Infektionen mit Herpes-simplex- und Varicella-zoster-Viren in der Schwangerschaft

Skin infections in pregnancy

A wide array of infectious diseases can occur in pregnancy. Their acquisition, clinical presentation, and course during gestation may be altered due to an impairment of the maternal cellular immunity. Some infectious diseases can lead to serious consequences for the mother or the offspring, including congenital malformations. This review describes in detail the clinical presentation, course, management, and associated maternal and fetal risks of selected viral (varicella-zoster virus infections, condylomata acuminata), fungal (candida vulvovaginitis), bacterial (Lyme borreliosis), and parasitic (scabies) infections. The treatment options are critically reviewed. First-line therapies include acyclovir and varicella-zoster virus immunoglobulin for varicella-zoster virus infections, surgical modalities for genital warts, topical clotrimazole and oral fluconazole for Candida vulvovaginitis, amoxicillin and cefuroxime for Lyme borreliosis, and permethrin for scabies. A synopsis of maternal and fetal risks of other important infections is also included.

[Skin infections in pregnancy]

The article outlines examples of a viral (varicella-zoster virus, VZV), a bacterial (Lyme borreliosis) and a parasitic (scabies) infection in pregnancy with their risk for the mother and/or child as well as their management. VZV infections cause various clinical scenarios depending on the maternal immune status and the time of infection. Herpes zoster usually poses no risk to the pregnant woman and there is no need for antiviral therapy. VZV infection of a seronegative mother, however, may lead to severe varicella in the pregnant woman and to congenital malformations (congenital varicella syndrome) in case of early infection or neonatal varicella in case of perinatal infection. Prompt therapy with acyclovir or administration of VZV immunoglobulin for prophylaxis is mandatory in those patients. In case of Lyme borreliosis of the mother, adequate antibiotic therapy with amoxicillin prevents harm to the fetus. Doxycycline is contraindicated during pregnancy. Scabies represents an important differential diagnosis of pruritic dermatoses in pregnancy and should be treated with permethrin 5% cream.

Comparison of the dynamics and correlates of transmission of Herpes Simplex Virus-1 (HSV-1) and Varicella-Zoster Virus (VZV) in a sample of the Israeli population

Herpes simplex virus types-1 (HSV-1) and Varicella-zoster virus (VZV) are herpes viruses that share many characteristics. However, HSV-1 spreads by close contact while VZV spreads mainly by the airborne route. In this study we compared the dynamics and correlates of transmission of these viruses in the same population. In 2000-2001, 1555 sera from an age-stratified general population sample were tested using commercial ELISA kits to measure type-specific HSV-1 and varicella IgG antibodies. The VZV seroprevalence increased rapidly with age reaching 50% seropositivity by the age of 3 years, while HSV-1 reached 50% seropositivity at the age of 14 years. The highest VZV force of infection was in the 3.5-5.5-year age group followed by the 5.5-10.5 years age group, while for HSV-1 the age specific force of infection was substantially lower and stable over the various age groups. Multivariate analysis revealed that HSV-1 seroprevalence was significantly, independently associated with age, country of birth, country of origin, ethnicity, socio-economic status and VZV sero-status. Only age, country of origin and HSV-1 sero-status were found to be associated with VZV seropositivity. In developed countries such as Israel the transmission of VZV is much quicker and less dependent on socioeconomic status as compared with HSV-1.