Remington and Klein’s Infectious Diseases of the Fetus and Newborn (8th Edition)

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Download Remington and Klein’s Infectious Diseases of the Fetus and Newborn (8th Edition) written by Christopher B. Wilson, Victor Nizet, Yvonne Maldonado, Jack S. Remington, Jerome O. Klein in PDF format. This book is under the category Medicine and bearing the isbn/isbn13 number 323241476/9780323241472. You may reffer the table below for additional details of the book.

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Specifications

book-author

Christopher B. Wilson, Victor Nizet, Yvonne Maldonado, Jack S. Remington, Jerome O. Klein

publisher

Saunders; 8th edition

file-type

PDF

pages

1227 pages

language

English

asin

B00ROSWM4S

isbn10

323241476

isbn13

9780323241472


Book Description

Regarded as the definitive source of information in the field; Infectious Diseases of the Fetus and Newborn Infant; 8th Edition; (PDF) remains your invaluable source for authoritative; state-of-the-art answers. Edited by Drs. Wilson; Nizet; Maldonado; Remington; and Klein; this fully updated reference assists you apply the latest evidence-based recommendations in the prevention; diagnosis; and management of infections found in utero; during delivery; and in the neonatal period in both premature and term infants.

  • Consult this title on your favorite e-reader.
  • Overcome clinical challenges in developing countries where access to proper medical care is limited.
  • Form a definitive diagnosis and build the best treatment plans possible using evidence-based recommendations and expert guidance from world authorities.
  • Examine what’s changing in key areas such as:- arising problems and concepts in maternal; fetal; and neonatal infectious diseases – anticipation and recognition of infections occurring in utero; during delivery; and in the neonatal period.
  • Keep up with the most related topics in fetal/neonatal infectious disease including new antimicrobial agents; gram-negative infections and their management; and recommendations for immunization of the fetus/mother.
  • Locate main content easily and identify clinical conditions quickly thanks to a consistent; highly user-friendly format now featuring a full-color design with hundreds of illustrations; and fresh perspectives from 6 new authoritative chapters lead authors.
  • Stay on the cutting edge of your field with new and improved chapters including: obstetric factors associated with infections of the fetus and newborn infant; human milk; borella infections;  bordetella pertussis and other bordetella sp infections; tuberculosis; herpes simplex; toxoplasmosis; pneumocystis and other less common fungal infections; and healthcare-associated infections in the nursery.

Reviews

A superbly updated classic recommended to all who offer care to the fetus and newborn.” ― JAMA

An important and outstanding reference…very easy to pick up and read.” ― Clinical Infectious Diseases

Its editors and authors are the clinicians and scientists whose work has advanced knowledge of maternal; fetal; and neonatal infections. For 30 years; this textbook has been the only best source of information in this area.” ― NEJM

This has been a standard reference for 35 years and the editors have completed their objectives of providing a single source book in this area of medicine… This ebook is still without peer and many chapters represent the most comprehensive reference on the subject.” ― Jay P. Goldsmith; MD; Doody’s Review

NOTE: The product includes the ebook; Remington and Klein’s Infectious Diseases of the Fetus and Newborn; 8th Edition in PDF. No access codes are included.

Additional information

book-author

Christopher B. Wilson, Victor Nizet, Yvonne Maldonado, Jack S. Remington, Jerome O. Klein

