1/120. hiv surveillance: a dynamic, not static, process to assure accurate local data.BACKGROUND AND OBJECTIVES: Accurate human immunodeficiency virus (hiv) surveillance data is critical for the allocation of resources for care services and community prevention planning efforts. GOAL OF THIS STUDY: To validate hiv status of women and assess risk factor information on all persons reported with either heterosexual transmission or no identifiable risk factor. STUDY DESIGN: The surveillance database is updated continually as additional information is received on all cases allowing continual monitoring of pregnant and nonpregnant women. Repeated queries of various record systems were employed to validate or reclassify reported heterosexual or no identifiable risk factor information for both men and women. RESULTS: Four pregnant women (24%) and one nonpregnant woman (0.4%) initially meeting hiv surveillance criteria were demonstrated not to be infected. risk factors were validated or reclassified for 77 (58%) patients initially reported with heterosexual transmission or no identifiable risk. CONCLUSION: hiv surveillance should be a dynamic process and continual updating of case reports provides the most accurate information on which to base service and prevention decisions.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
2/120. Transmission of varicella to a gravida via close contacts immunized with varicella-zoster vaccine. A case report.BACKGROUND: Varicella-zoster is a highly contagious dna virus, transmitted by direct contact and respiratory droplets. An attenuated live-virus vaccine has recently become available and is of value for susceptible, nonimmunized people. As with other attenuated vaccines, such as measles, mumps and rubella virus, there is no evidence of transmission by those immunized, and it is generally recognized that these vaccines can be given to the close contacts of pregnant women. CASE: A 32-year-old woman at 39 weeks of gestation presented with generalized pruritic vesicles and pustules. diagnosis of primary varicella infection was made and confirmed by serologic studies. The patient denied recent or past exposure. The only significant history that the patient could recall was her exposure to her two children, who were vaccinated with the varicella-zoster vaccine eight days prior to her admission but were asymptomatic. CONCLUSION: This is the first report of a pregnant woman contracting the primary varicella infection from exposure to close contacts vaccinated with the varicella vaccine. It may not be as safe as previously thought for seronegative gravidas to be in close contact with people vaccinated with the varicella vaccine.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
3/120. Human immunodeficiency virus infection: in situ polymerase chain reaction localization in human placentas after in utero and in vitro infection.OBJECTIVE: We compared localization of human immunodeficiency virus type 1 within human placentas infected in utero with localization within human placental explants infected in vitro. STUDY DESIGN: Placental tissues from 3 cases of vertical transmission of human immunodeficiency virus type 1 were studied. Human placental explants from 6 term pregnancies not complicated by human immunodeficiency virus type 1 infection were infected in vitro with human immunodeficiency virus type 1(Ba-L). Sections from each placental explant and each placenta infected in utero were analyzed for human immunodeficiency virus type 1 localization by means of in situ polymerase chain reaction. RESULTS: Human immunodeficiency virus type 1 was primarily localized within syncytiotrophoblast, Hofbauer cells, and extravillous mononuclear cells in placental tissue sections from cases of in utero infection. Within placental explants human immunodeficiency virus type 1 deoxyribonucleic acid was found in syncytiotrophoblast and Hofbauer cells. The distributions of viral localization were similar in placentas infected in utero and placental explants infected in vitro. CONCLUSION: Human immunodeficiency virus type 1 can be localized to specific human placental cells (eg, syncytiotrophoblast) after either in utero or in vitro infection, which demonstrates the specificity and selectivity of human immunodeficiency virus infection in the human placenta.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
