ABSTRACT
Pregnancy is associated with impaired T-cell-mediated immunity putting the woman at
risk for infectious diseases not typically seen in immunocompetent individuals. When
maternal infection is severe, and when a primary herpesvirus infection is acquired
during pregnancy, there is a risk of fetal loss, maternal death, neonatal death, or
congenital abnormalities from intrauterine infection. In this review, the authors
emphasize specific neurologic infectious diseases that occur in pregnancy, the safety
of the antimicrobial therapy of these diseases during pregnancy, as well as the congenital
and neonatal sequelae of infection.
KEYWORDS
Listeria monocytogenes, herpes simplex virus - varicella zoster virus - cytomegalovirus - toxoplasmosis -
West Nile virus - H1N1
REFERENCES
- 1
Medawar P B.
Some immunological and endocrinological problems raised by the evolution of viviparity
in vertebrates.
Symp Soc Exp Biol.
1953;
7
320-338
- 2
Koch C A, Platt J L.
T cell recognition and immunity in the fetus and mother.
Cell Immunol.
2007;
248
(1)
12-17
- 3
Silver H M.
Listeriosis during pregnancy.
Obstet Gynecol Surv.
1998;
53
(12)
737-740
- 4
Landrum L M, Hawkins A, Goodman J R.
Pneumococcal meningitis during pregnancy: a case report and review of literature.
Infect Dis Obstet Gynecol.
2009
63624
- 5
Temple M E, Nahata M C.
Treatment of listeriosis.
Ann Pharmacother.
2000;
34
(5)
656-661
- 6
Southwick F S, Purich D L.
Intracellular pathogenesis of listeriosis.
N Engl J Med.
1996;
334
(12)
770-776
- 7
Janakiraman V.
Listeriosis in pregnancy: diagnosis, treatment, and prevention.
Rev Obstet Gynecol.
2008;
1
(4)
179-185
- 8
Mylonakis E, Paliou M, Hohmann E L, Calderwood S B, Wing E J.
Listeriosis during pregnancy: a case series and review of 222 cases.
Medicine (Baltimore).
2002;
81
(4)
260-269
- 9
Jackson K A, Iwamoto M, Swerdlow D.
Pregnancy-associated listeriosis.
Epidemiol Infect.
2010;
138
(10)
1503-1509
- 10
Bartt R.
Listeria and atypical presentations of Listeria in the central nervous system.
Semin Neurol.
2000;
20
(3)
361-373
- 11
Uldry P A, Kuntzer T, Bogousslavsky J et al..
Early symptoms and outcome of Listeria monocytogenes rhombencephalitis: 14 adult cases.
J Neurol.
1993;
240
(4)
235-242
- 12
van de Beek D, de Gans J, Tunkel A R, Wijdicks E F.
Community-acquired bacterial meningitis in adults.
N Engl J Med.
2006;
354
(1)
44-53
- 13
Lucas A O.
Pneumococcal meningitis in pregnancy and the puerperium.
BMJ.
1964;
1
(5375)
92-95
- 14
Tunkel A R, Hartman B J, Kaplan S L et al..
Practice guidelines for the management of bacterial meningitis.
Clin Infect Dis.
2004;
39
(9)
1267-1284
- 15
Brouwer M C, Heckenberg S G, de Gans J, Spanjaard L, Reitsma J B, van de Beek D.
Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis.
Neurology.
2010;
75
(17)
1533-1539
- 16
Crowley P A.
Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to
1994.
Am J Obstet Gynecol.
1995;
173
(1)
322-335
- 17
MacArthur B A, Howie R N, Dezoete J A, Elkins J.
School progress and cognitive development of 6-year-old children whose mothers were
treated antenatally with betamethasone.
Pediatrics.
1982;
70
(1)
99-105
- 18
Dessens A B, Haas H S, Koppe J G.
Twenty-year follow-up of antenatal corticosteroid treatment.
Pediatrics.
2000;
105
(6)
E77
- 19
Costa M L, Souza J P, Oliveira Neto A F, Pinto E Silva J L.
Cryptococcal meningitis in HIV negative pregnant women: case report and review of
literature.
Rev Inst Med Trop Sao Paulo.
