Early Maternal Infection Research Articles

Long-term Ocular Outcomes in Congenital Toxoplasmosis Treated Perinatally.

Congenital toxoplasmosis (CT) can be accompanied by serious organ manifestations, particularly retinochoroiditis, and may occur throughout life. We aimed to monitor long-term ocular prognosis in a large French cohort of patients with CT and its changes over time in the context of mandatory prenatal screening (since 1992) and incidence decrease since 2008. Patients with CT diagnosed between 1987 and 2021 were prospectively included and followed for up to 35 years. The effect of the period of conception on the risk of first retinochoroiditis has been tested using a flexible extension of the Cox model. Incidence rates of retinochoroiditis were estimated. A total of 646 infected live born children were followed for a median of 12 years (range, 0.5-35); 187 patients (29%) had at least 1 ocular lesion (first at a median age of 5 years; range, 0-26 years) with peaks at 7 and 12 years. Early maternal infection and the presence of nonocular signs at birth were associated with a higher risk of retinochoroiditis, whereas delayed diagnosis of CT (after birth versus before or at birth) was associated with a lower risk (13% decrease for each additional month after birth; P = .01). A period effect for the risk of developing retinochoroiditis in patients born after 2008 was not detected. Despite prenatal screening and prolonged perinatal treatment, retinochoroiditis is not a rare event in French patients with CT and can occur well into adulthood, with peak incidences at 7 and 12 years of age. It rarely causes severe damage but warrants regular follow-up into adulthood.

Desenvolvimento motor de crianças expostas ao zika vírus: revisão sistemática

Abstract Objectives: to describe the motor development, in the first two years of life, of children with evidence of congenital Zika virus syndrome (CZS) at birth and of children exposed to the Zika virus (ZIKV) during pregnancy, but without evidence of CZS. Methods: systematic review, according to the recommendations of the Preferred Reporting Items for Systematic Reviews (PRISMA). The search took place in the VHL/LILACS interface and BIREME/ PubMed interface databases until March 2020. Two researchers analyzed the quality of the studies using the Johanna Briggs Institute methodology. Results: 21 articles were selected. Children with CZS have severe impairment of motor functions and a high prevalence of spastic cerebral palsy. At two years of life, most reached only early levels of motor development; with impaired vision, hearing, language, cognition, behavior, and social interaction. On the other hand, children exposed to ZIKV, but without evidence of CZS, are at lower risk, about 20% have late manifestations of delay and/or neurodevelopmental disorder. Variables associated with greater motor impairment are early maternal infection, preterm birth, lower head circumference, abnormal imaging, use of anticonvulsant, increasing age, arthrogryposis, epilepsy, deficits in vision, language, cognition, and lower income. Conclusion: Most children with CZS show severe motor impairment; a small part of those exposed to ZIKV, without evidence of the syndrome at birth, have alteration in neurodevelopment. Those children should be followed in the long-term, since some manifestations may occur belatedly.

Cytomegalovirus screening during pregnancy : an ongoing debate still in 2022

Cytomegalovirus infection remains the main congenital infectious cause of abnormal development, notably neurological or auditory. In case of early maternal infection, vertical transmission is lower than later in pregnancy, but fetal/neonatal sequelae are more frequent and severe. Until recently, there was no available treatment to prevent transmission and complications and only preventive measures were recommended. Based on a recent literature review, we will discuss the possible indication for CMV screening before conception and/or in the first trimester of pregnancy, in order to improve patient's information, prevention and treatment.

Development of a novel bedside index for the early identification of severe maternal infection

