Infectious diseases
General • Marlaria • Parasites • Viruses

Viruses

1.      Yanez Maldonado E, San Martin Herrasti JM, Garcia Alonso A, Izquierdo Puente JC.. [Non-immunologic hydrops. Report of 2 cases]. Ginecol Obstet Mex  2000 Jul;68:282-5. [Article in Spanish]

2.      Timuragaoglu A, Surucu F, Nalcaci M, Dincol G, Pekcelen Y.. Anemia and thrombocytopenia due to parvovirus B-19 infection in a pregnant woman. J Med  1997;28(3-4):245-9

3.      Sodja I, Mrazova M, Smelhausova M, Uhlir M, Kotrbova K, Pazdiora P, Bruj J, Kadlecik D. [Parvovirus B 19 in pregnancy]. Epidemiol Mikrobiol Imunol  1996 Dec;45(4):143-7 [Article in Czech]

4.      Eiros JM, Bachiller R, Martin JF, Bayon E, de Lejarazu RO, Torres AR.. [Infection by parvovirus B-19 and pregnancy]. J Gynecol Obstet Biol Reprod (Paris)  1994;23(2):209. [Article in French]

5.      Humphrey W, Magoon M, O'Shaughnessy R.. Severe nonimmune hydrops secondary to parvovirus B-19 infection: Spontaneous reversal in utero and survival of a term infant. Obstet Gynecol  1991 Nov;78(5 Pt 2):900-2

6.      Kuhlmann RS, Autry AM. An approach to nonbacterial infections in pregnancy. Clinics in Family Practice. Volume 3 • Number 2 • June 2001

Hepatitis

1.        Smith JL.. A review of hepatitis E virus. J Food Prot 2001 Apr;64(4):572-586. Hepatitis E virus (HEV) is a major cause of outbreaks and sporadic cases of viral hepatitis in tropical and subtropical countries but is infrequent in industrialized countries. The virus is transmitted by the fecal-oral route with fecally contaminated drinking water being the usual vehicle. Hepatitis resulting from HEV infection is a moderately severe jaundice that is self-limiting in most patients. Young adults, 15 to 30 years of age, are the main targets of infection, and the overall death rate is 0.5 to 3.0%. However, the death rate during pregnancy approaches 15 to 25%. Death of the mother and fetus, abortion, premature delivery, or death of a live-born baby soon after birth are common complications of hepatitis E infection during pregnancy. Hepatitis E virus is found in both wild and domestic animals; thus, HEV is a zoonotic virus. The viruses isolated from swine in the United States or Taiwan are closely related to human HEV found in those areas. The close genetic relationship of the swine and human virus suggests that swine may be a reservoir of HEV. In areas where swine are raised, swine manure could be a source of HEV contamination of irrigation water or coastal waters with concomitant contamination of produce or shellfish. Increasing globalization of food markets by industrialized countries has the potential of introducing HEV into new areas of the world. The purpose of this review is to cover certain aspects of hepatitis E including the causative agent, the disease, diagnosis, viral detection, viral transmission, epidemiology, populations targeted by HEV, and the role of animals as potential vectors of the virus.

4.      Int J Gynaecol Obstet 1998 Nov;63(2):195-202 ACOG educational bulletin. Viral hepatitis in pregnancy. Number 248, July 1998 (replaces No. 174, November 1992). American College of Obstetricians and Gynecologists. Hepatitis A is an uncommon complication of pregnancy and is not associated with perinatal transmission. In contrast, hepatitis B virus infection is more common and clearly poses a serious risk to the household contacts and neonates of infected mothers. Accordingly, all pregnant women should be tested for hepatitis B virus. Universal vaccination of all neonates with hepatitis B vaccine is now recommended. Infants delivered to HBsAg seropositive mothers also should receive HBIG and vaccination immediately after birth. Hepatitis E is extremely rare in the United States and is quite similar to hepatitis A, although perinatal transmission does occur with hepatitis E. Hepatitis C and D, which are transmitted parenterally and by sexual contact, have been associated with vertical transmission. No immunoprophylaxis currently is available for neonates of mothers with hepatitis C or E virus. Immunization against hepatitis B is protective against vertical transmission of hepatitis D.

