Clinical Manifestations

Viral Infections
a. Varicella-Zoster Virus (VZR) :
Background : double-stranded DNA herpesvirus
Transmission : primary infection varicella/chicken pox by direct
contact with an infected individual or respiratory transmission .
secondary infection herpes zoster/shingles when primary varicella
infection is reactivated
Incubation period : 10-21 days
Maternal : 1-2 day flulike prodrome >>> pruritic vesicular lesions that
crust over in 3-7 days , varicella pneumonia(symptoms : appear 3-5
days into course of illness, characterized by fever , tachypnea , dry
cough , dyspnea , & pleuritic pain) may persist for weeks.
Fetal : infections during first half pregnancy fetal may develop
congenital varicella syndrome (chorioretinitis , microphthalmia ,
cerebral cortical atrophy , growth restriction , hydronephrosis ,
skin/bone defects. Infection after 20 weeks is uncommon. Infection in
21-28 weeks gestation - central nervous system abnormalities & skin
lesions in fetuses
b. Influenza :
Background : cause by Orthomyxoviridae RNA virus
Transmission : more serious & usually develops during winter
Maternal : fever , dry cough , systemic symptoms & more susceptible
to serious pulmonary involvement
Fetal : increased neural tube defects in neonates possibly associated
with early hyperthermia
c. Mumps :
Background : caused by RNA paramyxovirus
Transmission : by direct contact with respiratory secretions , saliva ,
or through formites
Maternal : virus primarily infects the salivary glands and may also
involve gonads , meniges , pancreas , and other organ
Fetal : increase risk of spontaneous abortion , not associated with
congenital malformations & fetal infection is rare
d. Rubeola (Measles) :
Background : caused by paramyxovirus
Transmission : highly contagious
Maternal : pneumonia , diarrhea , fever , coryza , conjunctivitis ,
cough , rash [Koplik spots develops on the face and neck then spreads
to the back , trunk & extremities
Fetal : not appear to be teratogenic , increased frequency of abortion ,
preterm delivery , low-birthweight and serious infection in neonate (for
maternal develops measles shortly after birth)
e. Rubella (German Measles) :
Background : RNA togavirus
Transmission : via nasopharyngeal secretions , peak incidence in late
winter and spring
Incubation period : 12-23 days
Maternal : mild , febrile illness with generalized maculopapular rash
beginning on the face and spreading to the trunk and extremities ,

arthralgias/arthritis , head and neck lymphadenopathy , conjunctivitis ,

viremia preceds about a week , rash in 5-7 days
Fetal : one most teratogenic agents >>> congenital rubella syndrome
(eye defects , heart disease , sensorineural deafness , CNS defects ,
pigmentary retinopathy , neonatal purpura , hepatosplenomegaly and
jaundice , radiolucent bone disease
f.

Respiratory virus :
Background : cause by RNA virus (hantavirus ,
enteroviruses[coxsackievirus , poliovirus] ), DNA virus (Parvovirus ,
CMV)
Maternal : common cold , pharyngitis , laryngitis , bronchitis ,
pneumonia . RNA virus produce trivial , self-limited illness , rhinorrhea
, sneezing , and congestion . DNA virus produce cough , lower
respiratory tract involvement , pneumonia
Fetal : teratogenic effect are controversial , increased risk of fetal
anencephaly

Bacterial infections
I.
Group A Streptococcus
Background : Streptococcus pyogenes
Maternal : acute pharyngitis , systemic and cutaneous infections ,
scarlet fever , erysipelas , septicemia , bacteriuria , pyelonephritis ,
postpartum mastitis
Fetal : stillbirths , preterm labor , prematurely ruptured membranes ,
clinical and subclinical chorioamnionitis , fetal and neonatal infections
II.

Methicillin-Resistant Staphylococcus aureus (MRSA)

Background : Staphylococcal infections
Maternal : cause of skin and soft tissue infections , abscesses/cellulitis
form especially in HIV-infected women , injection drug users and
diabetics. Skin lesions
Fetal : skin infections

III.

