or perinatal. there is limited research on the effects of hepatitis d infection on fetal or infant outcomes, but the effects are thought to be similar to those with hepatitis b infection. hepatitis e is a non-enveloped, single stranded rna virus that is spread through the fecal-oral route with the main modes of transmission being close personal contact or ingestion of contaminated food or water. during pregnancy, acute hepatitis e infections result in an increase in adverse pregnancy outcomes such as increased maternal and fetal morbidity and mortality, acute hepatic failure, and associated complications with preterm birth. other viral pathogens other viral infections, such as respiratory syncytial virus (rsv), metapneumovirus (hmpv), rhinovirus, parainfluenza(piv), and human coronavirus in the neonatal period are associated with recurrent wheezing in later childhood. fungi in very low birth weight infants (vlbwi), systemic fungus infection is a hospital-acquired infection with serious consequences. the pathogens are usually candida albicans and candida parapsilosis. a small percentage of fungal infections are caused by aspergillus, zygomycetes, malassezia, and trichosporon. infection is usually late-onset. up to 9% of vlbwi with birth weights of <1,000 g develop these fungus infections leading to sepsis or meningitis. as many as one-third of these infants can die. candidiasis is associated with retinopathy, prematurity and negative neurodevelopmental consequences. candida can colonize the gastrointestinal tract of low birthweight infants (lbi). this gastrointestinal colonization is often a precursor to a more serious invasive infection. the risk of serious candida infection increases when multiple factors are present. these are: thrombocytopenia, the presence of candidal dermatitis, the use of systemic steroids, birth weights of <1,000 g, presence of a central catheter, postponing enteral feeding, vaginal delivery, and the amount of time broad-spectrum antibiotics were given. protozoans infants born with malaria can be infected with a variety of species; plasmodium vivax, plasmodium malariae, plasmodium ovale, and plasmodium falciparum. in most instances of congenital malaria is caused by p. vivax and p. falciparum. women living in areas where malaria is prevalent and common are repeatedly exposed to malaria. in response to maternal infection, mothers develop antimalarial antibodies. it is probable that the antibodies present in the mother offers protection for the baby. bacterial infection can develop with malaria. infants that are infected by the protozoan toxoplasma gondii in utero can be born with chorioretinitis or ocular toxoplasmosis. globally, it is the most common cause of infections of the back of the eye. (posterior segment). the most common sign is decreased vision in one eye. other signs and symptoms may appear after the neonatal period and include: chorioretinitis development later in life, intracranial calcification hydrocephalus or central nervous system abnormalities. risk factors preterm neonates are at greater risk of infection, including severe complications such as sepsis and meningitis. preterm neonates usually have ineffective immune systems, due to decreased igg antibodies and decreased complement activation. additionally, preterm neonates require longer hospital admissions, including the placement of invasive devices that increase risk of infection. maternal risk factors for neonatal infection include: chorioamnionitis - acute inflammation of amniotic fluid and fetal membranes during pregnancy, usually caused by polymicrobial bacterial infection. signs of infection include maternal fever, vaginal discharge, tender uterus or pain with urination. gbs colonization - group b streptococcus is a bacterial pathogen commonly found in the gastrointestinal and vaginal membranes of healthy women. presence of this bacteria is usually asymptomatic; therefore, pregnant patients will routinely be screened for presence of gbs prior to delivery. delivery before 37 weeks - premature infants require more medical intervention and have less effective immune defenses, so these neonates are at increased risk of infection prolonged rupture of membranes (prom) - the amount of time between the rupture of amniotic membranes and delivery of the neonate is directly correlated with risk of neonatal infection. prolonged course of labor increases neonatal exposure to bacterial and viral pathogens, increasing chance of infection. mechanism chorioamnionitis inflammation accompanies infection and is likely to complicate treatment and recovery. inflammation is linked to reduced growth of the lungs of the premature baby. pathogenesis the recent identification of the presence of microorganisms in maternal-infant body fluids that were previously thought to be sterile has provided one explanation for the presence of the inflammatory response in both the mother and infant. sixty-one percent of pregnant women with chorioamnionitis, or inflammation of the amniotic fluid, were found to be infected by microorganisms. often, more than one pathogen was present. in fifteen percent of pregnant women inflammation was still evident even though there was no evidence of pathogens. this may indicate that there are other causes. a high percentage, 51% to 62%, of pregnant women who had chorioamnionitis also had inflammation of the placenta. diagnosis diagnosis of infection is based upon the recovery of the pathogen or pathogens from the typically sterile sites in the mother or the baby. unfortunately, as many half of pregnant women are asymptomatic with a gonorrhea infection and other sexually transmitted infections. samples are obtained from urine, blood or cerebrospinal fluid. diagnosis of infection can also be aided by the use of more nonspecific tests such as determining the total white blood cell count, cytokine levels and other blood tests and signs. signs of infectionnotes