Chair of pediatrics with the medical Chair of pediatrics with the medical genetics genetics

LECTURE SUBJECTLECTURE SUBJECT::

““IIntntraurautterine infectionserine infections””

Definition

IIntntraurautterineerine infections (IUI) are an established infections (IUI) are an established fact of the virus or microorganism entry to the fact of the virus or microorganism entry to the

fetus from mother, it has clinical and laboratory fetus from mother, it has clinical and laboratory signs of infection disease.signs of infection disease.

Among the IUI the most frequent is Among the IUI the most frequent is TORCHTORCH--infectioninfection, , that means Tthat means T--ToxoplasmosisToxoplasmosis, ,

RR--RubeolaRubeola, , CC––CytomegaliaCytomegalia, , HH––Herpetica Herpetica infectioinfectio, , OO––OtherOther. .

Intrauterine contamination is a possible fact of Intrauterine contamination is a possible fact of the entry to the fetus of various causative agents, the entry to the fetus of various causative agents,

but there is no clinical manifestationsbut there is no clinical manifestations..

Actuality During last decades IUI take the I-III place at the During last decades IUI take the I-III place at the

structure of mortality reasons structure of mortality reasons (2-65%) (2-65%) of the of the newborns in Ukraine.newborns in Ukraine.

During last years the increase of frequency of this During last years the increase of frequency of this pathology is observed. This is caused by increase of pathology is observed. This is caused by increase of contamination by the IUI specific agents of women of contamination by the IUI specific agents of women of childbearing age childbearing age ((at pregnant women at pregnant women cytomegaloviruscytomegalovirus is determined at is determined at 13-91% 13-91% of cases, Coxsackie of cases, Coxsackie enterovirus enterovirus В-В-atat 2-74%, herpes 2-74%, herpes virus of the virus of the 2 2 type type – – atat 7-47%, chlamydia7-47%, chlamydiass – – atat 25-40%, mycoplasma 25-40%, mycoplasmass – –atat17-17-50%, streptococcus50%, streptococcus of the of the В В group group – – atat 35%). 35%). The The frequency of the fetus infection is frequency of the fetus infection is 5-70%.5-70%.

Risk factor of the IUI beginningsFrom the mother’s side:From the mother’s side:

CCompromised ompromised obstetric obstetric history history ((abortionsabortions, stillbirth, , stillbirth, miscarriage of the miscarriage of the previous pregnancies)previous pregnancies)

Pathologic course of present pregnancy Pathologic course of present pregnancy (threat of abortion, hydramnion, (threat of abortion, hydramnion, exfoliation of placenta, untimely exfoliation of placenta, untimely discharge of amniotic fluid, gestosis)discharge of amniotic fluid, gestosis)

Diseases of the urogenital system Diseases of the urogenital system (colpitis, vulvovaginitis, pyelonephritis, (colpitis, vulvovaginitis, pyelonephritis, cervical erosion, ovarian cysts)cervical erosion, ovarian cysts)

Extragenital pathology of pregnancy, Extragenital pathology of pregnancy, ARVI during pregnancyARVI during pregnancy

Pathologic course of delivery Pathologic course of delivery (protracted waterless interval, dirty (protracted waterless interval, dirty amniotic fluid, obstetric help at birth) amniotic fluid, obstetric help at birth)

Inflammatory infectious processes, Inflammatory infectious processes, increase of t of mother before, during increase of t of mother before, during or after birth (endometritis, mastitis)or after birth (endometritis, mastitis)

From the child’s side:From the child’s side: Prematurity, intrauterine growth Prematurity, intrauterine growth

retardation ,growth violations, retardation ,growth violations, disembriogenetic stigmadisembriogenetic stigma

Manifestations of the nonspecific Manifestations of the nonspecific infectious process (pneumonia , infectious process (pneumonia , hepatitis, meningoencephalitis, fever at hepatitis, meningoencephalitis, fever at the 1st day of life)the 1st day of life)

Manifestations of the specific infectious Manifestations of the specific infectious processprocess

