No abstract

Among the classic pathogens of congenital infection, herpes simplex viruses type 1 and type 2 play important role. Neonatal herpes develops as a result of antenatal transmission of HSV. The greatest risk occurs with the primary infection of a woman in the late stages of pregnancy. In 85% of cases, genital and neonatal herpes is associated with HSV-2.The purpose of study: to identify the relationship between early manifestations of neonatal herpes and genital herpes during pregnancy for early diagnosis and etiological therapy of the newborn.Materials and methods. The analysis of current clinical recommendations and international consensuses of professional communities in Russia, the USA, and a number of European countries in the management of pregnant women was carried out. The five medical histories of newborn infants with a diagnosis of congenital herpetic infection were analyzed. In the clinical guidelines for the management of normal pregnancy, routine screening of pregnant women for HSV is omitted, however, examination is recommended for symptoms of genital herpes. For the prevention of neonatal herpes, antiviral drugs and caesarean section are used. Congenital herpes develops rarely, proceeds severely with significant residual manifestations in children. Antiviral therapy (Acyclovir) is used for herpetic infection in newborns: with systemic and local infection (eye damage). The analysis showed: despite the recurrent course of genital herpes in 4 out of 5 women during pregnancy, none of the pregnant women had a laboratory examination for HSV, pregnant women did not receive systemic etiological therapy and all deliveries were natural. The absence of preventive measures contributed to the early, during the first three days of life, the development of severe forms of neonatal herpes. In respect that the lack of significant clinical specificity and delayed manifestation, an antenatal anamnesis is important diagnostic criterion for neonatal herpes.

© Коллектив авторов, 2013 г.Принято считать, что риск развития врожденной цитомегаловирусной инфекции при ее реактивации у беременной не превышает 2-5%. По мнению некоторых авторов, до 75% детей, родившихся с этой пато-логией, заразились именно при реактивации латентной инфекции у матери. Приведенный клинический пример иллюстрирует такую ситуацию. Обращается внимание специалистов на необходимость тщатель-ного изучения всей информации о риске врожденных инфекций у беременной и новорожденного.Ключевые слова: беременность, врожденные инфекции, цитомегаловирусная инфекция, диагностика, лечение.It is considered that the risk of congenital cytomegalovirus infection does not exceed 2-5% if it reactivates in pregnancy. According to some authors up to 75% of children born with this disease were infected as the result of reactivation of latent infection in the mother. The clinical case illustrates this situation. Attention is paid to the experts need to examine all the available information about the risk of congenital infection in pregnant women and newborns.Keywords: pregnancy, congenital infections, cytomegalovirus infection, diagnosis, treatment.Введение. Среди врожденных инфекций забо-левание, вызываемое цитомегаловирусом (ЦМВ), наиболее распространено. Несмотря на отсутствие официальной статистики, встречаемость врож-денной цитомегаловирусной инфекции (ЦМВИ) в США оценивается как один случай на 150 жи-вых новорожденных, что приводит к стойкой ин-валидизации каждого пятого ребенка с этим за-болеванием [1].Заражение плода может происходить антена-тально (трансплацентарно) и интранатально (в пе-риод родов при наличии активного вирусного про-цесса в родовых путях). Антенатальная передача ЦМВ более характерна для женщин, зараженных в период беременности. С учетом широкой рас-пространенности ЦМВ среди женщин репродук-тивного возраста риск первичного инфицирова-ния в период гестации оценивается в 1-4% [2], а частота передачи инфекции плоду (с развитием в большинстве случаев тяжелых последствий и ле-тальных исходов) достигает 50% [3]. При реакти-вации во время беременности ранее приобретен-ной ЦМВИ частота передачи возбудителя плоду не превышает 5%, врожденная ЦМВИ в этой си-ту ации протекает бессимптомно, а ее клинически значимые признаки могут выявляться с 3-го ме-сяца жизни ребенка [3,4]. До 75% случаев врож-денной ЦМВИ связано с заражением плода имен-но при реактивации латентной ЦМВИ у матери [4].Широкая распространенность ЦМВ в популя-ции, относительно низкий риск первичного зара-жения во время беременности и передачи вируса при реактивации ЦМВИ у беременных, ограни-ченные возможности использования противови-

Objective: to analyze clinical manifestations, diagnostic and therapeutic approaches to management of pregnant women with cytomegalovirus infection for optimization of clinical and laboratory diagnostics and reduction of risks of congenital cytomegalovirus infection in the postnatal period.Materials and methods: in the article describe results a retrospective study the pregnancy course of 92 women who had 94 children with a confirmed congenital manifest form of cytomegalovirus infection. The inclusion criteria in main group were women aged 18-40 years and presence the results of examination for TORCH-syndrome in the first trimester of pregnancy, negative results for HIV. Markers of cytomegalovirus infection were determined by PCR (blood, vaginal secretions) and serologically (IgM, IgG to CMV-infection).Findings: the study showed that acute cytomegalovirus infection was documented during pregnancy in 18.4% of cases, and recrudescence of CMV-infection only in 33.6% of cases. Acute cytomegalovirus infection was asymptomatic in 35.3% of patients, the rest had nonspecific symptoms in the form of fatigue and headache, cholestasis was registered in 35.2% of cases, whereas with recrudescence of cytomegalovirus infection, catarrhal symptoms in the form of rhinitis and pharyngitis prevailed 42,8% cases, p<0,05. 15 people received therapy during pregnancy: 2 of them – antiviral (valgancyclovir), 11 – immunocorrective (interferon2alfa) and 2 – pathogenetic therapy (blood transfusion to the fetus for anemia). Based on the literature data and obtained by analyzing management tactics of the observed pregnant women, an algorithm for the management of pregnant women with cytomegalovirus infection was created.Conclusion: the study made it possible to substantiate algorithm of diagnosis and tactics management of cytomegalovirus infection in immunocompetent pregnant women and gave recommendations for obstetricians and gynecologists about alertness regarding cytomegalovirus infection.