Fetal varicella – diagnosis, management, and outcome

Mandelbrot, Laurent

doi:10.1002/pd.3843

Cited by 52 publications

(42 citation statements)

References 94 publications

(186 reference statements)

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“…It has been reported that the mortality rate during the first month of life is 30%, but infants who survive this period can have a good long-term outcome even though there is a 15% risk of developing herpes zoster between the fourth and forty-first month of life [26,53,145,147,159,169,170] . CVS is probably due to herpes zoster-like reactivation in utero rather than initial varicella, and this view is supported by the fact that the skin lesions have a dermatomal distribution similar to that of herpes zoster [26,167,171] .…”

Section: Cvsmentioning

confidence: 99%

“…The most widely used drug, acyclovir (and its precursor valacyclovir) is a synthetic nucleoside analogue of guanine that is highly specific for cells infected by herpesvirus and does not interfere with human DNA [169] . When phosphorylated by cellular enzymes (thymidine kinases), acyclovir triphosphate inhibits viral DNA synthesis by competing with deoxyguanosine triphosphate as a substrate for viral DNA polymerase.…”

Section: Therapymentioning

confidence: 99%

“…It has been suggested that viral treatment after exposure is a means of preventing or mitigating the infection because, if administered within 24 h of the appearance of the rash, its use in immunocompromised children and immunocompetent adults reduces the symptoms [21,26,252,256,265,266] . Consequently, it has been suggested as prophylaxis in pregnant women (especially if VZIGs are not available) [169] , particularly if administered within seven days of exposure and within 24 h of the onset of the rash [26,54,252,265,266] . The use of acyclovir during pregnancy has been widely debated in the literature: There is general consensus concerning its use when the mother's life is in danger and as a means of reducing the severity of complications occurring in late pregnancy [19,53,151,156,256,267] , but its therapeutic and CVS prophylactic use before the twentieth week of gestation is more controversial; some authors favour its administration always, and others only after 20 wk [10,16,19,53,54,151,156,169,252,256,[267][268][269][270][271] .…”

Section: Therapymentioning

confidence: 99%

“…If the maternal varicella appears 20-7 d before the birth, the varicella in the newborn (if it develops) generally has a benign and non-fatal course because newly born infants have their mothers' antibodies and the risk of complications is low [5,26,131,165,[191][192][193] . In the case of maternal varicella between seven days before and seven after delivery, 2/3 of the infants become infected and 50% have severe symptoms because they do not have maternal antibodies and their cell-mediated response is insufficiently mature [26,145,169,191,194,195] . During this period, the most dangerous situation is when maternal varicella appears between five days before and two days after delivery because, in the absence of adequate therapy, the neonatal mortality rate may be as high as 20%-30% and, even with therapy, may still be 7% [5,153,157,159,165,191,[196][197][198] .…”

Section: Neonatal Varicellamentioning

confidence: 99%

“…However, as it is a live attenuated vaccine, it is not recommended for pregnant women exposed to infection [19] . Furthermore, pregnancy should be avoided for at least one month [199,206,239,240] , although it may be offered to susceptible women before conception or post partum, and it is not contraindicated during breastfeeding [5,169,241] . Finally, a vaccine against herpes zoster that contains a higher titre of the OKA strain used in the MMRV vaccine has been approved for subjects aged > 50 years, and is recommended for those aged > 60 years [5,242] .…”

Section: Prevention and Treatmentmentioning

confidence: 99%

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Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Paschale

Clerici

2016

WJV

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Varicella-zoster virus, which is responsible for varicella (chickenpox) and herpes zoster (shingles), is ubiquitous and causes an acute infection among children, especially those aged less than six years. As 90% of adults have had varicella in childhood, it is unusual to encounter an infected pregnant woman but, if the disease does appear, it can lead to complications for both the mother and fetus or newborn. The major maternal complications include pneumonia, which can lead to death if not treated. If the virus passes to the fetus, congenital varicella syndrome, neonatal varicella (particularly serious if maternal rash appears in the days immediately before or after childbirth) or herpes zoster in the early years of life may occur depending on the time of infection. A Microbiology laboratory can help in the diagnosis and management of mother-child infection at four main times: (1) when a pregnant woman has been exposed to varicella or herpes zoster, a prompt search for specific antibodies can determine whether she is susceptible to, or protected against infection; (2) when a pregnant woman develops clinical symptoms consistent with varicella, the diagnosis is usually clinical, but a laboratory can be crucial if the symptoms are doubtful or otherwise unclear (atypical patterns in immunocompromised subjects, patients with post-vaccination varicella, or subjects who have received immunoglobulins), or if there is a need for a differential diagnosis between varicella and other types of dermatoses with vesicle formation; (3) when a prenatal diagnosis of uterine infection is required in order to detect cases of congenital varicella syndrome after the onset of varicella in the mother; and (4) when the baby is born and it is necessary to confirm a diagnosis of varicella (and its complications), make a differential diagnosis between varicella and other diseases with similar symptoms, or confirm a causal relationship between maternal varicella and malformations in a newborn. Core tip: Although varicella during pregnancy is infrequent and congenital varicella syndrome (CVS) is rare, every available means should be used to prevent and diagnose them. Microbiology laboratories can be crucial in these situations: Evaluating a mother's immune status with sensitive and specific tests for the detection of antibodies; allowing a rapid diagnosis with molecular biology tests when a clinical manifestation may be due to different etiologies; following pregnant women with varicella for the prenatal diagnosis of CVS with close collaboration between molecular biology investigators and specialists in imaging diagnostics.De Paschale M, Clerici P. Microbiology laboratory and the management of mother-child varicella-zoster virus infection. World

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Section: Cvsmentioning

confidence: 99%

Section: Therapymentioning

confidence: 99%

Section: Therapymentioning

confidence: 99%

Section: Neonatal Varicellamentioning

confidence: 99%

Section: Prevention and Treatmentmentioning

confidence: 99%

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Microbiology laboratory and the management of mother-child varicella-zoster virus infection

Paschale

Clerici

2016

WJV

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Dermatoses of the Neonate

Paige

2016

Rook's Textbook of Dermatology, Ninth Edition

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Rashes in the first 4 weeks of life are common and can be alarming for both parents and medical staff. Many of these are entirely innocent and resolve spontaneously and reassurance of the parents is all that is required. It is important to be aware of such ‘benign’ rashes (as well as the appearance of preterm and post‐term skin) when assessing genuine pathology in the neonate. Pathological dermatoses may arise by a number of different mechanisms. Iatrogenic causes (medical procedures) can cause rashes/lesions both in utero and in the neonatal period. Transplacental transfer of antibodies, infection or malignant cells from mother to child is another mechanism for causing neonatal rashes. Infection can also be passed on from attendant medical staff. Finally, primary dermatoses may present early in the neonatal period, especially genodermatoses such as collodion baby and epidermolysis bullosa.

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