publisher

Saunders; 8th edition

file-type

PDF

pages

1227 pages

language

English

asin

B00ROSWM4S

isbn10

323241476

isbn13

9780323241472

Table of contents


Table of contents :
cover.pdf (p.1)
a Front Matter.pdf (p.2)
Remington and Klein’s Infectious Diseasesof the Fetus and Newborn Infant
b Copyright.pdf (p.3)
Copyright
c Dedication.pdf (p.4)
Dedication
d Contributors.pdf (p.5-9)
Contributors
e Preface.pdf (p.10-11)
Preface
1. Current Concepts of Infections of the Fetus and Newborn Infant.pdf (p.12-32)
1 – Current Concepts of Infections of the Fetus and Newborn Infant
Overview
Infections of the Fetus
Pathogenesis
Microbial Invasion of the Maternal Bloodstream
.After reaching the intervillous spaces on the maternal side of the placenta, organisms can remain localized in the placenta wit…
.Microorganisms may traverse the chorionic villi directly through pinocytosis, placental leaks, or diapedesis of infected matern…
.Invasion of the bloodstream by microorganisms is common in pregnant women, yet in most cases, neither fetal nor placental infec…
.Microorganisms disseminate from the infected placenta to the fetal bloodstream through infected emboli of necrotic chorionic ti…
Infection of the Embryo and Fetus
.Various organisms may infect the pregnant woman in the first few weeks of gestation and cause death and resorption of the embry…
.The earliest recognizable effects of fetal infection are seen after 6 to 8 weeks of pregnancy and include abortion and stillbir…
.Prematurity is defined as the birth of a viable infant before week 37 of gestation. Premature birth may result from almost any …
.Infection of the fetus may result in birth of an infant who is small for gestational age. Although many maternal infections are…
.CMV, rubella virus, and VZV cause developmental anomalies in the human fetus. Coxsackieviruses B3 and B4 have been associated w…
.Clinical evidence of intrauterine infections, resulting from tissue damage or secondary physiologic changes caused by the invad…
.Most newborn infants infected in utero by rubella virus, T. gondii, CMV, HIV, or Treponema pallidum have no signs of congenital…
.Microbial agents may continue to survive and replicate in tissues for months or years after in utero infection. Rubella virus a…
Efficiency of Transmission of Microorganisms from Mother to Fetus
Diagnosis of Infection in the Pregnant Woman
Clinical Diagnosis
.In many instances, infection in the pregnant woman and congenital infection in the newborn infant can be suspected on the basis…
.Many infectious diseases with serious consequences for the fetus are difficult or impossible to diagnose in the mother solely o…
.Some microorganisms can infect a susceptible person more than once, and when such reinfections occur in a pregnant woman, the o…
.The occurrence of acute infection immediately before conception may result in infection of the fetus, and the association may g…
Isolation and Identification of Infectious Agents
.Diagnostic tests for microorganisms or infectious diseases are part of routine obstetric care; special care is warranted for se…
.Isolation of CMV and rubella virus97 and demonstration of HBsAg98 from amniotic fluid obtained by amniocentesis have been repor…
.Histologic review of cytologic preparations and tissue sections is no longer used as the primary method of diagnosing maternal …
.The serologic diagnosis of infection in the pregnant woman most often requires demonstration of elevated antibody titer against…
.Routine skin tests for diagnosis of tuberculosis should be considered a part of prenatal care. Tuberculin skin tests can be adm…
Universal Screening
Diagnosis of Infection in the Newborn Infant
Prevention and Management of Infection in the Pregnant Woman
Prevention of Infection
Infections Acquired by the Newborn Infant During Birth
Pathogenesis
Microbiology
Diagnosis
Management
Prevention
Immunoprophylaxis
Chemoprophylaxis
Infections of the Newborn Infant in the First Month of Life
Pathogenesis and Microbiology
Congenital Infections
Infections Acquired During Delivery
Nursery-Acquired Infections
Community-Acquired Infections
Infections That Indicate Underlying Abnormalities
References
2. Neonatal Infections A Global Perspective.pdf (p.33-62)
2 – Neonatal Infections: A Global Perspective
Global Burden of Neonatal Infections
Infection as A Cause of Neonatal Death
Incidence of Neonatal Sepsis, Bacteremia, and Meningitis and Associated Mortality
Bacterial Pathogens Associated with Infections in Different Geographic Regions
Incidence of Group B Streptococcal Colonization and Infection
Antimicrobial Resistance in Neonatal Pathogens
Nosocomial Infections
Hospital Infection Control
Selected Neonatal Infections
Acute Respiratory Infections/Pneumonia
Diarrhea
Omphalitis
Tetanus
Ophthalmia Neonatorum
Human Immunodeficiency Virus (HIV) Infection
Transmission: Reducing the Disparity Between Low- and High-Income Countries
Breastfeeding and Human Immunodeficiency Virus
Prevention of Human Immunodeficiency Virus Infection in Low- and Middle-Income Countries
Prevention of Transmission From an Infected Mother to Her Infant
.The era of antiretroviral therapy (ART) to reduce vertical transmission of HIV started in 1994 with publication of the Pediatri…
.Meta-analyses of North American and European studies performed in the late 1990s found that elective cesarean section reduced t…
Integrated Health Care Programs
Human Immunodeficiency Virus and Child Survival
Tuberculosis
Malaria
Malaria in Pregnancy
Perinatal Outcome
Congenital Malaria
Prevention and Treatment of Malaria in Pregnancy
Prophylaxis and Treatment Using Antimalarial Drugs
Prevention Using Insecticide-Treated Nets
Malaria Control Strategies and Challenges
Indirect Causes of Neonatal Death Related to Infection
Strategies to Prevent and Treat Infection in the Neonate
Maternal Immunization to Prevent Neonatal Disease
Neonatal Immunization
Antenatal Care and Prevention of Neonatal Infection
Intrapartum and Delivery Care and Prevention of Neonatal Infection
Postnatal Care and Prevention of Neonatal Infection
Breastfeeding
Management of Neonatal Infection
Identification of Neonates with Infection
Antibiotic Treatment of Neonates with Infection
Integrated Management of Neonatal Illness
Maternal Education and Socioeconomic Status
Conclusion
Acknowledgment
References
3. Obstetric Factors Associated with Infections of the Fetus and Newborn Infant.pdf (p.63-89)
3 – Obstetric Factors Associated with Infections of the Fetus and Newborn Infant
Overview
Infection as a Cause of Preterm Birth
Pathogenesis
Histologic Chorioamnionitis
Animal Models
Microbiology
Diagnosis of Intraamniotic Infection
Amniotic Fluid Testing
Proteomics
Treatment of Intraamniotic Infection
Antenatal Antibiotics to Prevent Intraamniotic Infection
Prevention of Postpartum Endometritis After Intraamniotic Infection Diagnosis
Antibiotic Choice
Timing of Antibiotic Therapy
Delivery as Therapy
Neonatal Outcomes
Fetal Lung Injury
Fetal Brain Injury
Magnesium Sulfate for Neuroprotection
Premature Rupture of Membranes
Natural History of Premature Rupture of the Membranes and Preterm Premature Rupture of the Membranes
Biomechanical Strength of the Chorioamnion
Pathogenesis
Infection and Inflammation, Matrix Metalloproteinase Activation, and Oxidative Stress
Abruption (Placental Bleeding) and Thrombin
Genetic Predisposition
Diagnosis
Management of Premature Rupture of the Membranes and Preterm Premature Rupture of the Membranes
Preterm Premature Rupture of the Membranes Before Fetal Viability
Preterm Premature Rupture of the Membranes Between 24 and 34 Weeks
Antenatal Corticosteroids and Tocolytics
Determination of Fetal Lung Maturity
Antenatal Surveillance
Preterm Premature Rupture of the Membranes Between 34 to 37 Weeks
Premature Rupture of the Membranes After 37 Weeks
Maternal and Neonatal Outcomes
Maternal Outcomes
Neonatal Outcomes
Conclusion
References
4. Developmental Immunology and Role of Host Defenses in Fetal and Neonatal Susceptibility to Infec.pdf (p.90-197)
4 – Developmental Immunology and Role of Host Defenses in Fetal and Neonatal Susceptibility to Infection
Epithelial Barriers
Antimicrobial Peptides and Proteins
Skin
The Gastrointestinal Tract
The Respiratory Tract
Summary
Complement and Other Humoral Mediators of Innate Immunity
Collectins, Pentraxins, and Ficolins
Complement
Classical and Mannose-Binding Lectin Pathways
Alternative Pathway
Terminal Components, Membrane Attack Complex, and Biologic Consequences of Complement Activation
Complement in the Fetus and Neonate
Summary
Phagocytes
Hematopoiesis
Phagocyte Production by the Bone Marrow
Innate Immune Pattern Recognition Receptors Used by Leukocytes
Toll-like Receptors
Nucleotide-Binding Domain– and Leucine-Rich Repeat–Containing Receptors (NLRs)
Retinoic Acid–Inducible Gene-I–Like Receptors
C-Type Lectin Receptors
Cytoplasmic DNA Receptors
Decoding the Nature of the Threat Through Combinatorial Receptor Engagement
Neutrophils
Production
Migration to Sites of Infection or Injury
Migration of Neonatal Neutrophils
Phagocytosis
Killing
Activation by Innate Immune Receptors
Neutrophil Clearance and Resolution of Neutrophilic Inflammation
Effects of Immunomodulators
Eosinophils
Mononuclear Phagocytes
Production and Differentiation of Monocytes and Resident Tissue Macrophages
Migration to Sites of Infection and Delayed Hypersensitivity Responses
Antimicrobial Properties of Monocytes and Macrophages
.Monocytes from human neonates and adults ingest and kill S. aureus, E. coli, and GBS with similar efficiency.207-211 Consistent…
Mononuclear Phagocytes Produce Cytokines and Other Mediators That Regulate Inflammation and Immunity
Cytokine Production, Toll-like Receptors, and Regulation of Innate Immunity and Inflammation by Neonatal Monocytes and Macrophag…
.Levy and colleagues240,261 identified adenosine as a factor in cord blood plasma that inhibited TNF-α production but preserved …
Resolution of Mononuclear Phagocytic Inflammation
SUMMARY
Dendritic Cells: the Link between Innate and Adaptive Immunity
OVERVIEW
Conventional Dendritic Cells
Neonatal Conventional Dendritic Cells
Plasmacytoid Dendritic Cells
Neonatal Plasmacytoid Dendritic Cells
Langerhans Cells
Inflammatory and Monocyte-Derived Dendritic Cells
Summary
Natural Killer Cells and Innate Lymphoid Cells
Natural Killer Cells
Overview and Development
Natural Killer Cell Receptors
Natural Killer Cell Cytotoxicity
Natural Killer Cell Cytokine Responsiveness and Dependence
Natural Killer Cell Cytokine and Chemokine Production
Natural Killer Cells of the Maternal Decidua and Human Leukocyte Antigen G
Natural Killer–Cell Numbers and Surface Phenotype in the Fetus and Neonate
Fetal and Neonatal Natural Killer Cell–Mediated Cytotoxicity and Cytokine Production
Innate Lymphoid Cells
Summary
T Cells and Antigen Presentation
Overview
Antigen Presentation by Classic Major Histocompatibility Complex Molecules
Major Histocompatibility Complex Class Ia
Major Histocompatibility Complex Class II
Major Histocompatibility Complex Molecule Expression and Antigen Presentation in the Fetus and Neonate
Nonclassic Antigen-Presentation Molecules
Human Leukocyte Antigen E
Human Leukocyte Antigen G
Major Histocompatibility Class I–Related Chains A and B
CD1
Prothymocytes and Early Thymocyte Differentiation
Thymic Ontogeny
Intrathymic Generation of T-Cell Receptor Diversity
Overview
Fetal and Neonatal T-Cell Receptor Repertoire
T-Cell Receptor Excision Circles
Thymocyte Selection and Late Maturation
Positive and Negative Selection
Thymocyte Growth and Differentiation Factors
Thymocyte Postselection Maturation
NaÏve T Cells
CD4 and CD8 Recent Thymic Emigrants
Naïve T-Cell Entry into Lymphoid Tissue, Recirculation, and Survival
Ontogeny of NaÏve T-Cell Surface Phenotype
CD31
CD38
CD45 Isoforms
Homeostatic Proliferation
Spontaneous Naïve Peripheral T-Cell Proliferation
Antigen-Independent Naïve T-Cell Proliferation in Response to IL-7 and IL-15
NaÏve T-Cell Activation, Anergy, and Co-stimulation
Neonatal T-Cell Activation, Co-Stimulation, and Anergy
Differentiation of Activated NaÏve T Cells into Effector and Memory Cells
Effector CD4 T-Cell Subsets Are Defined by Their Patterns of Cytokine Production
Regulation of CD4 Effector T-Cell Subset Differentiation
CD4 T-Cell Help for Antibody Production
Overview of Memory T Cells
Memory T-Cell Activation
Postnatal Ontogeny of Memory CD4 T-Cell Subsets
Production of Cytokines, Chemokines, and Tumor Necrosis Factor–Ligand Proteins by Neonatal T Cells
CD4 T-Cell Cytokine Production
CD8 T-Cell Cytokine and Chemokine Production
Postnatal Ontogeny of Cytokine Production
CD40 Ligand
Other Tumor Necrosis Factor Family Ligands
Mechanisms for Decreased Cytokine, Chemokine, and TNF Ligand Production by Neonatal T Cells
Cytokine Production by Neonatal T Cells after Short-Term In Vitro Differentiation
Cytokine Production After Long-Term In Vitro Generation of Effector CD4 T Cells
T Cell–Mediated Cytotoxicity
Effector T-Cell Migration
Termination of the T-Cell Effector Response
