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Congenital and Opportunistic Infections
Seminars in Fetal & Neonatal Medicine (2007) 12, 153
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / s i n y
EDITORIAL
Congenital and Opportunistic Infections Perinatal and congenital infections are major causes of morbidity and mortality in the fetus and newborn throughout the world. There is an increased demand for preventative strategies, early diagnosis, clinical intervention and therapeutic alternatives to combat these infections. The diagnostic advances in microbiology have a key role in the field since maternal infections are often subclinical or noncharacteristic. Diagnosis of vertically transmitted infections form the basis for the evaluation of preventative or therapeutic drugs and vaccines. We can thus gain further knowledge concerning the mode of spread, epidemiology and impact of the infection. Once the impact of a certain infection has been clarified, preventative measures can be discussed in relation to available resources and their acceptance in the population. However, in many parts of the world the lack of resources and the absence of adequate maternal care stand in the way of adequate prevention. The mode of infection, timing of the harmful period in pregnancy, short and long term effects of the different causative agents, as well as the epidemiology of the pathogens, vary not only in different areas and populations but also over time. Prevention requires knowledge and collaboration between experts representing many disciplines. Due to the rapid progress in the field, continual updating of information for physicians, midwives and parents is needed. The different papers in this issue represent overviews for selected infections. The authors are all experts in their fields but represent various disciplines and illustrate different aspects of the problems. Prevention strategies using vaccination are illustrated by rubella and hepatitis B infections, the latter focusing on the effect of early universal childhood vaccination on serious long term sequelae as exemplified by the experience from Taiwan. The importance of antenatal screening programs is illustrated by human immunodeficiency virus (HIV), syphilis and hepatitis B infections. HIV is also an example of an infection where pharmacological prophylaxis has been successful in preventing mother-to-child transmission. The universal screening for group B streptococci in late pregnancy followed by intrapartum antibiotic therapy, introduced in the USA and some other countries, has, to date, successfully reduced the burden of group B streptococcus disease and will be followed with great interest. Novel 1744-165X/$ - see front matter ª 2007 Published by Elsevier Ltd. doi:10.1016/j.siny.2007.01.016
evaluations of screening against toxoplasmosis have demonstrated only a limited effect of screening programs and, therefore, the need for more efficacious treatment is apparent and instruction regarding hygiene and food remains important. Moreover hepatitis C as well as cytomegalovirus infections are candidates for antiviral therapy. Finally, we focus on congenital malaria, which, according to the authors, is the least known manifestation of malaria and further knowledge about this condition is needed. The field of fetal and congenital infections is extensive and, for obvious reasons, this issue cannot cover all of the important pathogens and aspects. Many other infections may cause severe sequelae, such as herpes simplex, varicella zoster virus and parvovirus B19 infections, the latter a cause of hydrops fetalis and intrauterine fetal death. The wide field of bacterial infections in preterm and term infants and the global problem of neonatal exposure to maternal microbes such as tuberculosis are of major importance but could not be covered here. We thank the authors for sharing their expert knowledge and we hope that readers will enjoy this issue of Fetal and Neonatal Medicine. We hope it will provide new insights in the rapidly developing field of fetal and congenital infections which can be implemented in clinical care and hopefully inspire further research. Marianne Forsgren* Department of Laboratory Medicine, Division of Clinical Virology, Karolinska University Hospital, Stockholm, Sweden *Corresponding author. E-mail address: [email protected] (M. Forsgren) Kristina Broliden Department of Medicine, Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden Lars Nave ´r Department of Neonatology, Division of Pediatrics Karolinska University Hospital, Stockholm, Sweden
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / s i n y
EDITORIAL
Congenital and Opportunistic Infections Perinatal and congenital infections are major causes of morbidity and mortality in the fetus and newborn throughout the world. There is an increased demand for preventative strategies, early diagnosis, clinical intervention and therapeutic alternatives to combat these infections. The diagnostic advances in microbiology have a key role in the field since maternal infections are often subclinical or noncharacteristic. Diagnosis of vertically transmitted infections form the basis for the evaluation of preventative or therapeutic drugs and vaccines. We can thus gain further knowledge concerning the mode of spread, epidemiology and impact of the infection. Once the impact of a certain infection has been clarified, preventative measures can be discussed in relation to available resources and their acceptance in the population. However, in many parts of the world the lack of resources and the absence of adequate maternal care stand in the way of adequate prevention. The mode of infection, timing of the harmful period in pregnancy, short and long term effects of the different causative agents, as well as the epidemiology of the pathogens, vary not only in different areas and populations but also over time. Prevention requires knowledge and collaboration between experts representing many disciplines. Due to the rapid progress in the field, continual updating of information for physicians, midwives and parents is needed. The different papers in this issue represent overviews for selected infections. The authors are all experts in their fields but represent various disciplines and illustrate different aspects of the problems. Prevention strategies using vaccination are illustrated by rubella and hepatitis B infections, the latter focusing on the effect of early universal childhood vaccination on serious long term sequelae as exemplified by the experience from Taiwan. The importance of antenatal screening programs is illustrated by human immunodeficiency virus (HIV), syphilis and hepatitis B infections. HIV is also an example of an infection where pharmacological prophylaxis has been successful in preventing mother-to-child transmission. The universal screening for group B streptococci in late pregnancy followed by intrapartum antibiotic therapy, introduced in the USA and some other countries, has, to date, successfully reduced the burden of group B streptococcus disease and will be followed with great interest. Novel 1744-165X/$ - see front matter ª 2007 Published by Elsevier Ltd. doi:10.1016/j.siny.2007.01.016
evaluations of screening against toxoplasmosis have demonstrated only a limited effect of screening programs and, therefore, the need for more efficacious treatment is apparent and instruction regarding hygiene and food remains important. Moreover hepatitis C as well as cytomegalovirus infections are candidates for antiviral therapy. Finally, we focus on congenital malaria, which, according to the authors, is the least known manifestation of malaria and further knowledge about this condition is needed. The field of fetal and congenital infections is extensive and, for obvious reasons, this issue cannot cover all of the important pathogens and aspects. Many other infections may cause severe sequelae, such as herpes simplex, varicella zoster virus and parvovirus B19 infections, the latter a cause of hydrops fetalis and intrauterine fetal death. The wide field of bacterial infections in preterm and term infants and the global problem of neonatal exposure to maternal microbes such as tuberculosis are of major importance but could not be covered here. We thank the authors for sharing their expert knowledge and we hope that readers will enjoy this issue of Fetal and Neonatal Medicine. We hope it will provide new insights in the rapidly developing field of fetal and congenital infections which can be implemented in clinical care and hopefully inspire further research. Marianne Forsgren* Department of Laboratory Medicine, Division of Clinical Virology, Karolinska University Hospital, Stockholm, Sweden *Corresponding author. E-mail address: [email protected] (M. Forsgren) Kristina Broliden Department of Medicine, Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden Lars Nave ´r Department of Neonatology, Division of Pediatrics Karolinska University Hospital, Stockholm, Sweden