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4415 Acyclovir antiretroviral drugs and other virustatics

With acyclovir, with an M P ratio of 2-4, the fully breastfed infant takes in 1 of an oral maternal weight-related dosage (Meyer 1988). When 900 mg daily is administered intravenously, this is on average 5 (Bork 1995). Toxic symptoms have not been observed (Taddio 1994, Meyer 1988). The risk of influencing the infant's immune system as a result of exposure via the mother's milk appears, in the light of current experience, to be simply theoretical. Recommendation. Breastfeeding may continue when acyclovir or valaciclovir are administered externally or systemically. The other virustatics and antiretroviral substances, if really indicated, require an individual decision about continuing breastfeeding. In the case of drugs developed for HIV infection, an additional consideration is the risk of virus transmission via the mother's milk (see Chapter 4.15) here, guidelines only clearly recommend exclusive breastfeeding in those regions where lack of clean water for preparing infant formula...

Cytomegalovirus CMV infections

Cytomegalovirus (CMV) is a viral illness that's common among preschool-age children. The symptoms are very similar to the ones you get with the flu fatigue, malaise, and aches. In most cases, though, an infection produces no symptoms at all. By the time they're old enough to have children, more than half of women have already had a CMV infection at some time in their lives, as evidenced by antibodies present in their blood.

41510 Human cytomegalovirus

Human cytomegalovirus (HCMV) infection is the most frequent congenital infection, affecting 1-3 of newborns. Even more relevant is the postnatal infection, transmitted mainly via breast milk. Of seropositive mothers, 40-96 shed the virus with their milk, reaching a peak 1 month after delivery (survey in Meier 2005, Hamprecht 2001), A reactivated infection in the lactating breast probably explains the frequent detection of HCMV in milk, leading to an infection rate of 10-60 of the infants. Postnatal infection via the breast milk in term infants does not cause illness. Very premature infants, however, develop bronchopulmonary dysplasia and other problems. Approximately 10 of premature infants become severely ill. In up to 50 of the typical problems of premature newborns, such as respiratory distress syndrome, HCMV infection was causative. The virus is killed by pasteurization. Recommendations vary regarding from when (gestational week 28 or week 32, or below a birth weight of 1500g )...

2644 Aciclovir and other herpes antivirals

Aciclovir (acyclovir is an acyclic nucleoside analog, highly specific for HSV-infected cells. It inhibits viral ribonucleotide production in Herpes 1 and 2 and in varicella zoster infections. Valaciclovir is the prodrug of aciclovir, with the benefit of a greater bioavailability and a longer half-life (less frequent dosing). Aciclovir can cross the placenta, and fetal aciclovir levels arc comparable to maternal levels once a steady state is reached. It is concentrated in the amniotic fluid, approximately four-fold, but does not concentrate in the fetus (Frcnkel 1991). There is substantial experience with systemic use of aciclovir during pregnancy. The manufacturer initiated the Acyclovir Pregnancy Registry (June 1984-April 1999). In total, the outcomes of 1234 prospectively registered pregnancies were obtained 756 infants were exposed during the first trimester and 291 in the third trimester. There was no evidence of an increased risk of congenital defects or adverse fetal or neonatal...

4158 Herpes zoster shingles chickenpox

Varicella zoster virus (VZV) has not been cultured from the milk with either herpes zoster or chickenpox (Frederick 1986), but VZV-DNA has been identified in breast milk (Yoshida 1992). One case of suspected transfer of VZV to an infant via breastfeeding has been reported, but the virus may have been transmitted by droplet or exposure to the rash. Recommendation. When the mother develops chickenpox 2-4 days after the birth, the baby is given varicella immunoglobulin and perhaps prophylactic acyclovir. The milk can be expressed and fed to the baby. If the mother becomes ill after this point, prophylactic measures are not needed and the baby can be breastfed. If the baby becomes ill, varicella infections normally proceed without complications. With herpes zoster, the baby may continue to be breastfed, but direct contact with the affected part of the skin should be avoided. With the readily available vaccine to prevent chickenpox and the approval of the varicella vaccine for adults to...

Cytomegalovirus

Cytomegalovirus is caused by the herpes virus and is a common infection to acquire prenatally. Infection can occur at any time during pregnancy and may produce mild influenza-type symptoms. Over 50 of pregnant women are immune and of those who are not, only a small proportion will pass the infection to their baby. A blood test can confirm whether the infection is past or present. Cytomegalovirus can lead to serious problems and in very severe cases will lead to still birth. It is a known risk factor associated with miscarriage and is implicated in causing mental retardation in infants.