2009;
51
(5)
289-294
- 20
Pebody R G, Andrews N, Brown D et al..
The seroepidemiology of herpes simplex virus type 1 and 2 in Europe.
Sex Transm Infect.
2004;
80
(3)
185-191
- 21
Anzivino E, Fioriti D, Mischitelli M et al..
Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology,
diagnosis, therapy and prevention.
Virol J.
2009;
6
40
- 22
Young E J, Chafizadeh E, Oliveira V L, Genta R M.
Disseminated herpesvirus infection during pregnancy.
Clin Infect Dis.
1996;
22
(1)
51-58
- 23
Sauerbrei A, Wutzler P.
Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts
of prevention, diagnosis and therapy. Part 1: herpes simplex virus infections.
Med Microbiol Immunol (Berl).
2007;
196
(2)
89-94
- 24
Hutto C, Arvin A, Jacobs R et al..
Intrauterine herpes simplex virus infections.
J Pediatr.
1987;
110
(1)
97-101
- 25
Boucher F D, Yasukawa L L, Bronzan R N, Hensleigh P A, Arvin A M, Prober C G.
A prospective evaluation of primary genital herpes simplex virus type 2 infections
acquired during pregnancy.
Pediatr Infect Dis J.
1990;
9
(7)
499-504
- 26 Whitley R J. Herpes Simplex Viruses. Clinical Virology. Washington, DC: ASM Press;
2004: 375-401
- 27
James S H, Kimberlin D W, Whitley R J.
Antiviral therapy for herpesvirus central nervous system infections: neonatal herpes
simplex virus infection, herpes simplex encephalitis, and congenital cytomegalovirus
infection.
Antiviral Res.
2009;
83
(3)
207-213
- 28
Sheffield J S, Hollier L M, Hill J B, Stuart G S, Wendel G D.
Acyclovir prophylaxis to prevent herpes simplex virus recurrence at delivery: a systematic
review.
Obstet Gynecol.
2003;
102
(6)
1396-1403
- 29
Gardella C, Brown Z A.
Managing varicella zoster infection in pregnancy.
Cleve Clin J Med.
2007;
74
(4)
290-296
- 30
Sauerbrei A, Wutzler P.
Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts
of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections.
Med Microbiol Immunol (Berl).
2007;
196
(2)
95-102
- 31 Enders G, Miller E. Varicella and herpes zoster in pregnancy and the newborn. In:
Arvin A M, Gershon A A, eds. Varicella Zoster Virus: Virology and Clinical Management.
Cambridge: Cambridge University Press; 2000: 317-347
- 32
Mustafa M B, Arduino P G, Porter S R.
Varicella zoster virus: review of its management.
J Oral Pathol Med.
2009;
38
(9)
673-688
- 33
Kenneson A, Cannon M J.
Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection.
Rev Med Virol.
2007;
17
(4)
253-276
- 34
Cannon M J, Schmid D S, Hyde T B.
Review of cytomegalovirus seroprevalence and demographic characteristics associated
with infection.
Rev Med Virol.
2010;
20
(4)
202-213
- 35
Cheeran M C, Lokensgard J R, Schleiss M R.
Neuropathogenesis of congenital cytomegalovirus infection: disease mechanisms and
prospects for intervention.
Clin Microbiol Rev.
2009;
22
(1)
99-126
- 36
Syggelou A, Iacovidou N, Kloudas S, Christoni Z, Papaevangelou V.
Congenital cytomegalovirus infection.
Ann N Y Acad Sci.
2010;
1205
144-147
- 37
Torpy J M, Burke A E, Glass R M.
JAMA patient page. Cytomegalovirus.
JAMA.
2010;
303
(14)
1440
- 38
Pass R F, Zhang C, Evans A et al..
Vaccine prevention of maternal cytomegalovirus infection.
N Engl J Med.
2009;
360
(12)
1191-1199
- 39
Boyer K M, Holfels E, Roizen N Toxoplasmosis Study Group et al.
Risk factors for Toxoplasma gondii infection in mothers of infants with congenital toxoplasmosis: Implications for prenatal
management and screening.
Am J Obstet Gynecol.
2005;
192
(2)
564-571
- 40
Jones J, Lopez A, Wilson M.
Congenital toxoplasmosis.
