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Congenital varicella
- Maternal antibodies are transferred to the fetus through the placenta if the mother has had a vaccination or previous infection.
- Transmission of the virus is through the placenta
- Fetal infection early in the pregnancy known as congenital varicella syndrome
- The child can have an array of development issues skin issues to brain defects
- Child infection near term or immediately after birth
- These newborns are at in increase risk of severe disease and pneumonia
Treatment
- Varicella-Zoster Immune globulin (VZIG) right after birth, it can decrease the chances and severity of the infection.
- Prevention
- Pregnant women who come in contact with shingles or the chicken pox may also be given VZIG
- Women seeking to become pregnant and have not had the chickenpox or the vaccination should be encourage to get the vaccination at least 30 days prior to getting pregnant
Neonatal Herpes Simplex
- Rare but serious
- Transmission from mother to newborn usually during delivery
- A patient does not need to have symptoms to have active virus
- Three variations
- SEM – Skin, eyes and mouth herpes
- External lesions with no internal organ involvement
- DIS – Disseminated herpes
- Internal lesions particularly the liver
- CNS – Central nervous system herpes
- Infection of the nervous system which may lead to encephalitis
- SEM – Skin, eyes and mouth herpes
Clinical Presentation
- Skin vesicles
- Encephalopathy
- Neurologic findings
- Hepatitis
- DIC
- Respiratory distress
Labs and Studies
- HSV culture
- PCR testing
- Tzanck test
Treatment
- The risk of transmission can be reduced by
- Taking antiviral medication during pregnancy
- Avoiding sexual activity during the third trimester
- Cesarean delivery if there are active lesions or a high viral load.
- Treatment of the infant
- Acyclovir
- For patients with nervous system infection acyclovir is continued for up to one year
- Supportive care as necessary
- Acyclovir
Human papillomavirus
- HPV can be transmitted to the newborn during delivery these cases are rare although HPV is capable of hiding for years without symptoms
- The risk of perinatal HPV transmission is higher if the mother has active genital warts or an HPV-related cervical lesion at the time of delivery.
- If a newborn is exposed to HPV during delivery, they may develop warts in the throat or genital area, although this is rare.
- In extremely rare cases, perinatal HPV infection can lead to respiratory papillomatosis, a rare condition in which warts grow in the airways and can cause breathing difficulties.
- Studies have shown that transmission rates are lower in cesarean deliveries vs vaginal deliveries
Zika virus
- Mosquito borne virus
- Only 1 -5 adults experience symptoms when infected
- All clinical cases must be reported to the CDC
- Symptoms and history of travel should sway suspicion of zika
Transmission
- Primarily through mosquitos
- Sexual transmission
- Blood transfusion
- Intrauterine transmission
- Breast milk transmission
Clinical Presentation in Adults
- Headaches
- Conjunctivitis
- Fever
- Skin rash
- Muscle and Joint Pain
Clinical Presentation in Neonates
- Microcephaly and other eye and brain disorders
Labs and Studies
- Serologic Testing
- Reverse transcriptase–polymerase chain reaction (RT-PCR) testing
Treatment
- Supportive care
- Acetaminophen for pain and fever control
- Preventative
- If pregnant, avoid travel to areas where zika cases are known to be high. Check with the CDC for travel alerts
- Avoid mosquito bites
- CDC recommends serologic testing of all pregnant women upon returning from travel to areas known to have elevated zika levels regardless of symptoms.