Herpes

Herpes is caused by the herpes simplex virus type 2 and is transmitted through sexual intercourse. (Type 1 virus can cause genital infection but is usually associated with lesions of the face, lips and eyes.) Herpes simplex infection of the newborn (neonate) is a serious disease, which may result from passage of the virus across the placenta or from direct contact with infectious lesions during delivery. The major risk to the fetus occurs after the first or primary infection. Recurrent disease is associated with a low risk to the fetus, even when genital lesions are present. If the lesions are active or there is an outbreak of the infection prior to delivery, the baby may have to be delivered by caesarean section. However, this may not be necessary for recurrent herpes if there are no lesions or positive swabs at delivery.

Herpes Simplex

Cause The two types of herpes simplex generally cause different types of infections. Herpes simplex virus-type 1 (HSV-1) most often causes cold sores around the mouth. Herpes simplex virus-type 2 (HSV-2) usually causes genital herpes, which occur mainly in sexually active adolescents or adults. When to Call Your Child's Doctor Call your child's doctor if your child has a blister or open sore around the mouth, fever, swollen glands, or eating difficulties because of mouth sores. A genital herpes infection in a child or infant suggests that the infection could have been transmitted by sexual abuse (see Chapter 32, Health Problems in Early Childhood, for information about child abuse). Pregnant women who have had genital herpes should tell their doctor before delivery. Treatment Your child's doctor may prescribe an antiviral drug such as acyclovir to help shorten the course of the outbreak. Prevention Herpes sores are contagious until they are completely crusted over. The saliva of...

Herpes infections

Herpes is a common virus that infects the mouth, the throat, the skin, and the genital tract. If you have a history of herpes, rest assured that the infection poses no risk to the developing fetus. The main concern is that you may have an active genital herpes lesion when you go into labor or when your water breaks. If you do, there is a small risk of transmitting the infection to the baby as she passes through the birth canal. If it's your first herpes infection, the chance of the fetus contracting the virus is greater because you have no antibodies to the virus. Studies show that women with a history of recurrent herpes may lower the chance of having an active herpes infection at delivery by taking a medication called acyclovir or valcyclovir in the last month of pregnancy. If you have active genital herpes lesions at the time of labor or ruptured membranes, let your practitioner know. She is likely to perform a cesarean delivery to avoid infecting the baby. If you see no lesions,...

4157 Herpes simplex

Perinatal herpes infections are transmitted during birth because of the presence of the virus in the birth canal. When lesions are present near the anticipated time of delivery, a cesarian section is performed immediately when labor starts or the membranes rupture, to avoid infection of the infant. With the exception of one case (Dunkle 1979), no herpes simplex virus has been detected in mother's milk. This is as would be expected, because the infection in adults is usually a local one that does not involve viremia. All infant deaths that have been reported have been subsequent to suckling at a breast with a herpetic lesion (Sullivan-Bolyai 1983).

Initial Exposure During 3rd Trimester number of cases

As for pregnancies reported retrospectively (i.e., in which the outcome was known before reporting), there were 616 outcomes (3 sets of twins) in which initial exposure occurred in 259 (1 set of twins) during the 1st, 76 during the 2nd, and 280 (2 sets of twins) during the 3rd trimester, and 1 during an unknown gestational time (9). These data exclude those pregnancies exposed to topical acyclovir only. There were 45 spontaneous losses (37 abortions 4 stillbirths after initial exposure during the 1st trimester, 2 abortions after initial exposure during the 2nd trimester, and 2 stillbirths after initial exposure in 3rd trimester) and 22 induced abortions (20 and 2 after initial exposure in the 1st and 2nd trimesters, respectively). Congenital defects were observed in 47 outcomes in which the initial exposure had occurred in 34, 8, and 5 during the 1st, 2nd, and 3rd trimesters, respectively. In a surveillance study of Michigan Medicaid recipients conducted between 1985 and 1992...

