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Chapter 17 : Laryngeal Papillomatosis
This chapter briefly summarizes maternally transmitted genital human papillomavirus (HPV) infections in children and problems associated with HPV-related diseases among pregnant women near parturition. Most of the discussion focuses on juvenile-onset laryngeal papillomatosis (recurrent respiratory papillomatosis [RRP]), the most challenging and costly of the diseases associated with mother-child HPV transmission. Laryngeal papillomatosis is the most common benign neoplasm of the larynx. The lesions are characterized by recurrent tumors, which cause hoarseness and upper airway obstruction. The incidence of both juvenile-onset and adult-onset papillomatosis is unknown, and the prevalence of disease has not been accurately assessed. The various forms of therapy have included different ablative and surgical techniques, topical and oral medical therapies, interferon, and laser therapy. Most of these treatment strategies have been evaluated by means of uncontrolled trials, although a few well-designed controlled clinical trials have evaluated the effects of intramuscular interferon as an adjunct therapy for control of RRP. Congenital condylomata acuminata is a rarely reported disease of newborns and infants. Several case reports, however, clearly indicate the occurrence of maternal-fetal transmission even in the absence of fetal exposure to the maternal genital tract through cesarean delivery. Research in the field of maternal transmission of HPV to infants has been hampered by the same limitations that have slowed progress in studies of genital HPV and cervical neoplasia—inability to culture or propagate the virus and uncertain test characteristics (sensitivity and specificity) in identification of HPV infection.