Inflammatory changes of the Inflammatory changes of the peripheral bloodperipheral blood

Typical changes at USE of brain Typical changes at USE of brain ((hemorrhageshemorrhages, , ventriculitis, echodense ventriculitis, echodense inclusions, internal hydrocephalus) inclusions, internal hydrocephalus)

Jaundice of the unknown originJaundice of the unknown origin Micro- or hydrocephalus, lasting Micro- or hydrocephalus, lasting

convulsionsconvulsions Neurologic violations, that are first Neurologic violations, that are first

time registered in few days after birthtime registered in few days after birth

Etiology Viruses:Viruses:

cytomegaloviruscytomegalovirus – – DNADNA--virus from the group of herpetic infection;virus from the group of herpetic infection;

of herpes simplex of the 1st – 2nd type – DNA-virus from the group of of herpes simplex of the 1st – 2nd type – DNA-virus from the group of herpetic infection;herpetic infection;

of of chickenpox - chickenpox - DNADNA--virus from the group of herpetic infection;virus from the group of herpetic infection;

of rubella, measles, epidemic parotiditis – RNA-virus, mixovirus;of rubella, measles, epidemic parotiditis – RNA-virus, mixovirus;

enterovirusenterovirus – – RNA-virus from the group of Coxsackie, RNA-virus from the group of Coxsackie, ЕСНО;ЕСНО;

respiratoryrespiratory viruses viruses – – of grippe, paragrippe, adenoviruses, RS-viruses;of grippe, paragrippe, adenoviruses, RS-viruses;

of viral hepatitisof viral hepatitis.. BacteriaBacteria: : listerialisteria, , treponematreponema, , mycobacteria Kochiimycobacteria Kochii, opportunistic , opportunistic

pathogenic pathogenic floraflora ( (streptococcus Bstreptococcus B, , DD, Escherichia coli, , Escherichia coli, enterobacteriaenterobacteria). ).

Parasites Parasites – – toxoplasma.toxoplasma. Mycoplasma.Mycoplasma. ChlamidiaChlamidia. .

IUI characteristic features Source of infection (pregnant woman, parturient woman, mother)Source of infection (pregnant woman, parturient woman, mother) Infection waysInfection ways::CContaminationontaminational al – – it occurs through infected amniotic fluid by:it occurs through infected amniotic fluid by:Hematogenic Hematogenic (diaplacental) - (diaplacental) - placenta injure, placental barrier violations.placenta injure, placental barrier violations.ascending wayascending way – – in case of infection entry from vaginain case of infection entry from vagina, neck of uterus;, neck of uterus;descending waydescending way – – in case of infection entry from abdominal cavity through uterine tubesin case of infection entry from abdominal cavity through uterine tubes ;;contactingcontacting – – in case of localization of the infection source right in the uterine wall, in the placenta.in case of localization of the infection source right in the uterine wall, in the placenta.IntranatalIntranatal – – during fetus going through infectedduring fetus going through infected maternal passages maternal passages.. IUI causative agents have the high tropism to the majority of fetus tissues and organs.IUI causative agents have the high tropism to the majority of fetus tissues and organs. The diagnostics is difficult because of:The diagnostics is difficult because of:The infection process in the mother’s organism often is symptomlessThe infection process in the mother’s organism often is symptomless ;;The fetus disease is caused not only by the direct action of causative agentThe fetus disease is caused not only by the direct action of causative agent , , but also by mixed but also by mixed

infectioninfection, , intoxicationintoxication, , immunologic changesimmunologic changes, , metabolism violations at mother’s organismmetabolism violations at mother’s organism;;This pathology often is hidden by the mask ofThis pathology often is hidden by the mask of intrauterine growth retardation intrauterine growth retardation, hypoxia, birth trauma, hypoxia, birth trauma IUI of the newborns often is displayed by latent infection because of prolonged agentIUI of the newborns often is displayed by latent infection because of prolonged agent

persistencepersistence.. The level of injury depends onThe level of injury depends on ruggedness ruggedness ofof contagion contagion and the terms of gestation.and the terms of gestation. The possibility of fetus infection increases with increase of gestation terms. The possibility of fetus infection increases with increase of gestation terms.

