vertically transmitted infection

Bacteria, viruses, and other organisms are able to be passed from mother to child. Several vertically transmitted infections are included in the TORCH complex:{{cite journal |vauthors= Jaan A, Rajnik M|date= 2021|url= https://www.ncbi.nlm.nih.gov/books/NBK560528/| title= TORCH Complex|website=National Center for Biotechnology Information, U.S. National Library of Medicine |pmid= 32809363|access-date= 27 August 2021}}

1. T – toxoplasmosis from Toxoplasma gondii
2. O – other infections (see below)
3. R – rubella
4. C – cytomegalovirus
5. H – herpes simplex virus-2 or neonatal herpes simplex

Other infections include:

• Parvovirus B19{{cite web |url= https://www.lecturio.com/concepts/parvovirus-b19/| title= Parvovirus B19

|website=The Lecturio Medical Concept Library |access-date= 27 August 2021}}

• Coxsackievirus{{cite web |url= https://www.lecturio.com/concepts/coxsackievirus/| title= Coxsackievirus|website=The Lecturio Medical Concept Library |access-date= 27 August 2021}}
• Chickenpox (caused by varicella zoster virus){{cite web |url= https://www.lecturio.com/concepts/varicella-zoster-virus-chickenpox/| title= Varicella-Zoster Virus/Chickenpox

|website=The Lecturio Medical Concept Library |access-date= 27 August 2021}}

• Chlamydia{{cite journal | first1=Jialin | last1=Yu | title=Vertical Transmission of Chlamydia trachomatis in Chongqing China | last2=Wu | first2=Shixiao | last3=Li | first3=Fang | last4=Hu | first4=Linyan | s2cid=2758055 | journal=Current Microbiology | year=2009 | volume=58 | issue=4 | pages=315–320 | issn=0343-8651 | doi=10.1007/s00284-008-9331-5 | pmid=19123031}}
• HIV{{cite journal | date=June 1992 | first1=K E | first10=A | last2=Goedert | first2=J J | last3=Boyer | first3=J | last4=Refaeli | first4=Y | last5=Frank | first5=I | last6=Williams | first6=W V | last7=Willoughby | first7=A | last1=Ugen | last10=Rubinstein | title=Vertical transmission of human immunodeficiency virus (HIV) infection. Reactivity of maternal sera with glycoprotein 120 and 41 peptides from HIV type 1. | last8=Landesman | first8=S | last9=Mendez | first9=H | journal=Journal of Clinical Investigation | volume=89 | issue=6 | pages=1923–1930 | issn=0021-9738 | doi=10.1172/JCI115798 | pmc=295892 | pmid=1601999 | display-authors=3}}{{cite journal | first1=Wafaie W. | first10=Saidi | first11=Gretchen | first12=Max | first13=Donna | first2=Gernard | first4=Ernest | last1=Fawzi | last10=Kapiga | last11=Antelman | last12=Essex | last13=Spiegelman | title=Randomized Trial of Vitamin Supplements in Relation to Vertical Transmission of HIV-1 in Tanzania | last2=Msamanga | last3=Hunter | first3=David | last4=Urassa | last5=Renjifo | first5=Boris | last6=Mwakagile | first6=Davis | last7=Hertzmark | first7=Ellen | last8=Coley | first8=Jenny | last9=Garland | first9=Miriam | s2cid=35936352 | journal=Journal of Acquired Immune Deficiency Syndromes | year=2000 | volume=23 | issue=3 | pages=246–254 | issn=1525-4135 | doi=10.1097/00042560-200003010-00006 | pmid=10839660 | display-authors=3| doi-access=free }}