Am Fam Physician.
2003;
67
(10)
2131-2138
- 41
Montoya J G, Remington J S.
Management of Toxoplasma gondii infection during pregnancy.
Clin Infect Dis.
2008;
47
(4)
554-566
- 42
Xiao X, Miravalle L, Yuan J et al..
Failure to detect the presence of prions in the uterine and gestational tissues from
a gravida with Creutzfeldt-Jakob disease.
Am J Pathol.
2009;
174
(5)
1602-1608
- 43
Sperling R, Haak K, Hesson D, Hidde B B.
Creutzfeldt-Jakob disease in the obstetric patient.
J Obstet Gynecol Neonatal Nurs.
2005;
34
(5)
546-550
- 44
Tabrizi S J, Elliott C L, Weissmann C.
Ethical issues in human prion diseases.
Br Med Bull.
2003;
66
305-316
- 45
Tyler K L.
Emerging viral infections of the central nervous system: part 1.
Arch Neurol.
2009;
66
(8)
939-948
- 46
Davis L E, DeBiasi R, Goade D E et al..
West Nile virus neuroinvasive disease.
Ann Neurol.
2006;
60
(3)
286-300
- 47
Torno M, Vollmer M, Beck C K.
West Nile virus infection presenting as acute flaccid paralysis in an HIV-infected
patient: a case report and review of the literature.
Neurology.
2007;
68
(7)
E5-E7
- 48
Alpert S G, Fergerson J, Noël L P.
Intrauterine West Nile virus: ocular and systemic findings.
Am J Ophthalmol.
2003;
136
(4)
733-735
- 49
Paisley J E, Hinckley A F, O'Leary D R et al..
West Nile virus infection among pregnant women in a northern Colorado community, 2003
to 2004.
Pediatrics.
2006;
117
(3)
814-820
- 50
O'Leary D R, Kuhn S, Kniss K L et al..
Birth outcomes following West Nile Virus infection of pregnant women in the United
States: 2003–2004.
Pediatrics.
2006;
117
(3)
e537-e545
- 51
Centers for Disease Control and Prevention (CDC) .
Interim guidelines for the evaluation of infants born to mothers infected with West
Nile virus during pregnancy.
MMWR Morb Mortal Wkly Rep.
2004;
53
(7)
154-157
- 52
Fiore A E, Uyeki T M, Broder K Centers for Disease Control and Prevention (CDC) et
al.
Prevention and control of influenza with vaccines: recommendations of the Advisory
Committee on Immunization Practices (ACIP), 2010.
MMWR Recomm Rep.
2010;
59
(RR-8)
1-62
- 53
Girard M P, Tam J S, Assossou O M, Kieny M P.
The 2009 A (H1N1) influenza virus pandemic: a review.
Vaccine.
2010;
28
(31)
4895-4902
- 54
Akins P T, Belko J, Uyeki T M, Axelrod Y, Lee K K, Silverthorn J.
H1N1 encephalitis with malignant edema and review of neurologic complications from
influenza.
Neurocrit Care.
2010;
13
(3)
396-406
- 55
Sejvar J J, Uyeki T M.
Neurologic complications of 2009 influenza A (H1N1): heightened attention on an ongoing
question.
Neurology.
2010;
74
(13)
1020-1021
- 56
Fugate J E, Lam E M, Rabinstein A A, Wijdicks E F.
Acute hemorrhagic leukoencephalitis and hypoxic brain injury associated with H1N1
influenza.
Arch Neurol.
2010;
67
(6)
756-758
- 57
Lapinsky S E.
H1N1 novel influenza A in pregnant and immunocompromised patients.
Crit Care Med.
2010;
38
(4, Suppl)
e52-e57
- 58
ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System
.
Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population
based cohort study.
BMJ.
2010;
340
c1279
- 59
Louie J K, Guevara H, Boston E et al..
Rapid influenza antigen test for diagnosis of pandemic (H1N1) 2009.
Emerg Infect Dis.
2010;
16
(5)
824-826
Kelly J BaldwinM.D.
PGY 3 Resident, Department of Neurology, West Virginia University
P.O. Box 9180, Morgantown, WV 26506
Email: kbaldwin@hsc.wvu.edu