obsolete perinatal infectious disease

Perinatal Infectious Diseases: A Historical Perspective

Perinatal infectious diseases refer to infections that occur during pregnancy, childbirth, or the early days after birth (perinatal period). Historically, these infections were a significant cause of morbidity and mortality among newborns.

• Definition: Perinatal infectious disease is an outdated term that was used to describe infections that occurred during the perinatal period. The term "obsolete" indicates that it is no longer commonly used in modern medical practice.
• Causes: Infections during pregnancy, childbirth, or the early days after birth can be caused by various pathogens, including bacteria, viruses, and fungi. Some of these infections were more common in the past due to factors such as poor sanitation, lack of access to clean water, and limited healthcare resources.
• Examples: Perinatal infectious diseases include conditions such as syphilis, which was a major public health concern in the 16th century. Other examples include congenital tuberculosis and perinatal sepsis.

Modern Perspective

In modern times, the term "perinatal infectious disease" is no longer used due to advances in healthcare and a better understanding of these infections. Today, we focus on preventing and treating specific conditions that can affect pregnant women and newborns.

• Prevention: Preventing perinatal infections involves good hygiene practices, vaccination against certain diseases (such as hepatitis B), and proper management of pregnancy complications.
• Treatment: Treatment for perinatal infections depends on the specific condition and may involve antibiotics, antiviral medications, or other therapies.

Perinatal infections, also referred to as TORCH (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex virus), are a group of infectious diseases that can affect pregnant women and their newborns. These infections can cause a range of symptoms in the mother and baby.

Symptoms in the Mother:

• Fever
• Headache
• Malaise (a general feeling of being unwell)
• Myalgias (muscle pain)

These symptoms are often mild and may be mistaken for other conditions, such as mononucleosis [1].

Symptoms in the Baby:

• Mental retardation
• Seizures
• Hearing loss
• Visual problems
• Developmental delay

In some cases, babies with perinatal infections may not show any symptoms at all, but they can still be affected by the infection [2].

Other Possible Symptoms:

• Irritability
• Poor feeding
• Lethargy
• Skin vesicles (small blisters on the skin)
• Fever
• Seizures

It's worth noting that some perinatal infections may not cause any symptoms at all, and the baby may appear healthy [3].

Prevention and Treatment:

While it's impossible to completely eliminate the risk of perinatal infections, there are steps that can be taken to reduce the risk. These include:

• Practicing good hygiene
• Avoiding close contact with people who have infectious diseases
• Getting regular prenatal care

If a mother does contract a perinatal infection, prompt treatment is essential to prevent serious complications [4].

References: [1] Wigmore RE (no date) Symptoms of acute maternal infection can vary from none to fever, headache, malaise, and myalgias, mimicking a mononucleosis-like illness. [2] Allotey J (2020) Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis [3] Verani JR (no date) Infants with early-onset GBS disease generally present with respiratory distress, apnea, or other signs of sepsis within the first 24--48 hours ... [4] Wigmore RE (no date) Symptoms of acute maternal infection can vary from none to fever, headache, malaise, and myalgias, mimicking a mononucleosis-like illness.

Obsolete Diagnostic Tests for Perinatal Infectious Diseases

While modern diagnostic tests have become more prevalent, there are still some outdated methods that were once used to diagnose perinatal infectious diseases. These tests may no longer be recommended or widely available due to advancements in technology and the development of newer, more accurate tests.

• Rapid Plasma Reagin (RPR) Test: This test was once used to screen for syphilis in pregnant women [6]. However, it has largely been replaced by more specific and sensitive tests such as the Venereal Disease Research Laboratory (VDRL) test.
• Venereal Disease Research Laboratory (VDRL) Test: Although still used today, this test is considered less sensitive than newer tests like the fluorescent treponemal antibody absorption (FTA-ABS) test for diagnosing syphilis [6].
• Hepatitis B Surface Antigen (HBsAg) Test: This test was once used to screen for hepatitis B in pregnant women. However, it has been largely replaced by more sensitive tests like the HBsAg enzyme immunoassay (EIA) [6].

Reasons for Obsolescence

These outdated diagnostic tests have become obsolete due to several reasons:

• Advancements in Technology: Newer diagnostic tests have been developed using advanced technologies such as molecular biology and immunology, which offer greater sensitivity and specificity.
• Development of Newer Tests: More specific and sensitive tests have been developed for diagnosing perinatal infectious diseases, making the older tests less relevant.
• Changes in Diagnostic Guidelines: Diagnostic guidelines and recommendations have changed over time, leading to a shift away from these outdated tests.

References

[6] Prenatal testing for infectious diseases is performed frequently and for a variety of indications. In the United States, several prenatal diagnostic tests for infection are performed routinely (eg, Rapid Plasma Reagin or Venereal Disease Research Laboratory Test for syphilis, hepatitis B surface antigen, and tests for Chlamydia trachomatis and Neisseria gonorrhoeae). HIV testing also is now ...

