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Recent literature was reviewed to identify elements of antenatal care which are of proven benefit in preventing or ameliorating adverse outcomes in the mother such as bleeding, anemia, pre-eclampsia, sepsis and genitourinary infection, and obstructed labor. Recent trials indicate that while fewer routine visits for low-risk women do not jeopardize a positive pregnancy outcome, patients may be less satisfied. None of the many factors which can cause bleeding during pregnancy can be eliminated through antenatal care, although risk factors can be identified through history-taking. Counseling on what to do is the best option. Routine iron supplementation against anemia is not necessary in well-nourished populations, but circumstantial evidence suggests that iron and folate should be provided for every pregnant woman in areas of high anemia prevalence. Hemoglobin determination as a routine test is more important near week 30 of term rather than early in pregnancy. Recent trials do not support routine aspirin to prevent pre-eclampsia among low-risk women, nor is there evidence that anti-hypertensive treatment of mild pre-eclampsia will prevent more serious disease. Improved detection and care may, however, lead to better outcomes. Urine culture and dipstick for leucocyte esterase and nitrite with subsequent treatment of positive cases will reduce the risk of pyelonephritis and appear to be cost-effective. Serological screening and treatment of syphilis is inexpensive and cost-effective, while obstructed labor can be anticipated in multiparas based upon obstetrical history; hospital delivery should be secured.
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PMID:Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes. 903 38

Syncytial giant cell hepatitis in the neonatal period has been associated with many different etiologic agents and may present initially as cholestasis. Infectious causes are most common and include: (1 ) generalized bacterial sepsis, (2) viral agents, (3) toxoplasmosis, (4) syphilis, (5) listeriosis, and (6) tuberculosis. Viral hepatitis may be due to cytomegalovirus, rubella virus, herpes simplex, HHV-6, varicella, coxsackievirus, echovirus, reovirus 3, parvovirus B19, HIV, enteroviruses, paramyxovirus, and hepatitis A, B, or C (rare). Giant cell hepatitis may result in fulminant liver failure with massive hepatocyte necrosis and severe liver dysfunction leading to death, resolution with severely compromised liver function, or liver transplantation. The authors report a 6-week-old male who had an unremarkable perinatal period, became jaundiced after developing diarrhea, and subsequently developed liver dysfunction with massively increased liver enzymes and a coagulopathy. Open wedge and core liver biopsies were performed to determine if the patient should be listed for liver transplantation. Giant cell hepatitis with a significant mixed lymphocytic and neutrophilic infiltrate was present on both the wedge and core biopsies. The residual 60% of hepatocytes had ballooning degeneration and many possessed pyknotic nuclei. The hepatocytes were arranged in a pseudoacinar pattern. Electron microscopy showed paramyxoviral-like inclusions in the giant cells, characterized as large inclusions with fine filamentous, beaded substructures (18-20 nm). Paramyxoviridae are nonsegmented, negative-sense, single-stranded RNA viruses. This family is divided into the Paramyxovirinae subfamily containing respirovirus (Sendai virus, parainfluenza virus type 3), rubulavirus (mumps, parainfluenza virus type 2), and morbillivirus genera (measles); and Pneumovirinae subfamily (pneumovirus genus [respiratory syncytial virus]). Supportive care to determine if hepatic function resolves following the viral episode, liver transplantation with fulminant liver failure, and ongoing evaluation in those who recover to assess chronic liver disease are necessary. Ultrastructural evaluation may unmask the etiologic agent for hepatitis and direct therapy.
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PMID:Neonatal syncytial giant cell hepatitis with paramyxoviral-like inclusions. 1129 22

