[HSV感染的母婴和间接传播:治疗和预防)。
文章的细节
-
引用
复制到剪贴板 -
Henrot一
[HSV感染的母婴和间接传播:治疗和预防)。
安北京医学Venereol。2002年4月,129 (4 Pt 2): 533 - 49。
- PubMed ID
-
12122323 (在PubMed]
- 文摘
-
简介:新生儿疱疹是一种严重的情况。这个关键文献之回顾的目标是:1)定义HSV感染的母婴和间接传播的模式;2)确定目前的治疗和对未来的观点。方法:自1980年以来我们寻找文章发表在数据库中使用一系列的关键词。文章是由科学证据水平被分为三个类别:好的(1级),公平(要求等级2),可怜的(3级,4或5)。一般评论被排除在外。结果:我们选择了153篇文章,96保留。男人对女人污染普遍报道:10 p。100的夫妇被serodiscordant。anti-HSV1抗体的部分有预防感染。新生儿可以通过经胎盘的污染在子宫内造血的传播,在交付(最常见的路线),或产后期间(间接传播)。新生儿的风险是最大的污染为主要感染(π)或非主感染发生怀孕最后一个月(50 p.100),但传输低孕产妇复发在交货前一周(5 p.100)。 Cesarean section is mandatory in case of genital PI or non-primary maternal infection during the last month of pregnancy, especially in case of membrane rupture<6 hr, but does not protect the infant in two-thirds of the cases. The decision for cesarean is controversial in case of recurrence. Antiviral treatment of the mother using aciclovir (ACV) is well tolerated. ACV-cesarean combination provides maximal protection for the neonate. A neonate with proven or suspected HSV infection should be isolated from other neonates but not from the mother. Breastfeeding is contraindicated in case of breast lesions. Parenteral ACV 60 g/kg/d is preferred over vidarabine. It should be started immediately after the first virology samples. The risk of recurrence is estimated at 7p.100 for all neonates and warrants treatment using a high oral dose (90-100mg/kg/d) due to the low bioavailability, if the number of recurrences is>3 in 6 months. Antiviral treatment is formally indicated if: 1) neonate viral cultures are positive at day 1 and day 3, 2) clinical lesions suggest herpes, 3) neurological disorders or signs of sepsis with negative bacteriology are present and the mother has a history of herpes or contact with labial herpes; and can be discussed if: 4) PI is proven at delivery or during the last month of pregnancy (irrespective of the delivery route, even if the mother is treated or if the membranes are intact), 5) late cesarean (membrane rupture>4 h) with clinical herpes at delivery, 6) vaginal delivery and recurrent herpes within the last month with associated clinical risk factor(s). CONCLUSION: Many points remain to be clarified concerning optimal management of the mother-infant couple in case of maternal herpes during pregnancy or at delivery. New perspectives concerning diagnosis and prevention of neonatal contamination include: identification of asymptomatic primary infections using rapid identification of genital viral antigen during delivery, identification of women with a risk of asymptomatic excretion using specific serology tests for the pregnant woman and her partner, antiviral treatment for men, topical genital treatments, vaccination of women at risk, monoclonal antibodies, new antiviral agents with mechanisms of action independent of viral thymidine kinase.