[Measles, mumps and rubella virus infection in pregnancy. Possible adverse effects on pregnant women, pregnancy outcome and the fetus]. / Masern, Mumps und Röteln in der Schwangerschaft. Mögliche Auswirkungen auf Mutter, Schwangerschaft und Fetus.

Measles, mumps and rubella are common childhood diseases. Therefore, frequent and intense contact with children of preschool age may be associated with a higher infection risk for childcare providers. This overview summarizes current knowledge on possible adverse effects of these infections on pregnant women, pregnancy outcome and the fetus. Acute rubella or mumps virus infections are apparently not more severe in pregnant than non-pregnant women. In contrast, measles virus infection in pregnancy is linked to a higher incidence of pneumonitis and hospitalization. Evidence of congenital defects due to fetal infection is only provided in case of rubella virus infection in early pregnancy. Following rubella virus infection in the first trimester an increased fetal loss rate was reported. In 1966, a prospective study showed also a significant association between maternal mumps in the first trimester and an increased risk of abortion. But other investigators could not confirm this association. Measles and rubella but not mumps virus infections are linked to an increased premature birth rate. Occurring in late pregnancy, all three infections can result in birth of an infected infant. But severe disease occurs rarely and is mostly reported for premature infants with early neonatal measles. Preventive measures, aimed to reduce the risk of infection or severe complications for pregnant childcare providers, should consider the individual history of the employee (e.g. previous immunizations or antibody test results), the current epidemiological situation and possible interventions like passive immunization in case of exposure to measles.

A case of congenital mumps infection complicated with persistent pulmonary hypertension.

A low-birth-weight female baby was admitted with respiratory distress after birth. Her mother had been diagnosed with mumps 4 weeks and 5 days prior to delivery. Mumps IgM antibody was elevated in the neonate and mumps virus ribonucleic acid was detected in the umbilical cord blood by reverse transcription-polymerase chain reaction. The perinatal virus infection was complicated with persistent pulmonary hypertension of the newborn and pulmonary hemorrhage. Successful treatment included the use of high frequency oscillation ventilation together with the administration of artificial surfactant.

Thrombocytopenia in a case of neonatal mumps infection: evidence for further clinical presentations.

We report a rare case of congenital mumps infection in a newborn girl. Her mother developed bilateral parotitis beginning the day of the delivery. The child was subsequently severely ill and suffered from fever, splenomegaly and thrombocytopenia, however, without parotitis nor pancreatic involvement. Both mother and child recovered well with symptomatic treatment. A review of the literature shows that clinical mumps is rare and usually benign in neonates. However, severe respiratory distress may occur. The recent appearance of mumps outbreaks in adolescents and young adults calls for a reinforcement of mumps vaccination and should prompt an immunological assessment of pregnant women after exposure.

Congenital mumps pneumonia: a rare cause of neonatal respiratory distress.

A case of a fullterm infant with severe neonatal respiratory distress due to mumps infection is reported. Pregnancy was complicated by a self-limited febrile illness of the mother about two weeks before birth. Foetal heart rate patterns and delivery were normal. Immediately after birth the infant needed mechanical ventilation. Bacterial infections, as well as congenital cardiac or pulmonary malformations were excluded. The infant showed serologic evidence of mumps infection: IgM antibodies to mumps virus were highly positive. He expired on the 9th day of life due to bilateral pneumothoraces and pneumopericardium. Post-mortem examination showed interstitial pneumonia with intra-alveolar multinucleated giant cells, suggesting viral disease. This case demonstrates, that mumps pneumonia should be included in the differential diagnosis of severe neonatal respiratory distress in fullterm neonates.

Uncommon virus infections of the mother, fetus, and newborn: influenza, mumps and measles.

The literature contains reports of epidemics of varying sizes, which in the aggregate suggest that congenital malformations are not attributable to maternal measles infection during pregnancy, that the incidence of prematurity may be somewhat higher among infected mothers, and that the incidence of abortion also may be somewhat higher. Before the introduction of measles vaccine in this country, the universality of childhood experience rendered adult infection a rare event. Gestational measles was thus uncommon. With the introduction of measles vaccine, these numbers can be expected to have decreased substantially.

Induction of abnormal immunoglobulin maturation and antibody production by persistent embryonic mumps virus infection.

Intramuscular inoculation of 19-day old chickens with heterologous erythrocytes elicited significantly lower levels of agglutinins in embryonically infected birds when compared with control birds (reciprocal ha titer 10 vs. 100, respectively, P less than 0.01). The IgG component of this antibody was substantially less in experimental chickens, 25% vs. 70% in controls. Subsequent anamnestic antibody response in experimental birds was also significantly less than control chickens (reciprocal ha titers 25 vs. 512, respectively, P less than 0.02), with continued predominance of IgM antibody in experimental chickens (70% IgM-ha) vs. controls (60% IgG-ha). Induction of cell-mediated immunity by footpad inoculation of 46-day-old birds with diphtheria-tetanus toxoid in complete Freund's adjuvant failed to discern suppression of T cell function in previously infected chicks. Before hatch, the bursae of experimental and control embryos possessed a few IgM-producing lymphoid cells in equivalent numbers. There was also no difference in the relative population of IgM-producing cells in the medullary area of bursal follicles of 7-day-old hatchling chickens, approximately 70%. However, the mean density of IgG-producing cells in the bursae of experimental chickens was less than that of control chickens, 10% vs. 19%, respectively. Consistent with persistent embryonic viral infection and altered bursal function, only IgM-producing cells were detected in the spleens of 7-day-old experimental birds. These observations suggest that persistent embryonic viral infection disturbs the function of bursal-dependent immunopoiesis in the avian host.