Intrauterine varicella: a report of two cases associated with hyper-A-immunoglobulinemia

Fetal and placental pathology in two cases of maternal varicella infection

We describe the fetal and placental pathology in two cases of maternal varicella infection. Varicella in pregnancy is uncommon, and although sporadic cases of fetal involvement are described very little regard has been paid to placental features. Only one previous report describes the changes in both the fetus and its associated placenta. In both our cases the placenta showed chronic villitis with with granuloma formation, and occasional cells with nuclear viral-like inclusions were detected. Cells with similar inclusions were found in the lung interstitium, and foci of dystrophic calcification were present in the liver.

Ocular teratology

The principles of teratology are described, and animal models for research in abnormal ocular development and clinical studies of human teratogens are surveyed. A review is made of presumed ocular teratogenic agents: radiation; external environmental teratogens; maternal conditions such as infections, diabetes, and epilepsy; alcohol and drugs such as thalidomide, retinoic acid, and coumarin anticoagulants; and other agents, such as cigarettes.

Congenital varicella syndrome

The authors are reporting a typical case of congenital varicella syndrome following maternal varicella during the 17th week of pregnancy. At birth, the newborn showed necrotic bullae on the skin that healed later with characteristic scars. Other typical anomalies, i.e. hypoplastic limbs with muscular atrophy and clubfoot, intrauterine atrophy, dysphagia and anisocoria were also found. In view of the risk of serious malformations following intrauterine varicella infection attempts should be made to prevent varicella zoster virus infection during pregnancy.

Herpes zoster in a 2-week-old premature infant with possible congenital varicella encephalitis

This report concerns a case of neonatal herpes zoster associated with maternal gestational varicella. The child developed skin lesions at 18 days of age virologically confirmed to be varicella-zoster. The baby also had encephalitis and aspiration probably due to bulbar paralysis. Multiple small necrotic areas were found in the thalamus at post-mortem examination.

Fetal inflammatory response in second trimester candidal chorioamnionitis

Candidal chorioamnionitis is an uncommon and apparently rather indolent intrauterine infection in which the fetus is able to marshal some of the immunological forces at its disposal against an easily visualized antigen impinging on lung mucosal surfaces. In a retrospective histological study of one of the largest reported series of these cases, we have encountered one each of 13, 16 and 22 weeks gestation, respectively. Of these, the youngest at 13 weeks showed no inflammatory response or positive cells on immunoperoxidase staining for immunoglobulins and proliferating Candida colonies were evident in the lungs. The 16 and 22 week cases revealed a unique giant cell response in the terminal airways and increasing numbers of cells staining positively for immunoglobulins, predominantly IgM, but with an increased proportion of IgA positive cells in the older case. Preliminary studies with a pan-T-cell antiserum on paraffin-embedded lung tissue from these cases have been encouraging with few positive cells seen in sections from the 13-week or control cases but abundant cells in the lungs of the two older infected cases. Some aspects of the relationship of these uncommonly encountered cases to the ontogeny of human immunity are discussed.

Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus

New knowledge of the relationship between the varicella-zoster virus and its host suggests a heretofore unappreciated dynamic pattern. Molecular finger-printing has demonstrated a degree of heterogeneity between different strains of virus. It is probable that exogenous reinfection with different strains and endogenous reactivation are commonplace events, although usually asymptomatic. The lability of the endogenous interaction inversely parallels the responsiveness of the cell-mediated immune system--a major factor in viral containment by the human host. Thus, the therapeutic use of immunosuppressive or cytotoxic substances increases the morbidity and mortality associated with varicella-zoster. Promising new approaches to the prevention and treatment of the virus should alter the balance in favor of the host.