Regulation of T-Cell Expansion by Apoptosis
Unique Phenotype and Function of the Fetal T-Cell Compartment
Fetal Extrathymic T-Cell Differentiation
Regulatory T Cells
Overview
Fetal and Neonatal Tregs
Natural Killer and Mucosal-Associated Invariant T Cells
Overview of Natural Killer T Cells
NKT Cells of the Fetus and Neonate
Mucosal-Associated Invariant T Cells
Gamma-Delta T Cells
Phenotype and Function
Ontogeny of Gamma-Delta T-Cell Production and T-Cell Receptor Gene Rearrangements
Ontogeny of Gamma-Delta T-Cell Function
Antigen-Specific T-Cell Function in the Fetus and Neonate
Delayed Cutaneous Hypersensitivity, Graft Rejection, and Graft-versus-Host Disease
T-Cell Reactivity to Environmental Antigens
Fetal T-Cell Sensitization to Maternally Administered Vaccines and Maternally Derived Antigens
Maternal Transfer of T-Cell Immunity to the Fetus
T-Cell Response to Congenital Infection
CD4 T Cells
CD8 T Cells
Gamma-Delta T Cells
T-Cell Response to Postnatal Infections and Vaccination in Early Infancy
CD4 T-Cell Responses to Postnatal Infection
CD4 T-Cell Responses to Postnatal Immunization with Inactivated Vaccines
CD4 T-Cell Responses to Postnatal Immunization with Live-Attenuated Vaccines
CD8 T Cells
Summary
B Cells and Immunoglobulin
Overview
Early B-Cell Development and Immunoglobulin Repertoire Formation
Pro–B-Cell and Pre–B-Cell Maturation
V(D)J Recombination of the Immunoglobulin Gene Loci
V(D)J Segment Usage in the Fetus and Neonate
CDR3 Length and Terminal Deoxytransferase
B-Cell Maturation, PreImmune Selection, and Activation
Receptor Editing, Clonal Deletion, and Clonal Anergy
New Emigrant (Transitional) versus Fully-Mature Naïve B Cells
Follicular B-Cell Maturation
Fetal and Neonatal B-Cell Frequency and Surface Phenotype
B-Cell Activation and Immune Selection
Negative Regulation of B-Cell Signaling
CD4 T-Cell Help for Naïve B-Cell Activation
B-Cell Selection in Germinal Centers of the Follicle
Somatic Hypermutation
Memory B Cells
B Cells as Antigen-Presenting Cells
Switching of Immunoglobulin Isotype and Class and Antibody Production
Isotype Switching
Generation of Plasma Cells and the Molecular Basis for Immunoglobulin Secretion
Isotype Switching and Immunoglobulin Production by Fetal and Neonatal B Cells
The Marginal Zone and Marginal Zone B Cells
Marginal Zone B Cells of the Fetus and Neonate
B-1 Cells and Natural Immunoglobulin M
Regulatory B Cells
T-CELL–Dependent and T-CELL–Independent Responses by B Cells
Overview
Response to T-Cell Dependent Antigens
Response to T-Cell–Independent Antigens
Specific Antibody Response by the Fetus to Maternal Immunization and Congenital Infection
Response to Fetal Immunization in Animal Models
Response to Maternal Immunization
Response to Intrauterine Infection
PostNatal Specific Antibody Responses
Specific Antibody Responses by the Neonate and Young Infant to Protein Antigens
Specific Antibody Responses by the Term Neonate to Polysaccharide and Polysaccharide-Protein Conjugates
Antibody Responses by the Premature Infant to Immunization
Maternally Derived Immunoglobulin G Antibody
Placental Transfer of Specific Antibodies
.Maternal antibody also may inhibit the production by the fetus or newborn of antibodies of the same specificity. This inhibition…
Immunoglobulin Synthesis by the Fetus and Neonate
Immunoglobulin G
Immunoglobulin M
Immunoglobulin A
Immunoglobulin D
Immunoglobulin E
Summary
Immunologic Approaches to Prevent or Treat Fetal and Neonatal Infections
Overview
U.S. Food and Drug Administration–approved Uses of Passive Immunization in the Mother and Newborn Infant
Exploratory Evaluation of Passive Immunization for Other Indications
Prevention or Treatment of Neonatal Sepsis with Intravenous Immunoglobulin
Cytomegalovirus Hyperimmune Intravenous Immunoglobulin
Neutrophil Transfusions
Colony-Stimulating Factors
References
5. Human Milk.pdf (p.198-222)
5 – Human Milk
Developmental Anatomy of the Mammary Gland
Anatomy and Development
Postnatal Development
Physiology of Lactation
Endocrine Control of Mammary Gland Function
Initiation and Maintenance of Lactation
Milk Secretion
Lactation Performance
Components of Human Milk and Their Potential Benefits for the Breastfed Infant
Proteins, Peptides, and Nonprotein Nitrogen
Nutritional Proteins
Bioactive Proteins and Peptides
.A number of nutrients are supplied to the neonate bound to proteins found in human milk. This binding may play an important rol…
.The activity of several dozen enzymes has been detected in human milk.44 Most of these enzymes appear to originate from the blo…
.Human milk contains several growth factors with potential effects on the intestine, vasculature, nervous system, and endocrine …
.As observed in other peripheral mucosal sites, the major class of immunoglobulin in human colostrum and milk is the 11S secreto…
.In the 1990s, several cytokines, chemokines, and growth factors that mediate the effector phases of natural and specific immunit…
Protein-Derived Peptides
Nonprotein Nitrogen
Lipids
Carbohydrates
Lactose
Oligosaccharides
Vitamins
Vitamin D
Vitamin E
Vitamin K
Vitamin B
Minerals
Cells
Leukocytes
Epithelial Cells
Stem Cells
Bacteria
Benefits and Risks of Human Milk
Benefits
Gastrointestinal Homeostasis
Prevention of Diarrhea
Necrotizing Enterocolitis
Neonatal Sepsis
Prevention of Atopy and Allergy
Special Considerations for the Premature Neonate
Other Benefits
Noninfectious Risks
Infectious Risks
Bacterial Infections
Viral Infections
.Cytomegalovirus infection is a common perinatal infection. The virus is shed in the milk in about 25% of infected mothers. Alth…
.Hepatitis B surface antigen (HBsAg) has been detected in milk of HBV-infected mothers. Nevertheless, breastfeeding does not inc…
.The RNA of HCV and antibody to HCV have been detected in the milk from infected mothers. Transmission by means of breastfeeding…
.Herpes simplex virus transmission directly from maternal breast lesions to their infants has been demonstrated. Women with lesi…
.A number of studies have demonstrated HIV in milk.317-321 The findings include isolation of HIV from milk supernatants collected…
.Human T-lymphotropic virus type 1 is endemic in Japan, the Caribbean, and parts of South America. This infection can be transmi…
.Rubella virus has been recovered from milk after natural as well as vaccine-associated infection. It has not been associated wi…
.The RNA of West Nile virus has been detected in human milk, and seroconversion in breastfeeding infants also has been observed….
Current Trends in Breastfeeding
Summary and Conclusions
References
6. Bacterial Sepsis and Meningitis.pdf (p.223-277)
6 – Bacterial Sepsis and Meningitis
Bacteriology
Group B Streptococci
Group A Streptococci
Streptococcus Pneumoniae
Other Streptococci
Enterococcus Species
Staphylococcus Aureus and Coagulase-Negative Staphylococci
Listeria Monocytogenes
Escherichia Coli
Klebsiella Species
Enterobacter and Cronobacter Species
Citrobacter Species
Serratia Marcescens
Pseudomonas Aeruginosa
Salmonella Species
Neisseria Meningitidis
Haemophilus Influenzae
Anaerobic Bacteria
Neonatal Tetanus
Mixed Infections
Uncommon Bacterial Pathogens
Epidemiology
Incidence of Sepsis and Meningitis
Characteristics of Infants who Develop Sepsis
Birth Weight
Risk Factors of Infant and Mother
Ethnicity
Gender
Geographic Factors
Socioeconomic Factors
Procedures
Nursery Outbreaks or Epidemics
Pathogenesis
Host Factors Predisposing to Neonatal Bacterial Sepsis
Infection in Twins
The Umbilical Cord as a focus of Infection
Administration of Drugs to the Mother Before Delivery
Administration of Drugs other than Antibiotics to the Neonate
Pathology
Clinical Manifestations
Fever and Hypothermia
Respiratory Distress
Jaundice
Organomegaly
Gastrointestinal Signs
Skin Lesions
Neurologic Signs
Diagnosis
Maternal History
Microbiologic Techniques
Culture of Blood
.Technology has evolved from manually read, broth-based methods to continuously monitored, automated blood-culture systems that …
.Bacterial growth is evident in most cultures of blood from neonates within 48 hours.495-497 With use of conventional culture te…
.The optimal number of cultures to obtain for the diagnosis of bacteremia in the newborn remains uncertain. A single blood cultu…
.The optimal volume of blood needed to detect bacteremia in neonates has not been determined. Neal and colleagues500 evaluated t…
Buffy-Coat Examination
Culture of Urine
Cultures of Tracheal Aspirates and Pharynx
Diagnostic Needle Aspiration and Tissue Biopsy
Autopsy Microbiology
Rapid Techniques for Detection of Bacterial Antigens in Body Fluid Specimens
Lumbar Puncture and Examination of Cerebrospinal Fluid
.Lumbar puncture is more difficult to perform in the neonate than in the older child or adult; traumatic LPs resulting in blood i…
.Is it sufficient to culture only blood and urine for the diagnosis of neonatal bacterial meningitis Visser and Hall561 demonstra…
.The cell content and chemistry of the CSF of healthy newborn infants differ from those of older infants, children, and adults (…
.A traumatic LP can result in blood in the CSF and can complicate the interpretation of the results for CSF white blood cell cou…
.Brain abscess is a rare entity in the neonate, usually complicating meningitis caused by certain gram-negative bacilli. The CSF…
Laboratory Aids
Management
Choice of Antimicrobial Agents
Initial Therapy for Presumed Sepsis
Role of Third-Generation Cephalosporins and Carbapenems
Current Practice
Continuation of Therapy when Results of Cultures are Available
Management of the Infant whose Mother Received Intrapartum Antimicrobial Agents
Treatment of the Infant whose Bacterial Culture Results are Negative
Management of the Infant with Catheter-Associated Infection
Treatment of Neonatal Meningitis
Management of the Infant with a Brain Abscess
Treatment of the Infant with Meningitis whose Bacterial Culture Results are Negative
Treatment of Anaerobic Infections
Adjunctive Therapies for Treatment of Neonatal Sepsis
Prognosis
Prevention
Obstetric Factors
Chemoprophylaxis
Maternal Factors
Immunoprophylaxis
Decontamination of Fomites
Epidemiologic Surveillance
Endemic Infection
Epidemic Infection
Sepsis in the Newborn Recently Discharged From the Hospital
Congenital Infection
Late-Onset Disease
Infections in the Household
Fever in the First Month of Life
Acknowledgment
References
7. Bacterial Infections of the Respiratory Tract.pdf (p.278-296)
7 – Bacterial Infections of the Respiratory Tract
Infections of the Oral Cavity and Nasopharynx
Pharyngitis, Retropharyngeal Cellulitis, and Retropharyngeal Abscess
Noma
Epiglottitis
Laryngitis
Infection of the Paranasal Sinuses
Diphtheria
Pertussis
Otitis Media
Pathogenesis and Pathology
Epidemiology
Microbiology
Diagnosis
Treatment
Prognosis
Mastoiditis
Pneumonia
Pathogenesis and Pathology
Congenital or Intrauterine Pneumonia
Pneumonia Acquired During the Birth Process and in the First Month of Life
Microbiology
Epidemiology
Incidence
Race and Socioeconomic Status
Epidemic Disease
Developing Countries
Clinical Manifestations
Diagnosis
Clinical Diagnosis
Radiologic Diagnosis
Microbiologic Diagnosis
Histologic and Cytologic Diagnosis
Immunologic Diagnosis
Differential Diagnosis
Management
Prognosis
References
8. Bacterial Infections of the Bones and Joints.pdf (p.297-312)
8 – Bacterial Infections of the Bones and Joints
Osteomyelitis
Microbiology
Pathogenesis
Clinical Manifestations
Prognosis
Diagnosis
Differential Diagnosis
Therapy
Primary Septic Arthritis
Osteomyelitis of the Maxilla
References
9. Bacterial Infections of the Urinary Tract.pdf (p.313-324)
9 – Bacterial Infections of the Urinary Tract
Epidemiology
Microbiology
Pathogenesis
Anatomic and Physiologic Abnormalities
Bacterial Virulence
Pathology
Clinical Manifestations
Diagnosis
Culture of Urine
Culture of Blood and Cerebrospinal Fluid
Examination of Urine Sediment
Examination of Blood
Chemical Determinations
Imaging of the Urinary Tract
Management and Prevention
Prognosis
References
10. Focal Bacterial Infections.pdf (p.325-355)
10 – Focal Bacterial Infections
Infections of the Liver
Microbiology
Pathogenesis
Clinical Manifestations
Diagnosis
Prognosis
Treatment
Splenic Abscess
Infections of the Biliary Tract
Infections of the Adrenal Glands
Appendicitis
Microbiology
Pathogenesis
Clinical Manifestations
Diagnosis
Prognosis
Treatment
Peritonitis
Microbiology
Pathogenesis
Clinical Manifestations
Diagnosis
Prognosis
Treatment
Necrotizing Enterocolitis
Pathology and Pathogenesis
Microbiology
Clinical Manifestations
Diagnosis
Treatment
Prevention
Prognosis
Endocarditis
Pericarditis
Mediastinitis
Esophagitis
Infections of Endocrine Organs
Infections of the Salivary Glands
Infections of the Skin and Subcutaneous Tissue
Pathogenesis
Microbiology
Epidemiology
Clinical Manifestations
Diagnosis
Differential Diagnosis
Treatment
Prevention
Conjunctivitis and Other Eye Infections
References
11. Microorganisms Responsible for Neonatal Diarrhea.pdf (p.356-416)
11 – Microorganisms Responsible for Neonatal Diarrhea
