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Monday, April 24, 2017



Critical infections can affect unborn infants

“The eyes are the window to the soul.” Just as one can often tell a great deal about a person by looking at their eyes, pediatric ophthalmologists can often look inside the eye and see a great deal about serious infections that can be affecting your baby’s eyes. It is very important to take steps before and shortly after childbirth so your newborn infant is free of serious infections as well as toxins and drugs.

TORCHES is a mnemonic for critical infections that affect the unborn infant’s eyes, brain and body. The baby within a pregnant woman is protected by a fluid bag (amniotic sac) and placenta, which nourishes and protects the fetus, filtering out harmful organisms.

“T” stands for toxoplasmosis, a very small organism (250 in a row would make a millimeter). Kittens or cats that go outside can become infected with toxoplasmosis and pass the organism in their feces. Changing the kitty litter in less than 24 hours is protective. But the highest risk of toxoplasmosis is from handling or eating raw meat, unless frozen three days. Vegetables, especially carrots and lettuce, can harbor the organism, so a pregnant mother should wash her hands a lot, especially after handling vegetables raw meat or gardening. Toxoplasmosis can pass into the mother to the unborn child and inflict serious damage to the eyes, brain and other organs.

“O” stands for other, especially for viruses. Zika virus was discovered in 1947 in Uganda, but few human cases occurred until 2007 in the South Pacific islands, then the virus spread to Brazil and the Caribbean in 2014. The first U.S. cases occurred in 2016, mostly travelers from Latin America. As of February 2017, 5,040 Zika cases were reported in the USA, 39 in Louisiana. Zika is mostly spread by mosquitos, but also by sexual contact. Mothers infected have few symptoms or a flu-like illness, but their infants can become infected and develop microcephaly from damage to the developing brain, as well as scars to the retina and optic nerve. Fortunately, mosquito control is helpful in preventing the disease.

Lymphocytic choriomeningitis virus is carried by mice and hamsters, a good reason for pregnant women to avoid these creatures. Infection of the unborn infant can damage the eye (retina) and brain severely.

“R” stands for rubella, epidemic of microcephaly, cataracts and heart defects in the USA in the 1960s, but now uncommon due to a vaccine all infants receive. West Nile virus can rarely affect infants if the mother is infected by a mosquito bite. HIV, or human immunovirus, is a serious worldwide problem that can affect unborn babies, but treatment of mothers with drugs called anti-retroviral medications has been effective in reducing transmission to unborn babies.

“C” stands for cytomegalovirus (or CMV). Sixty percent of Americans have been infected, most with no or few symptoms. One percent of infants are infected at birth (30,000 United States), and 3,000 have symptoms at birth, sometimes with significant damage to the brain, eyes, hearing and other organs. Others will develop some problems later, mostly hearing and/or cognitive difficulty. Infants are treated with a medication called ganciclovir, which helps. CMV is present in all body fluids and can be sexually transmitted. Day care centers are notorious havens for CMV and should be avoided by pregnant mothers if at all possible. But CMV is not present on foods, in water or animals like toxoplasmosis.

“HE” stands for herpes simplex, present in the saliva of 70 percent of adults, so don’t let grandparents kiss your little infant in the first month, especially if fever blisters (caused by herpes simplex) are present.

Herpes simplex can be sexually transmitted. One thousand, five hundred babies in the United States are affected at birth. Permanent brain and ocular damage can occur. Antiviral medications are helpful but not usually curative. Highest risk for pregnant women is a new herpes infection from a sexual activity; late pregnancy is no time for new sexual partners.

“S” stands for syphilis, a harmful disease still around, but all pregnant women are screened and treated with blood tests.

Cataracts, retinal damage and brain damage can develop, so keep those OB appointments and take penicillin as instructed if a syphilis test becomes positive.

Newborn infants can develop infections of the outside of the eye, called neonatal conjunctivitis. Prevention with antibiotic ointment just after delivery usually but not always prevents infection, which can usually be successfully treated if infection does occur.

All pregnant mothers must exercise great care to keep their bodies clean, free of alcohol, toxins and contact with harmful bacteria, viruses and other infectious agents as much as possible.

Following safety measures for infants aid as well. Healthy mothers, healthy babies, healthy eyes.

Dr. Alan B. Richards is a pediatric ophthalmologist at Highland Clinic. Dr. Richards has special interest in the treatment of strabismus (eye muscle problems such as crossed eyes), amblyopia or lazy eye, ptosis or drooping eyelids, and nystagmus. He is accepting new patients and can be reached at 222-8402; located at 1400 East Bert Kouns Industrial Loop, Suite 103, Shreveport. Visit www. highlandclinic.com/staff/alan-richards-m-d for more information.


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