5.   Dinsmoor MJ. Hepatitis in the obstetric patient. Infect Dis Clin North Am 1997 Mar;11(1):77-91 The six agents identified thus far that cause viral hepatitis are reviewed, and their impact upon pregnancy is described. Although it is the most common cause of jaundice during pregnancy, viral hepatitis does not generally increase the risk of pregnancy complications, nor is it teratogenic. Vertical transmission of some types of viral hepatitis does occur, however. Acute hepatitis A in pregnancy does not appear to carry a different prognosis than in the nonpregnant, nor is there any evidence that the pregnant patient is more susceptible

6.      Steffen R. Hepatitis A and hepatitis B: risks compared with other vaccine preventable diseases and immunizations recommended. Vaccine 1993;11:518–520. Rates as high as 20 per 1,000 are seen in overland travelers living and eating under poor hygienic conditions. Hepatitis A is  usually no more severe during pregnancy than at other times and does not affect the outcome of  pregnancy. There have been reports, however, of acute fulminant disease in pregnant women during the third trimester when there is also an increased risk of premature labor and fetal death

7.      Gilbert GL. Miscellaneous viral infections. In: Infectious diseases in pregnancy and the newborn infant. Chur, Switzerland: Harwood Academic, 1991

8.      Jaiswal SP, Jain AK, Naik G, Soni N, Chitnis DS.. Viral hepatitis during pregnancy. Int J Gynaecol Obstet 2001 Feb;72(2):103-108. OBJECTIVE: A great degree of controversy prevails over the existing reports on the severity and outcome of acute viral hepatitis (AVH) during pregnancy. The present study describes the outcome of AVH associated with pregnancy. A correlation was also assessed for gestation period, viral etiology and outcome  of AVH. METHOD: The serum samples of 273 females with viral hepatitis (age group 18--23 years) were included in the study. Among them, 127 females were pregnant and 146 were non-pregnant cases (as a control group). The sera were screened for seromarkers of the hepatitis A virus (HAV) through to the hepatitis E virus (HEV) by the latest available generation ELISA kits. Among the 127 pregnant females, 83 were AVH cases, while 44 were fulminant hepatic failure (FHF) cases. Among the 146 non-pregnant females, 129 were AVH and 17 were FHF cases. RESULT: Among the AVH pregnant females, 73 (57.5%) had HEV infection. Fifty-eight percent of the HEV infected pregnant females were associated with FHF. Among non-pregnant females HEV was documented in 67 (46%) cases. HBV infection was observed in 19% and 18% of the pregnant and non-pregnant females, respectively. Twenty percent of the pregnant and 33% of the non-pregnant females remained non-reactive for seromarkers of HAV-HEV. The mortality rate was highest (56%) among HEV infected FHF cases during third trimester of pregnancy. The chi(2) test was applied to check the statistical significance for the differences over the prevalence in various groups. CONCLUSION: In the present study, HEV was found to be the chief etiological agent, associated with higher morbidity and mortality. However, the incidence of HEV in pregnant females was not significantly different from non-pregnant females. The prevalence of HAV, HCV and HDV were very low in the study. An increased incidence of FHF was noted among HEV infected pregnant females, while infection with an agent other than A-E was commonly associated with FHF among non-pregnant females.

9.      Menendez C, Sanchez-Tapias JM, Kahigwa E, Mshinda H, Costa J, Vidal J, Acosta Smith JL.. Foodborne infections during pregnancy.. J Food Prot 1999 Jul;62(7):818-829. Hepatitis B and C markers were tested in 980 pregnant women, in the infants born to infected mothers, and in a random sample of 42 and 50, respectively, children born to uninfected mothers in Tanzania. Sixty-two women (6.3%) were positive for HBsAg and 15 (24%) were HBeAg-seropositive. Anti-HCV was detected in 49 women (5%), 15 (31%) of whom had detectable viremia. HCV RNA serum levels were low and only genotype 4 was identified. Sixty-six women (6.7%) were positive for anti-HIV, six of whom were coinfected with HBV and one with HCV. Anti-HEV was negative in the 180 women tested. At 8 months of age, HBsAg was detected in 8% and 2% of children born to HBV-infected and noninfected mothers, respectively (P = 0.2). Corresponding figures at 18 months of age were 31% and 21% (P = 0.3). When tested at 2 months of age, HCV RNA was not detected in any of the 43 children born to anti-HCV-positive mothers nor in any of 50 children born to anti-HCV-negative mothers. At 18 months, only one child, born to an anti-HCV-positive mother, had detectable HCV RNA. None of the infants born to women with HIV coinfection were infected with hepatitis viruses. This study suggests that exposure to HEV does not occur in southern Tanzania. The prevalence of current HBV infection in pregnant women from rural Tanzania is lower than in other sub-Saharan areas. In early childhood, HBV infection appears to occur by horizontal rather than maternofilial mechanisms of transmission. The prevalence of HCV infection is similar to that in other African countries. The results of this study show for the first time in Africa that mother-to-infant transmission does not play a significant role in the acquisition of HCV infection