Enteric Host Defense Mechanisms
Protective Factors in Human Milk
Bacterial Pathogens
Enterotoxigenic Escherichia coli
.Although early work on the recognition of E. coli as a potential enteric pathogen focused on biochemical or serologic distincti…
.The two types of enterotoxins produced by enterotoxigenic E. coli146-148 have been found to be plasmid-encoded but genetically …
.ETEC are important diarrheal pathogens among infants in developing countries, predominantly affecting children younger than 2 y…
.The clinical manifestations of ETEC diarrhea tend to be mild and self-limited except in small or undernourished infants, in who…
.As in cholera, the pathologic changes associated with ETEC infection are minimal. From animal experiments in which intestinal l…
.The preliminary diagnosis of ETEC diarrhea can be suspected by the epidemiologic setting and the noninflammatory nature of stoo…
.The cornerstone of treatment for any diarrheal infection is rehydration.199 This principle especially pertains to ETEC diarrhea…
Enteroinvasive Escherichia coli
.Entero­invasive E. coli is similar genetically, pathogenetically, epidemiologically, and clinically to shigellosis, although th…
.Little is known about the epidemiology and transmission of this organism in newborns and infants; it is more frequently found i…
.Symptoms often include watery diarrhea, although a dysentery-like syndrome with an inflammatory exudate in stool, invasion and …
.Enteroinvasive E. coli should be suspected in infants who have an inflammatory diarrhea, as evidenced by fecal neutrophils or b…
.The management and prevention of EIEC diarrhea should be similar to that of acute Shigella or other E. coli enteric infections….
Enteropathogenic Escherichia coli
.Based on the molecular identification of two virulence factors, EPEC is now classified as either typical, usually associated wi…
.Bacterial cultures of the meconium and feces of newborns indicate that EPEC can effectively colonize the intestinal tract in th…
.The principal pathologic lesion in EPEC infection is the A/E lesion, manifest by electron microscopy but not light microscopy. …
.The incubation period after EPEC exposure is quite variable. Its duration has been calculated mostly from evidence in outbreaks…
.In 1987, the WHO came to a consensus that O serogroups of E. coli should be classified as EPEC: O26, O55, O86, O111, O114 O119,…
.The mortality rate recorded previously in epidemics of typical EPEC gastroenteritis is impressive for its variability. During t…
.The management of EPEC gastroenteritis should be directed primarily toward prevention or correction of problems caused by loss …
.The transmission for EPEC is fecal-oral. Therefore strict adherence to infection control and appropriate hygiene can help preve…
Enterohemorrhagic Escherichia coli
Enteroaggregative Escherichia coli
.The mode of transmission of EAEC is not well established. In adult volunteer studies, the infectious dose is high (>108 CFU), s…
.Descriptions from outbreaks and volunteer studies suggest that EAEC diarrhea is most often watery, with mucus and accompanied b…
.Diagnosis of EAEC requires identification of the organism in the patient’s feces. The HEp-2 adherence assay can be used for thi…
Other Escherichia coli Pathotypes
Salmonella
Nature of the Organism
Epidemiology and Transmission
Clinical Manifestations
Diagnosis
Therapy
Prevention
Shigella
Nature of the Organism
Epidemiology
Clinical Manifestations
Diagnosis
Therapy
Prevention
Campylobacter
Virulence Factors and Pathogenic Mechanisms
Epidemiology and Transmission
Clinical Manifestations
Pathology
Diagnosis
Therapy and Prevention
Clostridium Difficile
Virulence Factors and Pathogenic Mechanisms
Epidemiology
Clinical Manifestations
Diagnosis
Therapy
Prevention
Vibrio Cholerae
Nature of the Organism
Virulence Factors and Pathogenic Mechanisms
Epidemiology and Transmission
Clinical Manifestations
Diagnosis
Therapy and Prevention
Yersinia Enterocolitica
Nature of the Organism, Virulence Factors, and Pathogenic Mechanisms
Epidemiology
Clinical Manifestations
Diagnosis
Therapy
Aeromonas Species
Nature of the Organism, Virulence Factors, and Pathogenic Mechanisms
Epidemiology
Clinical Manifestations
Diagnosis
Therapy
Plesiomonas Shigelloides
Other Bacterial Agents and Fungi
Parasites
Entamoeba
Giardia Intestinalis
Cryptosporidium
Viruses
Enteric Viruses
Rotavirus
Pathogenesis
Infection and Immunity
Epidemiology
Clinical Manifestations
Diagnosis
Therapy and Prevention
Vaccines
Human Caliciviruses (Norovirus and Sapovirus), Astrovirus, and Enteric Adenoviruses
Differential Diagnosis
References
12. Group B Streptococcal Infections.pdf (p.417-462)
12 – Group B Streptococcal Infections
Organism
Colonial Morphology and Identification
Strains of Human and Bovine Origin
Classification
Ultrastructure
Immunochemistry of Polysaccharide Antigens
Growth Requirements and Bacterial Products
Epidemiology and Transmission
Asymptomatic Infection in Infants and Children
Transmission of Group B Streptococci to Neonates
Serotype Distribution of Isolates
Molecular Epidemiology
Incidence of Infection in Neonates and Parturients
Immunology and Pathogenesis
Maternal Colonization
Ascending Amniotic Infection
Pulmonary and Bloodstream Entry
Capsular Polysaccharide and Immune Resistance
Noncapsular Factors That Interfere with Immune Clearance
Inflammatory Mediators and Sepsis
Blood-Brain Barrier Penetration and Meningitis
Risk Factors for Early-Onset Infection
Antibody to Capsular Polysaccharide
Mucosal Immune Response
Complement and Antibody Interactions
Pathology
Clinical Manifestations and Outcome
Early-Onset Infection
Late-Onset Infection
Late Late–Onset Infection
Septic Arthritis and Osteomyelitis
Cellulitis or Adenitis
Unusual Manifestations of Infection
Relapse or Recurrence of Infection
Maternal Infections
Diagnosis
Antigen Detection Methods
Other Laboratory Tests
Differential Diagnosis
Treatment
In Vitro Susceptibility
Antimicrobial Therapy
Supportive Care
Prognosis
Prevention
Chemoprophylaxis
Historical Precedents
Rapid Assays for Antenatal Detection of Group B Streptococci
Intrapartum Antibiotic Prophylaxis
Impact of Intrapartum Antibiotic Prophylaxis on Neonatal Sepsis
Management of Neonates Born to Mothers Receiving Intrapartum Antibiotic Prophylaxis
Chemoprophylaxis for the Neonate
Immunoprophylaxis
References
13. Listeriosis.pdf (p.463-480)
13 – Listeriosis
The Organism
Typing
Epidemiology
Natural Reservoir and Transmission to Humans
Nosocomial Transmission
Risk Factors for Severe Listeriosis
Pathogenesis
Exposure
Virulence
Regulation of Bacterial Virulence Gene Expression
Host Response
Cell Autonomous Immunity
Systemic Immunity
.The first line of defense against Listeria is the gastrointestinal barrier.213 Within intestinal crypts, Paneth cells produce a…
.Several diseases or medications that interfere with cell-mediated immunity are known to increase susceptibility to systemic lis…
Host Response to Listeria During Pregnancy
Pathology
Clinical Manifestations
Listeriosis in Pregnancy
Neonatal Listeriosis
Early-Onset Neonatal Listeriosis
Late-Onset Neonatal Listeriosis
Listeriosis in the Older Child and Adult
Diagnosis
Microscopy and Gram Stain
Culture and Identification
Molecular and Other Detection Methods
Serology
Therapy
Suggested Management
Listeriosis in Pregnant Women
Early-Onset Neonatal Listeriosis
Late-Onset Neonatal Listeriosis
Prognosis
Prevention and Outbreak Management
References
14. Staphylococcal Infections.pdf (p.481-509)
14 – Staphylococcal Infections
Epidemiology and Transmission
Staphylococcus Aureus
Coagulase-Negative Staphylococci
Microbiology
Staphylococcus Aureus
Coagulase-Negative Staphylococci
Pathogenesis of Disease
Virulence Mechanisms of Staphylococcus Aureus
Epithelial Attachment and Invasion
Innate Immune Resistance
Secreted Toxins
Quorum Sensing and Regulation of Virulence Factor Expression
Virulence Mechanisms of Coagulase-Negative Staphylococci
Role of Host Defenses
Pathology
Clinical Manifestations
Bacteremia/Sepsis
Toxic Shock Syndromes
Endocarditis
Pustulosis, Cutaneous Abscess, Cellulitis
Adenitis and Parotitis
Breast Infection
Funisitis, Omphalitis, Necrotizing Fasciitis
Staphylococcal Scalded Skin Syndrome and Bullous Impetigo
Pneumonia
Meningitis
Brain Abscess
Osteomyelitis and Septic Arthritis
Gastrointestinal
Diagnosis
Antibiotic Treatment (see also Chapter 37)
General Principles
Vancomycin
Clindamycin and Erythromycin
Linezolid
Daptomycin
Quinupristin-Dalfopristin
Combination Antimicrobial Therapy
Catheter Removal
Prevention
Hygienic Measures
Antibiotic Prophylaxis
Immune Prophylaxis
Conclusion
Acknowledgment
References
15. Gonococcal Infections.pdf (p.510-517)
15 – Gonococcal Infections
Epidemiology and Transmission
Microbiology
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Prevention
References
16. Syphilis.pdf (p.518-549)
16 – Syphilis
Organism
Transmission
Acquired Syphilis
Congenital Syphilis
Syphilis and Human Immunodeficiency Virus
Syphilis in Sexually Abused Children
Infection Control
Epidemiology
Congenital Syphilis
Global Perspective
Pathogenesis
Treponemal Virulence-Associated Factors
Host Response
Host Innate Immune Response
Host Adaptive Immune Response
.The lack of cell surface targets has led T. pallidum to be labeled a “stealth pathogen.”27 But the importance of cellular immun…
.Humoral immunity has been a subject of study in syphilis since the serendipitous discovery of antibody to cardiolipin by Wasser…
Immune-Mediated Protection
Pathology
Clinical Manifestations
Syphilis in Pregnancy
Primary Syphilis in Pregnancy
Secondary Syphilis in Pregnancy
Latent Syphilis in Pregnancy
Late Stages (Tertiary Disease) in Pregnancy
Acquired Syphilis in Children
Congenital Syphilis
Early Congenital Syphilis
.Intrauterine growth restriction of prenatally infected infants may be noted at birth.168 The effect of syphilis on the growth o…
.Mucous patches may be seen in the mouth and genital tract168,191 and are more prevalent in infants with severe systemic disease…
.Hepatomegaly is present in nearly all infants with congenital syphilis and may occur in the absence of splenomegaly, although t…
.Anemia, thrombocytopenia, and leukopenia or leukocytosis are common findings in congenital syphilis.183 A characteristic featur…
.Bone findings210 are a frequent manifestation of early congenital syphilis and occur in 60% to 80% of untreated cases. They usu…
.Without therapy, approximately 15% of infants with congenital syphilis develop findings such as meningitis, meningeal irritatio…
.Fever has been reported to accompany other signs of congenital syphilis in infants beyond the immediate newborn period.203,228 …
Late Congenital Syphilis
.An infrequent sign of late congenital syphilis is linear scars that become fissured or ulcerated, resulting in deeper scars cal…
.Bone involvement in late congenital syphilis is relatively infrequent in comparison with the frequent occurrence of abnormaliti…
.Syphilitic vasculitis around the time of birth can damage the developing tooth buds and lead to dental anomalies called Hutchin…
.The same manifestations of neurosyphilis seen in acquired syphilis may occur in congenital syphilis and can include mental reta…
Diagnosis
Direct Identification
Indirect Identification
Nontreponemal Tests
Treponema-Specific Serologic Tests
Other Serologic Tests
.Several rapid or POC tests have been developed.291,292 Most of these tests are immunochromatographic strip-based assays that de…
.For evaluation of possible neurosyphilis, the VDRL test should be performed on CSF.296-298 As in evaluating a patient for neuro…
Approach to the Diagnosis of Acquired Syphilis in Pregnancy
Approach to the Diagnosis of Congenital Syphilis
Differential Diagnosis
Dermatologic Manifestations
Snuffles
Lymphadenopathy
Hepatosplenomegaly
Hydrops Fetalis
Renal Disease
Ophthalmologic Involvement
Bony Involvement
Therapy
Treatment of Acquired Syphilis in Pregnancy
Treatment of Neurosyphilis in the Pregnant Patient
Human Immunodeficiency Virus
Postexposure Prophylaxis
Treatment of Congenital Syphilis
Clinically Asymptomatic Infants
Internationally Adopted Children
Follow-Up for the Syphilis-Infected Pregnant Woman
Follow-Up for the Syphilis-Infected Infant
Problems Associated with Penicillin Therapy
Penicillin Hypersensitivity
Jarisch-Herxheimer Reaction
Penicillin Shortage
Prevention
References
17. Borella Infections Lyme Disease and Relapsing Fever.pdf (p.550-563)
17 – Borrelia Infections: Lyme Disease and Relapsing Fever
Lyme Disease
Epidemiology and Transmission
Microbiology
Pathogenesis and Pathology
Clinical Manifestations
Diagnosis
Management and Treatment
Early Localized Disease
Early Disseminated and Late Disease
Prognosis
Prevention
Relapsing Fever
References
18. Tuberculosis.pdf (p.564-581)
18 – Tuberculosis
Brief History
Epidemiology
In the Adult and Older Child
In Pregnancy
In the Newborn
Bacteriology
Pathogenesis and Pathology
In the Adult and Older Child
In Pregnancy
In the Newborn
Clinical Presentation
In the Adult and Older Child
