Treatment Of Infected Pregnant Women Research Articles

Congenital Syphilis: A Re-Emerging but Preventable Infection.

Congenital syphilis presents a significant global burden, contributing to fetal loss, stillbirth, neonatal mortality, and congenital infection. Despite the target established in 2007 by the World Health Organization (WHO) of fewer than 50 cases per 100,000 live births, the global incidence is on the rise, particularly in low- and middle-income regions. Recent data indicate a rate of 473 cases per 100,000 live births, resulting in 661,000 total cases of congenital syphilis, including 355,000 adverse birth outcomes such as early fetal deaths, stillbirths, neonatal deaths, preterm or low-birth-weight births, and infants with clinical congenital syphilis. Alarmingly, only 6% of these adverse outcomes occurred in mothers who were enrolled, screened, and treated. Unlike many neonatal infections, congenital syphilis is preventable through effective antenatal screening and treatment of infected pregnant women. However, despite available screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in various countries, congenital syphilis remains a pressing public health concern worldwide. This review aims to summarize the current epidemiology, transmission, and treatment of syphilis in pregnancy, as well as to explore global efforts to reduce vertical transmission and address the reasons for falling short of the WHO elimination target.

Syphilis in pregnancy

Congenital syphilis is showing a rising trend globally. Materno-fetal transmission of syphilis can be prevented by ensuring early diagnosis and prompt treatment of infected pregnant women. The risk of transmission from mother to child is directly related to the quantity of Treponema pallidum in the maternal circulation. Maximum number of the organisms is seen in early syphilis. Hence, early syphilis in mother (in comparison to late syphilis) places the baby at a higher risk for congenital syphilis. Amniocentesis and cordocentesis may help in the prenatal detection of congenital syphilis. Ultrasonography and Doppler studies supported by serological tests, and polymerase chain reaction, and dark field microscopic examination of the specimen from suspected lesions of early syphilis of mother may help to diagnose congenital syphilis prenatally. Benzathine penicillin G in appropriate dose is the ideal drug for syphilis in pregnancy, except for neurosyphilis for which the drug of choice remains crystalline penicillin.

Extensive bilateral diffuse infiltrates and deterioration of lung following infection with severe acute respiratory syndrome coronavirus 2 in a pregnant woman: a case report

IntroductionSevere acute respiratory syndrome coronavirus 2 is the third member of the coronavirus family to cause global concern in the twenty-first century. Pregnant women are particularly at higher risk of developing severe viral pneumonia, possibly because of a partial immune suppression during their pregnancy. Under such critical and rapidly evolving circumstances, these poor findings might be helpful for the treatment of infected pregnant women with the 2019 novel coronavirus.Case presentationIn this study, we report the case of a 33-year-old Asian pregnant woman at 25 gestational weeks with coronavirus disease 2019 who developed severe complications, including hypoxemia, acute respiratory distress syndrome, pulmonary infiltration, and bilateral pleural effusion. She died 1 month after admission to the hospital.ConclusionPregnant populations are especially at higher risk of viral pneumonia development caused by severe acute respiratory syndrome coronavirus 2. Further research on the prevention and treatment of the new coronavirus is necessary.

Syphilis testing adherence among women with livebirth deliveries: Indianapolis 2014-2016

BackgroundThe number of congenital syphilis (CS) cases in the United States are increasing. Effective prevention of CS requires routine serologic testing and treatment of infected pregnant women. The Centers for Disease Control and Prevention (CDC) recommends testing all pregnant women at their first prenatal visit and subsequent testing at 28 weeks gestation and delivery for women at increased risk.MethodsWe conducted a cross-sectional cohort study of syphilis testing among pregnant women with a livebirth delivery from January 2014 to December 2016 in Marion County, Indiana. We extracted and linked maternal and infant data from the vital records in a local health department to electronic health records available in a regional health information exchange. We examined syphilis testing rates and factors associated with non-testing among women with livebirth delivery. We further examined these rates and factors among women who reside in syphilis prevalent areas.ResultsAmong 21260 pregnancies that resulted in livebirths, syphilis testing in any trimester, including delivery, increased from 71.7% in 2014 to 86.6% in 2016. The number of maternal syphilis tests administered only at delivery decreased from 16.6% in 2014 to 4.04% in 2016. Among women living in areas with high syphilis rates, syphilis screening rates increased from 79.6% in 2014 to 94.2% in 2016.ConclusionImprovement in prenatal syphilis screening is apparent and encouraging, yet roughly 1-in-10 women do not receive syphilis screening during pregnancy. Adherence to recommendations set out by CDC improved over time. Given increasing congenital syphilis cases, the need for timely diagnoses and prevention of transmission from mother to fetus remains a priority for public health.

