[HSV感染的母婴和间接传播:治疗和预防]。
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Henrot一
[HSV感染的母婴和间接传播:治疗和预防]。
Ann Dermatol Venereol; 2002年4月;129(4 Pt 2):533-49。
- PubMed ID
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12122323 (在PubMed］
- 摘要
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导读:新生儿疱疹是一种严重的疾病。本文对相关文献进行批判性综述的目的是:1)明确HSV感染的母婴传播和间接传播模式;2)确定当前的治疗方法和未来的展望。方法:我们使用一系列关必威国际app键词在数据库中搜索1980年以来发表的文章。根据科学证据的水平，这些文章被分为三类:良好(1级)、一般(2级)、差(3级、4级或5级)。一般评论被排除在外。结果:我们筛选出153篇文章，保留96篇。男性对女性的感染一般报告为:10p。其中100对夫妇血清不一致。抗hsv1抗体的存在对HSV2感染有部分保护作用。新生儿可在子宫内通过胎盘经血源性传播、分娩时(最常见的途径)或产后(间接传播)受到污染。发生在妊娠最后一个月的原发性感染或非原发性感染的新生儿感染风险最大(50p.100)，但分娩前一周产妇复发的传播风险较低(5p.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.