ObjectivesInternational consensus reports have recently recommended that the Systemic Inflammatory Response Syndrome (SIRS) criteria for the diagnosis of sepsis should cease and that new bedside criteria need to be developed to improve prevention, early diagnosis and treatment.The aim of this retrospective audit was to evaluate a suite of four bedside clinical criteria, called the Early Maternal Infection Prompts (EMIP), in helping to identify women with a suspected severe infection who were admitted to a High Dependency Unit (HDU) in a large tertiary referral stand-alone maternity hospital. Study designThe four EMIP criteria were decided based on existing national obstetric guidelines and a review of the recent literature on maternal critical illnesses. Cases were identified from the HDU registry for the three years 2015-2017. Individual charts were retrieved, and the four EMIP parameters were measured at the time of the clinical assessment that led to the HDU admission. Clinical and sociodemographic details were computerised for analysis. ResultsOf 73 women admitted with suspected severe maternal infection, the handwritten records were available in 69. The mean age was 31.3 years, 71% were multiparous and 26.1% were obese. Three quarters of cases were antenatal admissions. Infection was confirmed microbiologically in 56 (81.1%) of cases. There were no maternal deaths. There was no case of organ dysfunction diagnosed but two women required vasopressors to maintain blood pressure. Recordings of the maternal vital signs were not always fully completed before admission. In 69.1% (n = 47) of cases the temperature was elevated ≥ 37.5 C, in 81.2% (n = 56) of cases the heart rate was increased ≥ 100 bpm, in 51.9% (n = 27) cases the respiratory rate was increased ≥ 20 bpm, and in 25.4% (n = 17) cases the systolic blood pressure was ≤100 mmHg. At least one of the four EMIP criteria was abnormal in 91.3% (n = 63) of cases of suspected severe infection. ConclusionsThe audit confirmed that this bedside index has potential in helping to identify maternal infection early before sepsis develops. Prospective studies are required to evaluate the index in different settings, for different infections and at the different stages of maternal infection.

Protective effect of Group B Streptococcus type-III polysaccharide conjugates against maternal colonization, ascending infection and neonatal transmission in rodent models

Group B Streptococcus (GBS) is a normal inhabitant of recto-vaginal mucosae in up to 30% of healthy women. Colonization is a major risk factor for perinatal infection which can lead to severe complications such as stillbirth and neonatal invasive disease. Intra-partum antibiotic prophylaxis in colonized women is a safe and cost-effective preventive measure against early-onset disease in the first days of life, but has no effect on late-onset manifestations or on early maternal infection. Maternal immunization with capsular polysaccharide-based vaccines shows promise for the prevention of both early-onset and late-onset neonatal infections, although ability to prevent maternal colonization and ascending infection has been less studied. Here we investigated the effect of a GBS glycoconjugate vaccine since the very early stage of maternal GBS acquisition to neonatal outcome by rodent models of vaginal colonization and ascending infection. Immunization of female mice and rats with a type III glycoconjugate reduced vaginal colonization, infection of chorioamniotic/ placental membranes and bacterial transmission to fetuses and pups. Type III specific antibodies were detected in the blood and vagina of vaccinated mothers and their offspring. The obtained data support a potential preventive effect of GBS glycoconjugate vaccines during the different stages of pregnancy.

Infection with Genital Herpes Virus and Its Treatment in Relation to Preterm Delivery

Infection with herpes simplex is a standout amongst the most well-sexually transmitted infections. As the infection is common in women of reproductive age it may be contracted and transmitted to the fetus amid pregnancy and the new-born. Herpes simplex virus is a significant cause of neonatal infection, which could lead to death or long-term disabilities. Infrequently in the uterus, as it happens frequently during the transmission delivery. The most serious danger of transmission to the fetus and the new-born happens in case of an early maternal infection contracted in the second half of pregnancy. The danger of transmission of maternal-fetal-neonatal herpes simplex could be diminished by applying a treatment with antiviral medicines or depending on a caesarean section in some particular cases. The aim of this paper is to provide recommendations on the management of herpes simplex infections in pregnancy and approaches to decrease perinatal transmission of herpes simplex virus.

Ophthalmic Outcomes of Congenital Toxoplasmosis Followed Until Adolescence

Congenital toxoplasmosis (CT) can elicit severe damage to several organs, especially the eye, and may be manifested at birth or later. We assessed the long-term ocular prognosis in a cohort of congenitally infected children treated according to a standardized protocol and monitored for up to 22 years. This prospective study included confirmed cases of CT, which were identified by obligatory antenatal screening at the Lyon (France) reference center between 1987 and 2008. Data obtained through ocular examinations were recorded on a standardized form and confirmed by an independent external committee. Risk factors for retinochoroiditis were identified by using a multivariable Cox model and a flexible model that accounted for changes in the factor effects during follow-up. A total of 477 of 485 infected live-born children were followed for a median of 10.5 years (75th percentile: 15.0 years). During the follow-up, 142 patients (29.8%) manifested at least 1 ocular lesion. Lesions were unilateral in 98 individuals (69.0%) and caused no vision loss in 80.6%. Lesions were first manifested at a median age of 3.1 (0.0-20.7) years. In 48 (33.8%) of the children, recurrences or new ocular lesions occurred up to 12 years after the appearance of the first lesion. Early maternal infection and confirmation of CT in children, prematurity, and nonocular CT lesions at baseline were associated with a higher risk of retinochoroiditis. Although the consequences of CT are rarely severe in treated children, regular postnatal monitoring is nevertheless justified because of the lifelong persisting risk of new ocular manifestations.