Distribution of Pilus island and antibiotic resistance genes in Streptococcus agalactiae obtained from vagina of pregnant women in Yazd, Iran.

Background and Objectives:Due to the important role of Streptococcus agalactiae, Group B streptococci (GBS), in production of invasive disease in neonates, investigation regarding the pathogenicity and antibiotic resistance factors is necessary in selecting the appropriate therapeutic agents. Beside capsule, the pilus has been currently recognized as an important factor in enhancing the pathogenicity of GBS. Resistance of GBS to selected antibiotics is noticeably increasing which is mainly due to the anomalous use of these drugs for treatment. The aim of this study was to determine the prevalence of pili genes followed by antibiotic susceptibility of GBS, previously serotyped, isolated from pregnant women in the city of Yazd, Iran.Materials and Methods:Fifty seven GBS from pregnant women were subjected to multiplex PCR for determination of PI-1, PI-2a and PI-2b pilus-islands and simultaneously, the phenotype of antibiotic resistance to penicillin, tetracycline, erythromycin, clindamycin, gentamycin and levofloxacin was determined. Antibiotic resistance genes (ermA, ermB, mefA, tetM, int-Tn) were further diagnosed using PCR and multiplex PCR.Results:PI-1+PI-2a with 71.9%; followed by PI-2a (21.1%) and PI-2b (7%) were observed. PI-1+PI-2a in serotype III was (73.2%), serotype II, Ia, Ib and V were 12.2%, 9.8%, 2.4% and 2.4% respectively. GBS penicillin sensitive was 89.5% and 96.5% resistance to tetracycline. The frequency of resistance genes were as follows: tetM (93%), ermA (33.3%), ermB (8.8%), int-Tn (80.7%) and mefA (0).Conclusion:Majority of GBS contained PI-1+PI-2a. Hence presence of this pilus stabilizes the colonization, therefore designing a program for diagnosing and treatment of infected pregnant women seems to be necessary.

Update on treatment of cytomegalovirus infection in pregnancy and of the newborn with congenital cytomegalovirus.

The purpose of this review is to assess the recent studies of therapy of pregnant women and neonates, aimed at preventing the consequences of congenital cytomegalovirus (CMV) infection. A recent randomized controlled trial of treatment of CMV during pregnancy with hyperimmune globulin did not show significant efficacy in prevention of foetal infection and morbidity, although there was a trend towards improvement with treatment. Trials of antiviral therapy of the mother during pregnancy have involved small numbers only, confounded by ethical and practical difficulties, and further studies are needed to demonstrate whether or not antivirals are useful and well tolerated in this setting.Antiviral treatment of neonatal CMV acquired congenitally has been studied in well controlled trials and the antiviral valganciclovir has shown efficacy in reducing the more severe outcomes. Trials are ongoing of the use of antivirals in less severe disease, although results are likely to take several years. Congenital CMV infection is the most frequent cause of congenital malformation in developed countries, with a symptomatic prevalence of 0.64% of all live births. Infection may result in neurodevelopmental delay, foetal or neonatal death, and most frequently, sensorineural hearing loss. Successful control of viral infections during pregnancy and in the newborn period is essential in reducing early and late morbidity and mortality. Control of congenital CMV infection may be via primary prevention methods such as reducing contact with the pathogen, improved hygiene - both for the pregnant mother and for the neonate, or secondary prevention via reduction of vertical transmission from mother to foetus and reduction in consequences of infection by treatment of infected pregnant women and infected neonates.

Antibiotic resistance properties of uropathogenic <i>Escherichia coli</i> isolated from pregnant women with history of recurrent urinary tract infections