Pathogenesis The fetus infection during the embryonal growth period causes the The fetus infection during the embryonal growth period causes the

development of infection embryopathies, that displays as fetus development of infection embryopathies, that displays as fetus wastage at the early terms, stillbirth, development of the congenital wastage at the early terms, stillbirth, development of the congenital growth defects (as a result of alternative, proliferative growth defects (as a result of alternative, proliferative inflammatory changes).inflammatory changes).

The fetus infection during placental growth period causes the The fetus infection during placental growth period causes the fetopathies development. In this case placenta and fetus have the fetopathies development. In this case placenta and fetus have the pathogenic changes. The fetopathies include: preterm delivery, pathogenic changes. The fetopathies include: preterm delivery, intrauterine growth retardation, plural stigmas. The development intrauterine growth retardation, plural stigmas. The development of congenital defects of the systems that did not finish its growth is of congenital defects of the systems that did not finish its growth is possible. Till the 5th- 6th month of antenatal growth the disease possible. Till the 5th- 6th month of antenatal growth the disease courses as generalized process with the blood circulation violations, courses as generalized process with the blood circulation violations, dystrophic and necrotic changes.dystrophic and necrotic changes.

The infection during the 3rd trimester of pregnancy causes the The infection during the 3rd trimester of pregnancy causes the child’s birth with the disease manifestations. Pathologic changes are child’s birth with the disease manifestations. Pathologic changes are caused by the ternary inflammation character.caused by the ternary inflammation character.

IUI consequencesІ. І. At antenatal infection:At antenatal infection:Abortions, miscarriages, stillbirthAbortions, miscarriages, stillbirth..Growth defectsGrowth defects, , dysplasia of the internalsdysplasia of the internals..Neonatal death.Neonatal death.Recovery.Recovery.PersistencePersistence of the causative agent of the clinically healthy of the causative agent of the clinically healthy

child.child.ІІ. ІІ. At intranatal infection:At intranatal infection:Growth imbalanceGrowth imbalance. . Functional and organic violationsFunctional and organic violations ( (encephalopathiesencephalopathies, ,

endocrinopathyendocrinopathy).).Chronic diseasesChronic diseases ( (nephritisnephritis, , pyelonephritispyelonephritis, , pneumoniapneumonia).).

Classification By the periods of initiation:

antenatal (embryopathies, fetopathies)

intranatal

postnatal (nosocomial) By the periods:

early neonatal ( from the birth till the 7th day)

late neonatal (8-28 days) By the transfer path:

hematogenic

contaminational

intranatal By the etiology: viral, bacterial,

parasitic, mycoplasmal, chlamidial, fungous, mixed

DIAGNOSIS EXAMPLES: Intrauterine infection, intranatal herpetic infection of the II type, localized skin form, active phase, acute course.

By the form:

localized

generalized By the phase:

active

inactive

residual By the course:

acute

subacute

chronic

latent

Clinical syndromes of the infection process at newborns

Intoxicational (decrease of appetite, weight increase delay, hypotrophy, Intoxicational (decrease of appetite, weight increase delay, hypotrophy, flaccidity, sclerema, bleach, grey color of skin or jaundice, purpura). flaccidity, sclerema, bleach, grey color of skin or jaundice, purpura).

RespiratoryRespiratory ( (dyspneadyspnea, , tachypneatachypnea, , apneaapnea, , cyanosis of thecyanosis of the nasolabial nasolabial triangletriangle, , thethe ancillary ancillary muscles part in the breathing actmuscles part in the breathing act).).

Dyspeptic (regurgitatDyspeptic (regurgitationion, , vomitingvomiting, , stomachstomach bloating, bloating, frequent fluid frequent fluid stoolstool, , sponginess of the frontsponginess of the front abdominal wall, abdominal wall, liver and spleen increase).liver and spleen increase).