Women aged 15-19 represent a high proportion of the female population of the Dominican Republic, and their rate of consensual unions of 24.6% leads to high rates of adolescent pregnancy. A retrospective study was made of the records of 600 adolescent pregnancies followed between 1975- 80 at a maternity hospital in Santo Domingo. The adolescents were classified into 3 age groups. Group 1 included 27 adolescents aged 12- 14, group 2 included 305 aged 15-17, and group 3 included 268 aged 18- 19. 3 adolescents in group 1, 64 in group 2, and 108 in group 3 had already had a child, while 10 in group 2 and 38 in group 3 had 2 previous children. 7 in group 3 had 3 or more children. 1 mother in group 1, 7 in group 2, and 12 in group 3 had a history of cesarean section. 331 of the 600 had no form of prenatal care. 202 had 1-4 prenatal visits and 67 had 5 or more. Among the 331 adolescents with no prenatal care, there were 92 cases of threatened premature delivery, 30 of slight and 31 of moderate to severe toxemia, and 7 of eclampsia. Among the 269 patients with prenatal care, there were 19 cases of slight and 2 of moderate toxemia during pregnancy. On admission to the hospital, there were 58 cases of threatened premature deliver, 23 of slight and 14 of moderate to severe toxemia, and 14 of premature rupture of membranes. Among the total group of 600 adolescents, 25% had threatened premature delivery, 8.8% had slight and 7.5% had moderate to severe toxemia, 1.1% had eclampsia, 4.2% had premature rupture of membranes, 1.3% had abortions, and .5% had syphilis. 428 deliveries occurred at 38-40 weeks. There were 57 caesareans and 8 abortions. 214 newborns had Apgar scores of under 7 points. There were 15 fetal deaths in utero, 28 hemorrhages during delivery, and 3 cases of retention of the placenta. There were 3 maternal deaths due to sepsis. It is apparent that adolescent pregnancy entails a high degree of risk.
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PMID:[Adolescent fertility. 1. Pregnancy and childbirth]. 1217 96

Some 250 million cases of sexually transmitted disease (STD) occur each year, and in some countries 1 or even 2 women in every 10 are infected with an STD. STDs are likely to reach an advanced stage before women notice them. The consequences of STDs are devastating, according to a report by the Population Information Program of the Johns Hopkins School of Public Health, and they include stillbirths, blinding eye infections in the newborn, chronic female abdominal pain, ectopic pregnancy, and infertility. There are social consequences for women such as divorce, and husbands may abandon infertile wives. Gonorrhea and chlamydia can cause both severe inflammation of the pelvis with acute pain and possible infertility. Pelvic inflammatory disease can permanently scar the fallopian tubes, increasing the risk of ectopic pregnancy, which can be fatal when the fallopian tube ruptures. Babies born to mothers with gonorrhea and chlamydia are likely to develop eye infections that may make them blind. Chlamydia infection in pregnant women may also cause premature rupture of the membranes, sepsis, and the death of premature neonate. Infection may spread to the lungs of newborns, leading to chlamydial pneumonia. Syphilis can cause spontaneous abortion, stillbirth, neonatal death, or congenital syphilis in the infant. Trichomoniasis and herpes can also be transmitted from mother to fetus. And infection with an STD increases the risk of infection with the human immunodeficiency virus (HIV). The World Health Organization (WHO) recommends that prenatal care should always include checks for STDs. A WHO Technical Working Group on Care of Mother and Baby has stressed the importance of detecting and treating STDs in pregnant women. The working group urged training of health workers to distinguish between STDs and other infections. The group, which met July 5-9, 1993, outlined health center strategies for prevention and treatment.
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PMID:STDs infect 250 million a year. 1234

On July 2, 1881, Charles Julius Guiteau shot President James Abram Garfield in the right flank. The President died because of infection produced by the unsterile fingers and probes repeatedly inserted into the wound. The major complaint of the wounded President was intractable pain in his legs and feet. This symptom failed to alert the doctors to the possibility of vertebral and spinal cord injury. Garfield died with sepsis after 80 days of intense national concern, and for the patient there was psychological, physical, and nutritional deprivation. His autopsy revealed the bullet was not in the pelvis as his doctors had expected, but adjacent to the first lumbar vertebra it had shattered. The trial and execution of Guiteau split the medical community into those that considered him insane and those who felt execution was justified. Guiteau was delusional and his brain revealed chronic inflammation and histological features suggestive of syphilis. At the time, and since, the propriety of the execution has been questioned.
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PMID:Death of a president and his assassin--errors in their diagnosis and autopsies. 1660 37

