Best J M
United Medical and Dental Schools of Guy's and St Thomas's Hospitals, St Thomas's Campus, London SE1 7EH, UK.
Clin Diagn Virol. 1996 May;5(2-3):121-9. doi: 10.1016/0928-0197(96)00213-9.
Intrauterine infection with rubella, cytomegalovirus (CMV), varicella zoster virus (VZV), parvovirus B19 and human immunodeficiency virus type 1 (HIV-1) may occur following maternal infection. Diagnosis of congenital infection in the neonate is dependent on the appropriate laboratory techniques being used. Prenatal diagnosis of intrauterine infection may also be indicated. Herpes simplex virus (HSV), HIV-1, VZV, enteroviruses, hepatitis B (HBV) and hepatitis C viruses (HCV), human T-cell lymphotropic viruses (HTLV-1 and 2) and genital papillomaviruses (PVs) may be acquired at delivery. Neonatal HSV, VZV and enterovirus infections may be severe or even fatal. Perinatally acquired HBV, HCV, HIV-1 and HTLVs are associated with persistent infection and chronic disease in later life. However, if the mother is identified as a carrier in the antenatal period, mother-infant transmission of HBV may be prevented by active/passive immunisation of the neonate, HIV-1 by caesarian section or antiviral therapy, and of HTLV-1 by avoiding breast feeding.
To review the techniques available for the diagnosis of intrauterine infections, neonatal infections with HSV, HIV-1, VZV and enteroviruses, maternal infection with HBV, HCV and HIV-1 and prenatal diagnosis of intrauterine rubella, CMV and B19.
Congenital rubella may be diagnosed by detection of specific IgM, but virus detection is the technique of choice for congenital cytomegalovirus. Congenital VZV may be diagnosed by serological techniques in up to 71% of cases. Detection of virus in vesicle scrapings or swabs from the oropharynx is the technique of choice for neonatal HSV, while enterovirus infections are best diagnosed by detection of viral RNA. A clinical diagnosis of congenital VZV is often possible. HIV-1 may be diagnosed within 3 months of birth by testing serial blood samples with a combination of techniques. Maternal infection with HBV, HCV, HIV and HTLV1/11 may be diagnosed by serological techniques and genital PVs by detection of viral DNA. Chorionic villus samples, amniotic fluid and fetal blood may be obtained for prenatal diagnosis of infection. Although detection of virus in amniotic fluid is the technique of choice for prenatal diagnosis of CMV, insufficient data is currently available to determine whether it may be used for intrauterine rubella. The most reliable technique for diagnosis of fetal B19 infection is detection of viral DNA in fetal blood.
Close liaison between clinicians and microbiologists/virologists is required in order that appropriate specimens are collected from infant and/or mother and appropriate tests conducted. The use of TORCH screening should be discouraged.
孕妇感染风疹、巨细胞病毒（CMV）、水痘带状疱疹病毒（VZV）、细小病毒B19和人类免疫缺陷病毒1型（HIV-1）后可能发生宫内感染。新生儿先天性感染的诊断取决于所使用的适当实验室技术。宫内感染的产前诊断也可能是必要的。单纯疱疹病毒（HSV）、HIV-1、VZV、肠道病毒、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）、人类嗜T细胞病毒（HTLV-1和2）以及人乳头瘤病毒（PV）可能在分娩时获得。新生儿HSV、VZV和肠道病毒感染可能很严重甚至致命。围产期获得的HBV、HCV、HIV-1和HTLV与后期的持续感染和慢性病有关。然而，如果在产前确定母亲为携带者，新生儿的主动/被动免疫可预防HBV的母婴传播，剖宫产或抗病毒治疗可预防HIV-1的母婴传播，避免母乳喂养可预防HTLV-1的母婴传播。
综述可用于诊断宫内感染、新生儿HSV、HIV-1、VZV和肠道病毒感染、母亲HBV、HCV和HIV-1感染以及宫内风疹、CMV和B19产前诊断的技术。
先天性风疹可通过检测特异性IgM进行诊断，但病毒检测是先天性巨细胞病毒的首选技术。高达71%的先天性VZV病例可通过血清学技术诊断。从新生儿口腔疱疹刮片或拭子中检测病毒是诊断新生儿HSV的首选技术，而肠道病毒感染最好通过检测病毒RNA来诊断。先天性VZV通常可进行临床诊断。出生后3个月内可通过多种技术联合检测系列血样诊断HIV-1。母亲HBV、HCV、HIV和HTLV1/11感染可通过血清学技术诊断，人乳头瘤病毒可通过检测病毒DNA诊断。可获取绒毛膜绒毛样本、羊水和胎儿血液用于感染的产前诊断。虽然羊水病毒检测是CMV产前诊断的首选技术，但目前尚无足够数据确定其是否可用于宫内风疹诊断。诊断胎儿B19感染最可靠的技术是检测胎儿血液中的病毒DNA。
临床医生与微生物学家/病毒学家之间需要密切联系，以便从婴儿和/或母亲采集适当的标本并进行适当的检测。应不鼓励使用TORCH筛查。
