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Malaria and Less Common Protozoan and Helminth Infections

Parasitic infections are highly prevalent in many developing areas of the world and are common among pregnant women in developed countries. They may exacerbate maternal and fetal anemia, and contribute to low birth weight and poor infant survival. The placenta serves as an effective barrier, even in infections such as malaria and schistosomiasis in which systemic involvement and hematogenous spread are common. Although transplacental infections of…

Toxoplasmosis

Toxoplasma gondii is a worldwide, intracellular protozoan parasite that can infect humans and almost all warm-blooded animals. Among the fetal and neonatal pathogens, T. gondii is certainly one of the most: ▪ Widespread, because it affects one third of the world’s human population, although a wide discrepancy is observed between countries (range, 10%-80%), its prevalence is continually evolving, and it is related to regional socioeconomic parameters…

Less Common Viral Infections

Human Papillomavirus Human papillomaviruses (HPV) are the most common cause of sexually transmitted infection in the United States, with approximately 14 million new infections annually, according to the Centers for Disease Control and Prevention (CDC). These DNA viruses are the cause of condyloma acuminata (i.e., genital warts), cervical condylomata, and cervical cancer, but most infections are asymptomatic and resolve spontaneously within 2 years. More than 40…

Rubella

∗ Drs. Louis Cooper and Charles Alford, Jr., previously contributed to this chapter. § References . ‖ References . The impact of rubella virus infection and the progress made toward controlling congenital rubella infection have been well chronicled. Rubella was first recognized in the mid-18th century as a clinical entity by German researchers, who called it Rötheln . They considered it to be a modified form…

Human Parvovirus

The parvoviruses are a family of single-stranded DNA viruses that have a wide cellular tropism and broad host range, causing infection in invertebrate species and vertebrates, from insects to mammals. Although many parvoviruses are important veterinary pathogens, there are only two human pathogens in the family: human parvovirus B19 and the more recently described human bocavirus. Human bocavirus seems to be primarily a respiratory pathogen of…

Herpes Simplex Virus Infections

Neonatal herpes simplex virus infection (HSV) was identified as a distinct disease in the 1930s. The first written descriptions of neonatal HSV were attributed to Hass, who described the histopathologic findings of a fatal case, and to Batignani, who described a newborn child with HSV keratitis, During the initial decades that followed, our understanding of neonatal HSV infections was based on histopathologic descriptions of the disease,…

Hepatitis

Knowledge about the hepatotropic viruses has grown dramatically in the past century, with contributions from clinicians, molecular virologists, immunologists, and pharmacologists. Hepatotropic viruses (hepatitis A through G viruses and torque teno virus [TTV]) are not a common cause of neonatal morbidity and mortality in the developed world. When hepatitis E virus (HEV) is contracted during the second or third trimester, pregnant women are at risk of…

Enterovirus, Parechovirus, and Saffold Virus Infections

The enteroviruses, parechoviruses, and Saffold viruses are all members of the picornavirus family, a group of small, nonenveloped RNA viruses. Enteroviruses, including the polioviruses, coxsackieviruses, echoviruses, and numerically designated types, and parechoviruses constitute two distinct genera among the Picornaviridae, although Saffold viruses are members of the genus Cardiovirus, genetically related to Theiler murine encephalomyelitis virus. The enteroviruses, parechoviruses, and Saffold viruses exhibit clear differences in their…

Cytomegalovirus

Human cytomegaloviruses (HCMV) comprise a group of agents in the herpesvirus family known for their ubiquitous distribution in humans and in numerous other mammals. In vivo and in vitro infections with CMV are highly species specific and result in a characteristic cytopathology of greatly enlarged (cytomegalic) cells containing intranuclear and cytoplasmic inclusions. The strikingly large, inclusion-bearing cells with a typical owl’s eye appearance were first reported by Ribbert…

Varicella, Measles, and Mumps

The viruses that cause varicella, zoster, measles, and mumps may complicate the management of a mother, fetus, or newborn when maternal infection with one of these agents occurs during pregnancy or at term. In the United States and other countries with widespread vaccine use, most women of childbearing years are immune to measles and mumps, and there is little opportunity for exposure to these infections because…