In Pregnancy
In the Newborn
Diagnosis
In the Adult and Older Child
In Pregnancy
In the Newborn
Management
In the Adult and Older Child
In Pregnancy
In the Newborn
Prognosis
In Pregnancy
In the Newborn
Infection Control
Prevention
Special Considerations in Human Immunodeficiency Virus Infection or Exposure
Bacillus Calmette-Guérin in Human Immunodeficiency–Exposed and –Infected Infants
Special Considerations in Drug-Resistant Tuberculosis (DR-TB)
References
19. Chlamydia Infections.pdf (p.582-588)
19 – Chlamydia Infections
Epidemiology and Transmission
Microbiology
Pathogen
Chlamydial Developmental Cycle
Pathogenesis
Conjunctivitis
Pneumonia
Pathology
Clinical Manifestations
Conjunctivitis
Pneumonia
Perinatal Infections at other Sites
Diagnosis
Conjunctivitis
Pneumonia
Differential Diagnosis
Conjunctivitis
Pneumonia
Prognosis
Conjunctivitis
Pneumonia
Therapy
Prevention
References
20. Mycoplasmal Infections.pdf (p.589-603)
20 – Mycoplasmal Infections
Ureaplasma and Mycoplasma hominis: Colonization and Diseases of the Urinary and Reproductive Tracts in Adults
Colonization
Urinary Tract
Reproductive Tract
Histologic Chorioamnionitis
Infection of the Amniotic Fluid and Clinical Amnionitis
Postpartum and Postabortal Fever
Adverse Pregnancy Outcome
Fetal Loss
Preterm Birth
Transmission of Ureaplasma and Mycoplasma hominis to the Fetus and Newborn
Perinatal Ureaplasma and Mycoplasma hominis Infection
Pneumonia
Chronic Lung Disease
Bloodstream Infections
Central Nervous System Infections
Other Sites of Infection in the Neonate
Other Mycoplasmas
Diagnosis
Treatment of Neonatal Infections
References
21. Bordetella pertussis and Other Bordetella spp. Infections.pdf (p.604-622)
21 – Bordetella pertussis and Other Bordetella spp. Infections
Organisms
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical; Bordetella pertussis Infections
Adults, Including Pregnant Women and Mothers
Neonates and Young Infants
Other Bordetella Infections
Bordetella Parapertussis
Bordetella Bronchiseptica
Bordetella Holmesii
Differential Diagnosis
Specific Diagnosis
Antibiotics
Supportive Care
Prognosis
Prevention
Whole-Cell Vaccines (DTWP)
Acellular Vaccines (DTAP and TDAP)
Schedules and Contraindications
Isolation and Prophylactic Measures
Acknowledgments
References
22. Human Immunodeficiency VirusAcquired Immunodeficiency Syndrome in the Infant.pdf (p.623-678)
22 – Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in the Infant
Epidemiology
Global Scope of the Problem
United States
Human Immunodeficiency Virus in Women
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Infants and Children
Transmission
Mother-to-Child HIV Transmission: Rates, Timing, Risk Factors, and Mechanisms
Intrauterine Transmission
Intrapartum Infection
Postnatal Infection
Mechanisms of Transmission
Molecular Biology
Immunopathogenesis
Viral Replication in Early Infant Infection
Human Immunodeficiency Virus–Specific Immune Control
Immune Consequences in Human Immunodeficiency Virus Infection
Human Immunodeficiency Virus Reservoirs
Diagnosis
Early Infant Diagnosis
Classification of Human Immunodeficiency Virus Infection in Children
Clinical Manifestations and Pathology
Infectious Complications
Bacterial Infections
Viral Infections
Fungal and Protozoal Infections
Encephalopathy
Interstitial Lung Disease
Cardiovascular Complications
Gastrointestinal Disease
Nephropathy
Hematologic Problems
Skin
Malignancies
Immune Constitution Inflammatory Syndrome
Prognosis
Treatment
Antiretroviral Drugs
Timing of cart Initiation
Treatment Recommendations
Choice of Initial Antiretroviral Regimen
Clinical and Laboratory Monitoring
Challenges
Primary Care
Immunizations
Chemoprophylaxis
Prevention
Prenatal Human Immunodeficiency Virus Counseling and Testing
Antiretroviral Prophylaxis to Prevent Mother-to-Child Human Immunodeficiency Virus Transmission
Combination Antiretroviral Drugs During Pregnancy
Safety of Antiretroviral Prophylaxis in Pregnancy
Elective Cesarean Delivery
Neonatal Antiretroviral Prophylaxis
Avoidance of Breastfeeding
Anticipatory Guidance and Primary Care for Human Immunodeficiency Virus–Exposed Infants
Challenges to Elimination of Perinatal Human Immunodeficiency Virus Transmission in the United States
World Health Organization Revised Guidelines for Prevention of Mother-to-Child Transmission
World Health Organization Revised Guidelines for Infant Feeding
Future Goals
References
23. Varicella, Measles, and Mumps.pdf (p.679-727)
23 – Varicella, Measles, and Mumps
Varicella and Zoster
Organism
Classification and Morphology
Propagation
Serologic Tests and Antigenic Properties of Varicella-Zoster Virus
Immunity to Varicella-Zoster Virus
Epidemiology and Transmission
Communicability
Incubation Period
Relationship Between Varicella and Zoster
Transplacental Transmission
Epidemiology
Evidence of Immunity to Varicella
Incidence of Varicella, Mumps, and Measles in Pregnancy
Incidence and Distribution of Zoster
Incidence of Zoster in Pregnancy
Nosocomial Varicella in the Nursery
Pathogenesis of Varicella and Zoster
Pathology
Cutaneous Lesions
Visceral Lesions in the Fetus and Placenta
Visceral Lesions in the Mother
Zoster
Clinical Manifestations
Varicella Rash
Complications of Varicella
Varicella in Immunocompromised Children
Varicella Pneumonia
Maternal Effects of Varicella
Effects of Gestational Varicella on the Fetus
. Available data on chromosomal aberrations are often difficult to interpret, particularly in the absence of controls, which is …
. Several studies have addressed the question of whether gestational varicella and other viral diseases result in an increased i…
. For many years, there was uncertainty about whether gestational varicella led to a symptomatic congenital infection. Intensive…
zoster after congenital varicella syndrome. Of children with congenital varicella syndrome, 15% develop clinical zoster in infan…
diagnosis of congenital varicella syndrome. During the neonatal period or infancy, attempts to isolate VZV from the skin, CSF, e…
. In the 1990s, the incidence of fetal malformations after maternal VZV infection was clarified. Varicella is a significantly gr…
Perinatal Varicella
. Postnatally acquired varicella, which can begin 10 to 28 (average, ≈15) days after birth, is generally mild.348 The experience…
. Congenital varicella is not inevitable when maternal varicella occurs in the 21 days preceding parturition. In only 8 (24%) of…
Zoster in Neonates and Older Children
Diagnosis and Differential Diagnosis
Varicella
. If laboratory diagnosis is required, it is best accomplished by showing VZV antigen or DNA in skin lesions or isolating virus …
. Several diseases may be considered in the differential diagnosis of varicella in the newborn, including neonatal HSV, contact …
Zoster
Therapy
Treatment of the Mother
Treatment of the Newborn Infant
Prevention
Passive Immunization Against Varicella
Guidelines for Preventive Measures and Isolation Procedures
Active Immunization Against Varicella
Measles
Organism
Classification and Morphology
Propagation and Identification of Measles Virus
Antigenic Properties and Serologic Tests
Epidemiology and Transmission
Incidence of Measles in Pregnant Women
Pathogenesis
Incubation Period for Measles Acquired by Droplet Infection
Incubation Period for Hematogenously Acquired Measles
Period of Communicability
Pathology
Clinical Manifestations
Prodrome and Rash
Complications and Mortality
Maternal Effects of Measles
Effects of Gestational Measles on the Fetus
. The possibility that measles occurring in pregnancy may damage the fetus is suggested by the observation that there is a high …
. Studies examining outcomes of pregnancy complicated by measles infection are limited by study design (case reports or series),…
. The teratogenic potential of gestational measles for the fetus has been challenging to study because of the rarity of the infe…
Perinatal Measles
. Several reports describe cases of measles in which the onset of the exanthem occurred in infants 14 to 30 days of age. The cou…
. The historical literature described congenital measles as cases in which the exanthem was present at birth and infections acqu…
Diagnosis and Differential Diagnosis
Therapy
Prevention
Passive Immunization
Active Immunization
Nosocomial Measles in the Nursery: Guidelines for Prevention
Mumps
Organism
Properties and Propagation
Epidemiology and Transmission
Period of Communicability
Incubation Period
Incidence of Mumps in Pregnancy
Pathogenesis
Pathology
Clinical Manifestations
Maternal Effects of Mumps
Effects of Gestational Mumps on the Fetus
. One study has demonstrated an excessive number of abortions associated with gestational mumps when the disease occurs during t…
. In the only prospective study of low birth weight (a surrogate measure of prematurity) in relation to maternal mumps infection…
. In experimentally infected animals, mumps virus may induce congenital malformations.590-592 Definitive evidence of a teratogen…
. A postulated association between gestational mumps infection and endocardial fibroelastosis in the offspring was at one time t…
Perinatal Mumps
Diagnosis and Differential Diagnosis
Therapy
Prevention
Active Immunization
Passive Immunization
Prevention of Nosocomial Mumps in the Newborn Nursery
References
24. Cytomegalovirus.pdf (p.728-785)
24 – Cytomegalovirus
The Virus
Cytomegalovirus Replication
Cytomegalovirus Cellular Tropism
Epidemiology
Overview
Breastfeeding
Young Children as a Source of Cytomegalovirus
Maternal Infection and Vertical Transmission
Congenital Infection
Perinatal Infection
Sexual Transmission
Nosocomial Transmission
Transmission to Hospital Workers
Pathogenesis
CMV Infection and Cell-Associated Viremia
Virus-encoded Pathogenic Functions
Host Immunity and the Pathogenesis of Cytomegalovirus Infections
Modulation of the Host Immune Response to Cytomegalovirus
Pathogenesis of Acute Infections
Pathogenesis of Central Nervous System Infections in Congenitally Infected Infants
Pathogenesis of Hearing Loss Associated with Congenital CMV Infection
Nature of Maternal Infection
Perinatal Infection
Persistent Viral Excretion
Pathology
Commonly Involved Organ Systems
Central Nervous System
Liver
Hematopoietic System
Kidneys
Endocrine Glands
Gastrointestinal Tract
Lungs
Placenta
Clinical Manifestations
Congenital Infection
Symptomatic Infection
. Clinically apparent infections or CID is characterized by involvement of multiple organs, in particular, the reticuloendotheli…
. This clinical finding, along with splenomegaly, is probably the most common abnormality found in the newborn period in infants…
. Enlargement of the spleen exists to a greater or lesser degree in all the common human congenital infections and is especially…
. Jaundice is a common manifestation of congenital CID. The pattern of hyperbilirubinemia may take several forms, ranging from h…
. There is evidence from experimental animal models that CMV has a direct effect on the megakaryocytes of the bone marrow that r…
. Microcephaly, currently defined in epidemiologic studies as a head circumference of less than the third percentile, was found …
. The principal abnormality related to the eye in CMV infection is chorioretinitis, with strabismus and optic atrophy.265,472,56…
. Intrauterine growth retardation (IUGR), occasionally severe, was reported in 50% of 106 patients with symptomatic congenital C…
. Pneumonitis, a common clinical manifestation of CMV infection after hematopoietic and solid-organ transplantation in adults, i…
. Congenital CMV infection is also associated with a distinct defect of enamel, which thus far seems to affect mainly primary de…
deafness. Sensorineural deafness is the most common disorder of neurodevelopmental deficit caused by congenital CMV infection. M…
. The likelihood of survival with normal intellect and hearing after symptomatic congenital CMV infection is clearly reduced com…
Asymptomatic Infection
Effect of Type of Maternal Infection on Symptoms and Long-Term Outcome
Public Health Significance
Perinatal Infection
Diagnosis
Detection of Virus
Tissue Culture
DNA Hybridization
DNA Amplification
Antigenemia
Detection of Immune Response
Detection of IgG Antibodies
Detection of IgM Antibodies
Diagnosis of Cytomegalovirus Infection During Pregnancy
Clinical Signs and Symptoms
Laboratory Markers
IgM Assays
IgG Avidity Assay
Viral Cultures
Other Tests
Maternal Laboratory Tests of Fetal Infection
Prenatal Diagnosis
Diagnosis of Perinatally Acquired Infections
Differential Diagnosis
Congenital Rubella Syndrome
Congenital Toxoplasmosis
Congenital Syphilis
Neonatal Herpes Simplex Virus Infections
Treatment
Chemotherapy
Passive Immunization
Vaccines
Recombinant Virus Vaccine
Subunit Vaccines
Prevention
Pregnant Women
Nosocomial Infection
References
25. Enterovirus and Parechovirus Infections.pdf (p.786-831)
25 – Enterovirus, Parechovirus, and Saffold Virus Infections
The Viruses
Taxonomy1,2,14,88-103
Morphology and Replication
Replication Characteristics and Host Systems1,96,124,125