Purpose: To investigate the antibiotic resistance pattern of uropathogenic Escherichia coli (UPEC) strains isolated from pregnant women with history of recurrent urinary tract infections (RUTIs) and healthy pregnant women. Methods: A total of 485 high vaginal swab specimens were collected from pregnant women with history of RUTIs and healthy ones. Samples were cultured and those that were E. coli positive were analyzed by polymerase chain reaction (PCR) and disk diffusion tests. Results: Twenty eight out of 445 (6.29 %) samples were positive for E. coli . Prevalence of E. coli in pregnant women with history of RUTIs and healthy ones were 9 and 4.08 %, respectively. Women older than 40 years were the most commonly infected. UPEC strains showed the highest levels of resistance against ampicillin (96.42 %), tetracycline (85.71 %), amikacin (71.42 %), ciprofloxacin (67.85 %) and gentamycin (58.71 %). Conclusion: RUTIs and pregnancy in old age are two important risk factors for transmission of UPEC strains from the urinary tract into the vagina. Primary treatment of infected pregnant women with imipenem, mezlocillin and nitrofurantoin would be effective for the prevention and management of vaginal infections in pregnant women. Keywords: Uropathogenic Escherichia coli , Recurrent urinary tract infections, Antibiotic resistance, Pregnant women

Prevalence, sociodemographic features and risk factors of Hepatitis B virus infection among pregnant women in Southwestern Nigeria

IntroductionHepatitis B virus is responsible for 50%-80% of Hepatocellular carcinoma cases worldwide. In Nigeria, vertical transmission remains a major route of Hepatitis B virus infection. Primary (vaccines and post-exposure prophylaxis) and secondary prevention of HBV transmission by appropriate sexual and sanitary practices are not yet optimal in the country yet measures for early detection (serological, molecular) and treatment of infected pregnant women is not a practice. This study aimed at identifying the prevalence and risk factors for Hepatitis B virus infection among pregnant women in Ibadan, Southwestern Nigeria.MethodsA cross-sectional study was done at the Ante-natal clinic of the University College Hospital Ibadan. One hundred and eighty pregnant women were recruited from March to August 2013, and tested for Hepatitis B surface antigen (BIORAD FRANCE) using third generation ELISA, as well as HIV-1 and 2 using Uni-Gold Recombigen and ALERE determine (a rapid immunoassay designed to detect antibodies to HIV 1 and/or 2). Positive HBsAg samples were tested for Hepatitis B envelope antigen, antibody and Hepatitis B core antibody (DIAPRO Italy) while serum HBV DNA was detected using PCR. Data were obtained using questionnaires to establish and analysis was performed using SPSS version 20.ResultsThe seroprevalence of HBsAg was 8.3% out of which 26.7% were positive for HBeAg, 53.3% had HBeAb, 20% had neither HBeAg nor HBeAb, 100% had total HBcAb and 86.7% had HBV DNA in their serum. The mean age was 32.1years, the highest HBV infection rate occurred in 25-29 year age group. Multiple sexual partners (OR- 3.987, P- value=0.026) and early age at sexual debut (OR 11.996, P- value=0.022) were independent risk factors for HBV infection.ConclusionHepatitis B virus infection is of high endemicity in Nigeria thus early detection, treatment of infected pregnant women, immunoprophylaxis for exposed newborns and surveillance for those with chronic infection is essential. Health education programs on prevention and control measures must be instituted.

Cost-Effectiveness of Rapid Point-of-Care Prenatal Syphilis Screening in Sub-Saharan Africa

Syphilis continues to be an important public health problem among pregnant women in sub-Saharan Africa with prevalence rates as high as 17%. Pregnant women are a critical population to screen to prevent the devastating consequences of infection to their unborn children. Although screening and appropriate treatment of infected pregnant women can prevent fetal and maternal complications, traditional screening algorithms requiring multiple tests have proven to be difficult to implement in resource-poor settings. We assess the cost-effectiveness of on-site prenatal syphilis screening with newly available rapid point-of-care screening tests in sub-Saharan Africa. Data from the literature were used to model the acquisition and subsequent natural history of syphilis in pregnant sub-Saharan African women over the course of their lifetime. We assessed the health and economic outcomes associated with screening strategies that differed by the initial test [rapid plasma reagin (RPR), immunochromographic strip (ICS)], need for confirmation with Treponema pallidum hemagglutination assay, and number of visits required. Model outcomes include adverse pregnancy outcomes (miscarriage, low birth weight, congenital syphilis, stillbirth, and neonatal death), life expectancy, lifetime costs (2004 US dollars), and incremental cost-effectiveness ratios. With no screening, for a cohort of 1000 women with an average of 6 pregnancies in their lifetime, there were 256 cases of congenital syphilis, 583 low birth weight infants, and 170 stillbirths or neonatal deaths. The most effective and least costly strategy was one-visit rapid testing with ICS, which averted 178 cases of congenital syphilis, 43 low birth weight infants, and 37 perinatal deaths, and saved $170,030 per 1000 women compared with no screening. The choice between ICS and RPR was most influenced by test kit, labor and supply costs, and test sensitivity. RPR was preferred when the ICS cost more than doubled or ICS test sensitivity fell below 88%. Universal prenatal syphilis screening using rapid point-of-care tests will improve both maternal and infant outcomes and is cost-effective.

