[Significance of diagnostics and treatment in preventing congenital infections with Toxoplasma gondii (Tg), cytomegalovirus (CMV) and parvowirus B19 (PVB19)]

Abstract

Common use of available techniques detecting perinatal infections needs to be accompanied with knowledge of proper interpretation of the tests and indications for treatment as well as communication with patients. The aim of this paper is to summarize current standards of diagnosis and treatment of infections in pregnant women and neonates. The detection of specific IgG antibodies in pre-conceptive period excludes the risk of transplacental Tg and PVB19 infection, while the risk of CMV infection is diminished and probable symptoms alleviated. Confirmed diagnosis of primary infection during pregnancy: 1. Toxoplasmosis (seroconversion, presence of IgA and IgM, low avidity IgG, PCR in amniotic fluid) is an indication for antimicrobial therapy; 2. Symptomatic CMV infection [seroconversion, virus detected in blood and urine (PCR, pp65 antigen)] for prophylactic IgG administration in mother; 3. PVB19 (seroconversion, IgM, PCR in blood and amniotic fluid) for frequent ultrasonographic evaluation of possible symptoms of fetal hydrops, and fetal transfusin if hydrops occurs. Diagnosis and treatment of the neonates should be managed in specialized c enters. Further monitoring of the infection is handicapped by the presence of maternal antibodies as well as the suppression of neonatal production of specific IgA and IgM. Toxoplasmosis requires from 6 (in asymptomatic infestation) to 12 months (in symptomatic infestation) treatment with pyrimethamine and sulfadiazine with supplementation of folinic acid. In symptomatic CMV infection 6 weeks treatment with ganciclovir is legitimate (decreases viruria and the risk of hearing impairment); while in asymptomatic infection with massive viral replication it can be considered as supposedly beneficial. The impact of prolonged treatment (over 6 weeks) as well as oral antiviral (valganciclovir) is currently under clinical investigation. The educational efforts should include: methods of preventing infections (Tg, CMV), necessity of repeated testing and treatment in pregnancy (Tg, PVB19), treatment of the neonate (Tg, CMV) and breastfeeding (CMV).