Breast Feeding Summary

Acyclovir is concentrated in human milk with levels usually exceeding those found in maternal serum (6.5,6.6,6.7,6.8 and 69). In an in vitro experiment, the transfer of acyclovir from the plasma to breast milk was determined to be due to passive diffusion (65). A woman, breast feeding a 4-month-old infant, was treated with acyclovir 200 mg orally every 3 hours (five times daily) for presumed oral herpes (66). She had taken 15 doses of the drug before the study dose. Approximately 9 hours after her 15th dose, she was given another 200-mg dose and paired maternal plasma and breast milk samples were drawn at 0, 0.5, 1.5, 2.0, and 3.0 hours. Breast feeding was discontinued during the study interval. Milk plasma ratios ranged from 0.6 to 4.1. Milk concentrations were greater than those in maternal serum at all times except at 1.5 hours, the time of peak plasma concentration (4.23 pmol L). (Note 1 pmol L 0.225 pg mL 10 ). The initial level in the milk was 3.3 pmol L, reflecting the doses...

271 Vaccination and pregnancy

When there is a high infection risk without protection from prior immunization, a vaccination should be pursued in the interest of both mother and child, even during pregnancy. Candidate vaccines should be immunogenic, safe, and cause minimal reactions. The potential effect on the incidence of communicable diseases in the newborn and young infant will increase as more candidate vaccines that could be administered during prcgnancy become available. In the future, infections such as herpes simplex virus infection, cytomegalovirus, and human immunodeficiency virus infection could be prevented with this intervention (Munoz 2001). Details of different compounds are discussed below.

Antenatal maternal infections

The baby is generally protected from infection by the sac surrounding it and by the placenta. However, certain micro-organisms can cross the placenta from the mother's blood. The most common of these are intrauterine infections rubella, cytomegalovirus, toxoplasmosis and syphilis. The acronym 'TORCH' has been devised to list some of them. O - other, e.g. listeriosis, Chlamydia, chicken pox, parvovirus R - rubella C - cytomegalovirus H - herpes

When Should Sex be Definitely Avoided

You should also avoid sex in pregnancy if you have abnormal vaginal discharge, or if either of you has an outbreak of herpes or any sexually transmitted infection. Avoid sex in the third trimester if your partner had genital herpes in the past, even if he is now well and has no sores. Avoid receiving oral sex if your partner has cold sores on his mouth.

Teen Std And Aids Cases Also Fell

A similar trend occurred for sexually transmitted disease, though STD trends have to be viewed with caution. The only STDs consistently tabulated over the last half century are gonorrhea and primary secondary syphilis.15 Cases of chlamydia, herpes, and human pappilloma virus (HPV) were not screened until recently we simply do not know their prevalence in past generations. Asymptomatic STD cases in females in particular were poorly

2172 Antiinfective agents

No risk during pregnancy has been identified for the virostatic acyclovir (see also extensive experience with sytemic use during pregnancy, Chapter 2.6) or for local treatment for condylomata acuminata (venereal warts) with podophyllotoxin, a plant-based mitosis inhibitor (Robert 1994, Bargman 1988, Kami 1980).

21717 Eye nose and ear drops

Glucocorticoids, cromoglicic acid, antihistamines, antibiotics, and acyclovir, as well as artificial tears'' such as, for instance, povidone, may be used for the appropriate indications. The antibiotic chloramphenicol should not be used (see Chapter 2.6). Nasal or inhalative application of budesonide (Kallen 2003) or nasal fluticason Ellegard 2001) has not been associated with developmental disorders in the newborn. There is no specific experience yet with loteprednol during pregnancy.

Perinatal Infection

The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or perinatal infection with herpes simplex virus, Toxoplasma gondii and varicella-zoster virus occurs in about 1 per 1,000 live births and the sequelae may be severe. In-utero acquired infection may result in resorption of the embryo, abortion, stillbirth, malformation, intrauterine growth retardation, prematurity, and the numerous untoward sequelae associated with chronic infection. Infection acquired at or soon after birth may lead to death or persistent postnatal infection. Some infections may be...

Explanation Of Condition

Herpes simplex virus (HSV) can manifest itself in a variety of different ways and can be due to primary infection, when the virus is first encountered, or reactivation of the latent virus. The clinical manifestations of a primary infection include Herpetic whitlow- seen as a lesion on the fingers Genital herpes - as vesicular eruption on the genital area Neonatal herpes - as generalised infection (see below) The virus then remains dormant in either the trigeminal or sacral ganglion, until reactivated, causing recurrent infection. This manifests itself in the form of cold sores (orolabial herpes), keratitis or recurrent genital herpes. Neonatal herpes is caused by transmission to neonate at or around delivery and is associated with a high morbidity and mortality3. Orolabial herpes is usually caused by HSV type 1. Genital herpes (GH) can be caused by HSV 1 or HSV 24. Symptoms of GH include blistering and painful ulceration of the external genitalia, which may involve the cervix and...

