1/19. Persistent fetal rubella vaccine virus infection following inadvertent vaccination during early pregnancy.Inadvertent immunisation of seronegative women with RA27/3 rubella virus live-attenuated vaccine several weeks before and after conception is described. Whereas in 5 cases the vaccine virus was not transmitted vertically, in 1 case vaccination led to the development of persistent fetal infection with prolonged virus shedding for more than 8 months. sequence analysis carried out on isolates from amniotic fluid, from cord blood leukocytes as well as from infantile urine confirmed an infection by the vaccine strain. At birth, the newborn infant exhibited none of the symptoms compatible with the congenital rubella syndrome and signs indicative for development of late onset disease are not apparent. This observation constitutes the first unequivocal documented case of rubella vaccine virus related to persistent fetal infection.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
2/19. Rapid voluntary testing and counseling for hiv. Acceptability and feasibility in Zambian antenatal care clinics.Voluntary testing and counseling (VTC) for hiv/AIDS is now widely accepted as an effective hiv prevention and control strategy among heterosexual couples in sub-Saharan africa. The most appropriate format and venue for VTC remains a topic of debate among clinicians and public health professionals. Our research done in Lusaka, zambia, took a tripartite approach to exploring the most acceptable format and venue for VTC: a community survey of attitudes towards VTC, a pre- and postcounseling knowledge survey, and a pilot study of same-day VTC in urban antenatal care clinics. A community survey of 181 individuals was conducted in July-August 1996 based on a structured questionnaire. A pre- and post-VTC intervention knowledge survey was conducted during the same period among 82 couples attending the zambia-UAB hiv research Project (ZUHRP) hiv VTC center in Lusaka. Finally, same-day hiv VTC was pilot tested in six antenatal clinic locations during February-May 1997 and June-August 1998. The community survey revealed that 98% of participants support promotion of hiv VTC in the community and 83.8% prefer the same-day testing format. The knowledge survey revealed misconceptions about discordance within a couple and perinatal transmission of hiv. Pilot testing in antenatal clinics was well received, with 84% of pregnant women requesting testing and 25% having positive hiv serologies. Women with primary school or less education, those seeking antenatal care in local clinics, and those seen before the third trimester of pregnancy were more likely to request hiv testing. Testing and counseling for hiv were shown to be feasible and effective in the antenatal clinic setting. Implementation of same-day hiv VTC in antenatal clinics is an effective strategy to prevent vertical transmission and should be expanded to include couples to leverage a decrease in heterosexual transmission as well.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
3/19. A case of pregnancy complicated by the development of a tubo-ovarian abscess following in vitro fertilization and embryo transfer.Tubo-ovarian abscess is an uncommon complication in pregnant women. In this report, we present a patient who developed a tubo-ovarian abscess during pregnancy following in vitro fertilization and embryo transfer (IVF-ET). Despite treatment with intravenous antibiotics she delivered at 22 weeks of gestation. After delivery, she underwent a left salpingo-oophorectomy. review of the literature revealed only 26 reported cases of tubo-ovarian or pelvic abscess during pregnancy. pelvic inflammatory disease, previous laparotomy, and structural genital anomalies are known risk factors for pelvic abscess during pregnancy. Pelvic abscess resulting as a complication of vaginal oocyte retrieval has been reported. Therefore, although enabling women with organic pelvic disease such as endometriosis and hydrosalpinx to achieve pregnancy, assisted reproductive techniques may potentially result in pelvic infection during pregnancy. This case suggests that a preconception evaluation and treatment for such conditions should be considered for women undergoing treatment for infertility.- - - - - - - - - - ranking = 109.29614802622keywords = fertilization, conception (Clic here for more details about this article) |
4/19. Two cases of systemic candida glabrata infection following in vitro fertilization and embryo transfer.Presented here are two cases of systemic candida glabrata infection diagnosed in two expectant mothers and their fetuses at 34 and 22 weeks' gestation. The underlying risk factors in case 1 were in vitro fertilization and embryo transfer, recurrent yeast vaginitis and two intravenous injections of betamethasone. The risk factors in case 2 were in vitro fertilization and embryo transfer, recurrent yeast vaginitis, antibiotics for treatment of a urinary tract infection due to morganella morganii and amniocentesis. In both cases, vaginal fluid yielded growth of a yeast that was not identified. candida glabrata was isolated from samples obtained from the mothers and their babies. Since candida glabrata lacks hyphae, membranitis and infection of the fetuses were demonstrated only on slides stained with Gomori Grocott and periodic acid-Schiff. Both cases suggest that for such pregnancies the follow-up of vaginal fluid should include the identification of any yeasts grown on selective Candida medium. In case of premature rupture of membranes, systematic sampling of mothers and their infants or fetuses should be associated with microscopic study of placentas, membranes and stillborn fetuses with Gomori Grocott and periodic acid-Schiff staining techniques.- - - - - - - - - - ranking = 129.95537763146keywords = fertilization (Clic here for more details about this article) |
5/19. Ovine chlamydiosis in an abattoir worker.The strain of chlamydia psittaci causing enzootic abortion in ewes (the EAE strain) may cause serious infection in pregnant women, often resulting in hepatic and renal dysfunction, disseminated intravascular coagulation and fetal loss. The first case of such an infection in an abattoir worker is described and the possibility of human-to-human transmission considered. Direct handling of sheep or their products of conception can usually be established but this is not always so. There is much still to be learned about this uncommon but severe zoonosis.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