4/120. Maternal intrauterine herpes simplex virus infection leading to persistent fetal vasculature.herpes simplex virus can cause serious ocular and systemic disease in the neonate. The mode of transmission to the neonate is usually from the maternal birth canal to the fetus intrapartum; but much more rarely, hematogenous transplacental infection can affect the developing fetus months prior to birth. Persistent fetal vasculature occurs when there is persistence of the fetal ocular vasculature, which normally regresses prior to birth. To our knowledge, we report the first case of serologically proven intrauterine herpes simplex virus infection associated with bilateral persistent fetal vasculature in a surviving term infant. Arch Ophthalmol. 2000;118:837-840- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
5/120. Molecular evolution of HCV genotype 2c persistent infection following mother-to-infant transmission.The molecular evolution of HCV 2c in a case of vertical transmission was studied by comparing the virus quasispecies in the sera from the mother and from the child in a two-year follow-up. The positivity of HCV-rna since the delivery accounted for an in-utero infection. The Core-E1 genome region (nt 928-1225) was amplified by polymerase chain reaction (PCR) from serum samples collected at delivery and at 3, 9, 18 and 24 months after birth. The RIBA pattern was characterised by isolated anti-c22 positivity in the serum from mother and in sera from the child during the first 9 months. Additional presence of anti-c33 was observed afterwards. Genetic relatedness among isolates and with a mother minor variant serum (Mo1. 13) was found (mean variability ranged between 0.79% and 1.20%). From phylogenetic analysis this variant was identified as the origin of one of the two main lineages that included all isolates from child sera at 9, 18 and 24 months. The variability analysis has shown that high viral heterogeneity is present in the child serum collected at birth (3.16%). In this phase the dn/ds index (1.26%) indicates the presence of strong selective pressures. The development of child specific immune response at 9th month was concurrent with the disappearance of two mutants at positions 11 and 104 of E1. This rare case of in-utero mother-to-infant transmission can be considered as a model to elucidate the HCV quasispecies diversification during the first stage of infection.- - - - - - - - - - ranking = 3keywords = transmission (Clic here for more details about this article) |
6/120. Obstetric risks and vertical transmission of hepatitis c virus infection in pregnancy.BACKGROUND: Reports of obstetric complications of mothers infected with hepatitis c virus (HCV) are limited and the risk of mother-to-infant transmission varies widely. We assessed the course of pregnancy in HCV-infected women and the rate of vertical transmission. methods: Between October 1992 and December 1996, 3712 pregnant patients of the university hospital Grosshadern Munich, germany, were screened for anti-HCV and analyzed for HCV-rna by polymerase chain reaction. Clinical and biochemical parameters were monitored. Children born to HCV-positive women were followed up at 6, 12 and 18 month intervals and screened for anti-HCV and HCV-rna. RESULTS: Thirteen (42%) of 31 anti-HCV positive patients had a cesarean section which was twice the rate of that in the HCV-negative group (p=0.004). None of the cesarean deliveries was due to complications directly caused by HCV infection. Nine (29%) of 31 anti-HCV positive women had preterm delivery compared to 19% in the anti-HCV negative patients, the difference being statistically not significant. Fetal outcome parameters such as apgar score, umbilical pH and birth weight of HCV infected pregnancies were not impaired. All 29 babies tested for anti-HCV were seropositive after birth. Between 12 and 18 months of age, 10% of the infants still were anti-HCV positive, whereas only one baby was HCV-rna positive beyond 12 months yielding a vertical transmission rate of 5% among HCV-rna positive mothers. CONCLUSION: Anti-HCV positive pregnancies have an increased risk of cesarean delivery, probably due to the high-risk collective of anti-HCV positive mothers. The mother-to-child transmission rate is low and linked to maternal HCV-rna positivity.- - - - - - - - - - ranking = 4keywords = transmission (Clic here for more details about this article) |
7/120. Congenital skin lesions caused by intrauterine infection with coxsackievirus B3.BACKGROUND: Serious neonatal coxsackievirus infections transplacentally acquired in late pregnancy involve primarily the central nervous system, heart, liver and rarely the skin. patients AND methods: A boy born with a disseminated papulovesicular, nodular, bullous and necrotic ulcerated rash at 39 weeks gestational age developed pneumonia, carditis and hepatitis during the first days after birth. Molecular biological and serological methods were used for virological diagnosis. RESULTS: Coxsackievirus B3 (CVB3) was found in throat swabs and/or feces of the neonate and his mother. In addition, there was serological evidence of intrauterine infection. CONCLUSION: Intrauterine transmission of CVB3 during late pregnancy may lead to varicella-like congenital skin lesions.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
