TORCH Update: Focus on Rubella and Cytomegalovirus (original) (raw)

TORCH Update: Focus on Rubella and Cytomegalovirus Umar Zein Internal Medicine Department Faculty of Medicine, Faculty of Medicine Islamic University of Sumatera Utara Abstract Rubella is an infectious disease caused by pleomorphic RNA virus of genus Rubivirus that can only infect human. Its initial symptoms are generalized maculopapular rash with body temperature of 37.2 o C high (99o F) with arthritis/arthralgia, or lymphadenopathy or conjunctivitis. Pathogenetically, the virus passes through respiration and multiply within nasopharynx and regional lymph glands. Viremia appears in the period between 5-7 days after the exposure to the virus and then invade body tissue The incubation period of Rubella is 14 days (12-23 days), with a prodrome as mild fever, lymphadenopathy on the second week, rash as maculopapular on day 14-17 after the exposure. Transmission occurs 5-7 days before the development of rash. Infant with CRS can harbor and then release the virus within 1 year period or more. Laboratory findings determining diagnosis of rubella by means of rubella virus isolation using specimen taken from nasopharynx and urine, is a significant raise of Rubella IgG besides standard serological test (enzyme immunoassay) and serologic positive against rubella IgM. Mothers who contract it before 12 weeks of pregnancy have the risks of miscarriage, congenital heart defects, deafness, cataract or retinopathy, mental retardation, and about half of them can cause hepato-splenomegaly, growth disturbances, osteitis, diabetes, hypothyroidism, growth hormone deficiency, and panencephalitis, which are all refers to Congenital Rubella Syndrome. CMV is a family of herpes virus (EBV, Varicella-zoster, herpes simplex), with sero-prevalence of 30-100%, is found in body fluid, blood, saliva, urine and breast milk. Types of infection can represent primary infection (asymptomatic to mononucleosis-like syndrome in immune-competence individuals), latent infection (the existence of genome virus in the mononuclear leucocites, endothelial cells, and organs in the absence of active replication of virus) , re-activation and re-infection (new strain of CMV). Diagnosis is determined by serological test of IgG, culture of the virus, antigen-level test, and the qualitative and quantitative assay of PCR. Clinical symptoms of some patients are prolonged fever and mild hepatitis Once the individual is contracted, the virus will remain harbored in dormant. CMV infection needs to be taken into account on certain group such as, (1) fetus in the womb of infected woman, 2) those who work with high-risk children. 3) those groups of high-risk of infection with immunocompromized, organ transplantation recipient and patient contracted HIV. A CMV-infected woman is generally without symptoms, and when she becomes pregnant, her infant might have the risk of congenital CMV. Although one third of the infants originated from infected women, are not infected, and only 10-15% of them bears signs and symptoms upon their delivery. Light CMV infection with complications will occur if the infection takes place six months prior to conception. To this group, 50-80% fertile women have the risk of giving infants with CMV infection and 1% of the infants born do not have any symptom or abnormality. . Keyword: Rubella – CMV – pregnant women – congenital diseases