10.      Michielsen PP, Van Damme P. Viral hepatitis and pregnancy. Acta Gastroenterol Belg 1999 Jan;62(1):21-29. This paper reviews data on the mutual relationship between pregnancy and viral hepatitis and the mother-to-infant transmission of the virus. In the western world, hepatitis A, B or C do not seem to influence the course of pregnancy, or to be associated with foetal risks. In contrast, women who contract a hepatitis E infection in their third trimester of pregnancy have a relatively high probability to develop a fulminant hepatitis. Mother-to-infant transmission of hepatitis A seems to be very uncommon. On the contrary, HBsAg and HBeAg positive mothers have a 80-90% risk to transmit the disease to their offspring, more than 85% of these becoming chronic carriers of HBsAg. The risk depends on the level of viral replication. In HBsAg positive and HBeAg negative mothers the rate of transmission is only 2-15%, these babies rarely become carriers. A possible explanation is the transplacental passage of the HBeAg making the infant tolerant to the hepatitis B virus. As most of the infections occur during or directly after delivery, the neonates are suitable for postexposure prophylaxis. It is recommended by the Centers for Disease Control and Prevention and the American Academy of Pediatrics that newborns of HBsAg positive mothers should receive hepatitis B immunoglobulins within 12 hours after birth concurrently with the first paediatric dose of the vaccine. Vaccination should be completed at 1 and 6 months. This regimen confers a protective efficacy of > or = 90%. Vertical transmission of hepatitis C is considered to be relatively rare, around 11% when HCV-RNA is positive. The highest rates of vertical transmission of HCV are noted in women with high HCV-RNA level or concurrent HIV infection. The risk is extremely low when no HCV-RNA is detected. There is currently no treatment to prevent this vertical transmission; routine screening of all mothers is unwarranted, and pregnancies among HCV-positive mothers should not be discouraged, but their infants should be tested for anti-HCV at 1 year and followed for the development of hepatitis. Breast feeding does not seem to play an important role in the transmission of hepatitis B and C.

11.  Hunt CM, Sharara AI. Liver disease in pregnancy. Am Fam Physician 1999 Feb 15;59(4):829-836. Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of acute hepatitis is unaffected by pregnancy, except in patients with hepatitis E and disseminated herpes simplex infections, in which maternal and fetal mortality rates are significantly increased. Chronic hepatitis B or C infections may be transmitted to neonates; however, hepatitis B virus transmission is effectively prevented with perinatal hepatitis B vaccination and prophylaxis with hepatitis B immune globulin. Cholelithiasis occurs in 6 percent of pregnancies; complications can safely be treated with surgery. Women with chronic liver disease or cirrhosis exhibit a higher risk of fetal loss during pregnancy. Preeclampsia is associated with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome, acute fatty liver of pregnancy, and hepatic infarction and rupture. These rare diseases result in increased maternal and fetal mortality. Treatment involves prompt delivery, whereupon the liver disease quickly reverses. Therapy with penicillamine, trientine, prednisone or azathioprine can be safely continued during pregnancy.

