Intrauterine infections are a group of diseases arising from transplacental or contamination of the fetus with microflora.
Etiology: viruses, bacteria, toxoplasma, pneumocysts, mycoplasmas, chlamydia. Among the viruses, the most important are cytomegalovirus, enteroviruses, herpetic virus, rubella virus, hepatitis B, C, human immunodeficiency. Bacterial infection is caused by streptococci, staphylococci, listeria, spirochetes, mycobacterium tuberculosis, enterobacteria (klebsiella, proteus, E. coli, etc.).
How is infection with intrauterine infections and what are the consequences?
There are two ways of infection: hematogenous, contaminated (via infected amniotic fluid and excretion of the birth canal). Infection of the embryo to 12 weeks of gestation (embryopathy) leads to the formation of congenital malformations, interruption of pregnancy and the birth of a dead fetus. Infection after 12 weeks of gestation (fetopathy) is accompanied by placenta damage. Fetoplacental insufficiency leads to chronic fetal hypoxia, premature birth, stillbirth, etc. If the infection occurred in the 3rd trimester of pregnancy, the child can be born with signs of the disease: lethargy, decreased muscle tone, hyperbilirubinemia, anemia, hypotrophy, etc. In case of hematogenous infection a sick child with manifestations of pneumonia, meningitis, sepsis can be born. However, the clinical development of the infection is possible in 2-3 weeks after birth.
Toxoplasmosis - intrauterine infection
Toxoplasmosis is a disease that causes toxoplasm (parasitic pathogen), with hematogenous lesions. Pregnant women are more often infected by nutritional means. The disease develops after infection of a woman during pregnancy and as a result of the development of her parasitaemia, which leads to placenta and fetal damage. High risk of infection of the fetus in the last trimester of pregnancy. Clinical manifestations are nonspecific: low body weight, hyperbilirubinemia, edematous and hemorrhagic syndromes, anemia, petechial rashes.
Perhaps the defeat of the central nervous system: a change in muscle tone, anxiety, cramps, regurgitation, hydrocephalus. A characteristic feature is the defeat of the eyes with the development of chorioretinitis. Possible the development of pneumonia, myocarditis. There may be clinical manifestations of encephalitis or meningoencephalitis. Chronic form of toxoplasmosis is characterized by hydrocephalus, chorioretinitis, intracerebral calcifications. In the process of development, the child may develop oligophrenia, epilepsy, deafness.
Diagnostic significance is the presence of specific IgG in the blood serum, the reaction of immunofluorescence, the binding reaction to the complement, the radiographic examination of the skull, ultrasound examination of the brain, neurosonography.
Treatment of toxoplasmosis
Treatment: Chloridine or pyrimethamine (1-2 mg per kg of body weight per day in 2 divided doses) in combination with sulfadimezin or sulfadiazine (0.1 g per kg of body weight per day for 2-4 doses) for 3-6 weeks. Twice a week, folic acid 5 mg is prescribed. Then a monthly course of spiramycin is shown (100 mg per kg of body weight in 2-3 divided doses). During the year, 3-4 courses of treatment are carried out. Use Fan-Cedar (1-1.5 mg per kg) once a week for 6-8 months or spiramycin (100 mg per kg per day for 2 doses) for 1-1.5 months (4 courses per year ).
Cytomegaly - A disease that causes cytomegalovirus (DNA-containing viruses of herpetic game-pi), with hematogenous infection. Rarely, a newborn baby can become infected through the mother's milk.
Clinic of cytomegalovirus
In the case of infection of the fetus in the early stages of intrauterine development, the formation of congenital defects of the central nervous system (microcephaly, hydrocephalus) is possible. Clinical manifestations of congenital cytomegalia are possible after 2-3 weeks of the child's life: hyperbilirubinemia, anemia, hepatosplenomegaly, thrombocytopenia, elevation of ALT level, AST. There may be deafness, blindness, chorioretinitis, encephalopathy, etc
Classical is tetrad: jaundice, hepatosplenomegaly, hemorrhagic syndrome, severe damage to the nervous system. Diagnostic value has cytoscopic (giant cells), virological (the isolation of CMV infection), immunofluorescent (the presence of antigens and antibodies), immunoenzyme, radioimmunity (the presence of antibodies) methods and a chain polymerase reaction (detection of viral DNA).
Effective intravenous administration of ganciclovir in a dose of 10-15 mg per kg per day or foscarnet at 120 mg per kg per day for 3-6-12 months. Cytotect is shown in 2-4 ml per kg intravenously after 2-4 days 6 injections. You can use viferon-1.
The disease that causes the herpes simplex virus, and has a more often a hematogenous way of infection. Contaminated infection through infected amniotic fluid or during passage through the birth canal is genital herpes (herpes simplex virus of the second type).
Infection of the fetus before the 20th week of pregnancy contributes to the formation of congenital malformations, abortion, stillbirth. In case of infection after 32 weeks of gestation, the affected infant may have skin, mucous membranes (vesicles), vision (chorioretinitis, cataract, microphthalmia), CNS (meningoencephalitis, hydrocephalus, microcephaly). With intranatal infection, the disease occurs after 2-3 weeks of life: SDR, hyperbilirubinemia, hepatosplenomegaly, anemia, hepatitis, pneumonia, diarrhea, meningoencephalitis. The generalized form is accompanied by toxicosis, hemorrhages and a serious condition.
Diagnostic value is the detection in the blood serum of specific IgM, IgG antibodies, herpes virus antigens in washings from the upper respiratory tract, rectal washings, virus isolation from rash elements, smears from the mucous membranes (chain polymerase reaction method).
Treatment: Acyclovir (a single dose of 10-20 mg per kg of body 3 times intravenously for 5-20 days), viferon-1 - 2 times a day for 5 days. Provided 2-3 courses of treatment with viferon with a 5-day break. You can use iodine (daily dose of 50-100 mg per kg of mass intravenously for 4-5 days), vidarabin, imunovir, reaferon, etc. The pathogenetic and symptomatic treatment is carried out.
Listeriosis is one of the intrauterine infections of
Listeriosis is a disease that causes listeria (Gram-positive rod). Listeria is very common in the environment, its bearer is often a person. The fetus can be infected by the transplacental pathway, through infected amniotic fluid, and also when passing through the birth canal.
With transplacental infection, the child is born with manifestations of the disease: granulomas of the skin and mucous membranes, liver, lungs, spleen, brain.
Clinic of listeriosis granulomatous sepsis : hepatosplenomegaly, hyperbilirubinemia, diarrhea, convulsions, dehydration, toxicosis, and sometimes meningitis. The diagnosis confirms the isolation of the pathogen from the blood, cerebrospinal fluid, placenta, serological examination (the antibody titer increases 4 times or more).
Ampicillin, azlocillin (wide-spectrum penicillins), gentamicin and other aminoglycosides. The course of treatment is 10-14-20 days Cephalosporins are ineffective. You can use macrolides.
Rubella of newborn children.
Rubella is a disease that causes an RNA virus. The path of infection is transplacental. Infection in the early stages of pregnancy causes the development of vices, in later terms causes spontaneous miscarriages, stillbirth, and also the defeat of many organs and systems. Characteristic are a small mass at birth, prematurity, skin eruptions, urine of the nervous system, heart, musculoskeletal system, hepatosplenomegaly.
Note the triad: eye damage (cataract, micro-ophthalmia, glaucoma, chorioretinitis), heart disease, ear lesions (deafness).
Treatment is pathogenetic and symptomatic. You can use viferon-1.