CardiovascularCardiovascular ( (ttachycardiaachycardia, relief of the heart sounds, broadening of the , relief of the heart sounds, broadening of the heart borders, paleness, mottled skin, cold limbs, edema, sponginess, AP heart borders, paleness, mottled skin, cold limbs, edema, sponginess, AP decrease).decrease).

Nervous system injuryNervous system injury ( (flaccidity, adynamia or excitation, convulsions, flaccidity, adynamia or excitation, convulsions, brain scream, bulging of the large fontanel, muscular hypotension, brain scream, bulging of the large fontanel, muscular hypotension, hyporeflexia).hyporeflexia).

Hematologic violationsHematologic violations ( (anemiaanemia, , trobocytopeniatrobocytopenia, , leucopenia or leucopenia or leukocytosisleukocytosis, , raisedraised hemorrhage hemorrhage, splenomegaly)., splenomegaly).

Diagnostics Anamnesis (accounting all the risk factors).Anamnesis (accounting all the risk factors). Clinical presentationClinical presentation Laboratory dataLaboratory data, subsidiary, subsidiary research methods data: research methods data:

Transabdominal amniocentesis Transabdominal amniocentesis ((indification of the infection agentindification of the infection agent, , glucose level glucose level determinationdetermination, , CC--reactive proteinreactive protein, , correlation of the amount of stab granulocytes correlation of the amount of stab granulocytes and the total leukocytes content, the part of haptoglobulins)and the total leukocytes content, the part of haptoglobulins);;

Cordocentesis (the agent determination or the level of specific antibodies in the Cordocentesis (the agent determination or the level of specific antibodies in the umbilical blood)umbilical blood);;

Bacteriologic and viral researches of the cervical canal of urethraBacteriologic and viral researches of the cervical canal of urethra, , vaginavagina););

Serologic methodsSerologic methods ( (level of specific antibodies in the womenlevel of specific antibodies in the women’’s bloods blood));;

Ultrasonic scanningUltrasonic scanning ( (the next features mean the fetus infection: disparity of the head the next features mean the fetus infection: disparity of the head size to the pregnancy period, intrauterine growth retardation, calcifications in the size to the pregnancy period, intrauterine growth retardation, calcifications in the liver, kidneys, brain ventricles, placenta, hydramnion, violation of the structure liver, kidneys, brain ventricles, placenta, hydramnion, violation of the structure and placenta development).and placenta development).

CardiotocographyCardiotocography;;

Hystologic research of placentaHystologic research of placenta;;

IFAIFA, , PCRPCR, , DNADNA- - hybridizationhybridization..

The inspections complex at the IUI

suspicion AAmniotic fluidmniotic fluid research: research:

bacteriologic researchbacteriologic research ( (diagnostic criteria is the presence ofdiagnostic criteria is the presence of 103 103 microbal units of the opportunistic microbal units of the opportunistic group ingroup in 1 1ml of fluid)ml of fluid)

cytological research ofcytological research of sediment sediment (5 and (5 and > > leukocytes is high level of ANI development)leukocytes is high level of ANI development) Vagina content research (bacteriologic and bacterioscopic)Vagina content research (bacteriologic and bacterioscopic).. Placenta analysisPlacenta analysis ( (bacteriologic, virological, histological).bacteriologic, virological, histological). General blood analysis with accounting of thrombocytes (anemia, thrombocytopenia, General blood analysis with accounting of thrombocytes (anemia, thrombocytopenia,

leucopenia, raised ESR, leukocytosis with the lymphocytosis, monocytosis, shift of the formula leucopenia, raised ESR, leukocytosis with the lymphocytosis, monocytosis, shift of the formula to the left).to the left).

Biochemical analysis of blood (total protein content, protein fraction decrease, presence of C-Biochemical analysis of blood (total protein content, protein fraction decrease, presence of C-reactive protein, increased activity of transaminases). reactive protein, increased activity of transaminases).

