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Screening for infectious diseases.

INTRODUCTION: Fetal brain injury is an essential cause of lifelong morbidity. Infection appears as a cause of brain damage. Apart from chorioamnionitis, screening for infectious diseases must be considered in pregnancies with a risk of congenital infection or cases with abnormal cerebral ultrasound findings. DISCUSSION: Congenital infections include most of the major components of the TORCH complex: toxoplasmosis, rubella, cytomegalovirus, herpes, and varicella. Seronegative mothers can develop primary infection, which carries a risk of vertical transmission. The timing of the infection is a critical point, because fetal damage often depends on the gestational age at which acute maternal infection took place and occurs more likely in the first half of pregnancy. Antenatal ultrasound can detect brain abnormalities, like hydrocephalus, periventricular leukomalacia, calcifications or hemorrhage. Maternal serologic tests must be performed to look for an infectious etiology; the most frequent agents are the components of the TORCH complex. But additional serology must include parvovirus B19, HIV, and coxsackieviruses.

Brain Injuries↗

The aetiology of ocular toxoplasmosis in Melbourne.

The biological mothers of 23 patients presenting with acute chorioretinal toxoplasmosis had sera screened for the presence of antibodies to Toxoplasma gondii. Twenty-two of the mothers (96%) had positive serology and one (4%) had negative serology. This is consistent with the hypothesis that most cases of ocular toxoplasmosis are congenital in origin, but indicates that some cases are due to acquired toxoplasmosis.

Adolescent↗

[The role of Toxoplasma gondii persistence in human clinical pathology].

The publications, including those of the author, on persistence phenomenon of the obligatory intracellular parasite, Toxoplasma gondii, are updated. The latent form of toxoplasmosis was shown to be prevailing. The role of congenital and acquired toxoplasmosis in kids' and adults' pathology, the opportunistic nature of this infection, the reactivating factors of latent and chronic infection as well as the mechanism of pathogen persistence are under discussion.

Acquired Immunodeficiency Syndrome↗

Sinusoidal fetal heart rate pattern associated with congenital hydrocephalus. A report of 2 cases.

Two cases of hydrocephalus with an intrapartum sinusoidal heart rate pattern are presented. In the first patient, the diagnosis of toxoplasmosis during pregnancy and congenital hydrocephalus was made antenatally. Intrapartum the fetal heart showed intermittent periods of a sinusoidal pattern, alternating with a normal heart rate pattern. At birth there were signs of congenital toxoplasmosis. In the second patient there was a sinusoidal heart rate pattern associated with late decelerations and a loss of beat-to-beat variation. A brief review of the literature shows that the debate still continues over the aetiology, pathogenesis and prognosis of this entity.

Adult↗

Fetal and maternal white cells and B- and T-lymphocyte subpopulations in pregnant women with recent infection.

OBJECTIVE: To study maternal and fetal white cell counts, B- and T-lymphocyte subpopulations in pregnant women with evidence of recent infection. METHODS: Thirty-seven pregnant women with recent infection and 38 controls were studied. All were referred for fetal blood sampling to exclude congenital infection, or to perform fetal chromosome analysis. There were 16 infected fetuses: 9 cytomegalovirus (CMV), 4 rubella, and 3 toxoplasmosis. Maternal and fetal blood was taken and white cell counts, the percentage of CD3+, CD4+, CD8+, CD56+, HLADR+CD3+ T-lymphocyte subpopulations and CD19+ B lymphocytes were measured. RESULTS: The percentage of CD3+, CD8+, and HLADR+CD3+ lymphocytes were significantly higher in infected mothers compared to controls, while CD19+ and the CD4+/CD8+ ratio were lower. Infected mothers carrying infected fetuses had significantly lower white blood cell counts compared to those infected mothers without fetal infection. The percentage of HLADR+CD3+ T lymphocytes was significantly higher and the CD4+/CD8+ ratio lower in infected fetuses compared to controls and noninfected fetuses of infected mothers. Abnormal CD4+/CD8+ ratios and/or increased HLADR+CT3+ T lymphocytes were found in 8 of 10 fetuses with structural abnormalities and/or hematological/biochemical signs of systemic damage, and in 7 of 27 without (RR = 3.1, 95% CI = 1.5-6.3). CONCLUSION: Both infected fetuses and their mothers have significant identifiable changes in white cell counts and T-lymphocyte subpopulations compared to controls. These tests may help in diagnosing maternal and fetal infection.

B-Lymphocytes↗

[Infectious fetal diseases. Prevention, prenatal diagnosis, practical measures].

Many congenital infections can produce foetal diseases and are sometimes responsible for major disablements. The most frequent infectious foetal diseases are toxoplasmosis, rubella and chickenpox. Diseases caused by parvovirus or cytomegalovirus are exceptional. Foetal blood sampling has considerably simplified the prenatal diagnosis and made it accessible to more medical centres; it has also widened the therapeutic possibilities and above all, it has considerably reduced the number of therapeutic abortions. It may well be that the development of molecular biology, which has the great advantage of permitting an earlier diagnosis, will in the near future make it possible not only to detect numerous monogenic diseases before birth, but also to diagnose some foetal infections. We might then hope that a much earlier treatment in utero will also be more effective.

Chickenpox↗