{{Further|HIV and pregnancy}}

• Human T-lymphotropic virus{{cite journal | first1=Michie | first2=Elizabeth M. | first4=Wendell J. | first8=Angela | journal=Clinical Infectious Diseases | last1=Hisada | title=Virus Markers Associated with Vertical Transmission of Human T Lymphotropic Virus Type 1 in Jamaica | last2=Maloney | last3=Sawada | first3=Takashi | last4=Miley | last5=Palmer | first5=Paulette | last6=Hanchard | first6=Barrie | last7=Goedert | first7=James J. | last8=Manns | year=2002 | volume=34 | issue=12 | pages=1551–1557 | issn=1058-4838 | doi=10.1086/340537 | pmid=12032888 | display-authors=3| doi-access=free }}
• Syphilis{{cite journal | first1=M.-J. | last1=Lee | title=Maternal syphilis and vertical perinatal transmission of human immunodeficiency virus type-1 infection | last2=Hallmark | first2=R.J. | last3=Frenkel | first3=L.M. | last4=Del Priore | first4=G. | journal=International Journal of Gynecology & Obstetrics | year=1998 | volume=63 | issue=3 | pages=247–252 | issn=0020-7292 | doi=10.1016/S0020-7292(98)00165-9 | pmid=9989893| s2cid=22297001 }}
• Zika fever, caused by Zika virus, can cause microcephaly and other brain defects in the child.{{cite web | url=https://www.cdc.gov/media/releases/2016/s0413-zika-microcephaly.html | title=CDC Concludes Zika Causes Microcephaly and Other Birth Defects | publisher=Centers for Disease Control and Prevention | work=CDC Newsroom Releases | date=13 April 2016}}
• COVID-19 in pregnancy is associated with an increased risk of stillbirth with an odds ratio of approximately 2.{{cite journal| author=Wei SQ, Bilodeau-Bertrand M, Liu S, Auger N| title=The impact of COVID-19 on pregnancy outcomes: a systematic review and meta-analysis. | journal=CMAJ | year= 2021 | volume= 193 | issue= 16 | pages= E540–E548 | pmid=33741725 | doi=10.1503/cmaj.202604 | pmc=8084555 }}

Hepatitis B may also be classified as a vertically transmitted infection. The hepatitis B virus is large and does not cross the placenta. Hence, it cannot infect the fetus unless breaks in the maternal-fetal barrier have occurred, but such breaks can occur in bleeding during childbirth or amniocentesis.{{cite web |url=https://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html |title=Hepatitis B |work=Emergencies preparedness, response |publisher=World Health Organization |access-date=29 April 2016 }}

The TORCH complex was originally considered to consist of the four conditions mentioned above,{{cite journal | title=Should we expand the TORCH complex? A description of clinical and diagnostic aspects of selected old and new agents | date=December 1988 | first1=JS | last2=Kumar | first2=ML | journal=Clinics in Perinatology | volume=15 | issue=4 | last1=Kinney | pages=727–44 | pmid=2850128 | issn=0095-5108| doi=10.1016/S0095-5108(18)30670-5 }} with the "TO" referring to Toxoplasma. The four-term form is still used in many modern references,{{cite journal | date=November 2005 | first1=Sherif A. | first2=Abha | first3=Sebastian | last4=Bartha | first4=Jose L. | last1=Abdel-Fattah | title=TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom | last2=Bhat | last3=Illanes | last5=Carrington | first5=David | journal=Prenatal Diagnosis | volume=25 | issue=11 | pages=1028–1031 | issn=0197-3851 | doi=10.1002/pd.1242 | pmid=16231309 | s2cid=25481658 | display-authors=3}} and the capitalization "ToRCH" is sometimes used in these contexts.{{cite journal | first1=Ding | last1=Li | url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=GOI2006062004220 | title=A Simple Parallel Analytical Method of Prenatal Screening | last2=Yang | first2=Hao | last3=Zhang | first3=Wen-Hong | last4=Pan | first4=Hao | last5=Wen | first5=Dong-Qing | last6=Han | first6=Feng-Chan | last7=Guo | first7=Hui-Fang | last8=Wang | first8=Xiao-Ming | last9=Yan | first9=Xiao-Jun | s2cid=41493830 | journal=Gynecologic and Obstetric Investigation | year=2006 | volume=62 | issue=4 | pages=220–225 | issn=1423-002X | doi=10.1159/000094092 | pmid=16791006 | display-authors=3| url-access=subscription }} The acronym has also been listed as TORCHES, for TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, and Syphilis.{{cn|date=December 2020}}

