بنام خدا

1. بنام خدا Toxoplasmosis & Chicken pox In Pregnancy

2. Toxoplasmosis in pregnancy • Introduction • a ubiquitous protozoan parasite • serological evidence of past infection(15-45% in industrially developed and 80% in another countries) • in neural and muscle tissue • retinochoroiditisis the most frequent manifestation

3. Toxoplasmosis in pregnancy • Sources of infection • the oocyst, which is shed only in cat feces • the tachyzoite • the bradyzoite(within tissue cysts)

4. Toxoplasmosis in pregnancy

5. Toxoplasmosis in pregnancy • Maternal infection • Incidence: 1 to 8 per 1000 pregnancy • Clinical manifestations: Acute infection is usually asymptomatic Nonspecific (fatigue, fever, headache, malaise, and myalgia) Lymphadenopathy

6. Toxoplasmosis in pregnancy • MATERNAL INFECTION • Clinical differential: acute Epstein-Barr virus infection, cytomegalovirus infection, HIV infection, syphilis, sarcoidosis, Hodgkin's disease, and lymphoma

7. Toxoplasmosis in pregnancy • Diagnosis: a minimum of two blood samples at least two weeks apart showing seroconversion from negative to positive Toxoplasma-specific IgM or IgG • IgMantibodies…positive from 1-2 w to years • igG antibodies…positive from 6-8 w for 2-4 w • IgG avidity assay • Screening: Not recommended!

8. Toxoplasmosis in pregnancy • FETAL INFECTION • Risk factors: advancing gestational age at the time of maternal seroconversion mother”s immunity

9. Toxoplasmosis in pregnancy • Pathogenesis of fetal infection: via plasenta during the parasitemic phase the transition from acute infective tachyzoite form to the dormant bradyzoite form contained in tissue cysts…therapeutic "window of opportunity."

10. Toxoplasmosis in pregnancy • Fetal sequelae: • cerebral palsy, microcephaly, or bilateral blindness, or hydrocephalus or epilepsy • retinochoroiditis, or lymphadenopathy or hepatosplenomegaly

11. Toxoplasmosis in pregnancy • Fetal sequelae in sonograghy:  intracranial hyperechogenic foci or calcifications ventricular dilatation Intrahepatic densities, increased thickness and hyperdensity of the placenta, ascites, and, rarely, pericardial and pleural effusions

12. Toxoplasmosis in pregnancy • Prenatal diagnosis: purpose: decide whether to change prenatal treatment from spiramycine to a pyrimethamine-sulfonamide combination and terminate the pregnancy Amniocentesis PCR for T. gondii DNA in amniotic fluid In placenta after delivvery:granulomatousvillitis, cysts, plasma cell deciduitis, villous sclerosis, and chorionic vascular thromboses.

13. Toxoplasmosis in pregnancy • Prenatal treatment spiramycin alone, spiramycin followed by pyrimethamine-sulfonamides, and pyrimethamine-sulfonamides alone • three-week course of spiramycin (1 g orally three times per day) • Pyrimethamine (25 mg once per day orally) and sulfadiazine (4 g/day orally divided into two to four doses) administered continuously until term.

14. Toxoplasmosis in pregnancy Azithromycin animal model and in humans with acquired immunodeficiency syndromes (AIDS) • reduces serious neurological sequelae of congenital toxoplasmosis, but no evidence of any effect on ocular disease, vision, or mother-to-child transmission of infection

15. Toxoplasmosis in pregnancy • Termination of pregnancy the most infected babies have a good prognosis • PREVENTION: • avoid drinking unfiltered water • hand hygiene after touching soil • washing fruit and vegetables • avoid undercooked meat

16. Toxoplasmosis in pregnancy • Timing pregnancy after maternal infection: delay of six months has been suggested

17. Varicella-zoster virus infection in pregnancy • Introduction • one of eight herpesviruses • infection in adults can lead to significant morbidity and mortality • transmitted by: • nasopharyngeal mucosa by droplets onto the conjunctival or nasal/oral mucosa • direct contact with vesicular fluids • rarely, the airborne spread

18. Varicella-zoster virus infection in pregnancy • Maternal varicella • Incidence:1 to 5 cases per 10,000 pregnancies • the incidence of varicella is not higher in pregnant compared to nonpregnant adults, disease severity appears to be increased • Transmission can occur in utero, perinatally, or postnatally

19. Varicella-zoster virus infection in pregnancy • Maternal varicella •  Primary infection:regional lymph nodes and tonsils and possibly ductal tissue of salivary glands, VZV exanthem • Uncomplicated varicella:rash of varicella, lesions in different stages of development, fever, malaise, and myalgia oral acyclovir therapy (800 mg five times per day for seven days)

20. Varicella-zoster virus infection in pregnancy • Maternal varicella • Complicated infection:meningitis, encephalitis, cerebellar ataxia, pneumonia, glomerulonephritis, myocarditis, ocular disease, adrenal insufficiency, and death • Varicellapneumonia:specially in who smoking or have more than 100 vesicles   acyclovir (10 mg/kg every eight hours)

21. Varicella-zoster virus infection in pregnancy • Maternal varicella • DIAGNOSIS:clinical doubt:PCR testing of skin scrapings can also be cultured Serologic testing is usually not necessary for diagnosis

22. Varicella-zoster virus infection in pregnancy • Congenital varicella • the incidence of congenital abnormalities 0.4 percent before the 12th w;two percent between weeks 13 and 20; only 0.005 percent between weeks 21 to 28 of gestation

23. Varicella-zoster virus infection in pregnancy • Clinical features of congenital varicella syndrome: ●Cutaneous scars in a dermatomal pattern ●Neurological abnormalities (eg, mental retardation, microcephaly, hydrocephalus, seizures, Horner’s syndrome) ●Ocular abnormalities (eg, optic nerve atrophy, cataracts, chorioretinitis, microphthalmos, nystagmus) ●Limb abnormalities (hypoplasia, atrophy, paresis) ●Gastrointestinal abnormalities (gastroesophageal reflux, atretic or stenotic bowel) ●Low birth weight and intrauterine growth retardation

24. Varicella-zoster virus infection in pregnancy • Neonatal VZV infection:transmission from a mother to the fetus just prior to delivery mothers who have clinical disease within five days before to two days after delivery

25. Varicella-zoster virus infection in pregnancy • Congenital varicella • Prenatal diagnosis: PCR testing of fetal blood or AF for VZV ultrasonography for detection of fetal abnormalities • Postnatal diagnosis: ●History of maternal varicella infection during the first or second trimester of pregnancy ●Presence of compatible fetal abnormalities consistent with congenital varicella syndrome ●Evidence of intrauterine VZV infection

26. Varicella-zoster virus infection in pregnancy • POST-EXPOSURE PROPHYLAXIS :VZIG • is not needed among women who were immunized with varicella vaccine in the past • To decrease the risk of maternal infection and maternal morbidity • biologically plausible that might decrease viremia, leading to a lower risk of mother-to-child transmission

27. Varicella-zoster virus infection in pregnancy • no data on whether acyclovir is beneficial in reducing the risk of varicella after exposure during pregnancy • a single dose of intravenous immune globulin (IVIG) at 400 mg/kg • should be administered as soon as possible within 10 days of exposure

30. Toxoplasmosis & Chicken poxIn Pregnancy THANKS FOR YOUR ATTENTION