Transcript Clamydia, Rubella and CMV

TORCH tests
• The five categories of organisms whose antibodies are measured by the
TORCH test are grouped together because they can cause abortion for
pregnant woman and/or birth defects in newborns.
• Toxoplasmosis.
• Others e.g: Chlamydia, syphilis, hepatitis B, coxsackie virus, EpsteinBarr virus, varicella-zoster virus(chickenpox), and humanparvovirus.
• Rubella.
• Cytomegalovirus(CMV).
• Herpes(HSV)
• There are several causes for abortion, some of them are related
to viral infection from these viruses:
1. Cytomegalovirus ( CMV).
2. Rubella.
3. Herpes.
• Other non-viral causative agents for abortion include:
Clamydia
– Toxoplasma gondii (parasite)
The main routes of transmission are across:
• Placenta (transplacental)
• Birth canal.
–
Chlamydia
• Small obligate intracellular parasite.
• Confusion occurred by the discovery of Chlamydia as it was
classified as both bacteria and virus.
• It is classified as virus for it’s:
– Basophilic staining in the host cell to form the elementary body,
which are small, dense and about 0.3u in diameter.
– Intracellular microorganism, they can’t synthesize ATP, but use
the host cell for this purpose.
• Causes for classification of chlamydia as bacteria:
– They have both DNA and RNA.
– Have their self-metabolic system.
– They are able to grow and multiply by binary fission.
– They are surrounded by a cell membrane.
– Response to antibiotic therapy.
Species of chlamydia
1. C. psittsci, cause psittacosis.
2. C. lymphogranulomatis, cause lymphogranuloma venerum
( LGV).
3. C. trachomatis, cause conjuctival and cornea disease
(Trachoma)
4. C. occulogenitalis, cause conjunctivitis.
• Psittacosis:
– Is a respiratory disease of man acquired from contact with
infected birds, which excretes the organism in their stool.
– It causes infection in the upper respiratory system and
pneumonia.
• Laboratory diagnosis:
1. Sputum and blood test.
• Smear to show elementary bodies.
•
ELISA.
 PCR
2. isolation: by inoculation of the yolk sack of an
embryonated egg or intracerebral, intranasal or
intraperitonial injection into a mice.
3. Serological tests:
– Complement fixation.
– Agglutination test.
– Neutralization test.
• Lymphogranuloma venerum:
– It is a venereal disease characterized by:
• Enlargement of lymph regional lymph nodes,
tend to form sinuses.
• Infect the urethral parts and cause urethritis and is accompanied
by systemic symptoms.
– Laboratory diagnosis:
• Smears (biopsy from the infected lymph node), pus cells can
be seen in infected LN and stain (elementary bodies)
• Culture: is not useful as it will give negative result and resist
all antibiotics.
• C. Trachomatis:
– Causes Chlamydial infection which is a sexually
transmitted disease (STD)
– Causes Trachoma by it’s growth in the
conjunctival and cornea cells of the eye causing keratoconjunctivitis.
–If passed to the baby during the passage through the
birth canal, chlamydia can cause conjunctivitis
and pneumonia.
– Many women who are infected do not even realize it because they
often have no symptoms. However, when untreated, chlamydia can
cause a scarring infection of the woman's internal reproductive
organs, increasing her risk of a potentially fatal tubal pregnancy.
–Laboratory diagnosis:
• Smear(eye swab).
• ELISA (IgM, IgG or IgA).
Rubella
• Rubella is a rather mild disease spread by the way of respiratory
secretion, skin contact or congenitally.
• Cause German measles, causing the following symptoms:
– Firstly, catarrhal symptoms and mild fever.
– Irregular rash.
• Incubation period is (3-4) weeks.
• The tragic aspect of Rubella may become evident of infection
occurs during pregnancy.
• MMR vaccine .(IgG pesist for life)
symptoms
• The virus can cross placental wall and infect the fetus, this may lead
to fetal death or congenital defect which may be:
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Hearing loss
Mental retardation
heart disease
retarded growth
blood disorders
vision problems
pneumonia
Laboratory Diagnosis
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Complement fixation.
Neutralization test.
Heme agglutination inhibition (HAI).
ELISA IgM and IgG.
Herpes Human Viruses (HHV)
There are eight types of herpes viruses known to affect humans:
HSV1 (Herpes Simplex Virus 1 commonly known as oral herpes)
HSV2 (Herpes Simplex Virus 2 commonly known as genital herpes)
HHV3 - VZV (Varicella Zoster Virus commonly known as
chickenpox or shingles)
• HHV4 - EBV (Ebstein Barr Virus commonly known as infectious
mononucleosis [mono or glandular fever])
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• HHV5 - CMV (Cytomegolo Virus is the most common virus transmitted
to a pregnant woman's unborn child)
• HHV6 - Roseolovirus more commonly known as the 6th disease or
Roseola Infantum
• HHV7 - Similar to HHV6 (not yet classified)
• HHV8 - A type of rhadinovirus known as the Kaposi's sarcomaassociated herpesvirus (KSHV)
Herpes simplex virus
• There are two forms of the herpes simplex virus:
– Herpes simplex virus 1 (HSV-1)
– Herpes simplex virus 2 (HSV-2)
.
Area of infection
Transmission
HSV-1
HSV-2
Oral cavity(mouth)
Genital area
By contact
sexually
HSV-1
• also commonly referred to as fever blisters, oral herpes.
• It is a viral infection of the skin that may occur once or return again
and again.
• some factors that may trigger it to return:
– Stress
– Fever
– Menstruation Cycle
– Fatigue
– Certain foods
– Pregnancy
HSV-2
• Genital herpes outbreaks are contagious viral infection that
affects primarily the genitals of men and women.
• It is characterized by recurrent clusters of lesions in the genital
areas.
• It is sexually transmitted (STD)
Varicella zoster
• Infection with the varicell virus can cause chicken pox and shingles
• It can be spread through contact with the sneezes or coughs of an
infected person.
• becoming infected during pregnancy can cause serious complications
to newborn:
– Scarring
– malformed limbs
– damage to the eyes and brain.
Diagnosis of HSV and herpes zoster
1. Viral culture.
2. Tzanck smear.
3. Direct immunofluorescence study with monoclonal
antibodies (DFA)
4. Type-specific serologic tests for HSV.
Cytomegalo virus (CMV)
• CMV is also called salivary gland virus which may infect salivary
glands or parotid gland.
• An increase number of infections with the virus have reported in
adults with neoplastic disease, leukemia or tissue transplation.
• we can isolate this virus from all body fluids.
Symptoms of congenital CMV
• 90% of congenital CMV cases are asymptomatic at
birth.
• 0.5 –15% of these are at risk for psychomotor,
hearing, neurologic, ocular, or dental
abnormalities within first few years of life.
microcephaly, seizures, petechial rash also can be
manifeted.
• 10% of cases may have sensorineural hearing loss.
Laboratory diagnosis
• Histopathological studies, this virus leads to the
formation of certain inclusion in the infected cells.
• Virus isolation.
• ELISA(IgM and IgG)
– Note: when we measure IgG, it rarely negative and often
positive, so we determine the titer, suppose it is 300 IU/ml, after
2-3 weeks we make follow up and do the CMV again:
• The titer in the same level or less it is negative.
• The titer is higher, it is positive.