A further expansion of this acronym, CHEAPTORCHES, was proposed by Ford-Jones and Kellner in 1995:{{cite journal | title="Cheap torches": An acronym for congenital and perinatal infections | first2=J. D. | journal=The Pediatric Infectious Disease Journal | year=1995 | volume=14 | issue=7 | pages=638–640 | doi=10.1097/00006454-199507000-00028 | first1=E. L. | last1=Ford-Jones | last2=Kellner | pmid=7567307| doi-access=free }}

• C – chickenpox and shingles
• H – hepatitis, C{{cite journal | first1=G. | last1=Tosone | title=Vertical hepatitis C virus transmission: Main questions and answers | last2=Maraolo | first2=A.E. | last3=Mascolo | first3=S. | last4=Palmiero | first4=G. | last5=Tambaro | first5=O. | last6=Orlando | first6=R. | journal=World Journal of Hepatology | year=2014 | issue=8 | pages=538–548 | doi=10.4254/wjh.v6.i8.538 | pmc=4163737 | volume=6 | pmid=25232447 | display-authors=3 | doi-access=free }} (D), E
• E – enteroviruses
• A – AIDS (HIV infection)
• P – parvovirus B19 (produces hydrops fetalis secondary to aplastic anemia)
• T – toxoplasmosis
• O – other (group B streptococci, Listeria, Candida, and Lyme disease)
• R – rubella
• C – cytomegalovirus
• H – herpes simplex
• E – everything else sexually transmitted (gonorrhea, Chlamydia infection, Ureaplasma urealyticum, and human papillomavirus)
• S – Syphilis

The signs and symptoms of a vertically transmitted infection depend on the individual pathogen. In the mother, it may cause subtle signs such as an influenza-like illness, or possibly no symptoms at all. In such cases, the effects may be seen first at birth.{{citation needed|date=July 2020}}

Symptoms of a vertically transmitted infection may include fever and flu-like symptoms. The newborn is often small for gestational age. A petechial rash on the skin may be present, with small reddish or purplish spots due to bleeding from capillaries under the skin. An enlarged liver and spleen (hepatosplenomegaly) is common, as is jaundice. However, jaundice is less common in hepatitis B because a newborn's immune system is not developed well enough to mount a response against liver cells, as would normally be the cause of jaundice in an older child or adult. Hearing impairment, eye problems, mental retardation, autism, and death can be caused by vertically transmitted infections.{{cn|date=June 2021}}

The genetic conditions of Aicardi-Goutieres syndrome are possibly present in a similar manner.{{cite journal | first1=Hans | first2=Cornelia | first4=Hannes | first8=Folker | last1=Knoblauch | title=Two brothers with findings resembling congenital intrauterine infection-like syndrome (pseudo-TORCH syndrome) | last2=Tennstedt | last3=Brueck | first3=Wolfgang | last4=Hammer | last5=Vulliamy | first5=Tom | last6=Dokal | first6=Inderjeet | last7=Lehmann | first7=Rüdiger | last8=Hanefeld | last9=Tinschert | first9=Sigrid | journal=American Journal of Medical Genetics | year=2003 | volume=120A | issue=2 | pages=261–265 | issn=0148-7299 | doi=10.1002/ajmg.a.20138 | pmid=12833411| s2cid=25402036 }}{{cite journal | first1=Rossella | date=March 2001 | first2=Salvatore | first4=Paolo | last1=Vivarelli | title=Pseudo-TORCH syndrome or Baraitser–Reardon syndrome: diagnostic criteria | last2=Grosso | last3=Cioni | first3=Maddalena | last4=Galluzzi | last5=Monti | first5=Lucia | last6=Morgese | first6=Guido | last7=Balestri | first7=Paolo | s2cid=21209676 | journal=Brain and Development | volume=23 | issue=1 | pages=18–23 | issn=0387-7604 | doi=10.1016/S0387-7604(00)00188-1 | pmid=11226724}}

The main routes of transmission of vertically transmitted infections are across the placenta (transplacental) and across the female reproductive tract during childbirth. Transmission is also possible by breaks in the maternal-fetal barrier such by amniocentesis or major trauma.

