Vertically transmitted infection
Vertically transmitted infection | |
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Micrograph of cytomegalovirus (CMV) infection of the placenta (CMV placentitis), a vertically transmitted infection: The characteristic large nucleus of a CMV-infected cell is seen off-centre at the bottom right of the image, H&E stain. | |
Specialty | Pediatrics |
A vertically transmitted infection is an
Types of infections
Bacteria, viruses, and other organisms are able to be passed from mother to child. Several vertically transmitted infections are included in the TORCH complex:[2]
- T – toxoplasmosis from Toxoplasma gondii
- O – other infections (see below)
- R – rubella
- C – cytomegalovirus
- H – neonatal herpes simplex
Other infections include:
- Parvovirus B19[3]
- Coxsackievirus[4]
- Chickenpox (caused by varicella zoster virus)[5]
- Chlamydia[6]
- HIV[7][8]
- Human T-lymphotropic virus[9]
- Syphilis[10]
- Zika fever, caused by Zika virus, can cause microcephaly and other brain defects in the child.[11]
- COVID-19 in pregnancy is associated with an increased risk of stillbirth with an odds ratio of approximately 2.[12]
The TORCH complex was originally considered to consist of the four conditions mentioned above,[14] with the "TO" referring to Toxoplasma. The four-term form is still used in many modern references,[15] and the capitalization "ToRCH" is sometimes used in these contexts.[16] The acronym has also been listed as TORCHES, for TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, and Syphilis.[citation needed]
A further expansion of this acronym, CHEAPTORCHES, was proposed by Ford-Jones and Kellner in 1995:[17]
- C – chickenpox and shingles
- H – hepatitis, C[18] (D), E
- E – enteroviruses
- A – AIDS (HIV infection)
- P – parvovirus B19 (produces hydrops fetalis secondary to aplastic anemia)
- T – toxoplasmosis
- O – other (group B streptococci, Listeria, Candida, and Lyme disease)
- R – rubella
- C – cytomegalovirus
- H – herpes simplex
- E – everything else sexually transmitted (human papillomavirus)
- S – Syphilis
Signs and symptoms
The signs and symptoms of a vertically transmitted infection depend on the individual pathogen. In the mother, it may cause subtle signs such as an influenza-like illness, or possibly no symptoms at all. In such cases, the effects may be seen first at birth.[citation needed]
Symptoms of a vertically transmitted infection may include fever and flu-like symptoms. The newborn is often
The genetic conditions of
Causal routes
The main routes of transmission of vertically transmitted infections are across the
.Transplacental
The embryo and fetus have little or no
Apart from infecting the fetus, transplacental pathogens may cause placentitis (inflammation of the placenta) and/or chorioamnionitis (inflammation of the fetal membranes).[citation needed]
During childbirth
Babies can also become infected by their mothers during
Pathophysiology
Virulence versus symbiosis
In the spectrum of optimal virulence, vertical transmission tends to evolve benign symbiosis, so is a critical concept for evolutionary medicine. Because a pathogen's ability to pass from mother to child depends significantly on the hosts' ability to reproduce, pathogens' transmissibility tends to be inversely related to their virulence. In other words, as pathogens become more harmful to, and thus decrease the reproduction rate of, their host organism, they are less likely to be passed on to the hosts' offspring since they will have fewer offspring.[21]
Although HIV is sometimes transmitted through perinatal transmission, its virulence can be accounted for because its primary mode of transmission is not vertical. Moreover, medicine has further decreased the frequency of vertical transmission of HIV. The incidence of perinatal HIV cases in the United States has declined as a result of the implementation of recommendations on HIV counselling and voluntary testing practices and the use of zidovudine therapy by providers to reduce perinatal HIV transmission.[22]
The price paid in the evolution of symbiosis is, however, great: for many generations, almost all cases of vertical transmission continue to be pathological—in particular if any other routes of transmission exist. Many generations of random mutation and selection are needed to evolve symbiosis. During this time, the vast majority of vertical transmission cases exhibit the initial virulence.[citation needed]
In dual inheritance theory, vertical transmission refers to the passing of cultural traits from parents to children.[23]
Diagnosis
When physical examination of the newborn shows signs of a vertically transmitted infection, the examiner may test blood, urine, and spinal fluid for evidence of the infections listed above. Diagnosis can be confirmed by culture of one of the specific pathogens or by increased levels of
Classification
A vertically transmitted infection can be called a perinatal infection if it is transmitted in the
The term congenital infection can be used if the vertically transmitted infection persists after childbirth.[citation needed]
Treatment
Some vertically transmitted infections, such as toxoplasmosis and syphilis, can be effectively treated with antibiotics if the mother is diagnosed early in her pregnancy. Many viral vertically transmitted infections have no effective treatment, but some, notably rubella and varicella-zoster, can be prevented by vaccinating the mother prior to pregnancy.[citation needed]
Pregnant women living in malaria-endemic areas are candidates for malaria prophylaxis. It clinically improves the anemia and parasitemia of the pregnant women, and birthweight in their infants.[26]
If the mother has active herpes simplex (as may be suggested by a pap test), delivery by Caesarean section can prevent the newborn from contact, and consequent infection, with this virus.[citation needed]
IgG2 antibody may play a crucial role in prevention of intrauterine infections and extensive research is going on for developing IgG2-based therapies for treatment and vaccination.[27]
Prognosis
Each type of vertically transmitted infection has a different prognosis. The stage of the pregnancy at the time of infection also can change the effect on the newborn.[citation needed]
See also
- Group B streptococcal infection
- Susceptibility and severity of infections in pregnancy
- Horizontal disease transmission
- TORCH syndrome
- Congenital cytomegalovirus infection
- Congenital rubella syndrome
- Congenital syphilis
- Neonatal herpes simplex
References
- ISBN 978-0-323-95389-4, retrieved 5 March 2023
- PMID 32809363. Retrieved 27 August 2021.
- ^ "Parvovirus B19". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
- ^ "Coxsackievirus". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
- ^ "Varicella-Zoster Virus/Chickenpox". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
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- ^ "CDC Concludes Zika Causes Microcephaly and Other Birth Defects". CDC Newsroom Releases. Centers for Disease Control and Prevention. 13 April 2016.
- PMID 33741725.)
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: CS1 maint: multiple names: authors list (link - ^ a b "Hepatitis B". Emergencies preparedness, response. World Health Organization. Retrieved 29 April 2016.
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- PMID 7300842. Retrieved 30 April 2016.
- ^ a b "Definitions and Indicators in Family Planning. Maternal & Child Health and Reproductive Health" (PDF). Archived from the original (PDF) on 25 January 2012. By European Regional Office, World Health Organization. Revised March 1999 & January 2001. In turn citing: WHO Geneva, WHA20.19, WHA43.27, Article 23
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- ^ Syal K and Karande AA. IgG2 Subclass Isotype Antibody and Intrauterine Infections. Current Science Vol. 102, No. 11, 10 June 2012.