MICROBIOLOGY ASPECTS ON

FETOMATERNAL
INFECTION (2)

Department of Microbiology
Faculty of Medicine
Diponegoro University
2018
 OBJECTIVES
• Describe “Others” agents causing intrauterine and
perinatal infections (Chlamydia, Parvovirus B19,
Varicella-Zoster (VZV), HIV, Hepatitis B, Hepatitis C)
• Describe agents increasing morbidity/mortality on
fetomaternal and perinatal (GBS, E.coli,
Gonorrhoeae, Mycoplasma, Bacterial vaginosis,
Candidiasis, Zika virus)
• Know the clinical manifestations, microbiology
diagnosis, therapy, and prevention
MICROBIOLOGY ASPECTS ON FETOMATERNAL INFECTION

DESCRIPTION OF THE AGENTS

 Human Immunodeficiency Virus (HIV)
• Infected mother 25% chance fetus being infected
by the virus
• Fetus more likely be infected if mother:
– High viremia, Has developed AIDS, Low CD+count
• 50% infants are infected during late pregnancy or
during delivery  Treatment of :
– Mother during the last half of their pregnancy and during
the birthing process
– Infant for 6 weeks following delivery
lower the infection rate sinificantly
Human Immunodeficiency Virus (HIV)
Clinical Manifestations
• Manifestations of congenital, intrapartum, or
postpartum infections:
– failure to thrive, fever, hepatomegaly,
splenomegaly, lymphadenopathy, frequent
opportunistic infections (oral thrush)
• Many infants infected with HIV do not have
any symptoms until opportunistic infections
start occurring  laboratory diagnostic is
substantial
 Human Immunodeficiency Virus (HIV)
Laboratory diagnosis in infants (The 2010 Panel on
Antiretroviral Therapy and Medical Management of HIV-Infected Children):
• maternal HIV antibody can be persistent up to 18
months  infants < 18 months require virologic assays
(HIV bDNA PCR and HIV RNA assays) at 14 days, 1
month, and 4 months.
• Children > 18 months and older, HIV antibody assays can
be used for diagnosis
• HIV p24 antigen assay for infant diagnosis is not
recommended because the sensitivity and specificity of
the assay in the first months of life is <<
Human Immunodeficiency Virus (HIV)
Prevention of Mother to Child Transmission
(PMTCT)
PMTCT :
- Prevention of HIV transmission to women
- Prevention of unwanted pregnancy in HIV+ women
- Antiretroviral (zidovudine, lamivudine, nevirapine)
- for pregnant HIV+ in the late pregnancy and during
birthing
- For babies : immediately after birth – 6 weeks
- No breast feeding, or exclusive breast feeding if
formula milk is not affordable
 Parvovirus B19
• Cause Erythema infectiosum (slapped cheek
syndrome/ the fifth disease in young children)
• A non-immune pregnant women can become
infected and the infection can infect the fetus
in utero (rare)
• Infect foetal erythroblast  severe anemia
• Infections in utero can result in fetal death
(rare), nonimmune fetal hydrops (uncommon),
birth defects (eyes, CNS), and prematurity.
 Hepatitis B virus
• Hepatitis B infection during pregnancy 
– increase prematurity and low birth weight
– Increase transmission to the babies (in utero
(10%) and perinatally
• Most infections are asymptomatic in the infant are
much more likely to develop into chronic hepatitis
and hepatocellular carcinoma
• Symptomatic infants may have hepatomegaly,
splenomegaly, jaundice, and/or icterus
 Varicella Zoster Virus (VZV)
• Quite rare (about 5 cases/10,000 births)
• More fetal deaths occur if the fetus is infected
in the 1st or 2nd trimester (30% )
• congenital varicella syndrome (CVS):
– skin lesions in dermatomal distribution (76%),
– neurologic defects (60%)
– eye diseases (51%)
– skeletal anomalies (49%)
• .
 S. agalactiae (Group B
Streptococcus) and E.coli
• The two most commonly associated with
neonatal sepsis and meningitis
• Diagnosis (based first on clinical suspicion)
– a history of recent maternal febrile illness
immediately before or at birth
– fetal distress, prolonged rupture of membranes
(>12hours), foul-smelling amniotic fluid, and
premature delivery
 GBS and E.coli (2)
• The first signs and symptoms of illness in the
infant :
– Respiratory distress, apneic episodes, cyanosis,
irritability, unexplained jaundice, tachycardia, poor
feeding, abdominal distention, and fever
• Initial laboratory findings :
– leukocytosis, with an increased proportion of
immature neutrophils, or leukopenia
 GBS and E.coli (3)
• Culture of CSF and blood followed by
empirical antimicrobial therapy (ampicilllin for
the streptococci and an aminoglycoside such
as gentamicin for E.coli)
 Other Bacterial and Chlamydial
Infections
• N. gonorrhoeae and C. trachomatis produce
a severe conjunctivitis in the newborn (<5
days: gonococcal ophtalmia, >5 days:
chlamydial conjunctivitis)
 Other Bacterial and Chlamydial
Infections
• C. trachomatis infection infant pneumonia
syndrome (2 weeks-6 mos)
• S. aureus staphylococcal scalded skin
syndrome (SSSS)
 Other Bacterial and Chlamydial
Infections
• The genital mycoplasma  spontaneous
preterm labour and preterm birth
• M. hominis  post-partum and post-abortal
sepsis
• Ureaplasma sp  chronic lung disease or
death in very low birthweight infants
Candidiasis
 Bacterial Vaginosis
• Bacterial vaginosis often occurs during
pregnancy
• may cause premature labor and delivery,
premature rupture of membranes (PROMs),
and postpartum uterine infections
MICROBIOLOGY ASPECTS ON FETOMATERNAL