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in the Infant

The human immunodeficiency virus type 1 (HIV-1) pandemic remains one of the greatest public health challenges in the 21st century. More than 3 decades after the initial descriptions of acquired immunodeficiency syndrome (AIDS) in adults and children, the epidemiology of HIV has evolved significantly in high-income as well as low- and middle-income countries (LMIC) because of extraordinary biomedical advances in prevention, coupled with programmatic scale-up of…

Bordetella pertussis and Other Bordetella spp. Infections

Pertussis, commonly known as “whooping cough,” is an acute infectious illness of the respiratory tract causing disease in all age groups but taking its worst toll in unprotected infants and neonates too young to benefit from immunization. It is caused by Bordetella pertussis and, less frequently, by Bordetella parapertussis and Bordetella holmesii . The first epidemic of pertussis was noted in Paris in 1578 and described…

Mycoplasmal Infections

Mycoplasmas are prokaryotes of the class Mollicutes and represent the smallest known free-living organisms. Their small size of 150 to 350 nm is more on the order of viruses than of bacteria. They lack a cell wall and are bound by a cell membrane. Many of the biologic properties of mycoplasmas are due to the absence of a rigid cell wall, including resistance to β-lactam antibiotics…

Chlamydia Infections

In 1911, Lindner and colleagues identified typical intracytoplasmic inclusions in infants with a nongonococcal form of ophthalmia neonatorum called inclusion conjunctivitis of the newborn (ICN) or inclusion blennorrhea, leading to the elucidation of the epidemiology of sexually transmitted chlamydial infections. Mothers of affected infants were found to have inclusions in their cervical epithelial cells, and fathers of affected infants had inclusions in their urethral cells. For…

Tuberculosis

Mycobacterium tuberculosis (Mtb) may spread by aerosol when an adult with pulmonary tuberculosis (TB) coughs. Ninety percent of newly infected adults never develop disease; in the other 10%, TB most commonly manifests as lung disease. Infants and young children appear to have a 5- to 10-fold increased risk of progressing to TB disease after infection, compared with adults The young could be viewed as epidemiologic sentinels…

Borrelia Infections: Lyme Disease and Relapsing Fever

Lyme Disease Lyme disease, caused by the spirochete Borrelia burgdorferi, is the most common vector-borne illness in the United States. Although, in retrospect, a form of the illness had been recognized in Scandinavia in the early 1900s, modern awareness of Lyme disease began in the mid-1970s after a group of parents living on one small street reported a cluster of cases of “juvenile rheumatoid arthritis” in…

Syphilis

Syphilis is a sexually transmitted disease caused by infection with the bacterium Treponema pallidum . Congenital syphilis results when the infection is transmitted from a pregnant mother to her fetus. Syphilis has been known for a long time to cause serious infections in the newborn of an infected mother. The horror syphilis causes is best encapsulated in its other old name “lues,” which means “plague” in…

Gonococcal Infections

Infections of the fetus and newborn infant caused by Neisseria gonorrhoeae are restricted primarily to mucosal surfaces of the newborn infant, although scalp abscess and systemic infections, including bacteremia, meningitis, and septic arthritis, can occasionally occur. The most common condition related to infection by this organism during the neonatal period is ophthalmia neonatorum, or neonatal conjunctivitis. N. gonorrhoeae produces purulent conjunctivitis in the newborn, which may…

Staphylococcal Infections

Acknowledgment The authors are indebted to Rachel C. Orscheln, Henry R. Shinefield, and Joseph W. St. Geme III, whose previous contributions to this chapter and clinical images provided the strong baseline framework and inspiration for the current version. Staphylococcal disease has been recognized in neonates for centuries and reported at least as early as 1773, when pemphigus neonatorum was described. Outbreaks of staphylococcal disease in nurseries…

Listeriosis

Listeria monocytogenes is a serious and sometimes lethal pathogen, especially for pregnant women and their fetuses, the newborn, and for older adults and immunocompromised individuals. The pathogen was first described in 1926 by Murray and colleagues during an investigation of an epizootic outbreak of infection in laboratory rabbit and guinea pigs. Human disease caused by L. monocytogenes was identified in 1929 by Nyfeldt. The present name…