12.  Duff P. Hepatitis in pregnancy. Semin Perinatol 1998 Aug;22(4):277-283. Currently, six distinct types of hepatitis virus have been identified: A, B, C, D, E, and G. Hepatitis A virus infection does not cause a chronic carrier state, and perinatal transmission is extremely uncommon. Hepatitis B can be transmitted perinatally, but immunization of the newborn with hepatitis B immune globulin and hepatitis B vaccine markedly reduces the risk of neonatal infection. Hepatitis D virus is dependent on coinfection with the hepatitis B virus for replication. Immunoprophylaxis against hepatitis B also is effective against hepatitis D. Hepatitis C virus is primarily transmitted by the parenteral route and is particularly likely to cause chronic liver disease. Perinatal transmission of hepatitis C principally occurs in women who have high titers of HCV-RNA or who are coinfected with human immunodeficiency virus. At this time, no immunoprophylaxis for hepatitis C is available. Hepatitis G, a recently described organism, is related to hepatitis C. Its clinical significance remains undetermined. Hepatitis E is transmitted in a manner similar to hepatitis A. Perinatal transmission is unusual, but maternal disease is often severe.

13.  Magriples U. Hepatitis in pregnancy. Semin Perinatol 1998 Apr;22(2):112-117. The study of viral hepatitis was expanded over the past decade with the emergence of new viruses, therapies, and vaccination guidelines as well as new data on the risks of perinatal transmission. There are now at least six hepatitis viruses. Hepatitis A and E are causes of epidemic, enteric infection and do not carry a significant risk of chronic infection. Hepatitis B, C, D, and G are hematogenously spread and are significant causes of chronic hepatitis, hepatocellular carcinoma, and cirrhosis. The following report reviews the types of hepatitis as well as the consequences of infection to the mother and fetus.

14.  Yang H, Li Z, Qi W. [Clinical analysis of 39 cases of hepatitis E in pregnancy]. Zhonghua Fu Chan Ke Za Zhi 1997 Feb;32(2):78-80 [Article in Chinese]. OBJECTIVE: To introduce clinical manifestations and treatment of hepatitis E in pregnancy. METHODS: Thirty-nine cases of hepatitis E in pregnancy, were analysed from June. 1992 to Jun. 1994, retrospectively on its epidemiologic characteristics, clinical manifestations and prognosis. RESULTS: The prognosis of sporadic cases of hepatitis E in pregnancy was good and its main complications were premature rupture of membranes, uterine inertia and fetal distress. CONCLUSIONS: Sporadic case is the main form of hepatitis E in pregnancy in Beijing. Active treatment and intensive monitoring would improve its prognosis.

15.  Hussaini SH, Skidmore SJ, Richardson P, Sherratt LM, Cooper BT, O'Grady JG. Severe hepatitis E infection during pregnancy. J Viral Hepat 1997 Jan;4(1):51-54. In areas with endemic hepatitis E virus (HEV), acute liver failure secondary to hepatitis E infection is common in pregnancy and associated with a mortality rate of up to 20%. However, there is little information on the clinical course of severe hepatitis E infection during pregnancy in non-endemic areas such as the UK. Here we describe two cases of severe hepatitis E in pregnancy in patients returning from the Indian subcontinent. These cases were diagnosed by the detection of IgM anti-HEV antibody using an enzyme immunoassay with recombinant hepatitis E viral antigens. The first case describes acute hepatic failure, with coagulopathy and encephalopathy, warranting intensive therapy and elective ventilation. In the other case, the patient had severe hepatitis with coagulopathy. Both cases spontaneously resolved with no foetal loss. These cases highlight the need for suspicion of HEV infection in patients returning from endemic areas and presenting with acute non-A non-B hepatitis, especially when pregnant. Furthermore, the intensive treatment of acute liver failure caused by HEV may reduce the high mortality reported in Asia.

16.  Mast EE, Purdy MA, Krawczynski K. Hepatitis E. Baillieres Clin Gastroenterol 1996 Jul;10(2):227-242. Hepatitis E has a world-wide distribution and causes substantial morbidity and mortality in some developing countries, particularly among pregnant women. Hepatitis E virus (HEV) has recently been cloned and sequenced, and new diagnostic tests have been developed. These tests have been used to begin to characterize the natural history and epidemiological features of HEV infection. Experimental vaccines have also been developed that offer the potential to prevent hepatitis E. However, much remains to be learned about HEV, including the mechanisms of transmission, the reservoir(s) of the virus, and the natural history of protective immunity in order to develop effective strategies to prevent this disease.