CLINICAL MANIFESTATIONS
 Manifestations of “OTHERS” in
CONGENITAL INFECTIONS
Effect Sof Infection on the Fetus and Newborn Infant

Agents Prematurity IUGR IUFD Develop- Congenital Persistant

mental Disease Postnatal
Anomalies Infection
VZV - + - + + +
Hep.B + - - - - +
HIV + + - - + +
Parvovirus - - + - + -
B19
 Manifestations of “OTHERS” in
CONGENITAL INFECTIONS
Syndromes in the Neonate Caused by Congenital Infections

Microorganism Signs
VZV Limb abnormalities, cicatrical lesions
Parvovirus B19 Diffuse edema (in utero hydrops fetalis)
HIV Severe thrush, failure to thrive, recurrent
bacterial infections, calcification of the basal
ganglia
Manifestations of bacterial infection
Acquired In Utero or at Delivery

Microorganis Clinical Signs

m
S. agalactiae • Hepatosplenomegaly
(GBS) • Jaundice
E.coli • Pneumonitis
• Petechiae/purpura
• Meningoencephalitis
 Perinatal Infections Manifestations
Microorganism Clinical Signs
S. pyogenes (GAS) sepsis, pneumonia, meningitis
S. agalactiae (GBS) sepsis, pneumonia, meningitis
Enterococcus spp. urinary tract infections, sepsis
E. coli sepsis, meningitis, pneumonia
N. gonorrhoeae opthalmia neonatorium, sepsis
L. monocytogenes sepsis, meningitis, diarrhea
C. trachomatis pneumonia and/or conjuctivitis
CMV usually asymptomatic
HSV (type 2) encephalitis
Hep B virus usually asymptomatic, but can have symptoms similar to
adults
Candida albicans mucocutaneus (common;thrush) and lung (rare) infections
MICROBIOLOGY ASPECTS ON FETOMATERNAL

DIAGNOSIS
 DIAGNOSIS
• Asymptomatic or subclinical infections are
commonly seen in congenital infections
• Only 50% of women infected with Rubella
present with rash
• << pregnant women have signs and symptoms
of CMV mononucleosis
• The genital lesions of HSV and syphilis
unrecognized
• Bacterial vaginosis : Amsel criteria (3 of 4)
1.Vaginal discharge is thin and homogenous
2.pH vagina > 4,5
3.“Whiff" test (drop KOH on vaginal discharge 
fishy odour
4.Clue cell : squamous epithelial cell with
abundant coccobacili attaching on the cell
surface
MICROBIOLOGY ASPECTS ON FETOMATERNAL

THERAPY
 TREATMENT
• Depends on the infection
• Congenital syphilis penicillin
• Meningitis  appropriate antibiotics
• CMV Ganciclovir for CMV
• HSV infections Acyclovir
• HepB HBIg
• Fungal infections antifungal
• VZV  VZV Ig
MICROBIOLOGY ASPECTS ON FETOMATERNAL

PREVENTION
 PREVENTION (1)
• PREGNANT WOMEN SHOULD AVOID:
– Contact with ill people (particularly if
seronegatives)
– Eating raw or undercooked meat (may contain
T.gondii, Campylobacter fetus, L.monocytogenes,
Salmonella spp.)
– Contact with cat feses
– Having sex with partner who has had genital
herpes or HIV
 PREVENTION (2)
• HIV (+) women ART during pregnancy and delivery;
treat the newborn
• Discouraging breastfeeding in HIV and HepB infected
mothers (or exclusive breast feeding when formula
milk is not affordable)
• Treat pregnant women that GBS culture (+) and or
premature membrane rupture during labor
• Chloramphenicol eye drops are given as
gonobleorrhae prophylactic
 PREVENTION (3)
• Seronegative women planning for pregnancy
 immunizations for Rubella, Hepatitis, and
VZV
– Live attenuated viral vaccine (MMR, VZV): at least
3-6 months before conception
– No live attenuated viral vaccine should be given to
a pregnant women!