Over last decade problem of infectious diseases in Poland remains stable with trends of decreasing incidence of most reported infectious diseases. In particular there was observed decrease in incidence of tuberculosis and foodborne infections causes by Salmonella sp. On the other hand it was observed increase of reported foodborne infections caused by Campylobacter and Yersinia as well and viral ones caused by noroviruses and rotaviruses. Despite marked increase of diagnosed and reported cases sensitivity of reporting of those infections remains unacceptably low. Reported incidence of HIV infections remains relatively stable over last years. But increased fraction of heterosexually transmitted cases points to the problem of increased incidence out of so called "risk groups" among the general population. It was also noted worrisome increase of incidence of syphilis. The highest incidence was noted regarding influenza and other upper respiratory tract infections. Low level of vaccinations against influenza remains the problem which requires continuous health promotion efforts. The best epidemiological situation was observed among vaccine preventable diseases, which reflects effectiveness of vaccination program. Though widening of our program into several important infections included in vaccination programs of other EU countries would be needed in oncoming years. Infectious diseases caused 0.70% of deaths. Mortality from infectious diseases was 6.8/100,000 and was significantly higher among men (8.8) then among women. (5.0). In urban settings mortality from infectious diseases was higher (7.4/100,000) then in the country (5.8). In particular districts (voivodeships) mortality indices remained in the range of 5.2 (podlaskie) to 9.7 (slaskie). The highest number of deaths was caused by sepsis (41.1%, without neonatal sepsis).
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PMID:[Infectious diseases in Poland in 2006]. 1880 59

A 48-years-old man presented with slowly progressive bradykinesia, personality change and rapidly progressive left hemiparesis. On admission, he presented dementia, poor judgment, left hemiparesis. MRI revealed a widespread high intensity area in right hemisphere and MRA was almost normal. Serological tests of serum and CSF demonstrated high titers of antibodies to Treponema pallidum. He was treated for syphilis with daily penicillin injections without improvement. He died of sepsis eight months after admission. At autopsy, the brain weighed 1,100 g and the right cerebral hemisphere was atrophic, especially in frontal base, temporal, parietal, angular, and posterior regions covered by thickened, fibrotic leptomeninges. Microscopically, chronic meningoencephalitis was observed. Severe neuronal loss with gliosis was seen in the right cerebral cortices. Scattered rod-shaped microglia and inflammatory cell infiltration were visible in the cerebral parenchyma. The dorsal column of the spinal cord was not involved and meningovascular syphilis was unclear. The distribution of the encephalitic lesions was well correlated with the clinical and neuroradiological findings. This was a rare autopsy case presenting Lissauer's general paresis, clinically manifesting as rapidly progressive stroke-like episode.
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PMID:[Autopsy case of Lissauer's general paresis with rapidly progressive left hemiparesis]. 1961 44

