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Perinatal infections- Diagnosis & Management

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Update on diagnosis & treatment of Perinatal infections

Publicado en: Salud y medicina
  • About 2 years ago, I developed a severe case of vaginal yeast infection that would not let up. The itching, burning and swelling of my labia were simply unbearable. I have purchased several over-the-counter treatments, including Monistat cream to subside the symptoms. While it worked initially, eventually things wore off and left me with an even worse infection than before. The same goes for the antibiotics I took with the advice of my doctor. I felt horrible. After doing some research online, I guessed I had a yeast infection and purchased your program. The results were almost instantaneous. In less than 7 hours, I felt a tremendous relief. Two weeks later and I became completely free from the unbearable vaginal itching, burning, swelling and discharge. Using your methods, I have kept my chronic yeast infection at bay ever since. No more drugs or OTC�s for me.  http://scamcb.com/index7/pdf
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  • This program is a must read for anyone suffering from Candida or ones like me who has ever taken antibiotics and is now experiencing any of the many problems that go along with intestinal flora imbalance. I must also add that several people in my church have been following this book and are doing great! ★★★ http://scamcb.com/index7/pdf
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  • About 2 years ago, I developed a severe case of vaginal yeast infection that would not let up. The itching, burning and swelling of my labia were simply unbearable. I have purchased several over-the-counter treatments, including Monistat cream to subside the symptoms. While it worked initially, eventually things wore off and left me with an even worse infection than before. The same goes for the antibiotics I took with the advice of my doctor. I felt horrible. After doing some research online, I guessed I had a yeast infection and purchased your program. The results were almost instantaneous. In less than 7 hours, I felt a tremendous relief. Two weeks later and I became completely free from the unbearable vaginal itching, burning, swelling and discharge. Using your methods, I have kept my chronic yeast infection at bay ever since. No more drugs or OTC�s for me. ➤➤ https://tinyurl.com/y4uu6uch
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  • Hello, I'm 45 and have battled with severe Yeast Infection for the last nine years. A month and a half ago, I stumbled across your Yeast Infection No More program. I had my doubts and didn't think it was the right program for my Yeast Infection or if it was going to work at all, but I did order it because I'll do anything to rid myself of this crippling condition. Over 3 week period, I have seen an improvement that I had never experienced with any other conventional or so called natural treatment. The non-stop vaginal itching and burning have stopped. My skin looks significantly better and I slowly got rid of the psoriasis on my right elbow that I had for years. I can now save the money that I would have wasted on drugs like Monistat and Diflucan. Your suggestions have kept my vaginal yeast infections as well as the other candida related symptoms at bay incredibly well! I also lost about 15 lbs! I am feeling so healthy, too. ●●● https://tinyurl.com/y3flbeje
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  • Njce! Thanks for sharing.
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Perinatal infections- Diagnosis & Management