8/120. Rapid voluntary testing and counseling for hiv. Acceptability and feasibility in Zambian antenatal care clinics.Voluntary testing and counseling (VTC) for hiv/AIDS is now widely accepted as an effective hiv prevention and control strategy among heterosexual couples in sub-Saharan africa. The most appropriate format and venue for VTC remains a topic of debate among clinicians and public health professionals. Our research done in Lusaka, zambia, took a tripartite approach to exploring the most acceptable format and venue for VTC: a community survey of attitudes towards VTC, a pre- and postcounseling knowledge survey, and a pilot study of same-day VTC in urban antenatal care clinics. A community survey of 181 individuals was conducted in July-August 1996 based on a structured questionnaire. A pre- and post-VTC intervention knowledge survey was conducted during the same period among 82 couples attending the zambia-UAB hiv research Project (ZUHRP) hiv VTC center in Lusaka. Finally, same-day hiv VTC was pilot tested in six antenatal clinic locations during February-May 1997 and June-August 1998. The community survey revealed that 98% of participants support promotion of hiv VTC in the community and 83.8% prefer the same-day testing format. The knowledge survey revealed misconceptions about discordance within a couple and perinatal transmission of hiv. Pilot testing in antenatal clinics was well received, with 84% of pregnant women requesting testing and 25% having positive hiv serologies. Women with primary school or less education, those seeking antenatal care in local clinics, and those seen before the third trimester of pregnancy were more likely to request hiv testing. Testing and counseling for hiv were shown to be feasible and effective in the antenatal clinic setting. Implementation of same-day hiv VTC in antenatal clinics is an effective strategy to prevent vertical transmission and should be expanded to include couples to leverage a decrease in heterosexual transmission as well.- - - - - - - - - - ranking = 1.5keywords = transmission (Clic here for more details about this article) |
9/120. rocky mountain spotted fever and pregnancy: a case report and review of the literature.The classic triad of fever, headache, and characteristic rash occurring 1 to 2 weeks after a tick bite in an endemic area should raise suspicions for rocky mountain spotted fever (RMSF). All providers with primary care responsibility for women should be familiar with the diagnosis and treatment of this illness. As a recent case illustrates, the diagnosis of rocky mountain spotted fever may be complicated by pregnancy. Several conditions of pregnancy have similar presentations to the initial, often nonspecific manifestations of RMSF. Although doxycycline is the recommended therapy for children and nonpregnant women, chloramphenicol remains the recommended therapy for women during pregnancy. The time of year, local prevalence, and patient's exposure history may be taken into account when deciding to treat during pregnancy. Vertical transmission of RMSF has not been documented in humans. Prevention of RMSF by avoidance of tick-infested areas or by the use of insect repellents and long clothing is recommended for all patients.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
10/120. q fever during pregnancy: an emerging cause of prematurity and abortion.BACKGROUND: Although the pathogenic role of coxiella burnetii infection during pregnancy is controversial, some cases of stillbirth and abortion occurring after an acute or chronic infection have been mentioned in the literature. Recently, Q fever has been advocated as a significant cause of morbidity and mortality in pregnancy CASE: We describe an 18-year-old primipara woman admitted to our hospital for high fever and pancytopenia during an acute C. burnetii infection. She was successfully treated with clarithromycin, overcoming fever and pancytopenia. Finally, she gave birth to a healthy infant, and 1 year later both remained well. CONCLUSION: q fever is a potentially serious disease in pregnancy owing to the possibility of placenta infection and fetal transmission affecting its outcome. q fever infection should be suspected in unexplained febrile episodes or abortion during pregnancy, when epidemiologic and clinical data are present. We believe that C. burnetii serology should be tested in cases of fever of known origin or unexplained abortions, as the TORCH infections are.- - - - - - - - - - ranking = 0.5keywords = transmission (Clic here for more details about this article) |
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