Vertically transmitted infection

Vertically transmitted infection

Perinatal infection
Classification and external resources

Micrograph of cytomegalovirus (CMV) infection of the placenta (CMV placentitis), a vertically transmitted infection. The characteristic large
nucleus of a CMV infected cell is seen off-centre at the bottom-right of the image. H&E stain.
ICD-10

P35

ICD-9

771

[1]

-P39

[2]

[3]

A vertically transmitted infection is an infection caused by bacteria, viruses or, in rare cases, parasites transmitted
directly from the mother to an embryo, fetus or baby during pregnancy or childbirth. It can occur when the mother
gets an infection as an intercurrent disease in pregnancy.
Nutritional deficiencies may exacerbate the risks of perinatal infection.

Classification
The transmission can also be called mother-to-child transmission.
A vertically transmitted infection can be called a perinatal infection if it is transmitted in the perinatal period, which
is the period starting at a gestational age of 22[4] to 28[5] weeks (with regional variations in the definition) and ending
7 completed days after birth.
The term congenital infection can be used if the vertically transmitted infection persists after childbirth.

Examples
Several vertically transmitted infections are included in the TORCH complex, which stands for:
1.
2.
3.
4.
5.

T Toxoplasmosis / Toxoplasma gondii

O Other infections (see below)
R Rubella
C Cytomegalovirus
H Herpes simplex virus-2 or neonatal herpes simplex

The "other agents" under O include:

Coxsackievirus
Chickenpox (caused by varicella zoster virus)
Parvovirus B19
Chlamydia

Vertically transmitted infection

HIV
Human T-lymphotropic virus
Syphilis
Hepatitis B may also be classified as a vertically transmitted infection, but the hepatitis B virus is a large virus and
does not cross the placenta, hence it cannot infect the fetus unless there have been breaks in the maternal-fetal
barrier, such as can occur in bleeding during childbirth or amniocentesis.[6]
The TORCH complex was originally considered to consist of the four conditions mentioned above, with the "TO"
referring to "Toxoplasma". The four-term form is still used in many modern references, and the capitalization
"ToRCH" is sometimes used in these contexts. The acronym has also been listed as TORCHES, for
TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, Syphilis.
A further expansion of this acronym, CHEAPTORCHES, was proposed by Ford-Jones and Kellner in 1995:

C Chickenpox and shingles

H Hepatitis B, C, (D), E
E Enteroviruses
A AIDS (HIV infection)
P Parvovirus B19
T Toxoplasmosis / Toxoplasma gondii

O Other (Group B Streptococcus, Listeria, Candida, Lyme disease)

R Rubella
C Cytomegalovirus
H Herpes simplex
E Everything else sexually transmitted (Gonorrhea, Chlamydia, Ureaplasma urealyticum, Human
papillomavirus)
S Syphilis

Signs and symptoms

The signs and symptoms of a vertically transmitted infection depend on the individual pathogen. It may cause subtle
signs such as a influenza-like illness and may not even be noticed by the mother during the pregnancy. In such cases,
the effects may be seen first at birth.
Symptoms of a vertically transmitted infection may include fever and poor feeding. The newborn is often small for
gestational age. A petechial rash on the skin may be present, with small reddish or purplish spots due to bleeding
from capillaries under the skin. An enlarged liver and spleen (hepatosplenomegaly) is common, as is jaundice.
However, jaundice is less common in Hepatitis B because a newborn's immune system is not developed well enough
to mount a response against liver cells, as would normally be the cause of jaundice in an older child or adult. Hearing
impairment, eye problems, mental retardation, autism, and death can be caused by vertically transmitted infections.
The mother often has a mild infection with few or no symptoms.
It is possible for genetic conditions (Aicardi-Goutieres syndrome) to present in a similar manner.

Vertically transmitted infection

Causes
The main routes of transmission of vertically transmitted infections are across the placenta (transplacental) and
across the female reproductive tract during childbirth:

Transplacental
The embryo and fetus have little or no immune function. They depend on the immune function of their mother.
Several pathogens can cross the placenta and cause (perinatal) infection. Often microorganisms that produce minor
illness in the mother are very dangerous for the developing embryo or fetus. This can result in spontaneous abortion
or major developmental disorders. For many infections, the baby is more at risk at particular stages of pregnancy.
Problems related to perinatal infection are not always directly noticeable.

During childbirth
Babies can also become infected by their mother during birth. Some infectious agents may be transmitted to the
embryo or fetus in the uterus, while passing through the birth canal or even shortly after birth. The distinction is
important because when transmission is primarily during or after birth, medical intervention can help prevent
infections in the infant.
During birth, babies are exposed to maternal blood and body fluids without the placental barrier intervening and to
the maternal genital tract. Because of this, blood-borne microorganisms (Hepatitis B, HIV), organisms associated
with sexually transmitted disease (e.g., Gonorrhoea and Chlamydia), and normal fauna of the genito-urinary tract
(e.g., Candida) are among those commonly seen in infection of newborns.

