23 November 2024 : Review article
A Review of Emerging Viral Pathogens and Current Concerns for Vertical Transmission of Infection
Dinah V. Parums1BDEF*DOI: 10.12659/MSM.947335
Med Sci Monit 2024; 30:e947335
Introduction
The Maternal-Fetal Interface and Defense from Infection
TORCH Infections: Toxoplasmosis, Rubella, Cytomegalovirus (CMV), Herpes Simplex Virus (HSV)
Ebola Virus
Zika Virus
Emerging Arbovirus Infections, Including West Nile Virus and Rift Valley Fever Virus
SARS-CoV-2 Infection and COVID-19
Conclusions
References
Table 1 Pathogens with vertical transmission including TORCH infections [1,6].
| Pathogen | Transmission | Congenital effects | Screening |
|---|---|---|---|
| A commensal organism | Neonatal sepsis | Not applicable for commensal organisms | |
| Contaminated foods | Stillbirth or pregnancy loss, preterm delivery, neonatal sepsis | Pregnant women are given dietary advice | |
| A commensal organism | Neonatal sepsis | Not applicable for commensal organisms | |
| A commensal organism | Neonatal sepsis | Not applicable for commensal organisms | |
| Sexual transmission | Stillbirth or pregnancy loss, low birth weight, hepatosplenomegaly, developmental delay, nose and dental deformities, chorioretinitis, rash, anemia, bowel anomalies, bone fractures | In the US, the CDC and ACOG recommend first-trimester screening for syphilis | |
| Cytomegalovirus | Feco-oral transmission | Chorioretinitis, low birth weight, hearing loss, anemia, thrombocytopenia, rash, developmental delay, stillbirth or pregnancy loss, enlarged heart, microcephaly, intracerebral and abdominal calcifications | CMV screening of infants who fail newborn hearing testing |
| Herpes simplex virus 1 & 2 | Oral and sexual transmission with neonatal infection during vaginal birth | Neonatal meningitis, skin lesions, enlarged heart, microcephaly, intracerebral calcifications, chorioretinitis, optic nerve atrophy, limb dysplasias | In cases of maternal genital HSV infection, cesarean delivery may be done |
| Human parvovirus B19 | Respiratory spread. Between 50–70% of pregnant women are immune to parvovirus | Anemia, fetal hydrops, stillbirth, and pregnancy loss | No vaccine or preventative treatment is available |
| Lymphocytic choriomeningitis virus (LCMV) | Fomites contaminated from rodents (mice and rats) | Ventriculomegaly and hydrocephalus, developmental delay, chorioretinitis, motor and sensory deficits, hearing loss | Infection risk reduction, as there is no vaccine to prevent LCMV infection |
| Rift Valley fever virus | An Arbovirus (., ., ., .) | Stillbirth, pregnancy loss, and preterm delivery | Infection risk reduction, as there is no vaccine to prevent Rift Valley fever |
| Rubella virus | Transmission by direct contact or respiratory spread to the pregnant woman | Congenital rubella syndrome (CRS) includes cataracts, sensorineural hearing loss (SNHL), cardiac malformations, microcephaly, cataracts, low birth weight, bone lesions, hepatosplenomegaly, jaundice, skin lesions | Rubella immunization programs in developed countries. In the US, the CDC and ACOG recommend first-trimester screening |
| Varicella zoster virus | Respiratory spread | IUGR, limb abnormalities | Varicella zoster virus vaccination. Treatment of infection during pregnancy with maternal varicella zoster immune globulin and antivirals |
| West Nile virus | An Arbovirus (.) | Chorioretinitis, meningitis, and encephalitis. | Infection risk reduction, as there is no vaccine to prevent infection. |
| Hepatitis B virus (HBV) | Maternal intravenous drug use, history of blood transfusions, sexual transmission, and direct contact | IUGR, placental abruption, and preterm delivery with a risk of developing chronic HBV infection | Vaccines are available, and infection risk reduction is advised |
| Hepatitis C virus (HCV) | Maternal intravenous drug use or a history of blood transfusions | IUGR with low birth weight and preterm delivery | Infection risk reduction, as there is no vaccine to prevent infection |
| Human immunodeficiency virus (HIV) | Spread in body fluids and breast milk, but >95% of HIV-infected pediatric cases are due to vertical transmission | The infant is born with immune suppression and an increased risk of opportunistic infections | Infection risk reduction, as there is no vaccine to prevent infection. Treatment with an antiretroviral therapy (ART) if the mother is HIV-positive |
| Zika virus | An Arbovirus (.) with vector-borne and blood-borne transmission | IUGR, microcephaly, hepatosplenomegaly, intrahepatic and intracerebral calcifications, stillbirth, or pregnancy loss | Infection risk reduction, as there is no vaccine to prevent infection |
| & | Arthropod-borne (.) | IUGR, preterm delivery, hypoglycemia | Infection risk reduction. New vaccines have been developed |
| Ingestion of contaminated food or oocytes | Ventriculomegaly and hydrocephalus, intracerebral calcifications, ascites, IUGR, hepatosplenomegaly | Several countries recommend first-trimester screening for toxoplasmosis | |
| (Chagas disease) | Feces/urine of infected . mites | IUGR, respiratory failure, hepatosplenomegaly, meningitis, fetal hydrops, cardiac and large bowel anomalies | Infection risk reduction, as there is no vaccine to prevent infection |
| CDC – Centers for Disease Control and Prevention; ACOG – American College of Obstetricians and Gynecologists; IUGR – intrauterine growth retardation; TORCH – Toxoplasmosis, Other, Rubella, Cytomegalovirus (CMV), Herpes simplex virus (HSV). | |||