17.  Hamid SS, Jafri SM, Khan H, Shah H, Abbas Z, Fields H. Fulminant hepatic failure in pregnant women: acute fatty liver or acute viral hepatitis? J Hepatol 1996 Jul;25(1):20-27. BACKGROUND: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction in pregnant women and this can be clinically confused with acute fatty liver of pregnancy. METHODS: We studied the clinical and laboratory data as well as the maternal and fetal outcomes of 12 pregnant women presenting with fulminant hepatic failure in order to determine the etiology of the disease. The clinical diagnoses were subsequently correlated with serologic assays for acute HEV infection. All patients were severely ill with deep jaundice, grade 3-4 encephalopathy and abnormal prothrombin times. RESULTS: A clinical diagnosis of acute viral hepatitis was made in nine patients and of acute fatty liver in the other three cases. IgM and IgG antibodies confirmed acute viral hepatitis E in six of the nine patients while one had acute hepatitis A infection. HEV IgM and IgG antibodies were, however, also positive in two of the three patients thought to have acute fatty liver. Maternal and fetal mortality were 16.6% and 50%, respectively. CONCLUSIONS: We conclude that hepatitis E is the usual cause of acute liver failure in our pregnant women and that clinical and laboratory features do not permit accurate distinction between acute HEV infection and acute fatty liver of pregnancy. The prognosis in patients with acute HEV infection is much better than in other groups with severe liver failure (mortality 16% vs 68%).

18.  Khuroo MS, Kamili S, Jameel S. Vertical transmission of hepatitis E virus. Lancet 1995 Apr 22;345(8956):1025-1026. Little is known about vertical transmission of hepatitis E virus from infected mothers to their infants. We studied eight babies born to mothers infected with hepatitis E in third trimester. One baby was icteric at birth with elevated transaminases and four babies had anicteric hepatitis. Two babies were born with hypothermia and hypoglycaemia and died within 24 h; one had massive hepatic necrosis. Hepatitis E virus RNA was detected by PCR in cord or birth blood samples of five infants. Six infants had evidence of hepatitis E infection. We conclude that hepatitis E virus is commonly transmitted from infected mothers to their babies with significant perinatal morbidity and mortality.

19.  Figueroa Damian R, Villagrana Zesati R, Sanchez Fernandez L, Benavides Covarrubias E. [Course of pregnancies complicated by viral hepatitis]. Ginecol Obstet Mex 1994 Aug;62:243-248 [Article in Spanish]. It has been described that viral hepatitis is the most frequent cause of jaundice in the pregnant women. In this article we present clinical cases of hepatitis in pregnancy and review the new knowledge about the perinatal repercussion of this association. Hepatitis A is rare in pregnant women and has not a significant perinatal risk. Hepatitis B virus (HBV) can be transmitted from mother to child by transplacental way or at born. Between 40 to 80 per cent of the children infected by this route will develop chronic hepatitis, so the infants of HBsAg carrier mothers must be immunized at birth. The perinatal transmission of hepatitis C virus has been proved but the repercussion in the fetus or newborn is unknown. Hepatitis D virus can only be transmitted from mother to child together with HBV. Hepatitis E has been associated with a mortality from 10 to 40 per cent in pregnant women and with an increase in the preterm pregnancy.

20.  Reinus JF, Leikin EL. Viral hepatitis in pregnancy. Clinics in Liver Disease, Volume 3 • Number 1 • February 1999

21.  Riely CA. Hepatic disease in pregnancy. Am J Med 1994 Jan 17;96(1A):18S-22S. Liver disease occurring in pregnancy can be categorized into three groups. The first group includes diseases unique to pregnancy and caused by it. Among these are hyperemesis gravidarum, cholestasis of pregnancy, and disorders associated with preeclampsia. Liver involvement may be expected in 50% of patients with hyperemesis gravidarum. Preeclampsia has been associated with both the HELLP syndrome (hemolysis, elevated liver tests, and low platelets), which includes hepatic infarction and rupture, and with acute fatty liver of pregnancy (AFLP). In patients with HELLP syndrome, liver test abnormalities do not correlate with liver injury. Therefore, this and other disorders associated with preeclampsia require aggressive treatment, primarily with delivery. The second group of liver diseases are those exacerbated by pregnancy. Viral infections involving the liver that are usually benign, such as hepatitis E and herpes simplex, are more likely to be exacerbated in pregnant women and are more likely to lead to fulminant hepatic failure. Cholelithiasis and Budd-Chiari syndrome are more prevalent in pregnant women. The third group is comprised of liver diseases that are preexisting in the pregnant patient and includes autoimmune chronic active hepatitis and Wilson's disease. The number of patients in the last group is small, as chronic liver disease is rare in women who are able to bear children.