Antigenic Characteristics1,14,41,93,96
Host Range
Epidemiology and Transmission
General Considerations
Geographic Distribution and Seasonality
Transplacental Transmission
Polioviruses
Coxsackieviruses
Echoviruses, Numbered Enteroviruses, and Parechoviruses
Ascending Infection and Contact Infection During Birth
Neonatal Infection
Polioviruses
Coxsackieviruses
Echoviruses and Parechoviruses
Pathogenesis
Events During Pathogenesis
Factors that Affect Pathogenesis
Pathology
General Considerations
Polioviruses
Coxsackieviruses A
Coxsackieviruses B
Brain and Spinal Cord
Heart
Other Organs
Echoviruses
Parechoviruses
Clinical Manifestations
Abortion
Polioviruses
Coxsackieviruses
Echoviruses
Parechoviruses
Prematurity and Stillbirths
Polioviruses
Coxsackieviruses
Echoviruses and Numbered Enteroviruses
Congenital Malformations
Polioviruses
Coxsackieviruses
Echoviruses
Parechoviruses
Neonatal Infection
Nonpolio Enteroviruses and Parechoviruses
Inapparent Infection. Inapparent infections in neonates occasionally occur with many different enteroviruses and parechoviruses….
Mild, Nonspecific Febrile Illness. In a review of 338 enteroviral infections in early infancy, 9% were classified as nonspecific…
. The major diagnostic problem in neonatal enteroviral and human parechovirus infections is differentiation of bacterial from vi…
. Respiratory complaints are generally overshadowed by other manifestations of neonatal enteroviral and parechoviral diseases. O…
. Chawareewong and associates505 described several infants with herpangina and coxsackievirus A5 infection. A vesicular lesion o…
. Several agents have been associated with coryza: coxsackievirus A9; and echoviruses 11, 17, and 19; and parechoviruses 1 and 3…
. Pharyngitis is uncommon in neonatal enteroviral infections. In more than 50 infants with enteroviral infections studied by Lin…
. A few enteroviruses have been identified in cases of laryngotracheobronchitis or bronchitis: coxsackieviruses B1 and B4 and ec…
. Pneumonia as the main manifestation of neonatal enteroviral and parechoviral infections is rare. Morens472 documented only sev…
. Eichenwald and associates357 recovered echovirus 20 from four full-term infants younger than 8 days. Although these infants ap…
. Vomiting and diarrhea are common but usually just part of the overall illness complex and not the major manifestations. In 195…
Abdominal Distention. Abdominal distention may be a prominent feature of parechovirus infections; it was noted in 5 of 8 infants…
. Morens472 observed that 2% of neonates with clinically severe enteroviral disease had hepatitis. Lake and colleagues433 found …
. Pancreatitis was recognized in three of four newborns with coxsackievirus B5 meningitis331 and in coxsackievirus B3 and B4 inf…
. Lake and associates433 described three infants with necrotizing enterocolitis. Coxsackievirus B3 was recovered from two of the…
Cardiovascular Manifestations. In contrast with enteroviral cardiac disease in children and adults, in which pericarditis is com…
Exanthem. Exanthem as a manifestation of neonatal enteroviral and parechoviral infections has occurred with coxsackieviruses B1,…
Meningitis and Meningoencephalitis. As shown in Table 25-5, meningitis and meningoencephalitis have been associated with coxsack…
. Johnson and associates540 reported a 1-­month-old boy with a right facial paralysis and loss of abdominal reflexes. The facial…
. Balduzzi and Greendyke427recovered coxsackievirus A5 from the stool of a 1-month-old child after sudden infant death. In a sim…
Manifestations of Polioviruses
. Polioviral infection in children classically results in a spectrum of clinical illness. As described by Paul550 and accepted b…
. Shelokov and Habel218 followed a virologically proven infected newborn without signs of illness. The infant was normal when 1 …
. Elliott and colleagues210 described an infant girl in whom “complete flaccidity” was observed at birth. This child’s mother ha…
. In contrast to infections acquired in utero, those acquired postnatally are more typical of classic poliomyelitis. Shelokov an…
. Administration of oral polio vaccines to newborns has been carried out in numerous studies.226,295-307 Vaccine viral infection…
Manifestations of Specific Nonpolio Enteroviruses
Coxsackieviruses
. There have been few reports of neonatal coxsackievirus A infections. Baker and Phillips426 reported a small-for-gestational-ag…
. Until recently, coxsackievirus B1 has only occasionally been recovered from newborns (Table 25-8). Eckert and coworkers510 rec…
. The reported instances of coxsackievirus B2 infections in neonates are provided Table 25-8. In most instances, the infants had…
. Neonatal infections with coxsackievirus B3 are summarized in Table 25-8. Most reported cases have been severe illnesses with m…
. Table 25-8 summarizes coxsackievirus B4 neonatal infections. Most were severe and frequently were fatal illnesses with neurolo…
Coxsackievirus B5. The spectrum of neonatal infection with coxsackievirus B5 is greater than that with the other coxsackieviruse…
. Dömök and Molnár317 described aseptic meningitis related to echovirus 1
. Krajden and Middleton30 described three infants with echovirus 2 infections. Two of the neonates had meningitis and recovered….
. In the summer of 1970, Haynes and coworkers537 studied an epidemic of infection caused by echovirus 3. Three infected neonates…
. Linnemann and associates487 studied 11 infants with echovirus 4 infections. All infants had fevers, and most were irritable. F…
. There have been six reports of neonatal illnesses associated with echovirus 5 infections.417,430,472,525 In one nursery epidem…
. Sanders and Cramblett376 reported a boy who was well until 9 days of age, when he developed a fever (38° C), severe diarrhea, …
. Piraino and colleagues273 reported three infants with echovirus 7 infections. All three had fever, one had respiratory distres…
. In a search for etiologic associations in infantile diarrhea, Ramos-Alvarez512 identified one neonate from whom echovirus 8 wa…
. Echovirus 9 is the most prevalent of all the enteroviruses (see Table 25-4). From 1955 to 1958, epidemic waves of infection sp…
. A wide array of neonatal illnesses have been associated with echovirus 11 infection. Reported cases are listed in Table 25-10….
. Before 2000, infection with echovirus 13 was rare in neonates. The virus was isolated from one asymptomatic infant in a neonat…
. Hughes and colleagues278 reported an infant boy who became febrile (38° C) and had cyanotic episodes on the third day of life….
. In 1974, Hall and colleagues477 studied five neonates with echovirus 16 infections. All five infants were admitted to the hosp…
. Neonatal infection with echovirus 17 has been observed by three investigators. Cherry and coworkers254 reported two ill infant…
. In 1958, Eichenwald and colleagues356 described epidemic diarrhea associated with echovirus 18 infections. In a nursery unit o…
. Cramblett and coworkers524 described two neonates with echovirus 19 infections. One child had an upper respiratory infection, …
. Eichenwald and Kostevalov280 recovered echovirus 20 from four asymptomatic infants younger than 8 days (see “Cloud Baby”). Fiv…
. Jack and coworkers363 recovered echovirus 21 from the feces of a 7-day-old infant with jaundice and diarrhea. No other details…
. Linnemann and colleagues487 reported one neonate with echovirus 25 infection. They gave no virus-specific details, except that…
. Matsumoto and associates541 described a nursery outbreak involving 11 infants during a 2-week period. All the neonates had ase…
. McDonald and associates367 described three neonates in an intensive care nursery with echovirus 31 infections. One infant had …
. In a study of epidemic illness related to echovirus 33 disease in the Netherlands, Kapsenberg364 stated that 7- to 8-day-old n…
. Schmidt and colleagues422 mentioned one 3-week-old infant with meningitis and enterovirus 71 infection. Chonmaitree and collea…
. Parechovirus 1 has been associated with three epidemics of nursery infections. During a survey of perinatal virus infections b…
. Ehrnst and Eriksson535 reported a 1-month-old girl with encephalopathy resulting from a nosocomial parechovirus 2 infection. N…
Parechovirus 3. A number of recent studies of illness with parechovirus 3 infections in neonates and young infants have been pre…
. A neonate with fever and poor feeding was found to be infected with parechovirus 4.476
Diagnosis and Differential Diagnosis
Clinical Diagnosis
Laboratory Diagnosis
Virus Isolation
Rapid Virus Identification
Serology
Histology
Differential Diagnosis
Prognosis
Polioviruses
Nonpolio Enteroviruses and Parechoviruses
Therapy
Specific Therapy
Nonspecific Therapy
Mild, Nonspecific Febrile Illness
Sepsis-like Illness
Myocarditis and Severe Hepatitis
Meningoencephalitis
Paralytic Poliomyelitis
Prevention
Immunization
Other Measures
References
26. Hepatitis.pdf (p.832-846)
26 – Hepatitis
Hepatitis A Virus
Epidemiology and Transmission
Microbiology and Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prevention
Hepatitis B Virus and Hepatitis D Virus
Epidemiology and Transmission
Microbiology and Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prevention
Hepatitis C Virus
Epidemiology and Transmission
Microbiology and Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prevention
Hepatitis E Virus
Epidemiology and Transmission
Microbiology and Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prevention
Other Hepatotropic Viruses
Conclusion
References
27. Herpes Simplex Virus Infections.pdf (p.847-869)
27 – Herpes Simplex Virus Infections
Herpes Simplex Virus
Structure
Replication
Latency and Reactivation
Epidemiology and Transmission
Maternal Infection
Factors Influencing Transmission of Infection to the Fetus
Incidence of Newborn Infection
Times of Transmission of Infection
Immunologic Response
Neonatal Infection
Pathogenesis and Pathology
Clinical Manifestations
Intrauterine Infection
Disseminated Disease
Central Nervous System Disease
Skin, Eye, or Mouth Disease
Subclinical Infection
Diagnosis
Clinical Evaluation
Laboratory Assessment
Treatment
Background
Antiviral Drugs
Other Issues in Acute Management
Long-Term Management of Infected Infants
Prevention
Background
Management of Pregnant Women with Known Genital Herpes
Management of Infants of Mothers with Genital Herpes
Conclusion
Acknowledgments
References
28. Human Parvovirus.pdf (p.870-897)
28 – Human Parvovirus
Microbiology
General Aspects of Pathogenesis
Epidemiology and Transmission
Overview
Global Distribution
Seasonality and Periodicity
Seroprevalence by Age
Seroprevalence by Gender
Seroprevalence by Race
Incidence
Risk Factors for Acquisition
Hospital Transmission
Routes of viral Spread
Risk of Parvovirus B19 Acquisition for Women of Childbearing Age
Clinical Manifestations (Other Than Intrauterine Infection)
Erythema Infectiosum
Transient Aplastic Crisis
Arthropathy
Infection in Immunocompromised Hosts
Other Dermatologic Syndromes
Vasculitis and Purpura
Papular-Purpuric “Gloves and Socks” Syndrome
Central Nervous System Infection and Neurologic Disorders
Renal Disease
Myocardial Disease
General Aspects of Diagnosis
Laboratory Diagnostic Methods
Epidemiology of Parvovirus B19 Infections and Risk of Acquisition in Pregnant Women
Prevalence and Incidence in the United States
Prevalence and Incidence in Other Countries
Clinical Manifestations of Parvovirus B19 Infections in Pregnant Women
Intrauterine Transmission Rates, Clinical Manifestations, and Fetal Outcomes
Overview
Fetal Death
Asymptomatic Fetal Infection
Birth Defects
Other Fetal Manifestations
Fetal Hydrops
Fetal outcome in relation to maternal manifestations
Long-term outcomes
Pathogenesis of Infection in the Fetus
Fetal Immune Responses to Parvovirus B19
Pathogenesis of Parvovirus B19 Hydrops
Pathology in the Fetus
Anatomic and Histologic Features
Placenta
Heart
Other Organs
Overview
Prevalence of Erythema Infectiosum
History of Exposure
Clinical Features Suggesting Signs and Symptoms of Parvovirus B19 Infection in the Pregnant Woman
Laboratory Diagnosis in the Pregnant Woman
Fetal Monitoring
Fetal Therapy
Differential Diagnosis
Prognosis
Prevention
General Measures
Vaccine Development
References
29. Rubella.pdf (p.898-936)
29 – Rubella
Virus
Classification
Antigen and Serologic Testing
Growth in Cell Culture
Pathogenicity for Animals
Epidemiology
Transmission In Utero
Risk of Fetal Infection
Risk of Congenital Defects
Natural History
Postnatal Infection
Virologic Findings
Humoral Immune Response
Cellular Immune Response
Local Immune Response
Congenital Infection
Virologic Findings
Humoral Immune Response
Cellular Immune Response
Interferon Response
Pathogenesis
Postnatal Infection
Congenital Infection
Pathology
Postnatal Infection
Congenital Infection
Clinical Manifestations
Postnatal Infection
Congenital Infection
Transient Manifestations
Permanent Manifestations
Developmental and Late-Onset Manifestations
Long-Term Prognosis
Laboratory Diagnosis