The embryo and fetus have little or no immune function. They depend on the immune function of their mother. Several pathogens can cross the placenta and cause perinatal infection. Often, microorganisms that produce minor illness in the mother are very dangerous for the developing embryo or fetus. This can result in spontaneous abortion or major developmental disorders. For many infections, the baby is more at risk at particular stages of pregnancy. Problems related to perinatal infection are not always directly noticeable.{{cn|date=December 2020}}

Apart from infecting the fetus, transplacental pathogens may cause placentitis (inflammation of the placenta) and/or chorioamnionitis (inflammation of the fetal membranes).{{cn|date=December 2020}}

Babies can also become infected by their mothers during birth. Some infectious agents may be transmitted to the embryo or fetus in the uterus, while passing through the birth canal, or even shortly after birth. The distinction is important because when transmission is primarily during or after birth, medical intervention can help prevent infections in the infant.{{cn|date=December 2020}}During birth, babies are exposed to maternal blood, body fluids, and to the maternal genital tract without the placental barrier intervening. Because of this, blood-borne microorganisms (hepatitis B, HIV), organisms associated with sexually transmitted infections (e.g., Neisseria gonorrhoeae and Chlamydia trachomatis), and normal fauna of the genitourinary tract (e.g., Candida albicans) are among those commonly seen in infection of newborns.{{cn|date=December 2020}}

In the spectrum of optimal virulence, vertical transmission tends to evolve benign symbiosis, so is a critical concept for evolutionary medicine. Because a pathogen's ability to pass from mother to child depends significantly on the hosts' ability to reproduce, pathogens' transmissibility tends to be inversely related to their virulence. In other words, as pathogens become more harmful to, and thus decrease the reproduction rate of, their host organism, they are less likely to be passed on to the hosts' offspring since they will have fewer offspring.{{cite journal | date=April 2005 | first1=Andrew D. | last2=Logsdon | first2=John M. | last1=Stewart | title=An empirical study of the evolution of virulence under both horizontal and vertical transmission | last3=Kelley | first3=Steven E. | s2cid=198155952 | journal=Evolution | volume=59 | issue=4 | pages=730–739 | issn=0014-3820 | doi=10.1554/03-330 | pmid=15926685}}

Although HIV is sometimes transmitted through perinatal transmission, its virulence can be accounted for because its primary mode of transmission is not vertical. Moreover, medicine has further decreased the frequency of vertical transmission of HIV. The incidence of perinatal HIV cases in the United States has declined as a result of the implementation of recommendations on HIV counselling and voluntary testing practices and the use of zidovudine therapy by providers to reduce perinatal HIV transmission.{{cite journal | first1=Esther | last1=Joo | title=Implementation of guidelines for HIV counseling and voluntary HIV testing of pregnant women | date=February 2000 | last2=Carmack | first2=Anne | last3=Garcia-Buñuel | first3=Elizabeth | last4=Kelly | first4=Chester J. | journal=American Journal of Public Health | pmc=1446152 | volume=90 | issue=2 | pages=273–276 | issn=0090-0036 | doi=10.2105/AJPH.90.2.273 | pmid=10667191}}

The price paid in the evolution of symbiosis is, however, great: for many generations, almost all cases of vertical transmission continue to be pathological—in particular if any other routes of transmission exist. Many generations of random mutation and selection are needed to evolve symbiosis. During this time, the vast majority of vertical transmission cases exhibit the initial virulence.{{Citation needed|date=October 2012}}

In dual inheritance theory, vertical transmission refers to the passing of cultural traits from parents to children.{{cite book|last1=Cavalli-Sforza|first1=Luigi Luca |author-link1=Luigi Luca Cavalli-Sforza|last2=Feldman|first2=Marcus W. |author-link2=Marcus Feldman|title=Cultural Transmission and Evolution: A Quantitative Approach|url=https://books.google.com/books?id=pBGvyNXkWYcC|access-date=30 April 2016|series=Monographs in Population Biology|volume=16|pages=1–388 |year=1981|publisher=Princeton University Press|isbn=0-691-08283-9|pmid=7300842 }}

