correlation between TORCH infection on pregnant women

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CREATED BY: MILA WIDYASTUTI 030.08.162 The Correlation Between TORCH Infections on Pregnant Women and The Effects on Their Children

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Page 1: correlation between TORCH infection on pregnant women

CREATED BY:MILA WIDYASTUTI

030.08.162

The Correlation Between TORCH Infections on Pregnant Women

and The Effects on Their Children

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ABSTRACT

TORCH infections is a medical acronym for a set of perinatal infections.

A group of viral, bacterial, and protozoan infections that gain access to the fetal bloodstream transplacentally via the chorionic villi.

Hematogenous transmission may occur at any time during gestation or occasionally at the time of delivery via maternal-to-fetal transfusion.

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TORCH INFECTIONS

T : ToxoplasmosisO : other infections (Hepatitis B, Coxsackievirus,

Syphilis, Varicella-Zoster Virus, HIV, and Parvovirus B19)

R : RubellaC : CytomegalovirusH : Herpes Simplex Virus

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INTRODUCTION

It can affect people of any age or sex. However, the term TORCH is only used when it applies to pregnant women and their unborn or newborn children.

Babies are usually most severely affected when the mother gets the infection in the first trimester, or first three months of pregnancy. This is the time of pregnancy when the baby's organs are first starting to form.(1)

The exception is herpes, which the baby can acquire as he or she goes through the birth canal.

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The aim of this paper is to provide the reader with more information in regards to TORCH infections on pregnant women and the effects on their children.

By reading this paper, the reader will obtain facts regarding the etiology and treatment of TORCH infections and the sign and symptoms of this disease.

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TOXOPLASMOSIS

Most common infectious diseasesCaused by the protozoa Toxoplasma gondii.

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Cyts full with toxoplasma gondii

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TRIMESTER

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Signs of congenital toxoplasmosis :

Retinochoroiditis Hidrocephaly/ Microcephaly

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cerebral calcification

Seizures Lymphadenopathy Fever Hepatosplenomeg

aly Jaundice rash

jaundice

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The examination : Anti-Toxoplasma IgG, IgM

IgM +, IgG - IgM +, IgG + IgM -, IgG + IgM -, IgG -

The beginning of infections/

IgM non specific

New infections

Maybe lateinfections

Resistance/ No

infections

Confirmation withIgG aviditas

Confirmation after 20 days with new sample

IgG aviditas < 30 IgG aviditas > 30

Late infections

Prevention andmonitoring

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Treatment : drug therapy :

Spiramycin 3 x 500 mg 10 days/month during pregnancy

Pyrimethamine + sulfadiazyn No safe, effective treatment exists for

chronic toxoplasmosis or toxoplasmosis occurring in the first trimester of pregnancy.(10)

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RUBELLA

commonly called German measlesan acute, mildly contagious viral disease that

produces a distinctive 3-day rash and lymphadenopathy.(11)

transmitted through contact with the blood, urine, stools, or nasopharyngeal secretions of infected people and, possibly, by contact with contaminated articles of clothing.

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Transplacental transmissionfirst trimester of pregnancy : 100 % abortus2nd and 3rd trimester most commonly cause

hearing loss

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can cause serious birth defects

microcephaly patent ductus arteriosus glaucoma

• Mental retardation• Bone defects

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In adults, prodromal signs and symptoms — headache, malaise, anorexia, low-grade fever, lymphadenopathy and, sometimes, conjunctivitis — are the first to appear

Suboccipital, postauricular, and postcervical lymph node enlargement is a hallmark of this disease

Low-grade fever may accompany the rash (37.2° to 38.3° C)(13)

Rubella Rash

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Because the rubella rash is self-limiting and only mildly pruritic, it doesn’t require topical or systemic medication.

Treatment consists of aspirin for fever and joint pain. Bed rest isn’t necessary, but the patient should be isolated until the rash disappears.

The rubella vaccine should be given with measles and mumps vaccines at age 15 months to decrease the cost and number of injections. (14)

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CYTOMEGALOVIRUS

caused by the cytomegalovirus, a deoxyribonucleic acid

The virus is usually transmitted through contact with these infected secretions, which can harbor the virus for months or even years.

It may be transmitted by sexual contact and can travel across the placenta, causing a congenital infection.

CMV infection during pregnancy can be hazardous to the fetus, possibly leading to stillbirth, brain damage, and other birth defects or to severe neonatal illness. About 1% of all neonates have CMV. (15)

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Afffects the heartMost patients with CMV infection have mild,

nonspecific complaints or none at allInfected infants ages 3 to 6 months usually

appear asymptomatic but may develop hepatic dysfunction, hepatosplenomegaly, spider angiomas, pneumonitis, and lymphadenopathy. (16)

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Congenital CMV infection is seldom apparent at birth, although the neonate’s urine contains the virus. CMV can cause brain damage that may not show up for months after birth.

It also can produce a rapidly fatal neonatal illness characterized by jaundice, petechial rash, hepatosplenomegaly, thrombocytopenia, hemolytic anemia, microcephaly, psychomotor retardation, mental deficiency, and hearing loss.(16)

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Figure 1. Micrograph of cytomegalovirus (CMV) infection of the placenta

The characteristic large nucleus of a CMV infected cell is seen off-centre at the bottom-right of the image. H&E stain.

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Treatment aims to relieve symptoms and prevent complications.

Most important, parents of children with severe congenital CMV infection need support and counseling to help them cope with the possibility of brain damage or death.

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HERPES SIMPLEX

a recurrent viral infection caused by Herpesvirus hominis (HVH)

Herpes type I : transmitted by oral and respiratory secretions, affects the skin and mucous membranes, commonly producing cold sores.

