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Microbiology Australia Microbiology Australia
Issue 4

Vertical Transmission, November 2008

Planning for the national meeting in Perth is now very much in full swing. As mentioned previously, we hope to make this meeting extra special as the Society will be turning 50 in 2009. We will have the usual impressive array of international speakers that will include Bonnie Bassler as the Rubbo Orator. In addition, the American Society for Microbiology has very generously agreed to sponsor an additional speaker to this meeting to help us celebrate our 50th anniversary. Following an approach from the Perth LOC, I am pleased to be able to annou...

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Infections in pregnancy and the newborn

There are many important issues relating to the investigation of infections during pregnancy and immediately after birth. They relate to the scientific areas of the need for diagnosis, for definition of markers of infection, and for the use of surrogate markers of severity, as well as clinical areas relating to diagnostic and therapeutic interventions. Ideally, at the same time, the integrity of any scientific research done to understand the pathogenesis of damage to the fetus and neonate must not be compromised.

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Microbiology Australia: have your say

How is Microbiology Australia meeting your interests? We would love to know.

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Serology testing for syphilis in pregnancy: is it still relevant?

Until the emergence of HIV and other more spectacular viral diseases, syphilis has probably been referred to more than any other infectious disease throughout history – in theatre, literature and politics. During the 19th century, aside from being a notorious disease transmitted sexually, it was the diverse clinical and pathological forms of syphilis which led to much of this mystique and fear.

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Congenital and perinatal cytomegalovirus (CMV): has diagnosis improved in 30 years?

The implication of a diagnosis of cytomegalovirus (CMV) during pregnancy or in the neonatal period remains uncertain despite our increased understanding of the pathophysiology of the disease. Current tests for CMV include serological tests (usually EIA IgG, IgM, avidity) and nucleic acid testing (NAT). When used together, these tests offer improved reliability in diagnosis of CMV in pregnant women and infants.

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What happens when a baby dies: stillbirth investigations for infection and other aetiologies

Infections in stillbirths are common, often clinically silent and need to be screened. The microbiology laboratory needs to have the appropriate culture techniques and expertise. The results of the clinical features, the pathology findings of the fetus and the placenta and the microbiological and serological features need to be interpreted together; individual results should not be considered in isolation.

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When a baby dies: stillbirth from the community perspective and what parents want to know

The death of a child at any time is a devastating experience for parents, with lifelong physical, psychological and spiritual sequelae. The death of a baby before birth presents its own particular challenges. This article is written by mothers whose babies have died. Our daughters, Olivia and Annie Rose, were stillborn at 36 weeks after uneventful pregnancies 15 years apart. In this article we describe the reality of stillbirth expressed by parents in sadness over their lost hopes and dreams and in the loss of a social identity that would valid...

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Longer-term outcomes of infections in pregnancy: pathogenesis of diabetes and other chronic infections

Rubella and cytomegalovirus (CMV) are recognised causes of congenital diabetes. The role of in utero infection with other viruses, such as enteroviruses (EV), in the development of childhood diabetes is less clear. Epidemiological studies have demonstrated an association between maternal EV infection and subsequent development of type 1 diabetes in their offspring, suggesting that the disease process begins in utero.

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Toxoplasmosis in pregnancy: often suspected, rarely convicted

Toxoplasmosis during pregnancy is uncommon and usually asymptomatic but can cause catastrophic fetal disease. It is often suspected because of non-specific symptoms or positive serological tests. However, false-positive toxoplasma IgM tests are common and confirmatory tests not always reliable. The risk of fetal infection increases as pregnancy progresses; it should be diagnosed or excluded by amniotic fluid PCR, especially early in pregnancy when the risk of severe damage is high. Prompt antibiotic therapy of maternal infection probably reduce...