Listeriosis :
Background : Listeria Monocytogenes ,gram-pasitive bacillus
Transmission : food borne (caused by raw vegetables , coleslaw ,
pple cider , melons , milk , fresh Mexican-style cheese , smoked fish
and processed foods)
Maternal : asymptomatic/ may cause febrile illness , occult/clinical
infection may stimulate labor
Fetal : produces disseminated granulomatous lesions with
microabscesses , chorioamnionitis , placental lesions ,
abortion/stillbirth , neonatal sepsis

IV.

Salmonellosis :
Background : Salmonella species
Transmission : food-borne illness by oral digestion of contaminated
food ,water , or milk
Maternal : Diarrhea ,abdominal pain , fever , chills , nausea , vomiting
starts 12-72 hours after exposure
Fetal : antepartum typhoid fever can result iin abortion , preterm labor
and maternal/fetal death

V.

Shigellosis :

Background : caused by Shigella

Transmission : via fecal-oral route
Maternal : bloody stool , mild diarrhea to severe dyscentery ,
abdominal cramping , tenesmus , fever , and systemic toxicity

VI.

Hansen Disease/leprosy :
Background : caused by Mycobacterium leprae
Transmission : skin-to-skin or droplet transmission and vertical
transmission in unthreatened mothers
Fetal : low-birthweight , newborns

VII.

Lyme Disease :
Background : caused by spirochete Borrelia burgdorferi
Transmission : vector-bone illness
Maternal : early infection cause distinctive local skin lesion ,
erythema , migrans , flulike syndrome , regional adenopathy , (skin
lesion , arthralgia and myalgia , carditis , and meningitis predominate).
Chronic phase- develop variety skin , joint , or neurological
manisfestations
Fetal : transplacental transmission has been confirmed but no
congenital effects of maternal borreliosis have been conclusively
identified

Protozoal Infections
i.
Malaria :
Background : Plasmodium that cause human malaria are vivax ,
ovale , malariae , and falciparum
Maternal : fever , chills , and flulike symptoms , headaches , myalgia ,
malaise which may occur intervals.anemia , jaundice and falciparum
infections can cause kidney failure , come , and death
Fetal : early infection has an increased risk for abortion , infected
erythrocytes as well as monocytes and macrophages accumulate in
the vascular area of the placenta , high levels of placental parasitemia
correlate with increase rates of stillbirth , preterm delivery , and fetalgrowth retriction
ii.

Amebiasis :
Background : by Entamoeba histolytica
Maternal : fever , abdominal pain , bloody stools

Emerging infectious
a) West Nile Virus :
Background : mosquito-borne flavivirus (human neuropathogen)
Transmission : through mosquito bites in late summer or through
blood transfusion
Incubation period : 3-14 days
Maternal : fever , metal status changes , muscle weakness and coma
Fetal : fetal are susceptible with infected virus at 27th week result in
term neonate with chorioretinitis and severe temporal and occipital
lobe leukomalacia, and risk of miscarriages ,and preterm birth
b) Severe Acute Respiratory Syndrome (SARS) :
Background : caused by coronavirus-SARS-CoV
Transmission : through droplets , close contact with infected
secretions , fluids , and waste

Incubation period : 2-16 days

Maternal : 1st week prodromal symptoms of fever , myalgias ,
headache , and diarrhea .2nd week recurrent fever , watery diarrhea
and dry nonproductive cough with mild dyspnea
Fetal : increase incidence of miscarriages , fetal-growth restriction ,
and preterm delivery

Bioterrorism
1. Smallpox :
Background : variola virus
Transmission : prolonged contact , infected body fluids or
contaminated objects such as clothing
Maternal : acute onset of fever followed by rash characterized by firm
, deepseated vesicles , or pustules in the same stage of development
2. Anthrax :
Background : Bacillus anthracis gram positive , spore forming ,
aerobic bacterium
Maternal : initially with low grade fever , nonproductive cough ,
malaise , and myalgias .2nd stage abrupt onset of severe respiratory
distress and high fever , mediastinitis , hemorrhagic thoracic
lymphadenitis