Treatment and prevention of malaria in pregnancy: opportunities and challenges

Control of malaria in pregnancy through prevention or treatment may save lives of mothers and babies. Selection of drugs for treatment of infected pregnant women, or for prevention in exposed populations is problematic owing to resistance to established drugs and lack of pregnancy-specific safety and pharmacological data for new drugs. Encouragingly, a number of new drugs and combinations of drugs hold promise for effective treatment, but adequate data on their safety in pregnancy is currently lacking. Our principal challenges are to decide which drugs to develop for use in malaria treatment and prevention in pregnancy and to develop mechanisms to rapidly and comprehensively evaluate their safety. Prevention of pregnancy malaria by vaccination may also become possible, but targets must be closely defined, and strategies developed to test candidates against meaningful end points.

Vertical HIV‐1 Transmission: Importance of Neutralizing Antibody Titer and Specificity

Neutralization analyses were carried out with plasma from 132 volunteer human immunodeficiency virus (HIV)-1 infected women (76% pregnant, 24% with infants suspected for HIV-1 infection) collected between 1994 and 1998, against autologous and heterologous primary- and the reference HIV-1 MN isolates. A significantly lower percentage of HIV-1 transmissions was observed after 1996, parallel to a more intense antiretroviral treatment of infected pregnant women. HIV-1 isolation was significantly more frequent from peripheral blood mononuclear cells of mothers of infected children than mothers of uninfected children (P = 0.0065). Neutralization of autologous HIV-1 isolates was comparable for HIV-1 transmitters and nontransmitters' plasma, whereas neutralization of the reference isolate HIV-1 MN was more frequent at high titers for pregnant women who did not transmit HIV to their offspring compared to pregnant women who did. Although neutralization of heterologous primary HIV-1 isolates from HIV transmitters and non transmitters by transmitter plasma occurred with similar frequency, neutralization of isolates from transmitters was much more frequent when heterologous plasma from nontransmitters were used. Macrophage-tropic heterologous HIV-1 isolates were neutralized more frequently at higher titers by plasma from nontransmitters than from transmitters. The results obtained indicate that antiretroviral treatment, lack of success of HIV-1 isolation and high titers of antibodies able to neutralize macrophage-tropic viruses appear to be of importance for protection against HIV-1 vertical transmission for the group of patients studied.

Book Review—Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States

Institute of Medicine, Committee on Perinatal Transmission of HIV. (1999). Reducing the odds: Preventing perinatal transmission of HIV in the United States. Stoto, M. A., Almario, D. A., & McCormick, M. C. (Eds.). National Academy Press: Washington, D.C. In 1994, the results of the AIDS Clinical Trials Group protocol number 76 (ACTG076) showed that perinatal transmission of AIDS to the fetus and newborn could be reduced by approximately 2/3 through the administration of the antiretroviral drug, zidovudine. As a result, various government agencies and professional organizations developed recommendations for counseling and testing all pregnant women for HIV. According to the Institute of Medicine, this approach appears to have been successful to some degree. However, a more formal evaluation of the process was mandated by the U.S. Congress to determine the effectiveness of programs designed to reduce perinatal transmission of HIV and to identify barriers to the reduction of HIV transmission. To perform this task, the Institute of Medicine formed the Committee on Perinatal Transmission of HIV, which was comprised of 13 members with diverse areas of expertise pertinent to the objectives of the committee. Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States is the committee's report of its findings and its recommendations for improving the existing guidelines. This publication is both a concise and a complete guidebook to HIV and pregnancy. The inclusion of appendices describing site visits to a number of HIV prevention programs in New York, New Jersey, Alabama, South Texas, and Florida is enlightening. Also valuable are appendices that provide excerpts from the Ryan White CARE Amendments of 1996 and the 1995 U.S. Public Health Service recommendations for HIV counseling and testing for pregnant women. The report itself includes information on the epidemiology of the perinatal transmission of HIV and the natural history, detection, and treatment of infected pregnant women and newborns. The implementation and impact of the U. S. Public Health Service guidelines for HIV testing and counseling are described contextually with the community services available for such programs. Finally, the committee's recommendations are presented. The main recommendation is a national policy of universal HIV testing, along with patient notification and the right to refuse. All other recommendations are geared toward implementation of this policy and improved access to care for HIV-positive women. Specific recommendations address education of prenatal care providers regarding the value of HIV testing, and the development of clinical practice guidelines and policies that promote universal prenatal HIV testing. An important point childbirth educators can take from this book comes from the committee's recommendation for education to respond to pregnant women's misgivings about HIV testing. Herein lies an opportunity to impact the rate of perinatal transmission of HIV. For example, in Seattle, Washington, as part of a comprehensive plan to increase perinatal testing for HIV, the Group Health Cooperative of Puget Sound, a large HMO affiliated with Kaiser Permanente, includes HIV education and counseling in prenatal classes. Women who understand the process of testing and the benefits of treatment have an improved ability to make truly informed decisions for the better health of themselves and their babies. Reducing the Odds: Preventing Perinatal Transmission of HIV in the United States provides a positive model for the development and implementation of programs designed to reduce the numbers of newborns infected with HIV. Healthier mothers and babies have always been the main focus of childbirth education.

