Vertically transmitted infection

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Vertically transmitted infection
CMV placentitis1 mini.jpg
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   OOjs UI icon edit-ltr-progressive.svg

A vertically transmitted infection is an infection caused by pathogenic bacteria or viruses that use mother-to-child transmission, that is, transmission directly from the mother to an embryo, fetus, or baby during pregnancy or childbirth. It can occur when the mother has a pre-existing disease or becomes infected during pregnancy. Nutritional deficiencies may exacerbate the risks of perinatal infections. Vertical transmission is important for the mathematical modelling of infectious diseases, especially for diseases of animals with large litter sizes, as it causes a wave of new infectious individuals. [1]

Contents

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]

  1. T – toxoplasmosis from Toxoplasma gondii
  2. O – other infections (see below)
  3. R – rubella
  4. C – cytomegalovirus
  5. H – herpes simplex virus-2 or neonatal herpes simplex

Other infections include:

Hepatitis B may also be classified as a vertically transmitted infection. The hepatitis B virus is large and does not cross the placenta. Hence, it cannot infect the fetus unless breaks in the maternal-fetal barrier have occurred, but such breaks can occur in bleeding during childbirth or amniocentesis. [13]

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]

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 small for gestational age. A petechial rash on the skin may be present, with small reddish or purplish spots due to bleeding from capillaries under the skin. An enlarged liver and spleen (hepatosplenomegaly) is common, as is jaundice. However, jaundice is less common in hepatitis B because a newborn's immune system is not developed well enough to mount a response against liver cells, as would normally be the cause of jaundice in an older child or adult. Hearing impairment, eye problems, mental retardation, autism, and death can be caused by vertically transmitted infections.[ citation needed ]

The genetic conditions of Aicardi-Goutieres syndrome are possibly present in a similar manner. [19] [20]

Causal routes

The main routes of transmission of vertically transmitted infections are across the placenta (transplacental) and across the female reproductive tract during childbirth. Transmission is also possible by breaks in the maternal-fetal barrier such by amniocentesis [13] or major trauma.

Transplacental

The embryo and fetus have little or no immune function. They depend on the immune function of their mother. Several pathogens can cross the placenta and cause perinatal infection. Often, microorganisms that produce minor illness in the mother are very dangerous for the developing embryo or fetus. This can result in spontaneous abortion or major developmental disorders. For many infections, the baby is more at risk at particular stages of pregnancy. Problems related to perinatal infection are not always directly noticeable.[ citation needed ]

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 birth. Some infectious agents may be transmitted to the embryo or fetus in the uterus, while passing through the birth canal, or even shortly after birth. The distinction is important because when transmission is primarily during or after birth, medical intervention can help prevent infections in the infant.[ citation needed ]During birth, babies are exposed to maternal blood, body fluids, and to the maternal genital tract without the placental barrier intervening. Because of this, blood-borne microorganisms (hepatitis B, HIV), organisms associated with sexually transmitted infections (e.g., Neisseria gonorrhoeae and Chlamydia trachomatis ), and normal fauna of the genitourinary tract (e.g., Candida albicans ) are among those commonly seen in infection of newborns.[ citation needed ]

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

CMV placentitis CMV placentitis1.jpg
CMV placentitis

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 IgM against the pathogen.[ citation needed ]

Classification

A vertically transmitted infection can be called a perinatal infection if it is transmitted in the perinatal period, which starts at gestational ages between 22 [24] and 28 weeks [25] (with regional variations in the definition) and ending seven completed days after birth. [24]

The term congenital infection can be used if the vertically transmitted infection persists after childbirth.[ citation needed ]

Treatment

Micrograph of a pap test showing changes (upper right of image) associated with herpes simplex virus, a vertically transmitted infection Herpes simplex virus pap test.jpg
Micrograph of a pap test showing changes (upper right of image) associated with herpes simplex virus, a vertically transmitted infection

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

Related Research Articles

<span class="mw-page-title-main">Rubella</span> Human viral disease

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. Joint pain is common in adults. Complications may include bleeding problems, testicular swelling, encephalitis, and inflammation of nerves. Infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). Symptoms of CRS manifest as problems with the eyes such as cataracts, deafness, as well as affecting the heart and brain. Problems are rare after the 20th week of pregnancy.