HIV

1.      Leroy V, Dabis F. [Reduction of mother-child transmission of HIV infection in Africa: from clinical research to public health programs]. Med Trop (Mars) 1999;59(4 Pt 2):456-464. [Article in French]. More and more African women are infected by HIV. As a result the mother-to-child transmission (MCT) rate is rising. Various prevention techniques have been assessed in randomized clinical trials in Africa but results need to be discussed to understand the full implications for prevention programs. To gain insight into this issue, we reviewed 11 randomized trials conducted in Africa and several other studies from developed countries. Trials using antiretroviral (ARV) drugs demonstrated good results for prevention of MCT in the first six months of life using abbreviated regimens involving either zidovudine (with or without lamivudine) or nevirapine alone. Preliminary results suggest long-term effectiveness of zidovudine. Antiseptic and nutritional interventions have demonstrated some efficacy in reducing maternal and newborn morbidity and mortality but have no effect on MCT rate. Confidential, voluntary HIV screening and counseling of pregnant women and short-course ARV treatment during the perinatal period associated with alternatives to breast-feeding such as early weaning or replacement of breast milk at birth are now the best methods to reduce MCT. Prevention of postnatal transmission will require further study in particular with regard to effects of different methods of feeding and post-exposure prophylaxis using ARV drugs in newborns. Management of HIV-infected children must remain a high priority. Implementation of currently available strategies is now under discussion.

2.      Kass NE, Taylor HA, Anderson J. Treatment of human immunodeficiency virus during pregnancy: The shift from an exclusive focus on fetal protection to a more balanced approach. American Journal of Obstetrics and Gynecology, Volume 182 • Number 4 • April 2000. A review is presented of policy and treatment guidelines for human immunodeficiency virus infection in pregnancy. Interventions that serve the best interests of pregnant women and their fetuses are suggested. Reproductive studies with animals should be done routinely, and more research with pregnant women should be conducted. Women and their health care providers need to shift away from the "therapeutic nihilism" paradigm. All clinical decisions must be made cautiously and thoughtfully, with the understanding that the health needs of the pregnant woman are usually whatever is in the best interest of the developing fetus.

3.      Krist AH.  Obstetric Care in Patients with HIV Disease. American Family Physician, Volume 63 • Number 1 • January 1, 2001. Appropriate management of pregnant patients who have human immunodeficiency virus (HIV) disease can have a major impact on maternal and infant health. The goals of therapy are to properly manage the pregnancy, treat the maternal HIV infection and minimize the risk of vertical transmission of HIV. Early detection of HIV through aggressive screening programs is necessary to initiate timely therapy. Zidovudine therapy given antepartum and intrapartum to the mother and after birth to the newborn has been shown to decrease the risk of vertical transmission. Evidence suggests that more aggressive antiretroviral therapy for the mother, which allows suppression of viral loads to undetectable levels, may be safe and may provide significant additional benefits. However, treatment needs to be individualized, weighing the possible teratogenic risks against the benefits of decreased transmission. Multiple prospective cohort studies support elective cesarean section as an additional means to decrease vertical transmission, but its role in relation to other therapies has not been determined. As in nonpregnant patients infected with HIV, prevention of opportunistic infections and adequate psychosocial support are essential.