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Diagnosis and treatment of herpes simplex virus (HSV) infection in the newborn

Neonatal herpes simplex virus (HSV) disease is a rare but sometimes highly lethal infection. The reported incidence in Australia is approximately four cases per 100,000 live births. HSV type 2 (HSV-2) is the predominant serotype that causes infection in the newborn in the United States, whereas in Australia 1 neonatal infection is usually caused by HSV type 1 (HSV-1), most likely due to greater prevalence of oral and genital HSV-1 disease in this country 3. Diagnosis of neonatal infection requires a high index of clinical suspicion as signs are...

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Respiratory infections in the newborn

It is well recognised that acute respiratory tract infection (ARTI) occurs commonly in children younger than 5 years of age, with pneumonia being the most serious complication. The greatest risk of death from pneumonia in childhood is in the neonatal period; it is estimated that pneumonia contributes to between 0.75-1.2 million neonatal deaths annually, accounting for approximately 10% of global child mortality. Of all neonatal deaths due to pneumonia, 96% occur in the developing world.

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Pathogenesis of cytomegalovirus (CMV) infection in pregnancy

Cytomegalovirus (CMV) infection during pregnancy can have devastating effects on the developing fetus. Maternal CMV infection can affect the fetus in two ways: firstly by transmission to, and replication in, fetal tissue resulting in direct damage to developing organs; or, less well recognised, through cellular changes that potentially affect placentation and transfer of nutrients and gases to the developing fetus.

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Pathogenesis of malaria in pregnancy

Even though we have good tools to prevent and treat malaria, it remains a tragically common disease in poor countries, especially in Africa. Pregnant women are particularly susceptible to malaria, causing anaemia and poor birth outcomes. There is marked sequestration of Plasmodium falciparum-infected erythrocytes (IEs) in the placenta, but the pathogenesis of malaria in pregnancy is still incompletely understood. Both intermittent preventive therapy and insecticide-impregnated bed nets are effective protective measures, but new measures are als...

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Goal setting and reality: maternal, perinatal and childhood malaria

The protozoan, viral and bacterial infections of malaria, human immunodeficiency virus (HIV) and tuberculosis (TB) cause over 5.5 million deaths each year. This burden of disease is largely concentrated in the same geographical regions, related to vector distribution, their association with poverty and the vulnerability of HIV infected people to both malaria and TB.

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Infection and preterm birth

Preterm birth (PTB) before 37 weeks’ gestation remains an important cause of perinatal morbidity and mortality, despite modern advances in obstetric and neonatal care. The causes of spontaneous PTB are multi-factorial; however, infection has been implicated as a significant cause of both PTB and late miscarriage, often with no visible signs or symptoms.

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Mother-to-child transmission of HIV: positive impacts

Mother-to-child-transmission (MTCT) of HIV remains the major mode of paediatric HIV infection. Advances in the prevention of MTCT over the past decade and a half represent a major public health achievement. Strategies to prevent MTCT are now the standard of care for countries rich enough to afford the interventions. As such, perinatally acquired HIV in countries like the USA and Europe is now a rare event. With clearly documented declines in MTCT rates in resource rich countries, the focus is shifting towards any downsides of these strategies i...

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Intrauterine infection: preterm birth and pulmonary impact

Acute chorioamnionitis is the histological hallmark of intrauterine infection and remains today the focus of intense, and increasing, research interest. This interest is underpinned by the association of chorioamnionitis with preterm delivery. Extreme prematurity is the fundamental, unresolved problem in perinatal medicine, has associated high morbidity and mortality, and accounts for a significant proportion of the health expenditure in the developed world. The preterm delivery rate is increasing in Australia, from 6.8% in 1991 to 8.1% in 2005...

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ASM Affairs, November 2008

National Scientific Advisory Committee (NSAC) Divisional Chairs 2011: Call for expressions of interest; New ASM Life Member, Ruth Bishop AO; Obituaries: Graeme Laver, Milton R J Salton; IUMS 2008: Microbiologists met where East meets West – Istanbul, Turkey

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