Herpes type II : primarily affects the genital area and is transmitted by sexual contact.(18)

the second most common viral infection in pregnant women. It can pass to the fetus transplacentally and, in early pregnancy, may cause spontaneous abortion or premature birth.(19)

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In neonates, HVH symptoms usually appear 1 to 2 weeks after birth. They range from localized skin lesions to a disseminated infection of organs, such as the liver, lungs, or brain. Common complications include seizures, mental retardation, blindness, chorioretinitis, deafness, microcephaly, diabetes insipidus, and spasticity. Up to 90% of infants with disseminated disease die.(19)

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Typical lesions may suggest HVH infection. However, confirmation requires isolation of the virus from local lesions and histologic biopsy. A rise in antibodies and moderate leukocytosis may support the diagnosis.

Figure 2. Micrograph of pap test showing changes assosiated with

herpes simpelx virus

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No cure for herpes exists; however, recurrences tend to be milder and of shorter duration than the primary infection.

Generalized primary infection usually requires an analgesic-antipyretic to reduce fever and relieve pain.

Drying agents, such as calamine lotion, ease the pain of labial or skin lesions. Avoid petroleum-based ointments, which promote viral spread and slow healing.

Topical corticosteroids are contraindicated in active infection

Oral acyclovir may bring relief to patients with genital herpes.

Foscarnet can be used to treat HVH that’s resistant to acyclovir. Anti-viral agents similar to acyclovir are valacyclovir and famciclovir. These agents are more active than acyclovir.(20)

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CONCLUSION

Pregnancy is the period of time when a fetus develops inside a woman’s uterus and ends with the birth of the infant. Pregnancies typically involve a variety of clinical laboratory tests. The tests provide useful information from the time pregnancy is first considered through the initial days of the newborn's life.

Now, the diagnosis for infectious diseases has been developed among others in the direction of immunological tests. The principle of this examination is the detection of anti-(antibody) specific to the bacteria causing the infection as the body’s response to the presence of a foreign body (the worst kuman. Antibodies can be immunoglobulin M (IgM) and immunoglobulin G (IgG).

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A treatment called immune globulin can be given to the mother or child in certain settings.

Prevention is related to the specific infection. Avoiding cats and raw meat can help prevent most cases of toxoplasmosis. rubella can be prevented by making sure the mother is immune (by testing her blood). Cytomegalovirus can rarely be prevented, but safer sex practices can help prevent some cases. Women who have active herpes lesions at the time of delivery are often advised to have a caesarean section.

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REFERENCES

1. Torch Infections. Available at : http://www.medicineonline.com/articles/t/2/TORCH-Infections.html

2. Boyer KM. Toxoplasmosis: Current status of diagnosis, treatment and prevention. Semin Pediatr Infect Dis 2000;11:165-171.

3. Robbins and Cotran Pathological Basis of Disease, pg 4804. Li D, Yang H, Zhang WH, et al. (2006). "A simple parallel analytical method of prenatal

screening". Gynecol. Obstet. Invest. 62 (4): 220–55. Springhouse, (2005). “Professional Guide to Diseases (Eighth Edition)”6. Torch infections on pregnancy. Available at : http://momandkids.us/torch-infection-in-

pregnancy.htm7. Klein J, Remington J. Current concepts in infections of the fetus and newborn. In

Infectious Diseases of the Fetus and Newborn Infant, eds Remington J and Klein J. Saunders, Philadelphia, PA 2001, 1-24.

8. Boyer KM. Toxoplasmosis: Current status of diagnosis, treatment and prevention. Semin Pediatr Infect Dis 2000;11

9. Update on TORCH Infections in the Newborn Infant. Available at : http://www.medscape.com/viewarticle/472409

10. Guerina NG, Hsu HW, Meissner HC, et al. Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. N Engl J Med 1994;330:1858-1863.

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11. Reef SE, Frey TK, Theall K, et al. The changing epidemiology of rubella in the 1990s: On the verge of elimination and new challenges for control and prevention. JAMA 2002;287:464-472.

12. Best JM, O'Shea S. Rubella virus. In Diagnostic Procedures for Viral, Rickettsial and Chamydial Infections, eds Lennette EH and Schmidt NJ. American Public Health Association, Washington DC 1989, 731-795.

13. Centers for Disease Control and Prevention. Rubella and congenital rubella syndrome—United States 1991–1997. MMWR 1997;46:350-354.

14. Maldonado Y. Rubella. In Nelson Textbook of Pediatrics, eds Behrman R, Kliegman R and Jenson H. 2004, 1032-1034. Philadelphia, PA.

15. Fowler KB, Stagno S, Pass RF. Maternal age and congenital cytomegalovirus infection: Screening of two diverse newborn populations: 1980–1990. J Infect Dis 1993;168:552.

16. Pass R. Cytomegalovirus. In Principles and Practice of Pediatric Infectious Diseases, eds Long S, Pickering L and Prober C. Churchill-Livingston, New York, NY 2003, 1050-1059.

17. Hicks T, Fowler K, Richardson M, et al. Congenital cytomegalovirus infection and neonatal auditory screening. J Pediatr 1993;123:779.

18. Arvin A, Whitley R. Herpes simplex virus infections. In Infectious Diseases of the Fetus and Newborn Infant, eds Remington J and Klein J. Saunders, Philadelphia, PA 2001, 425-446.

19. Prober CG, Yasukawa L, Aud S, et al. Low risk of herpes simplex virus infection in neonates exposed to virus at the time of vaginal delivery with recurrent herpes virus infection. N Engl J Med 1987;316:240-245.

20. Kohl S. Herpes simplex virus. In Nelson Textbook of Pediatrics, eds Behrman R, Kliegman R and Jenson H. Saunders, Philadelphia PA 2004, 1051-1057.