ReviewPregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses
Introduction
There are several infectious agents that have a high potential to cause significant fetal damage such as rubella virus, cytomegalovirus, varicella zoster virus and Toxoplasma Gondii, while others that are less noticeable in pregnancy, seem to have significantly less ability to damage the fetus. In this review, we will discuss the viruses that have little in common except that after infecting pregnant women they may cause fetal or neonatal damage. Their overall risk to pregnancy outcome seems to be low, and therefore their role as possible teratogens is often overlooked. This review is a summary of the relevant literature, especially in the English language, discussing two viruses affecting the nervous system: poliomyelitis and encephalitis viruses, and several other viruses: coxsackie, echo, mumps, measles and hepatitis viruses. In spite of the advances in immunization, there are still countries with poor immunization programs where many of these infections are still common and may affect pregnant women. The discussion will be divided into effects on adults, effects on pregnancy outcome, on the fetus and neonate, and, whenever appropriate, effects of immunization.
Section snippets
Effects on adults
Poliomyelitis is a highly contagious, sometimes fatal, acute viral infection that affects motor neurons and can produce permanent muscle weakness, paralysis and other symptoms. It produces a wide range of clinical illness, from none to rapidly progressive paralysis and death. Poliovirus is a RNA virus of the enterovirus group. The infection spreads by swallowing contaminated material; it spreads from the intestine to the parts of the brain and spinal cord that control muscle activity.
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Effects on adults
Coxsackie and echoviruses belong to a class known as enteroviruses. Both viruses may be transmitted to the fetus during delivery in 30–50% of mothers with seroconversion in pregnancy, but the rate of trans-placental transmission, although present, is unknown [22], [23], [24]. They are transmitted, like other enteroviruses from person to person orally through the fecal–oral route.
Coxsackie viruses are classified into two large groups with 24 coxsackie viruses in group A, and 6 in group B [22],
Effects on the fetus
Hepatitis E has an increased severity in pregnant women. In a prospective study carried out in Kashmir, India, Khuroo and Kamili identified 76 pregnant women and 337 non-pregnant women of childbearing age with sporadic acute viral hepatitis, half of them with hepatitis E [72]. Pregnancy was associated with a higher rate of severe disease, as 47 of the 76 pregnant women (61.8%), most of them infected with HEV, developed fulminant and sometimes fatal hepatic failure in comparison to only 34
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