  1. 1. Dr. Padmesh
  2. 2. • INTRODUCTION: • Important cause of still births and morbidity • Many diseases go undiagnosed • Appropriate treatment can prevent morbidity/mortality • 1971: Andres Nahmias proposed acronym ToRCH • 1975: Harold Fuerst added Syphilis to the acronym.
  3. 3. • ACRONYM: TORCHES CLAP -TOxoplasmosis -Chickenpox -Rubella -Lyme disease -CMV -AIDS -Herpes simplex -Parvovirus B19 -Enterovirus -Syphilis • Latest addition: Zika virus
  4. 4. • Toxoplasma: • Diagnosis : • IgG, IgM, IgA (Serum/CSF) • PCR • Ophthalmologic, auditory, and neurologic examinations • CT Brain Redbook American Academy of Pediatrics. 2012. p. 720–8.
  5. 5. • Toxoplasma: Investigations Normal Negative Abnormal TREAT FOR 12 MONTHS Positive Repeat IgG after 6 months
  6. 6. • Toxoplasma: • Treatment : • Pyrimethamine, sulphadiazine and folinic acid for a duration of 1 year.
  7. 7. • Toxoplasma: • Prevention- counselling : – Avoid raw/undercooked meat – wash hands after gardening – wash raw vegetables – minimise contact with young kittens and their litter etc
  8. 8. • Rubella: • In Maternal infection: - No treatment available 1st Trimester: Consider termination. 2nd Trimester: Consider fetal testing. After 20 wks gestation: Rarely causes CRS
  9. 9. • Rubella: • Diagnosis : • Isolation of virus by PCR or culture • Rubella-specific IgM (False positivity +/-) • Increasing IgG over first 7 to 11 months of life. • Avidity testing of IgG • Rubella virus RNA by reverse transcriptase PCR in nasopharyngeal swabs, urine, CSF, and blood at birth
  10. 10. • Rubella: • Diagnosis : Avidity: • Strength with which IgG binds to antigenic epitropes expressed by a specific protein. • Gradually matures over months. • IgG produced in first few months following primary infection  Low avidity (Bind weakly to Ag) • Therefore, LOW IgG avidity is a marker of RECENT PRIMARY infection. • High avidity excludes primary infection in preceding 3 months.
  11. 11. • Rubella: • Diagnosis : Avidity:
  12. 12. • Rubella: • Diagnosis : AT BIRTH: • Ophthalmology screening, • Cardiac screening • Hearing assessments FOLLOW UP UPTO 12 MONTHS
  13. 13. • Rubella: • Treatment : • No specific treatment • Breast feeding not contraindicated • Prevention: • Vaccination
  14. 14. • CMV: • Diagnosis : • Virus culture from urine/saliva • CMV-DNA PCR in urine, blood, saliva and CSF • CMV IgM antibodies in blood before 3 weeks of age. • IgG Avidity testing Rev Med Virol 2010;20(4): 202–13.
  15. 15. • CMV: Treatment : Virologically proven CMV in Newborn Underlying Immune disorder Treat as Life threatening infection Immunocompetent Life threatening symptoms Non-Life threatening symptoms No Symptoms No treatment
  16. 16. Life Threatening infection IV Ganciclovir for 4-6 weeks Oral Valganciclovir for 6 months Non-Life threatening infection • CMV: Treatment : Continue for 12 months/ Change in regimen Viremia at 6 mths
  17. 17. • CMV: • Treatment : • Foscarnet, Cidofovir for refractory CMV/ Ganciclovir resistance
  18. 18. • HSV: • Diagnosis : • Surface cultures: HSV culture on swab specimens from mouth, nasopharynx, conjunctivae, and anus 12-24 hours after birth • HSV culture & PCR from any skin vesicle present • HSV PCR on CSF and whole blood
  19. 19. • HSV: START EMPIRICAL IV ACYCLOVIR Diagnostic evaluation of Newborn Positive SEM disease CNS/ Disseminated Negative IV Acyclovir for 14 days IV Acyclovir for 21 days IV Acyclovir for 10 days
  20. 20. • HSV: • Treatment: • After completion of parenteral therapy  suppressive course of oral acyclovir for 6 months
  21. 21. • HSV: • 85% neonatal HSV are acquired perinatally. • True intrauterine infection  5% • Careful speculum examination for active genital HSV • Caesarean section reduces risk of HSV transmission
  22. 22. • Syphilis: • Diagnosis : • Adequacy of maternal treatment • Examination of placenta/umbilical cord for pathology • Dark field microscopy of suspicious lesions/body fluid • Clinical findings suggestive of syphilis: Non immune hydrops/ jaundice/ hepatosplenomegaly/ rhinitis/ skin rash • Quantitative VDRL / RPR (FTA-ABS or TPHA not required) BMC Public Health 2011;11(Suppl 3):S9.
  23. 23. • Syphilis: Treatment : PHYSICAL EXAM SUGGESTIVE OF CONGENITAL SYPHILIS BABY’S VDRL/RPR 4 TIMES HIGHER TITRE THAN MOTHER MOTHER NOT TREATED OR INADEQUATELY TREATED INJ. PENICILLIN G OR PROCAINE PENICIILIN FOR 10 DAYS ADDL TESTS: CSF VDRL, LONG BONE XRAY, OPHTHAL EVALUATION, BERA
  24. 24. • Syphilis: Treatment : PHYSICAL EXAM NORMAL BABY’S VDRL/RPR LESS THAN 4 TIMES MOTHER’S TITRE MOTHER NOT TREATED OR INADEQUATELY TREATED INJ. PENICILLIN G OR PROCAINE PENICIILIN FOR 10 DAYS ADDL TESTS: CSF VDRL, LONG BONE XRAY, OPHTHAL EVALUATION, BERA
  25. 25. • Syphilis: Treatment : PHYSICAL EXAM NORMAL BABY’S VDRL/RPR LESS THAN 4 TIMES MOTHER’S TITRE MOTHER NOT TREATED OR INADEQUATELY TREATED INJ. BENZATHINE PENICILLIN 50000 U/Kg/dose IM SINGLE DOSE ADDL TESTS: CSF VDRL, LONG BONE XRAY, OPHTHAL EVALUATION, BERA
  26. 26. • Syphilis: Treatment : PHYSICAL EXAM NORMAL BABY’S VDRL/RPR LESS THAN 4 TIMES MOTHER’S TITRE MOTHER ADEQUATELY TREATED DURING PREGNANCY NO TREATMENT REQUIRED IF FOLLOW-UP IS CERTAIN ELSE, INJ. BENZATHINE PENICILLIN 50000 U/Kg/dose IM SINGLE DOSE NO FURTHER EVALUATION
  27. 27. • Varicella: -7 -5-6 -2-4 -3 +1-1 +3+2 +4
  28. 28. • Varicella: -7 -5-6 -2-4 -3 +1-1 +3+2 +4 Newborn will have protective antibodies Likelihood of severe disease is low - Do not separate baby from mother - Continue breast feeding - No VZIG -Acyclovir if baby develops rash
  29. 29. • Varicella: -7 -5-6 -2-4 -3 +1-1 +3+2 +4 Newborn will not have protective antibodies Likelihood of severe disease is high -Separate baby from mother -If baby devps rash  stay with mother -VZIG within 72 hours -Acyclovir
  30. 30. • Varicella: -7 -5-6 -2-4 -3 +1-1 +3+2 +4 Newborn will not have protective antibodies But, likelihood of severe disease is low -Separate baby from mother -If baby devps rash  stay with mother -No VZIG -Acyclovir if baby develops rash
  31. 31. • TB: MOTHER WITH TB ON TREATMENT/ NO TREATMENT TREATMENT COMPLETED LOOK FOR CLINICAL EVIDENCE OF CONGENITAL TB ABSENT PRESENT ABSENT CXR, 3 GASTRIC ASPIRATES CXR, LP 3 GASTRIC ASPIRATES Treat : HRZE INH PROPHYLAXIS MANTOUX AT 3 MONTHS FOLLOW UP AND EVALUATE FOR CLINICAL EVIDENCE TILL 6 MONTHS
  32. 32. • TB: • Reassure the mother to breast feed the baby • Separation of mother & baby required only if mother – is sick – non adherent to treatment – has MDR TB
  33. 33. • CONCLUSION: • Universal vaccination. • Prompt recognition and management. • Public health measures: antenatal screening for syphilis, HIV and hepatitis B . • Good hygiene

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