Nonpregnancy Treatment And Care

Primary herpetic gingivo-stomatitis is treated by soft diet, encouraging adequate fluid intake and analgesia, including the use of local analgesic mouthwashes. Chlorhexidine mouthwash will help to prevent secondary infection7. If the lesions are severe, an antiviral, such as aciclovir, may be used orally.7 Aciclovir cream can be used for cold sores (recurrent orolabial herpes infection) and should be commenced at the first sign of an attack, ideally before vesicles appear7.

Do Cysts Spontaneously Resolve In Male Infants

Foreskin Retraction Toddlers

Balanoposthitis causing erythema and swelling of the prepuce and glans secondary to inflammation. Balanitis is inflammation of the glans and posthitis is inflammation of the foreskin. This change is frequently due to Candida infection but can occur with Trichomonas or herpes simplex virus infection. Balanitis should not be confused with a meatal ulceration, which is usually seen in circumcised male infants. In infants with meatal ulceration there is superficial ulceration often resulting from ammoniacal dermatitis. These usually heal spontaneously, but meatal stenosis may result.

Fetal Risk Summary

Cidofovir (HPMPC) is used in the treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome. The antiviral agent is converted to the active metabolite, cidofovir diphosphate, by intracellular enzymes. In animals, cidofovir is carcinogenic, embryotoxic, and teratogenic. Pregnant mice inoculated intranasally with equine herpesvirus 1 (EHV-1) in the 2nd or 3rd week of gestation, were treated with a single dose of cidofovir 50 mg kg SC 1 day prior to inoculation (2). A noninfected control group of pregnant mice was also treated at a similar gestational time with the same dose of cidofovir. In the infected group, cidofovir significantly reduced the incidence of virus transfer to the fetus and subsequent abortion, a predictable effect of the virus. No obvious toxic effects were observed in either group.

Mononucleosis Infectious

Cause More than 90 percent of infectious mononucleosis cases are caused by Epstein-Barr virus (EBV), a herpes virus 5 to 10 percent are caused by other viruses such as cytomegalovirus, adenovirus, viral hepatitis, HIV, and possibly rubella virus, as well as Toxoplasma gondii, a protozoan. Studies have shown that most people are infected with EBV at some point in their lives and most develop no symptoms.

Protozoal And Parasitic Infections

Lateral radiograph from the same child as in Figure 2.142, showing diffuse intracranial calcifications. Intracranial calcifications, in general, are diffuse and scattered in infants with congenital toxoplasmosis. Skull radiographs of infected infants frequently reveal this diffuse punctate intracranial calcification. The distribution of the calcification in infants with congenital cytomegalovirus infection is periventricular.

Staphylococcus Aureus And Fertility

Staphylococcus Aureus Neck

Scalp abscesses developed at 12 hours of age. Note the distribution over the area of the caput. In such an infant the diagnoses of herpes simplex and Staphylococcus aureus infection should be considered. Cultures from the lesions and the blood in this infant were positive for Staphylococcus aureus. The mother developed fever 24 hours postpartum, and Staphylococcus aureus was cultured from the episiotomy. Figure 2.4. Scalp abscesses developed at 12 hours of age. Note the distribution over the area of the caput. In such an infant the diagnoses of herpes simplex and Staphylococcus aureus infection should be considered. Cultures from the lesions and the blood in this infant were positive for Staphylococcus aureus. The mother developed fever 24 hours postpartum, and Staphylococcus aureus was cultured from the episiotomy.

Transplacental infection

Chicken pox is caused by the herpes varicella zoster virus (HZV). Maternal primary infection in early pregnancy may lead to serious fetal anomalies (congenital varicella syndrome), including central nervous system damage and eye deformities, although these are rare. Neonatal morbidity is highest when the mother develops the rash in the week surrounding the birth, and it is associated with a mortality rate of approximately 30 (ACOG 1993). Babies born to infectious mothers should be referred to a paediatrician for possible treatment with acyclovir and or vaccination. Cytomegalovirus (CMV)