In medicine, public health, and biology, transmission is the passing of a pathogen causing communicable disease from an infected host individual or group to a particular individual or group, regardless of whether the other individual was previously infected. The term strictly refers to the transmission of microorganisms directly from one individual to another by one or more of the following means:

<span class="mw-page-title-main">Congenital syphilis</span> Medical condition

Congenital syphilis is syphilis that occurs when a mother with untreated syphilis passes the infection to her baby during pregnancy or at birth. It may present in the fetus, infant, or later. Clinical features vary and differ between early onset, that is presentation before age 2-years of age, and late onset, presentation after age 2-years. Infection in the unborn baby may present as poor growth, non-immune hydrops leading to premature birth or loss of the baby, or no signs. Affected newborns mostly initially have no clinical signs. They may be small and irritable. Characteristic features include a rash, fever, large liver and spleen, a runny and congested nose, and inflammation around bone or cartilage. There may be jaundice, large glands, pneumonia, meningitis, warty bumps on genitals, deafness or blindness. Untreated babies that survive the early phase may develop skeletal deformities including deformity of the nose, lower legs, forehead, collar bone, jaw, and cheek bone. There may be a perforated or high arched palate, and recurrent joint disease. Other late signs include linear perioral tears, intellectual disability, hydrocephalus, and juvenile general paresis. Seizures and cranial nerve palsies may first occur in both early and late phases. Eighth nerve palsy, interstitial keratitis and small notched teeth may appear individually or together; known as Hutchinson's triad.

<span class="mw-page-title-main">Genital herpes</span> Infection by herpes simplex viruses of the genitals

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TORCH syndrome is a cluster of symptoms caused by congenital infection with toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and other organisms including syphilis, parvovirus, and Varicella zoster. Zika virus is considered the most recent member of TORCH infections.

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<span class="mw-page-title-main">Herpes</span> Viral disease caused by herpes simplex viruses

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<span class="mw-page-title-main">Congenital cytomegalovirus infection</span> Medical condition

Congenital cytomegalovirus (cCMV) is cytomegalovirus (CMV) infection in a newborn baby. Most have no symptoms. Some affected babies are small. Other signs and symptoms include a rash, jaundice, hepatomegaly, retinitis, and seizures. It may lead to loss of hearing or vision, developmental disability, or a small head.

<span class="mw-page-title-main">High-risk pregnancy</span> Medical condition

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A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy. A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.

In pregnancy, there is an increased susceptibility and/or severity of several infectious diseases.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

<span class="mw-page-title-main">Neonatal infection</span> Human disease

Neonatal infections are infections of the neonate (newborn) acquired during prenatal development or within the first four weeks of life. Neonatal infections may be contracted by mother to child transmission, in the birth canal during childbirth, or after birth. Neonatal infections may present soon after delivery, or take several weeks to show symptoms. Some neonatal infections such as HIV, hepatitis B, and malaria do not become apparent until much later. Signs and symptoms of infection may include respiratory distress, temperature instability, irritability, poor feeding, failure to thrive, persistent crying and skin rashes.

