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Early therapy interventions yield quick recovery in congenital infections
NEW YORK — New testing algorithms and available suppressive therapies are enhancing treatment options for congenital infections, according to a presentation at the 2016 Infectious Diseases in Children Symposium.
Early detection is the key to treating congenital infections in infants who present with similar viral infection symptoms, unremarkable lab work and negative cultures. Antenatal herpes frequently involves the liver, so aspartate aminotransferase and alanine aminotransferase are frequently elevated, and fever.
“About 7% to 14% of infants with neonatal herpes present with a fever without a source.
There are three components of HSV infection,” Michael T. Brady, MD, professor of pediatrics at The Ohio State University and the associate medical director at Nationwide Children’s Hospital said. “There is disseminated disease, which can include pneumonia and hepatitis C involvement, there is encephalitis or central nervous system disease, and then local disease, which has become more common I think because fortunately, people have identified the symptoms earlier on before it reaches the dissemination or encephalitis characteristics.”
Data from a study performed by Meireles et al presented at a recent Advisory Committee on Immunization Practices meeting showed a 91% decrease incidences of hepatitis B since 1982, and incidences remain presently stable, Brady said.
“There are 952 perinatal infections in the U.S. each year,” Brady said. “Hepatitis B vaccinations are 75% effective in preventing perinatal infection if the mother receives immunization, and combined with the hepatitis B immunoglobulin vaccine, a 94% preventive rate is achievable.”
Congenital syphilis in infants via maternal transmission is increasing, Brady said. “We are seeing many more congenital syphilis cases occurring in the United States because there are an increased number of cases of syphilis in the United States,” he said. “With that, we have an increased number of tests. There is the nontreponemal tests; these are tests that react to nontreponemal antigens and these are the most commonly used ones with [rapid plasma reagin] and [Venereal Disease Research Laboratory].”
The nontreponemal serologic test is prescribed after positive T. pallidum screening, and it often produces false-positives and recurrence with new T. pallidum infection.
The new treponemal non-serologic test provides protective antibody agents to syphilis for a significant amount of time after initial therapy, Brady said.
“The newer tests are less expensive than the RPR, and some hospitals and many labs now are testing with treponemal first more frequently because of the expense, but also because it is more compatible with some of their systems and can produce a positive syphilis reading faster, encouraging quicker turnaround to treatment.” – by Kate Sherrer
Reference:
Brady MT. “Congenital infections: the common and the not so uncommon”. Presented at: IDC NY; Nov. 19-20, 2016; New York.
Meireles LC, et al. World J Hepatol. 2015 Aug 28; 7(18): 2127–2132.
Disclosure: Brady reports receiving royalties from Up-To-Date chapter on HHV-6.