Infectious Conditions

Smego RA, Asperilla MO 1991 Use of acyclovir for varicella pneumonia during pregnancy. Obstetrics and Gynaecology, 78 1112-1116 7. Enders G, Miller E, Cradock-Watson J, Bolley I and Ridehalgh MK 1994 Consequences of varicella and Herpes zoster in pregnancy prospective study of 1739 cases. Lancet, 343 1548-1551 12.7 Herpes Simplex Virus 1. HPA 2004 Epidemiological data - genital herpes. Health Protection Agency www.hpa.org.uk accessed 22-04-2006 2. Tookey P and Peckham CS 1996 Neonatal Herpes simplex virus infection in the British Isles. Paediatric Perinatal Epidemiology, 10 432-442 3. Brown ZA, Selke S, Zeh J, Kopelman J, Maslow A, Ashley RL, et al. 1997 The acquisition of Herpes simplex virus during pregnancy. New England Journal of Medicine, 337 509-515 4. Clinical Effectiveness Group 2001 National guideline on the management of genital herpes. Clinical Effectiveness Group - 6. RCOG 2002 Guideline No. 30 Management of Genital Herpes in Pregnancy. Royal College of Obstetrics and...

1241 Macronutrients

HIV infection increases energy needs due to an increase in REE, as previously stated. This increased REE coupled with HIV-related infections and complications, such as anorexia, place HIV-infected pregnant women at greater nutritional risk than the uninfected woman 23, 24 . Current energy recommendations for HIV-infected pregnant and lactating women are an increase of 10 over baseline energy needs during the asymptomatic phase and an increase of 20-30 over baseline energy needs during the symptomatic phase 25 . Early symptomatic HIV infection is defined as the stage of viral infection caused by HIV when symptoms have begun, but before the development of AIDS. Symptoms may include but are not limited to mouth disorders (oral hairy leukoplakia, oral thrush, gingivitis), prolonged diarrhea, swollen lymph glands, prolonged fever, malaise, weight loss, bacterial pneumonia, joint pain, and recurrent herpes zoster. In addition, the World Health Organization (WHO) recommends an intake of an...

2224 Medicines

There are several publications on iron overdose during pregnancy (Tran 2000, 1998, McElhatton 1998, 1993, Lacoste 1992, Dugdalc 1964). In a case series, 85 pregnancies were evaluated 6 were exposed in the first trimester, 37 in the second, and 41 in the third. There were 73 live-born infants without congenital malformations. Five of these infants were delivered prematurely, one had genital herpes. and one had severe jaundice following exposure at week 36 37. Five infants, all exposed in the second and third Lrimesters, had malformations. Two fetal deaths, in weeks 22 and 29, were observed, one of them immediately after intoxication and another following abdominal trauma. Five pregnancies were terminated.

Infectious Disease

Congenitally acquired infection is discussed in detail elsewhere in this text and is examined only briefly in this chapter. The biological agents posing a threat to health care workers that have received the most attention are the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV). The most common occupational routes of exposure are through needlestick injury and splash injuries onto mucous membranes. Universal precautions should be followed when working with any patient. Other agents to which health care workers may be exposed include tuberculosis, hepatitis C, cytomegalovirus, parvovirus B19, and varicella.

Hepatitis Viral

Cause This inflammation of the liver is usually caused by infection with one of three hepatitis viruses hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Viral hepatitis can also occur with cytomegalovirus (CMV), Epstein-Barr virus (the virus that causes infectious mononucleosis), and other viral infections.

Hydrocephalus

Hydrocephalus may be caused by prenatal exposure to an infection such as rubella (German measles), herpes virus, cyto-megalovirus (CMV), or toxoplasmosis. Children born with spina bifida (see Spina Bifida in this chapter) and premature infants who have had hemorrhage (bleeding) in their brains often develop hydrocephalus.

Encephalitis

Arboviruses, transmitted by insects such as ticks and mosquitoes, can also cause encephalitis. West Nile encephalitis virus is an example. Measles, mumps, chicken pox, and mononucleosis can sometimes cause encephalitis, usually a mild case. Rabies can also cause encephalitis. Although rare, herpes simplex virus, the virus that causes cold sores, can cause a serious, life-threatening form of encephalitis. Tuberculosis, syphilis, and Lyme disease can also cause brain inflammation. How Long Symptoms Last For most types, the acute phase lasts several days to a week recovery takes two to three weeks. In severe cases, such as those caused by herpes simplex encephalitis, the child must be hospitalized, and recovery may take several weeks or longer. Treatment In some mild cases, children can be treated at home, but others need to be treated and observed closely in a hospital. In most cases children with viral encephalitis will be given nonaspirin medicines...