RESUMEN
Congenital parvovirus B19 infection is a rare but serious condition that can result in hydrops fetalis and fetal death. Due to the virus' cytotoxic effect on fetal red blood cell precursors, postnatal infection can cause a neonatal viremia and secondary pure red cell aplasia. Here, we describe a case of congenital parvovirus infection in a preterm infant complicated by hydrops fetalis and chronic anaemia that responded to postnatal treatment with intravenous immunoglobulin administered on day of life 44. After treatment, the anaemia resolved as the neonate exhibited interval increases in haemoglobin, haematocrit and reticulocyte count with no subsequent need for red blood cell transfusions.
Asunto(s)
Anemia/terapia , Inmunoglobulinas Intravenosas/administración & dosificación , Infecciones por Parvoviridae/tratamiento farmacológico , Parvovirus B19 Humano/aislamiento & purificación , Complicaciones Infecciosas del Embarazo/diagnóstico , Adulto , Anemia/sangre , Anemia/virología , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Cordocentesis , Ecocardiografía , Transfusión de Eritrocitos , Femenino , Sangre Fetal/virología , Rotura Prematura de Membranas Fetales/virología , Feto/diagnóstico por imagen , Feto/virología , Humanos , Hidropesía Fetal/sangre , Hidropesía Fetal/diagnóstico , Hidropesía Fetal/terapia , Hidropesía Fetal/virología , Inmunoglobulina M/sangre , Inmunoglobulina M/inmunología , Recién Nacido , Recien Nacido Prematuro , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Infecciones por Parvoviridae/complicaciones , Infecciones por Parvoviridae/congénito , Infecciones por Parvoviridae/transmisión , Parvovirus B19 Humano/inmunología , Polihidramnios/diagnóstico , Polihidramnios/virología , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Resultado del Tratamiento , Ultrasonografía PrenatalRESUMEN
This article reviews the sonographic manifestations of fetal infection and the role of ultrasound in the evaluation of the fetus at risk for congenital infection. Several ultrasound findings have been associated with in utero fetal infections. For the patient with a known or suspected fetal infection, sonographic identification of characteristic abnormalities can provide useful information for counseling and perinatal management. Demonstration of such findings in the low-risk patient may serve to identify the fetus with a previously unsuspected infection. The clinician should understand the limitations of ultrasound in the prenatal diagnosis of congenital infection and discuss them with the patient.
Asunto(s)
Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Ultrasonografía Prenatal , Virosis/complicaciones , Cardiomegalia/diagnóstico por imagen , Cardiomegalia/virología , Femenino , Retardo del Crecimiento Fetal/diagnóstico por imagen , Retardo del Crecimiento Fetal/virología , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/virología , Hepatomegalia/prevención & control , Hepatomegalia/virología , Humanos , Hidropesía Fetal/diagnóstico por imagen , Hidropesía Fetal/virología , Transmisión Vertical de Enfermedad Infecciosa , Deformidades Congénitas de las Extremidades/diagnóstico por imagen , Deformidades Congénitas de las Extremidades/virología , Microcefalia/diagnóstico por imagen , Microcefalia/virología , Placenta/diagnóstico por imagen , Placenta/virología , Polihidramnios/diagnóstico por imagen , Polihidramnios/virología , Embarazo , Cráneo/diagnóstico por imagen , Esplenomegalia/prevención & control , Esplenomegalia/virología , Virosis/diagnóstico , Virosis/transmisiónRESUMEN
OBJECTIVE: The aim of this study was to evaluate the rate of women with polyhydramnios who eventually screened positive to infectious disease by serum screening testing for TORCH and parvovirus B19. METHODS: This is a retrospective observational study on singleton pregnancies with a diagnosis of polyhydramnios and who had serum screening for TORCH and parvovirus B19. Patients were followed with serial ultrasounds between 2006 and 2013. Maternal characteristics, medical and obstetric history were reviewed. Ultrasound parameters, including amniotic fluid index and fetal anomalies, and the results of serologic tests were reviewed. RESULTS: Two hundred ninety patients met the inclusion criteria. Of these, 56 (19%) presented one of the following pathological conditions associated with polyhydramnios: diabetes (13% of total cases), obstructive gastrointestinal lesions (5%), Rhesus isoimmunization (0.3%), chromosomal abnormalities or genetic syndromes (1%). Among the remaining 234 patients, only three had a positive test result for infectious disease (1%, 95% Confidence Interval (CI) 0-4%): two women were positive for parvovirus B19 and one for toxoplasmosis infection. In none of them the fetus was affected, as confirmed by serum testing after birth and by 3 years follow-up. CONCLUSIONS: Infectious disease screening does not seem beneficial in pregnancies with isolated polyhydramnios.
Asunto(s)
Infecciones por Citomegalovirus/epidemiología , Herpes Simple/epidemiología , Parvovirus B19 Humano/aislamiento & purificación , Polihidramnios/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Síndrome de Rubéola Congénita/epidemiología , Toxoplasmosis Congénita/epidemiología , Adulto , Infecciones por Citomegalovirus/congénito , Infecciones por Citomegalovirus/virología , Femenino , Herpes Simple/congénito , Herpes Simple/virología , Humanos , Recién Nacido , Italia/epidemiología , Infecciones por Parvoviridae/congénito , Infecciones por Parvoviridae/epidemiología , Polihidramnios/virología , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Diagnóstico Prenatal/métodos , Diagnóstico Prenatal/estadística & datos numéricos , Prevalencia , Estudios Retrospectivos , Síndrome de Rubéola Congénita/virología , Toxoplasmosis Congénita/virologíaRESUMEN
Acute hydramnios is a rare complication of pregnancy, usually of idiopathic etiology and associated with a very poor perinatal prognosis. In this single case report, acute hydramnios at 21 weeks' gestation, associated with fetal CMV infection, was treated by a single large volume reduction amniocentesis combined with maternal indomethacin therapy and result in delivery of a near term survivor.