Congenital infections in the neonate have been described for a variety of opportunistic pathogens affecting the mother. These include Mycobacterium tuberculosis [14,15], cryptococcal infection [16,17], cytomegalovirus (CMV) [18], Pneumocystis jirovecii (PCP) [19,20] and toxoplasmosis
[21,22]. Vertical transmission is generally assumed to be the route of Dinaciclib purchase infection, although in some cases it may not be clear whether the neonate acquired the infection in utero or during the perinatal or postnatal period. Neonates born to HIV-seropositive women should be assessed by a paediatrician, and where necessary actively screened, for congenital opportunistic infections. The placenta should also be examined histologically Obeticholic Acid clinical trial for signs of infection or disease (category IV recommendation).
(Letters in parentheses denote US Food and Drug Administration-assigned pregnancy categories [23].) Therapeutic options are identical to non-pregnant patients. Trimethoprim-sulphamethoxazole (C/D) is the treatment of choice in pregnancy. Alternative options are limited to: clindamycin (B) with primaquine (C); dapsone (C) with trimethoprim (C); or atovaquone (C) suspension. Clindamycin is generally considered safe in pregnancy, but primaquine can cause haemolysis. There are limited data on the use of dapsone in pregnancy; however, one review identified mild degrees of haemolysis [24]. Intravenous pentamidine is embryotoxic Sitaxentan but not teratogenic, so should be used only if other options are not tolerated. Steroids should be administered as per standard guidelines for the treatment of PCP in non-pregnant women. Chemoprophylaxis for PCP should be prescribed to HIV-seropositive pregnant women as per guidelines for non-pregnant individuals. As for most drugs, avoidance of prescribing in the first trimester should be adhered to, other than in exceptional circumstances. It is important to remember that there is a false reduction in absolute CD4 cell counts during pregnancy, especially during the third trimester, and in such circumstances
more emphasis should be put on the CD4 percentage as an indicator for the need to commence PCP or indeed any prophylaxis. Trimethoprim-sulphamethoxazole (C/D) is the preferred prophylactic agent against PCP in pregnancy [25,26]. Concerns remain over the safety of this drug in the first trimester [27], and during this time an alternative agent could be used if indicated. Possible alternatives include once daily dapsone (C) or nebulised pentamidine (C). The dosing of these agents is the same as for non-pregnant individuals. Other alternatives to these agents include clindamycin (B) and primaquine (C) or atovaquone (C); however, data on their efficacy are not as clear as for the other agents, and data on their safety in pregnancy is not complete. First-line therapy should be with liposomal amphotericin B (B).