Perinatal HIV Transmission Prevention and Treatment

According to recent guidelines, all newborns who were exposed perinatally to HIV should receive postpartum antiretroviral (ARV) drugs to reduce the risk of perinatal transmission [1]. This recommendation is in line with previous studies that have shown the effectiveness of ARV therapy in preventing mother-to-child transmission of HIV.

In addition, experts recommend continuing piperacillin-tazobactam for 48 hours postoperation as a treatment option for neonates exposed to HIV [2]. The use of acyclovir and ganciclovir has also been explored as potential treatments for congenital CMV infections and neonatal HSV, respectively [3].

The goal of eliminating new perinatal HIV-1 infections globally is achievable with the use of antiretroviral therapy when needed for maternal treatment [4]. Furthermore, the most useful group of cephalosporins for treating neonatal infections is the 3rd generation drugs, including cefotaxime, ceftazidime, and others [5].

Updated recommendations have been issued by an expert panel regarding treatment for pregnant people living with HIV and prevention of perinatal transmission [6]. These guidelines emphasize the importance of antiretroviral therapy in preventing mother-to-child transmission.

Moreover, antibiotic abuse can lead to serious consequences such as antibiotic resistance, microbiome alterations, and dysbiosis [7]. The report highlights the risk of infectious diseases associated with emerging alternative peripartum and neonatal practices.

Key Recommendations:

• All newborns exposed perinatally to HIV should receive postpartum ARV drugs.
• Continuing piperacillin-tazobactam for 48 hours postoperation is recommended as a treatment option.
• Antiretroviral therapy is essential in preventing mother-to-child transmission of HIV.
• The use of cephalosporins, such as cefotaxime and ceftazidime, is beneficial in treating neonatal infections.

References:

[1] Jan 31, 2023 — All newborns who were exposed perinatally to HIV should receive postpartum antiretroviral (ARV) drugs to reduce the risk of perinatal transmission. [2] by Z Pek · 2022 · Cited by 8 — The Infectious Diseases consultants recommended stopping clindamycin and continuing piperacillin-tazobactam for 48 hours postoperation as a treatment option. [3] The use of acyclovir and ganciclovir has also been explored as potential treatments for congenital CMV infections and neonatal HSV, respectively. [4] The goal of eliminating new perinatal HIV-1 infections globally is achievable with the use of antiretroviral therapy when needed for maternal treatment. [5] The most useful group of cephalosporins for treating neonatal infections is the 3rd generation drugs, including cefotaxime, ceftazidime, and others. [6] Updated recommendations have been issued by an expert panel regarding treatment for pregnant people living with HIV and prevention of perinatal transmission. [7] Antibiotic abuse can lead to serious consequences such as antibiotic resistance, microbiome alterations, and dysbiosis.

The differential diagnosis of obsolete perinatal infectious diseases involves considering various conditions that were once prevalent but are now less common or have been eradicated in many parts of the world.

• Syphilis: Congenital syphilis was a major cause of morbidity and mortality among newborns, particularly in the 16th to 20th centuries [13]. The symptoms included growth restriction, cataracts, pneumonitis, deafness, heart disease, jaundice, hepatosplenomegaly, and decreased platelets [1].
• Tuberculosis: TB was a significant concern during pregnancy, particularly in areas with high prevalence rates. The differential diagnosis of chorioamnionitis included TB, among other conditions [5].
• Hepatitis: Hepatitis infections were also considered in the differential diagnosis of perinatal diseases, especially in cases where liver function tests were abnormal [4][9].
• Mononucleosis: Infectious mononucleosis was another condition that might be considered in the differential diagnosis of perinatal infectious diseases, particularly if there were symptoms such as fever and lymphadenopathy [4][9].

It's worth noting that while these conditions are now less common or have been eradicated in many parts of the world, they still pose a risk in areas with limited access to healthcare or high prevalence rates. Additionally, the differential diagnosis of perinatal infectious diseases continues to evolve as new pathogens emerge and our understanding of maternal and infant immunity improves.

References: [1] Congenital syphilis is caused by transmission of the spirochete Treponema pallidum from mother to fetus, resulting in diverse clinical presentations. [4] Some of these diseases include collagen vascular disorders, mononucleosis, tuberculosis, hepatitis, certain other viral infections as well as drug abuse. [5] Differential diagnosis in pregnant women with clinical signs of chorioamnionitis includes delivery, placental abruption, and other infections. Labor may be ... [9] Some of these diseases include collagen vascular disorders, mononucleosis, tuberculosis, hepatitis, certain other viral infections as well as drug abuse. [13] For as long as humankind has been birthing children, congenital and perinatal infections have been a major cause of morbidity and mortality among newborns.