Toxoplasmosis & Chicken pox In Pregnancy بنام خدا Toxoplasmosis & Chicken pox In Pregnancy

Toxoplasmosis in pregnancy Introduction a ubiquitous protozoan parasite serological evidence of past infection(15-45% in industrially developed and 80% in another countries) in neural and muscle tissue retinochoroiditis is the most frequent manifestation

Toxoplasmosis in pregnancy Sources of infection the oocyst, which is shed only in cat feces the tachyzoite the bradyzoite(within tissue cysts)

Toxoplasmosis in pregnancy

Toxoplasmosis in pregnancy Maternal infection Incidence: 1 to 8 per 1000 pregnancy Clinical manifestations: Acute infection is usually asymptomatic Nonspecific (fatigue, fever, headache, malaise, and myalgia) Lymphadenopathy

Toxoplasmosis in pregnancy MATERNAL INFECTION Clinical differential: acute Epstein-Barr virus infection, cytomegalovirus infection, HIV infection, syphilis, sarcoidosis, Hodgkin's disease, and lymphoma 

Toxoplasmosis in pregnancy Diagnosis: a minimum of two blood samples at least two weeks apart showing seroconversion from negative to positive Toxoplasma-specific IgM or IgG IgM antibodies…positive from 1-2 w to years igG antibodies…positive from 6-8 w for 2-4 w IgG avidity assay Screening: Not recommended!

Toxoplasmosis in pregnancy FETAL INFECTION Risk factors: advancing gestational age at the time of maternal seroconversion mother”s immunity

Toxoplasmosis in pregnancy Pathogenesis of fetal infection: via plasenta during the parasitemic phase the transition from acute infective tachyzoite form to the dormant bradyzoite form contained in tissue cysts…therapeutic "window of opportunity."

Toxoplasmosis in pregnancy Fetal sequelae: cerebral palsy, microcephaly, or bilateral blindness, or hydrocephalus or epilepsy retinochoroiditis, or lymphadenopathy or hepatosplenomegaly

Toxoplasmosis in pregnancy Fetal sequelae in sonograghy:  intracranial hyperechogenic foci or calcifications ventricular dilatation Intrahepatic densities, increased thickness and hyperdensity of the placenta, ascites, and, rarely, pericardial and pleural effusions

Toxoplasmosis in pregnancy Prenatal diagnosis: purpose: decide whether to change prenatal treatment from spiramycine to a pyrimethamine-sulfonamide combination and terminate the pregnancy Amniocentesis PCR for T. gondii DNA in amniotic fluid In placenta after delivvery:granulomatous villitis, cysts, plasma cell deciduitis, villous sclerosis, and chorionic vascular thromboses.

Toxoplasmosis in pregnancy Prenatal treatment spiramycin alone, spiramycin followed by pyrimethamine-sulfonamides, and pyrimethamine-sulfonamides alone three-week course of spiramycin (1 g orally three times per day) Pyrimethamine (25 mg once per day orally) and sulfadiazine (4 g/day orally divided into two to four doses) administered continuously until term.  

Toxoplasmosis in pregnancy Azithromycin animal model and in humans with acquired immunodeficiency syndromes (AIDS) reduces serious neurological sequelae of congenital toxoplasmosis, but no evidence of any effect on ocular disease, vision, or mother-to-child transmission of infection

Toxoplasmosis in pregnancy Termination of pregnancy the most infected babies have a good prognosis PREVENTION: avoid drinking unfiltered water hand hygiene after touching soil washing fruit and vegetables avoid undercooked meat

Toxoplasmosis in pregnancy Timing pregnancy after maternal infection: delay of six months has been suggested

Varicella-zoster virus infection in pregnancy Introduction one of eight herpesviruses infection in adults can lead to significant morbidity and mortality transmitted by: nasopharyngeal mucosa by droplets onto the conjunctival or nasal/oral mucosa direct contact with vesicular fluids rarely, the airborne spread

Varicella-zoster virus infection in pregnancy Maternal varicella  Incidence:1 to 5 cases per 10,000 pregnancies the incidence of varicella is not higher in pregnant compared to nonpregnant adults, disease severity appears to be increased Transmission can occur in utero, perinatally, or postnatally

Varicella-zoster virus infection in pregnancy Maternal varicella   Primary infection:regional lymph nodes and tonsils and possibly ductal tissue of salivary glands, VZV exanthem Uncomplicated varicella:rash of varicella, lesions in different stages of development, fever, malaise, and myalgia oral acyclovir therapy (800 mg five times per day for seven days)

Varicella-zoster virus infection in pregnancy Maternal varicella  Complicated infection:meningitis, encephalitis, cerebellar ataxia, pneumonia, glomerulonephritis, myocarditis, ocular disease, adrenal insufficiency, and death Varicella pneumonia:specially in who smoking or have more than 100 vesicles   acyclovir (10 mg/kg every eight hours)

Varicella-zoster virus infection in pregnancy Maternal varicella   DIAGNOSIS:clinical doubt:PCR testing of skin scrapings can also be cultured Serologic testing is usually not necessary for diagnosis

Varicella-zoster virus infection in pregnancy Congenital varicella the incidence of congenital abnormalities 0.4 percent before the 12th w;two percent between weeks 13 and 20; only 0.005 percent between weeks 21 to 28 of gestation

Varicella-zoster virus infection in pregnancy Clinical features of congenital varicella syndrome: ●Cutaneous scars in a dermatomal pattern ●Neurological abnormalities (eg, mental retardation, microcephaly, hydrocephalus, seizures, Horner’s syndrome) ●Ocular abnormalities (eg, optic nerve atrophy, cataracts, chorioretinitis, microphthalmos, nystagmus) ●Limb abnormalities (hypoplasia, atrophy, paresis) ●Gastrointestinal abnormalities (gastroesophageal reflux, atretic or stenotic bowel) ●Low birth weight and intrauterine growth retardation

Varicella-zoster virus infection in pregnancy Neonatal VZV infection:transmission from a mother to the fetus just prior to delivery mothers who have clinical disease within five days before to two days after delivery 

Varicella-zoster virus infection in pregnancy Congenital varicella Prenatal diagnosis: PCR testing of fetal blood or AF for VZV ultrasonography for detection of fetal abnormalities Postnatal diagnosis: ●History of maternal varicella infection during the first or second trimester of pregnancy ●Presence of compatible fetal abnormalities consistent with congenital varicella syndrome ●Evidence of intrauterine VZV infection  

Varicella-zoster virus infection in pregnancy POST-EXPOSURE PROPHYLAXIS :VZIG is not needed among women who were immunized with varicella vaccine in the past To decrease the risk of maternal infection and maternal morbidity biologically plausible that might decrease viremia, leading to a lower risk of mother-to-child transmission

Varicella-zoster virus infection in pregnancy no data on whether acyclovir is beneficial in reducing the risk of varicella after exposure during pregnancy a single dose of intravenous immune globulin (IVIG) at 400 mg/kg should be administered as soon as possible within 10 days of exposure

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