In Utero and at Birth Diagnosis of Congenital Toxoplasmosis

The results of the ante- and neonatal diagnostic tests for congenital toxoplasmosis influence the decision to treat the newborn immediately after birth. Here, we estimate the positive and negative likelihood ratios (LRs) and the probabilities of congenital infection according to PCR and IgM-IgA tests results. The study concerned 767 children born between 1996 and 2002 and followed-up for 1-year at Croix-Rousse hospital, Lyon, France. The LRs and the post-test probabilities were estimated conditionally on gestational age at maternal infection using a logistic regression approach. For the PCR and the IgM-IgA tests, the positive LRs were high. In children with one positive test when only one test was done, the probability of infection reached 90% when the maternal infection occurred at 18-weeks gestation or later. This probability was close to 100% when the 2 tests were positive, whatever the gestational age. The negative LRs of the 2 tests moved closer to 0 at later gestational ages. However, when the tests were negative, the probability of infection remained greater or equal to 10%, except in early maternal infection. When the 2 tests were discordant, the probability of infection was about 50% in early maternal infection. Providing reliable probabilities of congenital infection, the PCR and IgM-IgA tests guide clinical management and counseling of parents.

Prenatal diagnosis of congenital toxoplasmosis by duplex real-time PCR using fluorescence resonance energy transfer hybridization probes.

The diagnosis of congenital toxoplasmosis frequently relies on PCR tests of amniotic fluid (AF). A duplex real-time quantitative PCR test based on fluorescence resonance energy transfer was developed to quantify the parasite load and to decrease the risk of contamination. An internal control based on the detection of 10 pg mouse DNA added to the AF was included to check for PCR efficiency. The relationship between the parasite load and the occurrence of ultrasonographic abnormalities in 87 samples of AF was analyzed. Seven AF (8%) had a parasitic load > 10(3); 14 (16%) had > 10(2)-< or =10(3); 26 (30%) had > 10-< or = 10(2); and 40 (46%) had < or = 10 parasites/ml. Four of the six AF with cerebral ventriculomegaly had >10(3) parasites/ml. The other two had 130 and 24 parasites/ml, respectively. No parasitic loads of > 10(3) parasites/ml and no ultrasonographic abnormalities were observed in the 11 AF with maternal toxoplasmosis in the third trimester. Therefore, there is a trend to associate high parasite count with ultrasonographic abnormality, but the main concern remains early maternal infection. The importance of quantification should be better evaluated with postnatal studies. The duplex LightCycler PCR test currently provides rapid and safe results.

Prenatal diagnosis of intrauterine infection with parvovirus B19 by the polymerase chain reaction technique.

Human parvovirus B19 is a recently recognized cause of fetal hydrops and death. Efforts to characterize the natural history of fetal infection with this virus have been hampered by the lack of sensitive and specific tests for diagnosis in utero. Using the highly sensitive polymerase chain reaction (PCR) assay, we determined the fetal infection status in 56 pregnancies by testing amniotic fluid, fetal serum, and maternal serum for B19 DNA and antibodies. Factors associated with a high risk of B19 infection were fetal disease, exposure to persons with erythema infectiosum, or signs or symptoms of acute B19 infection. Fifteen women (27%) were B19 IgM-positive, a status suggesting recent infection; the positivity of all of the corresponding fetal specimens for B19 DNA in the PCR was indicative of fetal infection. In four of these cases, serial ultrasonographic examinations documented spontaneous resolution of fetal hydrops. Twenty-four women (43%) were IgG-positive and IgM-negative; this pattern suggested prior infection. The PCR gave positive results, consistent with recent maternal infection, in four of these cases. Seventeen women (30%) were IgG-negative and IgM-negative, a pattern suggesting no prior infection; the PCR results in four cases were indicative of a possible early maternal infection or a possible atypical immune response. The PCR is a sensitive and rapid method for the diagnosis of intrauterine infection with human parvovirus B19 and promises to facilitate studies of the natural history and treatment of this infection.