The significance of this invasion of the chorionic epithelium from the standpoint of pathogene'sis cannot be properly evaluated until a more complete history of the successive localizations of Bacillus abortus has been obtained. It is safe to assume that this particular cell parasitism is but one of a series of localizations and centers of multiplication in the fetal membranes although evidence points to it as perhaps the earliest stage in which the organism gains by rapid, unchecked multiplication a considerable advantage over the host. The local destruction of an epithelial covering by an infectious agent when other miscellaneous infectious agents are absent may or may not be of much importance, for it would depend on the regenerative activity of the epithelium, the tendency to the gathering of injurious transudates, and the toxic substances associated with the bacilli. It is probable that localizations also occur in the walls of the blood vessels of the chorion. Thus far only one case of this kind has been observed. The fusiform connective tissue cells of the adventitious coat of a blood vessel 0.8 mm. in diameter were completely replaced by clumps of minute bacilli. Since there is usually a slight perivascular cell infiltration in the diseased placenta this localization may be largely responsible for the circulatory disturbances which lead to death of the fetus. The case referred to may be but a greatly exaggerated illustration of the action of Bacillus abortus in the walls of the blood vessels where they are too few in number at any one time to be identified. It is known, that in the guinea pig disease with pronounced lesions Bacillus abortus is demonstrated only with great difficulty because of its scarcity. The more or less specific localization and multiplication of bacteria within cells not having phagocytic functions have thus far been demonstrated in leprosy, syphilis, and in a disease of mice recently described by Tyzzer, who found an active invasion of both liver cells and intestinal epithelium by a bacillus. In cells to which phagocytic powers have been ascribed the specific localization of certain bacteria is well known. Thus tubercle bacilli occur within the endothelial cells of the tubercle. Leprosy bacilli have been found within a variety of cell groups. Mouse septicemia bacilli occur regularly within certain phagocytic cells of the blood. Recently bacteria have been found attached to the cilia of the respiratory tract in pertussis by Mallory and Hornor, in a form of guinea pig pneumonia by the writer. Actual occupation of epithelial cells followed by active multiplication of the invaders and destruction of the cell has, however, been frequently demonstrated for the sporozoa. That it may occur more often among bacteria is highly probable. Rapidity of multiplication and cell destruction or invisibility or both may stand in the way of a satisfactory demonstration.
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PMID:A CHARACTERISTIC LOCALIZATION OF BACILLUS ABORTUS IN THE BOVINE FETAL MEMBRANES. 1986 30

Clinical spectrum of congenital syphilis ranges from asymptomatic infection to fulminant sepsis. Treponema pallidum is acquired crossing the placenta from the mother to the fetus during maternal spirochetemia or through direct contact of the child with an infected lesion at delivery. We report a 27 days-old previously healthy girl diagnosed with congenital syphilis. Her mother had an unremarkable previous history, adequate obstetric care and negative prenatal screening test for syphilis. The patient was brought to the ER due to development of skin lesions and fever in the last 24 h. She was admitted to pediatric ICU lethargic and poorly responsive, with hepa-tosplenomegaly and perioral, palmoplantar erythematous desquamative scaly lesions. Laboratory data revealed anemia, leukocytosis, thrombocytopenia and C-reactive protein of 183 mg/l. Soon after admission she developed septic shock with leukocytosis up to 45,800/mm3 and exacerbation of thrombocytopenia, hypoalbuminemia and metabolic acidosis. Congenital syphilis was diagnosed at the second day of admission with VDRL titers of 1:128 in serum and 1:8 in cerebrospinal fluid. Maternal serum VDRL was positive with titers of 1:32. The patient was treated with penicillin for three weeks with adequate clinical and laboratory response. Congenital syphilis is a life threatening infection, but cannot always be diagnosed at birth. Health care workers must be aware of the difficulties in obtaining a definitive diagnosis and must have a high index of suspicion, considering the possible errors of prenatal serology and the diverse possible clinical presentations, including neonatal sepsis during the first month of life.
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PMID:[Congenital syphilis: presenting as septic shock alter the neonatal period]. 2328 4

In 1879, during his specialization in dermatology, Albert Ludwig Sigesmund Neisser (1855-1916) discovered the bacterial cause of gonorrhoea. The gonococcus - Neisseria gonorrhoea - would, however, not bear his name until 1933. Neisser's early research focused primarily on venereal diseases, syphilis in particular, and on leprosy. Later, as a hygienist, he became a passionate advocate of public clinics for venereal diseases, regulated prostitution, and health education. In 1916, Neisser died of sepsis after lithotripsy for nephrolithiasis. His scientific inheritance includes many publications on a variety of venereal and skin diseases and public health-related topics, and textbooks such as Ikonographia dermatologica and Stereoskopischer Medizinischer Atlas.
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PMID:[Neisser and the clap]. 2373 5


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