Maternal Infection
Congenital Infection
Management Issues
Use of Immunoglobulin
Termination of Pregnancy
Clinical Management
Chemotherapy
Isolation
Prevention of Congenital Rubella
Update on Vaccine Characteristics
Vaccination Recommendations
Outbreak Control
Surveillance
Strategies for Elimination of Rubella and Congenital Rubella Syndrome
References
30. Less Common Viral Infections.pdf (p.937-950)
30 – Less Common Viral Infections
Human Papillomavirus
Epstein-Barr Virus
Human Herpesvirus 6
Human Herpesvirus 7
Influenza A and B
Respiratory Syncytial Virus
Lymphocytic Choriomeningitis Virus
Molluscum Contagiosum
Rabies Virus
West Nile Virus
Smallpox
Variola in Pregnancy
Vaccinia
Dengue
Chikungunya
References
31. Toxoplasmosis.pdf (p.951-1044)
31 – Toxoplasmosis
Biology of the Parasite
History
Stages and Life Cycle
Tachyzoites
Bradyzoites and Cysts
Sporozoites and Oocysts
Life Cycle of Toxoplasma gondii
. Cats (and other felids) are infected by the ingestion of cysts present within the tissues of their prey or by ingestion of ooc…
. Intermediate hosts are infected either by ingestion of cysts present in meat or oocysts that are present in food or water. In …
. Parasites invade cells by a self-driven multistep process that differs from endocytosis because of the rapid nature of the phe…
. This process is central to the pathogenesis and longevity of infection.30 As described above, cysts that harbor bradyzoites pe…
Genetic Diversity
Population Structure
Factors Associated with Pathogenicity
Parasitic Factors
Host Factors
Cellular Immunity and Immunopathology of Toxoplasmosis
Reinfection or Reactivation
What is the Driving Force Behind a Recurrence
Modulation of the Host Environment by Toxoplasma and Host Immune Countermeasures
Parasite-Host Interaction in Brain and Eye
Parasite-Host Interaction in Brain and Eye
Recurrences
Special Problems Relating to Brain and Eyes
Pathology in Congenital Toxoplasmosis*
Placenta
Central Nervous System
Eyes
Ears
Lung and Heart
Spleen, Liver, Ascites, and Kidneys
Endocrine Organs
Skeletal Muscle
Thymus
Skin
Bone
Immunoglobulin Abnormalities
Toxoplasma Gondii–Cytomegalovirus Infection
Epidemiology
Seroprevalence in the General Population
Oral Routes of Infection
The Role of Meat
. Despite being resistant to clinical toxoplasmosis, chickens have frequently been found to be infected with T. gondii in propor…
. Cattle are considered to be a poor host for T. gondii, and viable cysts have rarely been isolated from edible beef parts despi…
. Sheep are highly susceptible to Toxoplasma infection and, being free-range grazing animals, are widely exposed to infection.30…
. Toxoplasma gondii infection is also common in goats, and prevalence rates reached 75% in some surveys.285,325 Dubey and collea…
. The seroprevalence of T. gondii in horses varies worldwide.349 Most estimates reviewed by Tenter and colleagues285 or publishe…
. Viable cysts of T. gondii have been isolated from farmed domestic rabbits.362 However, only a few sero­prevalence rates are av…
. Humans can also be infected by the ingestion of cysts of T. gondii found in the tissues of venison and other wild animals, suc…
The Role of Milk and Eggs
The Role of Oocysts
Non-Oral Routes of Infection
Drugs Active Against Toxoplasma gondii
General Considerations
Historical Evolution of Therapeutic Strategies
Drugs in Current Use Effective Against Toxoplasma Gondii
Pyrimethamine and Sulfonamides
. Because pyrimethamine inhibits the activity of dihydrofolate reductase, a precursor of folic acid, it induces, as expected, a …
Spiramycin
Other Drugs
Drugs Under Consideration and Novel Drug Targets
Epidemiology and Diagnosis of Infections in the Mother and the Unborn Child
Epidemiology of Maternal Infection
Seroprevalence of Infection with Toxoplasma gondii and Related Risk Factors
. Only a few studies have been published on the seroprevalence of T. gondii infection in the United States. The most recent figu…
. Most estimates have been calculated from studies in Brazil, where the seropositivity rates in pregnant women are highest, as d…
. Recent information on the seroprevalence in pregnant women or women of childbearing age in Africa is limited but suggests high…
. The majority of rates of seropositivity for T. gondii infection in pregnant women or women of child-bearing age in Europe publ…
. The lowest seroprevalence rates for T. gondii infection in Asia were found in pregnant women and women of childbearing age who…
Incidence of Toxoplasma Infections During Pregnancy
Incidence of Congenital Infections
Clinical Signs of Maternal Infection
Diagnosis of Maternal Infection
Circumstances
Available Tests
. IgG anti-Toxoplasma antibodies are detectable 2 to 4 weeks after infection (Fig. 31-23), depending on the tests and the indivi…
. Anti-Toxoplasma IgM is traditionally tested in parallel to IgG and is useful for two reasons. First, in a susceptible patient,…
. Because the level of specific IgG in a single test does not provide a reliable indication of the acuteness of infection, and I…
. Specific anti-IgA antibodies can be measured using commercial ISAGA or ELISA assays. Their appearance is somewhat delayed comp…
. Qualitative tests based on immunoblotting, which detect anti–T. gondii–specific IgG, are also now available and can be used to…
. It has been shown that specific cellular immunity can be detected in patients infected with Toxoplasma, including pregnant wom…
Interpretation of Serologic Tests Based on the Results for Immunoglobulin M and Immunoglobulin G Antibodies
. This profile indicates the absence of previous contact with the parasite and the need to take specific measures to avoid infec…
. The detection of IgG without IgM indicates that the patient is immune as a consequence of an infection acquired at least 3 to …
. Equivocal IgG, in the “gray” zone, as defined by the manufacturer of the test, without IgM favors a past infection. Ideally, a…
. Isolated IgM without IgG can be an early marker of an acute infection, but, on a first serum specimen, false-positive IgM resu…
. The detection of IgG and IgM antibodies in the first prenatal test requires differentiating between two options: a long-standi…
Diagnostic Criteria for a Recent Infection
Possible Pitfalls
. As mentioned earlier, pregnant women can present with IgM antibodies that are not followed by the appearance of specific IgG, …
. Intravenous injection of immunoglobulins during pregnancy, to prevent fetal alloimmunization or for any other indication, can …
. Some patients exhibit very atypical seroconversion profiles in the course of their pregnancy, such as a switch from a negative…
Importance of Estimating the Stage of Gestation at the Time of Maternal Infection
. The serologic diagnosis of toxoplasmosis during pregnancy presents several characteristics that often complicate the interpret…
Infection in the Unborn Child
Risk and Severity
Antenatal Diagnosis
. In cases in which maternal seroconversion occurs during the pregnancy, ultrasound scans should be carried out monthly or every…
. Prenatal biologic diagnosis should be offered to pregnant women who seroconvert for toxoplasmosis during pregnancy or whose fe…
. Fetal blood sampling for the detection of nonspecific biologic signs (hypereosinophilia, high total IgM levels, thrombocytopen…
Treatment and Prevention of Infections in the Mother and the Unborn Child
Treatment in the Mother and Unborn Child
Indications
Drugs Available
Strategies for First-Line Treatment of Maternal Infections
In Utero Treatment of Proven Fetal Infection
. Abortion was frequently proposed in confirmed first-trimester fetal infections until the 1980s. The more general use of prenat…
Prevention of Toxoplasma Infection During Pregnancy
Primary Prevention in the Individual
. Educating pregnant women on the avoidance of Toxoplasma infection has the advantage of reducing both the human and financial c…
. Several prerequisites are essential for the effective education of pregnant women at risk. First, up-to-date information on th…
. Prevention relies on a set of recommendations based on the life cycle of the parasite and on factors that are traditionally as…
. Perinatal health professionals play a major role in the prevention of prenatal infections, including Toxoplasma. Only a few su…
. Providing physicians with prepared material would be useful to help them counsel their patients. It would also solve the probl…
. Information on what knowledge pregnant women have about the possibility of preventing Toxoplasma infection and on the precauti…
. A large number of recommendations have been circulated, not all of which are supported by solid evidence. These messages may m…
. Despite a large body of concordant evidence to the contrary,286,524,761 many people are under the misconception that owning a …
. Pregnant women who are exposed to specific risks in the course of their work, such as animal caretakers, including veterinaria…
Collective Efforts
Outlook for Vaccines
. The only commercial vaccine licensed solely for veterinary use is the live-attenuated tachyzoite of strain S48 (Toxovax).769 T…
. Studies in experimental mouse models reported that immunization against different antigens of T. gondii did not induce safe, l…
Infection in the Newborn
Clinical Evaluation
Clinical Presentation
Ophthalmologic Examination
Neonatal Neuroimaging
Differential Diagnosis
Particular Situations: Twin Pregnancy, Human Immunodeficiency Virus–Infected Mothers
. Congenital T. gondii infections in twins have been reported as clinical cases or small series.800,801 In monozygotic twin preg…
. In HIV-infected pregnant women, the reactivation of latent toxoplasmosis may lead to maternal-fetal transmission. The risk of …
Laboratory Diagnosis
Indirect Diagnosis by Detection of Antibodies
. Immunoglobulin G antibodies cross the placenta but are not a reliable marker of congenital infection in newborns because they …
. Neither IgM nor IgA cross the placenta; therefore their presence in newborn blood demonstrates congenital infection. Several s…
. The sensitivity of IgE antibody testing to detect congenital toxoplasmosis was 25% using an immunocapture method.823 With an E…
. This method was first described by Remington and associates,824 who reported specific band patterns of IgG and IgM in 50% of c…
Direct Detection of the Parasite
Cellular Immunity
Interpretation of Test Results to Make an Informed Decision Regarding Treatment
Postnatal Treatment
Anti-Toxoplasma Therapy (See “Drugs Active Against Toxoplasma gondii”)
Adjunctive Therapy
Breastfeeding
Management of Congenitally Infected Children and Long-Term Outcome
Serologic Follow-Up
In Treated Infants
In Untreated Infants
Long-Term Outcome
Ophthalmologic Evolution
. From the clinical picture of an ocular lesion, be it active or healed, it is virtually impossible to differentiate lesions res…
. Unbiased data derived from untreated cohorts are not available for European patients,874,875 and reports from American referra…
. Despite central localization of the lesion in up to 65% of instances, the overall functional prognosis of congenital toxoplasm…
. Any newly detected ocular lesion may be congenital or acquired in origin. In cases with confirmed congenital toxoplasmosis, th…
Neurologic Outcome
. The long-term neurologic outcome for untreated children has been studied in several series, the most recent of which are those…
Outcomes of Treated Congenital Toxoplasmosis. When present, systemic signs of active infection have regressed over a few weeks a…
Congenital Toxoplasmosis in Adults
Quality of Life and Visual Function in Adult Patients
Behavioral Abnormalities
Effectiveness of Current Approaches to Prevent Congenital Toxoplasmosis and Its Sequelae and Proposal for Improvement
Efficacy of Patient Education in the Primary Prevention of Maternal Infection
Efficacy of Secondary Prevention Through Treatment of Infection
Efficacy of Antenatal Treatment
. Prenatal screening was implemented in France and in Austria based on the belief that prompt treatment could reduce mother-to-c…
. The early treatment of an infected fetus is expected to reduce the risks of immediate and long-term lesions of toxoplasmosis. …
Efficacy of Postnatal Treatment
Screening
Option 1
Option 2
Option 3
Option 4
Proposal for Improvement
How Can You Counsel When You Do Not Know
Conclusion
Acknowledgments
References
32. Malaria and Less Common Protozoan and Helminth Infections.pdf (p.1045-1059)
32 – Malaria and Less Common Protozoan and Helminth Infections
Ascaris
Giardiasis
American Trypanosomiasis: Chagas Disease
The Organism
Epidemiology and Transmission
Pathology
Placenta
Biopsy and Autopsy Studies
Clinical Manifestations
Abortions and Stillbirths
Congenital Infections
Diagnosis
Prognosis for Recurrence
Therapy
Prevention
African Trypanosomiasis: African Sleeping Sickness
Entamoeba Histolytica
Malaria
The Organisms
Epidemiology and Transmission
Pathology
Effect of Pregnancy on Malaria
Infection of the Placenta
Effect of Malaria on Fetal Survival and Birth Weight