Follow-up of infants with congenital toxoplasmosis detected by polymerase chain reaction analysis of amniotic fluid.

This study was conducted to assess the validity of performing the polymerase chain reaction (PCR) on amniotic fluid for detecting fetal Toxoplasma infection. The primary endpoint was the outcome of the infant at 1 year of age. A prospective, consecutive study was performed in 49 infants born to mothers with primary Toxoplasma infection during pregnancy. PCR determinations of Toxoplasma gondii DNA in amniotic fluid were carried out as part of their prenatal management. Infants were examined at birth, and at 1, 3, 6, 9, and 12 months of age. Nine of 11 infants from pregnancies with positive PCR results proved to be infected based on follow-up serological investigations conducted during the first year of life. Two fetal deaths occurred. All 38 infants with negative PCR results remained uninfected at 1 year of age, irrespective of whether their mothers had received treatment with sulfadiazine/pyrimethamine or spiramycin alone. Psychomotor development was normal in all infants. This follow-up study confirms that PCR performed on amniotic fluid is a useful method for identification or exclusion of fetal Toxoplasma infection. Treatment of infected pregnant women and - in the event of a positive PCR result subsequent treatment of their infants is associated with a favorable outcome.

False-negative syphilis screening: The prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy

The prevalence of congenital syphilis is rapidly rising in several areas of the United States. Efforts to control the disease depend on the effectiveness of established screening strategies and treatment of infected pregnant women. False-negative test results hinder these efforts and leave the fetus at risk for acquiring congenital syphilis. Recently we encountered four cases of false-negative syphilis serologic results in women who gave birth to infants with congenital syphilis. The false-negative results were caused by the prozone phenomenon. The prozone phenomenon, seen during primary and secondary syphilis, occurs because a higher than optimal amount of antibody in the tested sera prevents the flocculation reaction typifying a positive result in reagin tests. Serum dilution is necessary to make the correct diagnosis. We recommend that for any pregnant woman with apparently negative syphilis serologic results in whom fetal compromise of unknown etiology exists, particularly nonimmune hydrops, nontreponemal testing should be repeated using serum dilutions to prevent a missed diagnosis of syphilis. We further recommend serum dilution as a routine procedure for all pregnant women in areas of high syphilis prevalence.

PROSPECTIVE STUDY OF CHLAMYDIAL INFECTION IN NEONATES

Chlamydia trachomatis was recovered from the cervices of 4% (36/900) of pregnant women tested. 20 infants born through chlamydia-infected cervices were followed up for a year, as were 18 infants born to chlamydia-negative mothers. A statistically significant excess of conjunctivitis and pneumonia was found in infants exposed to chlamydia. The attack-rate for inclusion conjunctivitis was 35% (7/20) and for chlamydial pneumonia it was 20% (4/20). Chlamydiæ were recovered from 10 of the 20 (50%) exposed infants, and seroconversion was demonstrated in 14 (70%). None of the 18 unexposed infants showed evidence of chlamydial infection. Thus in our clinic 2·8% of all newborns acquired chlamydial infection, with incidence-rates of 14 cases of conjunctivitis and 8 cases of pneumonia per 1000 live births. Neonatal chlamydial infection is thus a major public-health problem warranting a preventive programme based on the fuller provision of diagnostic services and the treatment of infected pregnant women.