6/19. Exploratory laparotomy for diagnosis of tuberculous peritonitis.Tuberculous (TB) peritonitis is uncommon but may present at any age and socioeconomic group. We reviewed 14 patients with TB peritonitis diagnosed during a five year period (six were white and eight, Pacific Islanders). The mean age was 31 years (a range of three to 69 years). Symptoms, signs and laboratory and roentgenologic studies were not specific. Peritoneal tap and laparoscopic procedures gave positive results of mycobacterium tuberculi in four of seven patients. Diagnosis was not suspected in two patients until autopsy. TB peritonitis was confirmed at exploratory laparotomy in the other eight patients. Several common misconceptions about TB peritonitis have been discussed and refuted.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
7/19. incidence of toxoplasmosis in pregnant women in the city of Malmo, sweden.The incidences of latent and primary toxoplasma gondii infections in pregnant women were studied using stored sera from 4,351 women delivered in the city of Malmo, sweden in 1982 and 1983. Infants born to mothers with signs of primary infection (seroconversion or specific IgM in sera collected during pregnancy) were studied with regard to serological evidence of congenital infection (specific IgM in cord serum). Sera were tested for specific IgG antibodies by direct agglutination test and enzyme-linked immunosorbent assay, and for specific IgM by immunosorbent assay. 40% of the women were seropositive at delivery. Seroconversion (change from negative to positive serological status) was demonstrated in 12 pregnant women and specific IgM in the first postconceptional serum sample (indicating infection in the first trimester or in the last year(s) before conception) in another 17. The incidence of primary maternal infection was calculated to 4-6:1,000 deliveries. Among the 29 infants born to mothers with seroconversion or, alternatively, IgM in the first postconceptional sample, 6 had laboratory signs of congenital infection. One of the 6 had a positive toxoplasma isolation test in autopsy material and 5 had a clearly positive IgM value in cord serum. The real incidence of congenital infection in this material is unknown since IgM might be absent or sparse in cord serum in spite of congenital infection. The noticeable prevalence of maternal toxoplasmosis in Malmo calls for further incidence studies in sweden.- - - - - - - - - - ranking = 3keywords = conception (Clic here for more details about this article) |
8/19. Detection of rubella-specific IgM in subclinical rubella reinfection in pregnancy.Seven cases of asymptomatic rubella reinfection in early pregnancy are described. In each, there was a history of exposure to a rubelliform illness and low levels of rubella-specific IgM subsequently appeared in the serum. Four of the women had been immunised, after having been shown to be susceptible to rubella, one had been immunised at school without previous antibody screening, and two were uncertain about immunisation. One pregnancy was terminated and rubella virus was not isolated from the products of conception. Six pregnancies went to term and the infants showed no evidence of intrauterine infection. In a further case it was impossible to discriminate between reinfection and primary infection, and termination of pregnancy was offered.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
9/19. microcephaly and congenital cytomegalovirus infection: a combined prospective and retrospective study of a Swedish infant population.microcephaly and its etiology were studied in an unselected Swedish urban infant population. Virtually, all live-born infants (14,724) born between October 1977 and December 1983 in the city of Malmo, sweden, were included in the study. Special attention was given to the role of congenital infections, particularly to cytomegalovirus infection. The infant population was studied from two points of view. One part of the study was prospective and based on regular cytomegalovirus isolation in urine within the first week of life. About 80% of the newborns were adequately studied by this test. None of 56 infants shown to be cytomegalovirus excreters (congenitally infected) and followed up were born with or developed microcephaly (head circumference smaller than 3 SD below the mean for age and sex) during the first 1 to 7 years of life. However, two of the 56 infants had a head circumference of -2 SD. In the beginning of 1985, an inventory was made of the presence of symptomatic microcephaly in the above mentioned population still living in the city or deceased there. Of about 10,000 such children, 12 were found to have symptomatic microcephaly. By studies of personal, clinical, and laboratory data and by retrospective serologic studies of frozen pre- and postconceptional maternal sera, a possible explanation or a recognized syndrome was obtained in ten of the 12 cases. In one of them, the mother had a primary cytomegalovirus infection, possibly in early pregnancy. Although the infant had symptoms compatible with a congenital infection, no laboratory evidence of transmitted infection was found. In no case were congenital rubella virus or toxoplasma gondii infections suspected.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
10/19. First trimester prenatal diagnosis of congenital rubella: a laboratory investigation.Acute primary maternal infection with rubella virus during pregnancy often, but not invariably, leads to the congenital rubella syndrome. Diagnosis by detection of virus specific IgM in the mother is not always possible, and in those cases in which IgM is detected the fetus has not necessarily also been infected. A method for direct, prenatal detection of fetal infection would allow more accurate early diagnosis of congenital rubella syndrome. In this study a case of suspected preconception rubella infection that was not referred until 14 weeks after the appearance of a rash was studied to determine whether a retrospective serological diagnosis of primary rubella could be made, and whether direct evidence of fetal infection could be obtained from a chorionic villus biopsy specimen by detecting virus specific antigens or ribonucleic acid (rna) sequences. Monoclonal antibodies and a cloned complementary deoxyribonucleic acid probe were used successfully to detect antigens to rubella virus antigens and rna sequences in the chorionic villus biopsy specimen, which was taken at 15 weeks' gestation. This method should serve as a new approach to the diagnosis of congenital rubella syndrome in utero.- - - - - - - - - - ranking = 1keywords = conception (Clic here for more details about this article) |
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