Bacteriologic research of blood, stomach content, stool, urine, liquor.Bacteriologic research of blood, stomach content, stool, urine, liquor. General urine analysis.General urine analysis. RRoentgenologicoentgenologic research of internal organs of chest, skull. research of internal organs of chest, skull. Neurosonography.Neurosonography. Immunologic research of the umbilical blood (decrease of Ig G and increase of Ig MImmunologic research of the umbilical blood (decrease of Ig G and increase of Ig M, , Ig AIg A, ,

alpha-fetoprotein level).alpha-fetoprotein level). Serologic analysis in dynamics.Serologic analysis in dynamics.

General treatment methods

- --At the viral IUIAt the viral IUI ( (herpesherpes, , CMVCMV) – ) – specific specific antiviral preparationsantiviral preparations ( (vidarabinvidarabin, , virazolvirazol, , virolexvirolex, , acycloviracyclovir));;

- --At bacterial and parasitogenic ANI (lysteriosis, At bacterial and parasitogenic ANI (lysteriosis, congenital syphilis, toxoplasmosis, chlamidiosis, congenital syphilis, toxoplasmosis, chlamidiosis, mycoplasmosis) – specific antibacterial therapy mycoplasmosis) – specific antibacterial therapy

- --Pathogenic methods of immunotherapyPathogenic methods of immunotherapy ((immunoglobulinimmunoglobulin, , interferoninterferon, , laferonlaferon).).

Clinical and diagnostic criteria of

cytomegalovirus infection Causative agentCausative agent: : cytomegaloviruscytomegalovirus – – DNADNA- - virus of the herpetic originvirus of the herpetic origin. . It has some features: It has some features:

immensely large DNA, the possibility of replication without cell damage, slow replication, it immensely large DNA, the possibility of replication without cell damage, slow replication, it causes the rapid decrease of the cell immunity, the viral excretion survives during 2-8 years.causes the rapid decrease of the cell immunity, the viral excretion survives during 2-8 years.

Source: mother, also biologic fluids and discharge.Source: mother, also biologic fluids and discharge.The infection path: transplacental, intranatal, during feeding with the breast milk, during The infection path: transplacental, intranatal, during feeding with the breast milk, during

hemotransfusions.hemotransfusions.For the generalized form of CMV-infection is characteristic the following: prematurity, intrauterine For the generalized form of CMV-infection is characteristic the following: prematurity, intrauterine

growth retardation, hepatosplenomegaly, jaundice, nervous system injury, interstitial growth retardation, hepatosplenomegaly, jaundice, nervous system injury, interstitial pneumonia, damage of salivary glands, eyes, internal ear, kidney, hemorrhagic syndrome.pneumonia, damage of salivary glands, eyes, internal ear, kidney, hemorrhagic syndrome.

The localized form (hepatitis) is much more rear.The localized form (hepatitis) is much more rear.The tetrad is characteristic: jaundice, hepatosplenomegaly, thrombocytopenia, hard damage of the The tetrad is characteristic: jaundice, hepatosplenomegaly, thrombocytopenia, hard damage of the

nervous system.nervous system.Laboratory diagnostics: cystoscopic, virological methods, IFA, PCR, DNA- hybridization. Laboratory diagnostics: cystoscopic, virological methods, IFA, PCR, DNA- hybridization.

Treatment: cytotect by 2ml/kg every 2 days or 4 ml/kg every 4 days intravenously till the decrease Treatment: cytotect by 2ml/kg every 2 days or 4 ml/kg every 4 days intravenously till the decrease of clinical symptomsof clinical symptoms; ; phoscarnet by 180ml/kg in 5 doses intravenously during 14-21 days. phoscarnet by 180ml/kg in 5 doses intravenously during 14-21 days. Sustentacular dose is Sustentacular dose is 90 90 ml/kg/day. Gancyclovir (cymeven) by 5 mg/kg 2 times a day ml/kg/day. Gancyclovir (cymeven) by 5 mg/kg 2 times a day intravenously during 14-21 daysintravenously during 14-21 days; ; laferon by laferon by 100 000 100 000 UA intravenously 1 time a day during 10 UA intravenously 1 time a day during 10 days.days.