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References

  1. ↑ von Csefalvay, Chris (2023), "Simple compartmental models", Computational Modeling of Infectious Disease, Elsevier, pp. 19–91, doi:10.1016/b978-0-32-395389-4.00011-6, ISBN   978-0-323-95389-4 , retrieved 5 March 2023
  2. ↑ Jaan A, Rajnik M (2021). "TORCH Complex". National Center for Biotechnology Information, U.S. National Library of Medicine. PMID   32809363 . Retrieved 27 August 2021.
  3. ↑ "Parvovirus B19". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
  4. ↑ "Coxsackievirus". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
  5. ↑ "Varicella-Zoster Virus/Chickenpox". The Lecturio Medical Concept Library. Retrieved 27 August 2021.
  6. ↑ Yu, Jialin; Wu, Shixiao; Li, Fang; Hu, Linyan (2009). "Vertical Transmission of Chlamydia trachomatis in Chongqing China". Current Microbiology. 58 (4): 315–320. doi:10.1007/s00284-008-9331-5. ISSN   0343-8651. PMID   19123031. S2CID   2758055.
  7. ↑ Ugen, K E; Goedert, J J; Boyer, J; et al. (June 1992). "Vertical transmission of human immunodeficiency virus (HIV) infection. Reactivity of maternal sera with glycoprotein 120 and 41 peptides from HIV type 1". Journal of Clinical Investigation. 89 (6): 1923–1930. doi:10.1172/JCI115798. ISSN   0021-9738. PMC   295892 . PMID   1601999.
  8. ↑ Fawzi, Wafaie W.; Msamanga, Gernard; Hunter, David; et al. (2000). "Randomized Trial of Vitamin Supplements in Relation to Vertical Transmission of HIV-1 in Tanzania". Journal of Acquired Immune Deficiency Syndromes. 23 (3): 246–254. doi:10.1097/00042560-200003010-00006. ISSN   1525-4135. PMID   10839660. S2CID   35936352.
  9. ↑ Hisada, Michie; Maloney, Elizabeth M.; Sawada, Takashi; et al. (2002). "Virus Markers Associated with Vertical Transmission of Human T Lymphotropic Virus Type 1 in Jamaica". Clinical Infectious Diseases. 34 (12): 1551–1557. doi: 10.1086/340537 . ISSN   1058-4838. PMID   12032888.
  10. ↑ Lee, M.-J.; Hallmark, R.J.; Frenkel, L.M.; Del Priore, G. (1998). "Maternal syphilis and vertical perinatal transmission of human immunodeficiency virus type-1 infection". International Journal of Gynecology & Obstetrics. 63 (3): 247–252. doi:10.1016/S0020-7292(98)00165-9. ISSN   0020-7292. PMID   9989893. S2CID   22297001.
  11. ↑ "CDC Concludes Zika Causes Microcephaly and Other Birth Defects". CDC Newsroom Releases. Centers for Disease Control and Prevention. 13 April 2016.
  12. ↑ Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N (2021). "The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis". CMAJ. 193 (16): E540–E548. doi:10.1503/cmaj.202604. PMC   8084555 . PMID   33741725.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. 1 2 "Hepatitis B". Emergencies preparedness, response. World Health Organization. Retrieved 29 April 2016.
  14. ↑ Kinney, JS; Kumar, ML (December 1988). "Should we expand the TORCH complex? A description of clinical and diagnostic aspects of selected old and new agents". Clinics in Perinatology. 15 (4): 727–44. doi:10.1016/S0095-5108(18)30670-5. ISSN   0095-5108. PMID   2850128.
  15. ↑ Abdel-Fattah, Sherif A.; Bhat, Abha; Illanes, Sebastian; et al. (November 2005). "TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom". Prenatal Diagnosis. 25 (11): 1028–1031. doi:10.1002/pd.1242. ISSN   0197-3851. PMID   16231309. S2CID   25481658.
  16. ↑ Li, Ding; Yang, Hao; Zhang, Wen-Hong; et al. (2006). "A Simple Parallel Analytical Method of Prenatal Screening". Gynecologic and Obstetric Investigation. 62 (4): 220–225. doi:10.1159/000094092. ISSN   1423-002X. PMID   16791006. S2CID   41493830.
  17. ↑ Ford-Jones, E. L.; Kellner, J. D. (1995). ""Cheap torches": An acronym for congenital and perinatal infections". The Pediatric Infectious Disease Journal. 14 (7): 638–640. doi:10.1097/00006454-199507000-00028. PMID   7567307.
  18. ↑ Tosone, G.; Maraolo, A.E.; Mascolo, S.; et al. (2014). "Vertical hepatitis C virus transmission: Main questions and answers". World Journal of Hepatology. 6 (8): 538–548. doi: 10.4254/wjh.v6.i8.538 . PMC   4163737 . PMID   25232447.
  19. ↑ Knoblauch, Hans; Tennstedt, Cornelia; Brueck, Wolfgang; Hammer, Hannes; Vulliamy, Tom; Dokal, Inderjeet; Lehmann, Rüdiger; Hanefeld, Folker; Tinschert, Sigrid (2003). "Two brothers with findings resembling congenital intrauterine infection-like syndrome (pseudo-TORCH syndrome)". American Journal of Medical Genetics. 120A (2): 261–265. doi:10.1002/ajmg.a.20138. ISSN   0148-7299. PMID   12833411. S2CID   25402036.
  20. ↑ Vivarelli, Rossella; Grosso, Salvatore; Cioni, Maddalena; Galluzzi, Paolo; Monti, Lucia; Morgese, Guido; Balestri, Paolo (March 2001). "Pseudo-TORCH syndrome or Baraitser–Reardon syndrome: diagnostic criteria". Brain and Development. 23 (1): 18–23. doi:10.1016/S0387-7604(00)00188-1. ISSN   0387-7604. PMID   11226724. S2CID   21209676.
  21. ↑ Stewart, Andrew D.; Logsdon, John M.; Kelley, Steven E. (April 2005). "An empirical study of the evolution of virulence under both horizontal and vertical transmission". Evolution. 59 (4): 730–739. doi:10.1554/03-330. ISSN   0014-3820. PMID   15926685. S2CID   198155952.
  22. ↑ Joo, Esther; Carmack, Anne; Garcia-Buñuel, Elizabeth; Kelly, Chester J. (February 2000). "Implementation of guidelines for HIV counseling and voluntary HIV testing of pregnant women". American Journal of Public Health. 90 (2): 273–276. doi:10.2105/AJPH.90.2.273. ISSN   0090-0036. PMC   1446152 . PMID   10667191.
  23. ↑ Cavalli-Sforza, Luigi Luca; Feldman, Marcus W. (1981). Cultural Transmission and Evolution: A Quantitative Approach. Monographs in Population Biology. Vol. 16. Princeton University Press. pp. 1–388. ISBN   0-691-08283-9. PMID   7300842 . Retrieved 30 April 2016.
  24. 1 2 "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
  25. ↑ Singh, Meharban (2010). Care of the Newborn. p. 7. Edition 7. ISBN   9788170820536
  26. ↑ Radeva-Petrova, D; Kayentao, K; ter Kuile, FO; Sinclair, D; Garner, P (10 October 2014). "Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment". The Cochrane Database of Systematic Reviews. 2014 (10): CD000169. doi:10.1002/14651858.CD000169.pub3. PMC   4498495 . PMID   25300703.
  27. ↑ Syal K and Karande AA. IgG2 Subclass Isotype Antibody and Intrauterine Infections. Current Science Vol. 102, No. 11, 10 June 2012.
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