Pathophysiology
Virulence versus symbiosis
In the spectrum of optimal virulence, vertical transmission tends to evolve benign symbiosis. It is therefore a critical
concept for evolutionary medicine. Because a pathogen's ability to pass from parent to child depends significantly on
the hosts' ability to reproduce, pathogens' transmissibility tends to be inversely related with their virulence. In other
words, as pathogens become more harmful to and thus decrease the reproduction rate of their host organism, they are
less likely to be passed on to the hosts' offspring, since there will be fewer offspring.
Although AIDS is sometimes transmitted through perinatal transmission, its virulence can be accounted for by the
fact that its primary mode of transmission is not vertical. Moreover, medicine has further decreased the frequency of
vertical transmission of AIDS. The incidence of perinatal AIDS cases in the United States has declined as a result of
the implementation of recommendations on HIV counselling and voluntary testing practices and the use of
zidovudine therapy by providers to reduce perinatal HIV transmission.
The price paid in the evolution of symbiosis is, however, great: for many generations, almost all cases of vertical
transmission will continue to be pathologicalin particular if there are any other routes of transmission. It takes
many generations of random mutation and selection to evolve symbiosis. During this time, the vast majority of
vertical transmission cases will exhibit the initial virulence.[citation needed]
In Dual Inheritance Theory, vertical transmission refers to the passing of cultural traits from parents to children.

Vertically transmitted infection

Diagnosis
When physical examination of the newborn shows signs of a vertically transmitted infection, the examiner may test
blood, urine, and spinal fluid for evidence of the infections listed above. Diagnosis can be confirmed by culture of
one of the specific pathogens or by increased levels of IgM against the pathogen.

Treatment and prevention

Some of the vertically transmitted infections, such as toxoplasmosis
and syphilis, can be effectively treated with antibiotics if the mother is
diagnosed early in her pregnancy. Many of the viral vertically
transmitted infections have no effective treatment, but some, notably
rubella and varicella-zoster, can be prevented by vaccinating the
mother prior to pregnancy.
If the mother has active herpes simplex (as may be suggested by a pap
test), delivery by Caesarean section can prevent the newborn from
contact, and consequent infection, with this virus.
It has been suggested that IgG2 antibody can play crucial role in
prevention of intrauterine infections and currently extensive research is
going on for developing IgG2 based therapies for treatment and
vaccination.[7]

Micrograph of a pap test showing changes

(upper-right of image) associated with herpes
simplex virus, a vertically transmitted infection.

Prognosis
Each type of vertically transmitted infection has a different prognosis. The stage of the pregnancy at the time of
infection also can change the effect on the newborn.

Additional images

CMV placentitis.

CMV placentitis.

Vertically transmitted infection

References
[1]
[2]
[3]
[4]

http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ P35
http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ P39
http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=771
Definitions and Indicators in Family Planning. Maternal & Child Health and Reproductive Health. (http:/ / test. cp. euro. who. int/ document/
e68459. pdf) By European Regional Office, World Health Organization. Revised March 1999 & January 2001. In turn citing: WHO Geneva,
WHA20.19, WHA43.27, Article 23
[5] Singh, Meharban (2010). Care of the Newborn. p. 7. Edition 7. ISBN 9788170820536
[6] Hepatitis B (http:/ / www. who. int/ csr/ disease/ hepatitis/ whocdscsrlyo20022/ en/ index1. html) by World Health Organization (WHO),
retrieved November, 2011
[7] Syal K* and Karande AA. IgG2 Subclass Isotype Antibody and Intrauterine Infections. Current Science Vol. 102, No. 11, 10 June 2012.

Article Sources and Contributors

Article Sources and Contributors

Vertically transmitted infection Source: http://en.wikipedia.org/w/index.php?oldid=597568411 Contributors: Arcadian, Arthena, DadaNeem, Emble64, Facts707, Herbee, KillerChihuahua,
Kirtimaansyal, LT910001, Lucien504, Mikael Hggstrm, Qetuth, SingleIntegral, TenPoundHammer, Una Smith, Wouterstomp, 3 anonymous edits

Image Sources, Licenses and Contributors

File:CMV placentitis1_mini.jpg Source: http://en.wikipedia.org/w/index.php?title=File:CMV_placentitis1_mini.jpg License: Creative Commons Attribution-Sharealike 3.0 Contributors:
Nephron
Image:Herpes simplex virus pap test.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Herpes_simplex_virus_pap_test.jpg License: Creative Commons Attribution-Sharealike 3.0
Contributors: Nephron
Image:CMV_placentitis1.jpg Source: http://en.wikipedia.org/w/index.php?title=File:CMV_placentitis1.jpg License: Creative Commons Attribution-Sharealike 3.0 Contributors: Nephron
Image:CMV_placentitis2.jpg Source: http://en.wikipedia.org/w/index.php?title=File:CMV_placentitis2.jpg License: Creative Commons Attribution-Sharealike 3.0 Contributors: Nephron

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