Clinical and diagnostic criteria of herpetic infection

Causative agent: herpes simplex virus, DNA- virus of the herpetic origin (in 90% of Causative agent: herpes simplex virus, DNA- virus of the herpetic origin (in 90% of cases – II type), that has some features: persistence in the CNS, support of latent cases – II type), that has some features: persistence in the CNS, support of latent infection.infection.

Source: mother.Source: mother.The infection path: intranatal (85 % of cases), transplacental (in case of viremia of The infection path: intranatal (85 % of cases), transplacental (in case of viremia of

mother), contaminational (ascending way).mother), contaminational (ascending way).Clinically the disease is presented as generalized forms (lethality without treatment is Clinically the disease is presented as generalized forms (lethality without treatment is

90%) 90%) and localized forms (with the mostly defeat of CNS – lethality without and localized forms (with the mostly defeat of CNS – lethality without treatment is 50%, with the mostly injury of skin and mucous - lethality without treatment is 50%, with the mostly injury of skin and mucous - lethality without treatment is 18%).treatment is 18%).

Laboratory diagnostics: virological method, IEA, PLR, DNA-hybridization, Laboratory diagnostics: virological method, IEA, PLR, DNA-hybridization, histological research of placenta.histological research of placenta.

Treatment: acyclovir (zovirax, virolex) by 30mg/kg/day in 3 doses intravenously Treatment: acyclovir (zovirax, virolex) by 30mg/kg/day in 3 doses intravenously during 2-3 weeks, vidarabin 15-30 mg/kg/day intravenously droply in 2 doses during 2-3 weeks, vidarabin 15-30 mg/kg/day intravenously droply in 2 doses during 10-14 days, laferon by 100 000 UA intravenously 1 time a day during 10 during 10-14 days, laferon by 100 000 UA intravenously 1 time a day during 10 days.days.

  

Clinical and diagnostic criteria of listeriosis

Causative agent - Listeria monocytogenesis- gram-positive bacillus.Causative agent - Listeria monocytogenesis- gram-positive bacillus.Source: mother.Source: mother.The infection path: transplacental The infection path: transplacental Diagnostics:Diagnostics:--In the anamnesis- contact with the pets, increase of body t during pregnancy, In the anamnesis- contact with the pets, increase of body t during pregnancy,

fever, pielitis phenomena, spontaneous abortions.fever, pielitis phenomena, spontaneous abortions.--Dirty amniotic fluid.Dirty amniotic fluid.--ChildChild’’s clinical presentations clinical presentation – – increase of body tincrease of body t, , RDSRDS, , convulsionsconvulsions, papular - , papular -

petechial skinpetechial skin, , mucous rashmucous rash, , inflectional granuloma at the tonsilsinflectional granuloma at the tonsils, , back pharynx back pharynx wall, conjunctiva.wall, conjunctiva.

-Radiological-Radiologicalyy – – pluralplural, , dense infiltrative shadowsdense infiltrative shadows, , that is similar to military that is similar to military tuberculosis presentationtuberculosis presentation. .

--Specific research methodsSpecific research methods- - bacteriologicalbacteriological research of the amniotic fluid, research of the amniotic fluid, placenta, liquor, blood; placenta, liquor, blood; histological histological placenta research; placenta research; serological serological research research (increase of antibodies titer in 4 times and more has the diagnostics value).(increase of antibodies titer in 4 times and more has the diagnostics value).