4.      Brettle RP. Pregnancy and its effect on HIV/AIDS. Clin Obstet Gynecol 1992;6:125-36.

5.      Meda N, Leroy V, Viho I, Msellati P, Yaro S, Mandelbrot L, Montcho C, Manigart O, Dabis F; Field acceptability and effectiveness of the routine utilization of zidovudine to reduce mother-to-child transmission of HIV-1 in West Africa. AIDS 2002 Nov 22;16(17):2323-8. OBJECTIVE: To ascertain the field acceptability and effectiveness of the routine utilization of zidovudine in reducing mother-to-child transmission (MTCT) of HIV in breastfed children after a randomized clinical trial demonstrated its efficacy in Cote d'Ivoire and Burkina Faso. METHODS: Pregnant women aged 18 years or older, who had confirmed HIV-1 infection, haemoglobinemia greater than 7 g/dl were enrolled in an open label cohort at 36-38 weeks' gestation to receive an oral short course of zidovudine. Paediatric HIV infection was defined as a positive HIV-1 polymerase chain reaction, or if aged 15 months or older, a positive HIV serology. RESULTS: The acceptability of HIV pretest counselling was significantly higher in the cohort (90.3%) than in the trial (83.7%) (P < 0.001), but the return rate for HIV test results and for inclusion was low. A similar proportion of women accepted starting zidovudine in the cohort, 30.4% compared with 27.3% in the trial (P = 0.13). The proportions of women who took more than 80% of the expected zidovudine regimen were 81.8% before labour, 86.7% during labour, and 88.1% during the postpartum period, compared with those observed during the trial, 78.1, 81.1, and 85%, respectively. The MTCT probability at age 15 months was 19.6% in the cohort (n = 185) versus 21.2% in the trial (P = 0.52). CONCLUSION: The major drawback with the implementation of a short zidovudine regimen to reduce MTCT is HIV counselling and testing procedures. For women who consent, zidovudine is well accepted and efficacious under routine circumstances. Copyright 2002 Lippincott Williams & Wilkins

West Nile Virus

2. O'Leary DR, Kuhn S, Kniss KL, et al. Birth outcomes following West Nile Virus infection of pregnant women in the United States: 2003-2004. Pediatrics. 2006 Mar;117(3):e537-45. CONCLUSIONS: Of 72 infants followed to date in 2003 and 2004, almost all seemed normal, and none had conclusive laboratory evidence of congenital WNV infection. Three infants had WNV infection that could have been congenitally acquired. Seven infants had major malformations, but only 3 of these had defects that could have been caused by maternal WNV infection based on the timing of the infections and the sensitive developmental period for the specific malformations, and none had any conclusive evidence of WNV etiology. However, the sensitivity and specificity of IgM testing of cord blood to detect congenital WNV infection are currently unknown, and congenital WNV infection among newborns with IgM-negative serology cannot be ruled out.

Dengue fever

1. Carles, G., A. Talarmin, C. Peneau, and M. Bertsch. 2000. [Dengue fever and pregnancy. A study of 38 cases in french Guiana]. J Gynecol.Obstet.Biol.Reprod.(Paris) 29, no. 8:758-762. CONCLUSION: In case of dengue fever infection of the mother during pregnancy, there is a serious risk of premature birth and fetal death. In case of infection close to term, there is a risk of hemorrhage for both the mother and the newborn

3. Perret, C., P. Chanthavanich, K. Pengsaa, K. Limkittikul, J. E. G. Bunn, B. J. Brabin, and P. Hutajaroen. 2005. Dengue infection during pregnancy and transplacental antibody transfer in Thai mothers. Journal of Infection 51, no. 4:287-293. OBJECTIVES: The objectives of this study were to estimate dengue seroprevalence in a population of Thai pregnant women, living in a highly endemic area and placental transfer of dengue antibodies. METHODS: A cross-sectional seroprevalence study of 245 pregnant women at delivery. RESULTS: Dengue HAI antibodies were positive in 94.7%. Maternal age was the only risk factor associated with dengue infection as older mothers (>20 years) were significantly more likely to be seropositive than younger women (p<0.0001). Cord antibody titres varied with maternal age and antibody titre, were significantly higher in babies born to younger mothers (<20 years) (p=0.01), and were significantly correlated with maternal titre. Low birthweight babies had lower transfer ratios for DEN-2 antibody (1.06) compared to heavier babies (1.36, p=0.05). No mother or neonate had dengue IgM detected. Two women were classified as recently, but not currently infected with dengue virus and we consider it likely these were first trimester infections. As no infant became infected the fetal infection was 0%. CONCLUSIONS: Younger mothers were more likely to have been recently infected, resulting in higher antibody titres. Maternal dengue antibody transfer was proportional to maternal antibody concentration.