackie B – in 15 (13,9%) predominating.The most severe course of infection was observed in premature infants. The most severe course of intrauterine enteroviral infection with the fatal outcome was observed in neonates in case of association of Coxsackie B6 with bacterial pathogens and influenza virus.Summary. On the basis of specific diagnostic methods, the role of various enteroviruses serotypes in the pathology of the fetus and neonates was identified. The most common perinatal risk factors for the development of intrauterine enteroviral infection in neonates are the presence of acute respiratory viral infections in pregnant women,abortion, premature labor, anemia, placental dysfunction, preeclampsia. The fact that enteroviruses cause visceral forms of lesions (serotypes of Coxacques B and ECHO) as well as subclinical forms of infection (serotypes of entero-68-71) in newborns was proved. Increased frequency (48,2%) of enteroviral isolation in neonate patients withintrauterine enteroviral infections, peculiarities of the severe clinical course motivate early diagnosis in case of visceral and generalized forms of intrauterine infections.