TreatmentTreatment: : ampicillin by 200 mg/kg/day, gentamicin by 7 mg/kg/day during 14 ampicillin by 200 mg/kg/day, gentamicin by 7 mg/kg/day during 14 weeksweeks

Clinical and diagnostic criteria of congenital syphilis

Causative agentCausative agent: : Treponema pallidumTreponema pallidumSource: mather.Source: mather.The infection path: transplacentalThe infection path: transplacental, , intranatal intranatal Typical clinical triad for congenital syphilis:Typical clinical triad for congenital syphilis:--Syphilitic pemphigus with tissue induration.Syphilitic pemphigus with tissue induration.--Syphilitic rhinitisSyphilitic rhinitis..- - HepatosplenomegalyHepatosplenomegaly..Also it can be syphilitic chorioretinitis, generalized lymphoepitheliopathy, syphilitic osteochondritis, periostitis, Also it can be syphilitic chorioretinitis, generalized lymphoepitheliopathy, syphilitic osteochondritis, periostitis,

serous meningitis, anemia, thrombocytopenia, monocytosis, intrauterine growth retardation, gerontal child’s serous meningitis, anemia, thrombocytopenia, monocytosis, intrauterine growth retardation, gerontal child’s look.look.

Diagnostics:Diagnostics:--Microscopy in the dark field of view – agent discharge from vesicles, nose discharges, liquor.Microscopy in the dark field of view – agent discharge from vesicles, nose discharges, liquor.--Serological childSerological child’’s and mothers and mother’’s researchs research ( (RVRV, , RIFRIF, , RITRIT – – results areresults are significant significant after theafter the 10 10thth day of child day of child’’s lifes life));;--Hystological placenta research.Hystological placenta research.-Radiological -Radiological research of flat skull bones and long tubular bones of the upper limbs.research of flat skull bones and long tubular bones of the upper limbs.--Research of the eye bottom.Research of the eye bottom.--Examination by otalaryngologist, neurologist.Examination by otalaryngologist, neurologist.--NeurosonographyNeurosonography, , US- research of the organs of chest.US- research of the organs of chest.TreatmentTreatment: : penicillin bypenicillin by 200 000 200 000/kg/day in 6 doses during 28 days./kg/day in 6 doses during 28 days.Preventive measures: three times obligatory serologic research of blood of pregnant women, the last one – not late Preventive measures: three times obligatory serologic research of blood of pregnant women, the last one – not late

than 36 weeks of pregnancy.than 36 weeks of pregnancy.

Clinical and diagnostic criteria of toxoplasmosis Causative agentCausative agent: : Toxoplasma gondi – intracellular parasite, that is protozoan.Toxoplasma gondi – intracellular parasite, that is protozoan.Source: mother.Source: mother.The infection path: transplacentalThe infection path: transplacental. . For the congenital toxoplasmosis the following triad is typical:For the congenital toxoplasmosis the following triad is typical:--Hydro- and microcephalusHydro- and microcephalus;;--convulsionsconvulsions;;-chorioretinitis;-chorioretinitis;--calcification in the brain.calcification in the brain.Generalized form is characterized by intoxication, hepatosplenomegaly with jaundice, hemorrhagic syndrome, Generalized form is characterized by intoxication, hepatosplenomegaly with jaundice, hemorrhagic syndrome,

skin rash, liquor changes, pneumonia development, myocarditis, nephritis, hematologic violations.skin rash, liquor changes, pneumonia development, myocarditis, nephritis, hematologic violations.Diagnostics:Diagnostics:--secretion of the causative agent from liquor, blood, placenta, brain tissues.secretion of the causative agent from liquor, blood, placenta, brain tissues.--IEAIEA;;--Reaction with methylene blueReaction with methylene blue;;--Skin test with toxoplasminSkin test with toxoplasmin ( (reaction is positive if diameter is more than 10mm).reaction is positive if diameter is more than 10mm).--Histological placenta researchHistological placenta research;;--Roentgenography of skullRoentgenography of skull;;--Reurosonography.Reurosonography.--Consultation of oculist, neurologist.Consultation of oculist, neurologist.Treatment: sulfadimesin by 100mg/kg/day in 2 doses + chloridin (pyrimethamin by 2mg/kg/day in the first 2 Treatment: sulfadimesin by 100mg/kg/day in 2 doses + chloridin (pyrimethamin by 2mg/kg/day in the first 2

days, then by 1mg/kg/day during 6 month and 3 times a week during 12 monthdays, then by 1mg/kg/day during 6 month and 3 times a week during 12 month; ; spyramycin (rovamycin) by spyramycin (rovamycin) by 100 mg/kg/day in 2 doses during 1 month (4 courses per year)100 mg/kg/day in 2 doses during 1 month (4 courses per year); ; in case of expressed inflammatory process – in case of expressed inflammatory process – prednizolon by 2 mg/kg/day.prednizolon by 2 mg/kg/day.

