Neurologic infections during pregnancy

Abstract

Neurologic infections during pregnancy represent a significant cause of maternal and fetal morbidity and mortality. Immunologic alterations during pregnancy increase the susceptibility of the premature brain to damage. This chapter summarizes the epidemiology, pathophysiology, and clinical manifestations in the pregnant woman and the infant, and the diagnosis, treatment, and prevention of the major viral, parasitic, and bacterial infections known to affect pregnancy. These organisms include herpes virus, parvovirus, cytomegalovirus, varicella, rubella, Zika virus, toxoplasmosis, malaria, group B streptococcus, listeriosis, syphilis, and tuberculosis. There is an emphasis on the important differences in diagnosis, treatment, and fetal outcome between trimesters. An additional overview is provided on the spectrum of neurologic sequelae of an affected infant, which ranges from developmental delay to hydrocephalus and seizures.

Primary HSV-2 Infection in Early Pregnancy Results in Transplacental Viral Transmission and Dose-Dependent Adverse Pregnancy Outcomes in a Novel Mouse Model

“…This is reminiscent of clinical findings observed in human pregnancies. Localized infection the skin, eyes or mouth, with or without CNS involvement, as observed following our low-dose, controlled infection, is rarely fatal in neonates but may have associated neurological morbidities [26]. Multiorgan, disseminated disease, as observed in our high dose pregnancies, is the most serious form of neonatal herpes infection accounting for around 25% of cases with an associated mortality rate of 35% [9,13,24].…”

“…Comparatively, in women who acquire HSV-2 during pregnancy (primary maternal infection), the risk of viral transmission to the neonate in utero is considerably higher [9] and maternal infection is usually asymptomatic [24]. Since current recommendations from the Centers for Disease Control, U.S. Preventive Services Task Force, and American and Royal Colleges of Obstetricians and Gynecologists do not support screening for HSV infection in asymptomatic pregnant women [6,25,26], many of these infections go unnoticed and untreated. Therefore, it is not surprising that in pregnancies complicated by primary maternal HSV-2 infection, an estimated 40-80% will lead to neonatal herpes infection, resulting in high rates of perinatal and infant mortality [11,13,14].…”

Neurodevelopmental outcomes of infants secondary to in utero exposure to maternal SARS-CoV-2 infection: A national prospective study in Kuwait

“…However, first-trimester infections are important as the principal stages of brain development, such as primary neurulation (weeks 3–4), prosencephalic development (months 2–3), and neuronal proliferation (months 3–4), occur during the early stages of pregnancy [ 24 ]. In fact, infections with some common pathogens, such as cytomegalovirus (CMV), Zika virus, Rubella virus, Mycobacterium tuberculosis (TB), and Toxoplasma gondii , during the first and early second trimesters increase the risk of symptomatic infants, with up to 32% being associated with neurological manifestations [ 25] . Owing to the relatively recent emergence of COVID-19, information related to pregnancy outcomes among women with SARS-CoV-2 infection and the consequences of infant exposure to the virus is very scarce.…”

“…The copyright holder for this this version posted November 14, 2021. ; https://doi.org/10.1101/2021.11.12.21266291 doi: medRxiv preprint infections with some common pathogens, such as cytomegalovirus (CMV), Zika virus, Rubella virus, Mycobacterium tuberculosis (TB), and Toxoplasma gondii, during the first and early second trimesters increase the risk of symptomatic infants, with up to 32% being associated with neurological manifestations [25]. Owing to the relatively recent emergence of COVID-19, information related to pregnancy outcomes among women with SARS-CoV-2 infection and the consequences of infant exposure to the virus is very scarce.…”

Unilateral brain injury to pregnant rats induces asymmetric neurological deficits in the offspring

“…Maternal stroke occurs in around 34 out of every 100,000 deliveries and is responsible for around 5%-12% of all maternal deaths (Liew et al, 2020;Sells & Feske, 2017;Swartz et al, 2017). Neurologic infections during pregnancy represent a significant cause of maternal and fetal morbidity and mortality (Curcio et al, 2020). Traumatic brain injury, stroke, and neurologic infections in pregnant females may produce neurological deficits in the offspring and increase the susceptibility of the premature brain to damage through mechanism of intergenerational transmission.…”