Cytomegalovirus (CMV) is the leading cause of congenital infection and the most common cause of non-genetic sensorineural hearing loss (SNHL) in childhood. Although most infected infants are asymptomatic at birth, the risk for SNHL and other neurodevelopmental morbidity makes congenital CMV (cCMV) a disease of significance. Adherence to hygienic measures in pregnancy can reduce risk for maternal CMV infection. The prompt identification of infected infants allows early initiation of surveillance and management. A multidisciplinary approach to management is critical to optimize outcomes in affected infants.

Group A Streptococcus (GAS) pharyngitis is a common clinical syndrome in primary care, yet controversy remains regarding the best approach to diagnosis and treatment, including the benefits of antibiotics. Children who are likely to have GAS pharyngitis based on history or physical examination should have a throat swab and, when positive, be treated with amoxicillin or penicillin. The disproportionate burden of acute rheumatic fever in Indigenous populations in Canada and special considerations for testing and treatment are discussed.

Le cytomégalovirus (CMV) est la principale cause d’infection congénitale et la première cause de surdité de perception d’origine non génétique pendant l’enfance. Même si la plupart des nouveau-nés infectés ne sont pas symptomatiques à la naissance, l’infection congénitale à cytomégalovirus est une affection importante, en raison du risque de surdité de perception et des autres atteintes neurodéveloppementales qui s’y associent. Le respect des mesures d’hygiène pendant la grossesse peut réduire le risque d’infection de la mère par le CMV. Grâce au dépistage rapide, il est possible de vite entreprendre la surveillance et la prise en charge des nouveau-nés infectés. Il est essentiel d’adopter une prise en charge multidisciplinaire pour optimiser le pronostic des nouveau-nés atteints.

IntroductionTrichomonas vaginalis (TV) is not common in the UK, with under 7,000 cases in 2015. It is associated with poor pregnancy outcomes, and consensus on treatment pathways in persistent infection is needed. We present 3 cases of TV infection in pregnancy from 2 UK centres.MethodsA retrospective review of electronic case records was performed.ResultsThe median age was 21 years (range 20–31), with a median presentation at 13 weeks (range 7–22). Discharge was the main presenting symptom. Initial microscopy was performed in 2/3 and was positive; culture was positive in 3/3. All patients initially received oral Metronidazole 400mg twice daily for 5–7 days. At test of cure (TOC), one patient (Pt 1) remained positive, the second (Pt 2) did not attend, and the third (Pt 3) was negative. However, Pt 2 and Pt 3 re-presented after 5 weeks and 3 months, respectively: Pt 2 reported poor adherence; Pt 3 denied poor adherence or re-infection risk. All underwent further treatment. Pt 1 required 3 treatment courses before cure was achieved, with Metronidazole 800mg tds for 1 week. Pt 2 received 4 courses of oral or IV Metronidazole; she awaits TOC. Pt 3 received 5 different antibiotic courses, then opted to deliver and wean her baby before re-engaging with care. All denied re-infection risk after the second treatment.DiscussionFactors that contribute to persistent TV infection in pregnancy include re-infection, poor adherence, resistance, poor engagement, and concerns about teratogenicity. Further research is needed to identify the optimal treatment strategy.

La pharyngite à streptocoque du groupe A est un syndrome clinique courant en première ligne, mais une controverse subsiste quant à la meilleure démarche diagnostique et thérapeutique, y compris les bienfaits des antibiotiques. Les enfants qui, d’après l’anamnèse ou l’examen physique, risquent de souffrir de ce type de pharyngite, doivent se soumettre à un écouvillonnage de la gorge et recevoir un traitement à l’amoxicilline ou à la pénicilline lorsque le résultat est positif. Le fardeau disproportionné du rhumatisme articulaire aigu dans les populations autochtones du Canada et les considérations particulières en matière de tests et de traitements sont présentés.