Clinical and diagnostic criteria of chlamidia infection

Causative agentCausative agent: : Chlamidia trachomatis – obligate intracellular Chlamidia trachomatis – obligate intracellular parasite, it occupies a middle place between bacteria and viruses.parasite, it occupies a middle place between bacteria and viruses.

Source: mother.Source: mother.

The infection path: ante- and intranatal.The infection path: ante- and intranatal.

Clinical forms:Clinical forms:

--Generalized infection with injury of lungsGeneralized infection with injury of lungs, , heartheart, , liverliver;;

--MeningoencephalitisMeningoencephalitis;;

--Antenatal pneumoniaAntenatal pneumonia;;

--Syndrome of breathing violationsSyndrome of breathing violations; ;

--gastroenteropathygastroenteropathy;;

--conjunctivitisconjunctivitis..

Clinical and diagnostic criteria of chlamidia infection

Diagnostics:Diagnostics:

--anamnesisanamnesis;;

--clinical presentationclinical presentation;;

--laboratory and instrumental research methodslaboratory and instrumental research methods: :

total blood analysistotal blood analysis – – moderate anemiamoderate anemia, , eosinophiliaeosinophilia > 7%, > 7%, monocytosis monocytosis >10%;>10%;

microbiological examination of mother and childmicrobiological examination of mother and child;;

method of direct immunofluorescencemethod of direct immunofluorescence;;

immunoenzyme method immunoenzyme method ((ELISA)ELISA);;

PLR, DNA- hybridizationPLR, DNA- hybridization;;

Cultural methodCultural method;;

Placenta research.Placenta research.

TreatmentTreatment: : erythromycin byerythromycin by 40 40 mgmg//kgkg/ / day per os duringday per os during 21 21 daysdays. . Chlamidia Chlamidia persistence can save during the first year of child’s life at 60% of newborns.persistence can save during the first year of child’s life at 60% of newborns.

Sumamed at the first day by 10 mg/kg per os, than during 7 days by 5 mg/kg/day. It Sumamed at the first day by 10 mg/kg per os, than during 7 days by 5 mg/kg/day. It provides total agents elimination from the organism.provides total agents elimination from the organism.

Clacyd by 10 mg/kg/day in 2 doses during 14 days intramuscularly or intravenously.Clacyd by 10 mg/kg/day in 2 doses during 14 days intramuscularly or intravenously.

Preventive measures Providing of microbiological health of women and men of Providing of microbiological health of women and men of

reproductive agereproductive agePregnancy planningPregnancy planning, conscious , conscious attitude to a child’s birthattitude to a child’s birthUsage and introducing of the modern methods of early Usage and introducing of the modern methods of early

diagnostics of ANI of fetus and pregnant women of the risk diagnostics of ANI of fetus and pregnant women of the risk groupgroup

Introducing of modern perinatal techniques of helping mothers Introducing of modern perinatal techniques of helping mothers and newbornsand newborns

Microbiological monitoring in the ITAR departments for Microbiological monitoring in the ITAR departments for controlling circulation of hospital viralcontrolling circulation of hospital viral, , fungusfungus, , bacteria strainsbacteria strains

Limited manipulations holdingLimited manipulations holding, , that presuppose contact with that presuppose contact with medical staff and equipmentmedical staff and equipment

Breast feedingBreast feeding, rooming-in, rooming-in of mother with newborn of mother with newborn

Thank You for attention!