Risk Factors and Outcome of Varicella‐Zoster Virus Pneumonia in Pregnant Women

Harger, James H.; Ernest, Joseph M.; Thurnau, Gary R.; Moawad, Atef H.; Momirova, Valerija; Landon, Mark B.; Paul, Richard H.; Miodovnik, Menachem; Dombrowski, Mitchell P.; Sibai, Baha M.; Dorsten, Peter Van

doi:10.1086/338832

Cited by 175 publications

(98 citation statements)

References 17 publications

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“…The incidence of pneumonia during pregnancy does not seem to be higher than in non-pregnant adults, but it is more severe in pregnant than in non-pregnant women especially if it appears in the third trimester of pregnancy [6,10,19,26,56,121,144,[153][154][155][156][157] . Pneumonia can appear in 5%-20% of pregnant women [54,121,152,158] and leads to death in 20%-45% of cases unless appropriate treatment is started, but with appropriate treatment and better breathing management, the mortality rate drops to 0%-14% [10,16,[152][153][154]157,[159][160][161][162][163] . During pregnancy, the infection can also be transmitted to the fetus and, depending on the time of transmission, may cause congenital varicella syndrome (CVS), neonatal varicella, or childhood herpes zoster.…”

Section: Consequences Of An Infection Contracted During Pregnancymentioning

confidence: 99%

“…The materials that can be used include skin swabs, cerebrospinal fluid (CSF), broncho-alveolar lavage (BAL) fluid, nasopharyngeal secretions, urine, saliva, blood, intraocular fluid, amniotic fluid, follicular fluid, corneal tissue and other body fluids. BAL is important [159] as pneumonia is found in 5%-20% of pregnant women with varicella [54,121,158,163] , although it can also be caused by bacterial superinfection. Saliva can be useful for diagnosing neurological diseases without rash [473] , and CSF for diagnosing encephalitis [429] .…”

Section: Direct Fluorescent Antibody Assaymentioning

confidence: 99%

See 1 more Smart Citation

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: Consequences Of An Infection Contracted During Pregnancymentioning

confidence: 99%

Section: Direct Fluorescent Antibody Assaymentioning

confidence: 99%

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

Paschale

Clerici

2016

WJV

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“…Finally, Varicella zoster, the chicken pox virus, causes pregnant women to develop more skin lesions and pneumonia at higher rates than the average adult with chicken pox [91]. Pregnant women are clearly especially vulnerable to infectious disease.…”

Section: Infectious Disease and Selection During Pregnancymentioning

confidence: 99%

Many ways to die, one way to arrive: how selection acts through pregnancy

2013

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“…1. Management of exposure to varicella during pregnancy (Gardella & Brown, 2007, as cited in Heuchan & Isaacs, 2001 www.intechopen.com Pregnant women appear no more likely than other adults to develop pneumonia (Royal College of Obstetricians and Gynaecologists [RCOG], 2001) which can occur in up to 10% of pregnant women suffering with varicella (Harger et al, 2002); however, varicella pneumonia may be more severe in pregnant compared to non-pregnant women. The severity of this complication seems to increase in later gestation (Tan & Koren, 2005).…”

Section: Varicella In Pregnancymentioning

confidence: 99%

“…The severity of this complication seems to increase in later gestation (Tan & Koren, 2005). Smoking and the occurrence of at least 100 skin lesions are well known risk factors for the development of VZV pneumonia (Harger et al, 2002). The mortality rate in untreated pregnant women is as high as 40% (Haake et al, 1990), therefore varicella pneumonia in pregnancy is considered a medical emergency.…”

Section: Varicella In Pregnancymentioning

confidence: 99%