Influence of Maternal Antibody on Risk of Infection
Other Factors Influencing Risk of Infection
Congenital Malaria
Occurrence
Clinical Presentation
Treatment
Prevention
Schistosomiasis
Trichomonas Vaginalis
Trichinosis
Babesiosis
Pneumocystis Jirovecii
References
33. Candidiasis.pdf (p.1060-1081)
33 – Candidiasis
Epidemiology and Transmission
Microbiology
Pathogenesis
Pathology
Clinical Manifestations
Oropharyngeal Candidiasis
Diaper Dermatitis
Congenital Candidiasis
Invasive Fungal Dermatitis
Catheter-Related Candidal Infections
Candidemia and Disseminated Candidiasis
Renal Candidiasis
Central Nervous System Candidiasis
Candidal Ophthalmologic Infections
Spontaneous Intestinal Perforation
Diagnosis
Treatment
Antifungal Agents
Topical Antifungal Therapy
Systemic Antifungal Therapy
Amphotericin B. Amphotericin B deoxycholate is an antifungal agent available since 1958. The American Academy of Pediatrics Comm…
. As an alternative to standard amphotericin B, three lipid-associated formulations are approved for use in adults: liposomal am…
. 5-Fluorocytosine (5-FC) is a fluorinated analogue of cytosine. All pathogenic Candida spp. are susceptible to this agent, but …
. The azoles are a class of synthetic fungistatic agents that inhibit fungal growth. The most common side effects are alteration…
. Echinocandins are a novel class of antifungal drugs that act by a unique and completely fungal-specific mechanism—inhibition o…
Length of Therapy
Prognosis
Prevention
Fluconazole Prophylaxis
References
34. Pneumocystis and Other Less Common Fungal Infections.pdf (p.1082-1110)
34 – Pneumocystis and Other Less Common Fungal Infections
Pneumocystis jirovecii (Formerly Known as Pneumocystis carinii) Infection
History
The Organism
Epidemiology and Transmission
Pathology
Pathogenesis
Clinical Manifestations
General Considerations
Symptoms and Signs
. The onset of epidemic-type infection, essentially nonexistent in developed countries, in infants is reported to be slow and in…
. The typical clinical syndrome is less evident in sporadic cases of pneumocystosis occurring in infants with acquired or congen…
Radiologic Findings
Laboratory Studies
Concurrent Infection
Diagnosis
Examination of Pulmonary Secretions
Percutaneous Lung Aspiration
Lung Biopsy
Serologic Tests
Treatment
Specific Therapy
Supportive Care
Prognosis
Chronic Sequelae
Recurrent Infection
Prevention
Aspergillosis
The Organism
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis/Differential Diagnosis
Therapy
Prognosis
Prevention
Blastomycosis
The Organism
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Therapy
Prognosis
Prevention
Histoplasmosis
The Organism
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prognosis
Coccidiodomycosis
The Organism
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prognosis
Cryptococcosis
The organism
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prognosis
Malassezia
The Organism
Epidemiology and Transmission
Pathogenesis
Clinical Manifestations
Diagnosis
Treatment
Prognosis
Prevention
Zygomycosis
The Organism
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical ManifestationS
Treatment
Prognosis
Dermatophytoses
The Organism
Epidemiology and Transmission
Pathogenesis
Pathology
Clinical Manifestations
Diagnosis
Treatment
Prognosis
Prevention
References
35. Healthcare-Associated Infections in the Nursery.pdf (p.1111-1131)
35 – Health Care–Associated Infections in the Nursery
Special Issues for Neonates
Epidemiology
Incidence
Maternally Acquired Infections
Nonmaternal Routes of Transmission
Risk Factors for Health Care–Associated Infections
Patient-Related Factors
Medical Devices
Therapeutic Agents
Etiologic Agents
Coagulase-Negative Staphylococci
Other Gram-Positive Bacteria
Gram-Negative Bacteria
Multidrug-Resistant Organisms
Fungi
Viral Pathogens
Enteric Viruses
Respiratory Viruses
Enteroviruses
Cytomegalovirus
Herpes Simplex Virus
Varicella-Zoster Virus
Hepatitis A
Device-Related Infections
Catheter-Associated Bloodstream Infections
Epidemiology and Pathogenesis
Prevention and Control
Ventilator-Associated Pneumonia
Epidemiology and Pathogenesis
Prevention and Control
Catheter-Associated Urinary Tract Infections
Ventricular Shunt–Associated Infections
Preventing Transmission of Health Care–Associated Infections
Surveillance
Standard and Transmission-Based Precautions in the Nursery
Standard Precautions
. Hand hygiene plays a critical role in the prevention of HAIs.26,42,263 In 2009, the World Health Organization (WHO) published …
. It should be emphasized that wearing gloves does not replace the need for hand hygiene. Clean, nonsterile gloves are to be wor…
. The use of cover gowns during all routine patient care has been a common historical practice by personnel in nurseries and NIC…
. Nonsterile masks, face shields, goggles, and other eye protectors are worn in various combinations to provide barrier protecti…
. Standard precautions also require that reusable patient care equipment be cleaned and appropriately reprocessed between patien…
Transmission-Based Precautions
. Contact precautions involve the use of barriers to prevent transmission of organisms by direct or indirect contact with the pa…
. Droplet precautions are intended to reduce the risk of transmission during care of patients known or suspected to be infected …
. Airborne precautions are designed to reduce the risk of airborne transmission of infectious agents.23 Because of their small s…
Other Related Issues
Health Care Workers
Family-Centered Care
Breastfeeding
Visitors
Skin and Cord Care
References
36. Laboratory Aids for Diagnosis of Neonatal Sepsis.pdf (p.1132-1146)
36 – Laboratory Aids for Diagnosis of Neonatal Sepsis
Diagnostic Utility of Laboratory Tests
In Search of the Ideal Laboratory Test
Blood Cell Counts, Ratios, and Flow Cytometric Markers
Total Leukocyte Count, Differential Leukocyte Count, and Morphology
Absolute Neutrophil Count
Total Nonsegmented Neutrophil (Band) Count
Neutrophil Ratios
Platelet Count
Neutrophil and Lymphocyte Flow Cytometric Markers
Acute-Phase Reactants
Erythrocyte Sedimentation Rate and Miscellaneous Acute-Phase Reactants
C-Reactive Protein
Procalcitonin
Other Biomarkers of Host Inflammation
Cytokines and Chemokines
Adhesion Molecules and Cellular Receptors
Miscellaneous Analytes
Improvements in Pathogen Detection
Combination Diagnostic Screening Panels
Perspectives and Conclusions
Why Have We not Yet Identified a “Best Test”
What Must We Do Without an Identified “Best Test”
References
37. Clinical Pharmacology of Antiinfective Drugs.pdf (p.1147-1202)
37 – Clinical Pharmacology of Antiinfective Drugs
Basic Principles of Clinical Pharmacology
Optimizing Antimicrobial Therapy Using PK-PD Principles
Minimal Inhibitory Concentration
Pharmacokinetic Data
Pharmacodynamics
Pharmacokinetic-Pharmacodynamic Approach
Placental Transport of Antimicrobial Drugs
Medications Contraindicated or Considered to be High Risk in Pregnancy
Antiviral and Antifungal Medications in Pregnancy
Excretion of Antibiotics in Human Milk
Penicillin
Microbiologic Activity
Pharmacokinetic Data
Aqueous Penicillin G
Procaine Penicillin G
Benzathine Penicillin G
Cerebrospinal Fluid Penetration
Safety
PK-PD and Clinical Implications for Dosing
Ampicillin
Antimicrobial Activity
Pharmacokinetic Data
Cerebrospinal Fluid Penetration
Safety
PK-PD and Clinical Implications for Dosing
Antistaphylococcal Treatment
Antistaphlococcal Penicillins (Table 37-7)
Antimicrobial Activity
Pharmacokinetic Data (See Table 37-7)
Safety
PK-PD and Clinical Implications for Dosing (See Tables 37-6 and 37-7)
Methicillin-Resistant Staphylococcal Infections (MRSE and MRSA) (See Table 37-7)
Vancomycin (See Table 37-7)
Antimicrobial Activity
Pharmacokinetic Data (See Table 37-7)
Safety
PK-PD and Clinical Implications for Dosing (See Tables 37-6 and 37-7)
Linezolid (See Table 37-7)
Antimicrobial Activity
Pharmacokinetic Data (See Table 37-7)
Safety
PK-PD and Clinical Implications for Dosing (See Tables 37-6 and 37-7)
Clindamycin (See Table 37-7)
Antimicrobial Activity
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications for Dosing (See Tables 37-6 and 37-7)
Rifampin
Teicoplanin
Daptomycin
Aminoglycosides (Table 37-8)
History
Antimicrobial Activity
Pharmacokinetic Data
Gentamicin (See Table 37-8)
Tobramycin (See Table 37-8)
Amikacin (See Table 37-8)
Safety
PK-PD and Clinical Implications for Dosing (See Tables 37-6, 37-8, and 37-9)
Use of Extended-Dosing Intervals to Achieve Pharmacodynamic Exposure Targets (See Tables 37-6 and 37-9)
Aztreonam
Antimicrobial Activity
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications for Dosing
Cephalosporins
Antimicrobial Activity
Pharmacokinetic Data
Cefazolin (Table 37-10)
Cefuroxime (See Table 37-10)
Cefotaxime (See Table 37-10)
Cefepime (See Table 37-10)
Safety
PK-PD and Clinical Implications for Dosing
Broad-Acting Agents With Activity Against Pseudomonas or Anaerobes (See Table 37-10)
β-Lactam/β-Lactamase Inhibitor Antibiotics
Antimicrobial Activity
Piperacillin-Tazobactam
Antimicrobial Activity
Pharmacokinetic Data (See Table 37-10)
Safety
PK-PD and Clinical Implications for Dosing
Ticarcillin-Clavulanate (See Table 37-10)
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications for Dosing
Carbapenems (See Table 37-10)
Antimicrobial Activity
Pharmacokinetic Data
Imipenem-Cilastatin (Table 37-11)
Meropenem (See Table 37-11)
Safety
PK-PD and Clinical Implications for Dosing (See Table 37-11)
Metronidazole
Pharmacokinetics
Safety
PK-PD and Clinical Implications for Dosing
Antiviral Medications
Acyclovir for the Treatment of Herpes Simplex Virus
Pharmacokinetics
Safety
PK-PD and Clinical Implications for Dosing
Antimicrobial Activity
Pharmacokinetic Data
Safety
PK-PD and Clinical Indication
Oseltamivir for the Treatment of Influenza
Antimicrobial Activity
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications for Dosing
Antifungal Therapy
Meningoencephalitis
Amphotericin B
Antimicrobial Activity
Pharmacokinetic Data
Safety
PK-PD and Clinical Implication
Amphotericin B Lipid-Associated Formulations
Pharmacokinetic Data
Safety Data
PK-PD and Clinical Implications for Dosing
Pyrimidine Analogues: 5-Fluorocytosine
Pharmacokinetic Data
Safety
Clinical Implications
Azoles: Fluconazole and Voriconazole
Antimicrobial Activity
Fluconazole
Safety
PK-PD and Clinical Implications for Dosing
Voriconazole
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications
Echinocandins
Antimicrobial Activity
Micafungin
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications
Caspofungin
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications
Anidulafungin
Pharmacokinetic Data
Safety
PK-PD and Clinical Implications
Conclusions
References
38. Prevention of Fetal and Early Life Infections Through Maternal-Neonatal Immunization.pdf (p.1203-1227)
38 – Prevention of Fetal and Early Life Infections Through Maternal−Neonatal Immunization
Overall Principles
Obstacles to Neonatal Vaccination
Safety Concerns
Immunologic Immaturity
Maternal Antibodies
Interference
Logistics of Immunization Programs
Vaccine Strategies for Protecting Neonates Against Infection
Maternal Immunization
Maternal Immunization to Prevent Tetanus, Diphtheria, and Pertussis
Maternal Immunization to Prevent Influenza
Maternal Immunization to Prevent Respiratory Syncytial Virus Infection
Measles-Mumps-Rubella (MMR) Vaccine During Pregnancy
Maternal Vaccines in the Setting of Special Risk Factors
Maternal Vaccines for Group B Streptococci Under Development
Passive Immunization
Respiratory Syncytial Virus Immune Globulin and Monoclonal Antibodies
Hepatitis B Immune Globulin
Varicella-Zoster Immune Globulin (VZIG)
Cytomegalovirus Immune Globulin (CMV-IVIG)
Botulinum Immune Globulin
Active Immunization
Jennerian Vaccines
Attenuation of Live Human Viruses
Inactivated Vaccines
Toxoids
Subunit Proteins
Polysaccharide Vaccines
Combination Vaccines
Experimental Approaches
. Immunologic adjuvants are substances that enhance the magnitude, induction, or durability of antigen-specific immune responses…
. Various routes of inoculation are used for immunization, depending on the mechanism of action, convenience, and the technology…
. The age of vaccine recipients and presence or absence of passively acquired maternal antibodies greatly affects response to va…
. Most infant vaccines are not actually administered during the neonatal period; however, there are a few notable exceptions. BC…
Specific Vaccines for Infants
Bacillus Calmette-Guérin
Diphtheria
Pertussis
Tetanus
Poliovirus
Varicella-Zoster Virus
Measles Virus Vaccines
Mumps Virus Vaccine
Rubella Virus Vaccine
Hepatitis B Vaccines
Hepatitis A Vaccines
Influenza Virus Vaccine
Streptococcus pneumoniae Vaccines
Rotavirus Vaccines
Haemophilus influenzae Type B (Hib) Vaccine
Neisseria meningitidis Vaccines
Premature Infants
Rotavirus
Influenza
Tetanus-Reduced–Diphtheria–Acellular Pertussis (Tdap) Vaccine
Regulation of Vaccines and Advisory Bodies
References

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