Image:CMV_placentitis1.jpg

When physical examination of the newborn shows signs of a vertically transmitted infection, the examiner may test blood, urine, and spinal fluid for evidence of the infections listed above. Diagnosis can be confirmed by culture of one of the specific pathogens or by increased levels of IgM against the pathogen.{{citation needed|date=April 2015}}

A vertically transmitted infection can be called a perinatal infection if it is transmitted in the perinatal period, which starts at gestational ages between 22{{cite web |url=http://test.cp.euro.who.int/document/e68459.pdf |title=Definitions and Indicators in Family Planning. Maternal & Child Health and Reproductive Health |url-status=dead |archive-url=https://web.archive.org/web/20120125195230/http://test.cp.euro.who.int/document/e68459.pdf |archive-date=25 January 2012 }} By European Regional Office, World Health Organization. Revised March 1999 & January 2001. In turn citing: WHO Geneva, WHA20.19, WHA43.27, Article 23 and 28 weeksSingh, Meharban (2010). Care of the Newborn. p. 7. Edition 7. {{ISBN|9788170820536}} (with regional variations in the definition) and ending seven completed days after birth.

The term congenital infection can be used if the vertically transmitted infection persists after childbirth.{{cn|date=December 2020}}

{{anchor|TORCH complex}}

Image:Herpes simplex virus pap test.jpg of a pap test showing changes (upper right of image) associated with herpes simplex virus, a vertically transmitted infection]]

Some vertically transmitted infections, such as toxoplasmosis and syphilis, can be effectively treated with antibiotics if the mother is diagnosed early in her pregnancy. Many viral vertically transmitted infections have no effective treatment, but some, notably rubella and varicella-zoster, can be prevented by vaccinating the mother prior to pregnancy.{{cn|date=December 2020}}

Pregnant women living in malaria-endemic areas are candidates for malaria prophylaxis. It clinically improves the anemia and parasitemia of the pregnant women, and birthweight in their infants.{{cite journal|last1=Radeva-Petrova|first1=D|last2=Kayentao|first2=K|last3=ter Kuile|first3=FO|last4=Sinclair|first4=D|last5=Garner|first5=P|title=Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment.|journal=The Cochrane Database of Systematic Reviews|date=10 October 2014|volume=2014|issue=10|pages=CD000169|doi=10.1002/14651858.CD000169.pub3|pmid=25300703|pmc=4498495}}

If the mother has active herpes simplex (as may be suggested by a pap test), delivery by Caesarean section can prevent the newborn from contact, and consequent infection, with this virus.{{cn|date=December 2020}}

IgG₂ antibody may play a crucial role in prevention of intrauterine infections and extensive research is going on for developing IgG₂-based therapies for treatment and vaccination.Syal K and Karande AA. IgG2 Subclass Isotype Antibody and Intrauterine Infections. Current Science Vol. 102, No. 11, 10 June 2012.

Each type of vertically transmitted infection has a different prognosis. The stage of the pregnancy at the time of infection also can change the effect on the newborn.{{cn|date=December 2020}}

• Group B streptococcal infection
• Susceptibility and severity of infections in pregnancy
• Horizontal disease transmission
• TORCH syndrome
• Congenital cytomegalovirus infection
• Congenital rubella syndrome
• Congenital syphilis
• Neonatal herpes simplex

{{reflist}}

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|P|35||p|35}}-{{ICD10|P|39||p|35}}

| ICD9 = {{ICD9|771}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj =

| eMedicineTopic =

| MeshID =

}}

{{Women's health|state=collapsed}}

{{Diseases of maternal transmission}}

{{Concepts in infectious disease}}

{{Certain conditions originating in the perinatal period}}

Category:Infections specific to the perinatal period

Category:Obstetrics

Category:Neonatology

Category:Disease transmission