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Fazecas T, Lopes FPPL, Guedes B, Castro P, Nogueira R, Werner H. Zika virus as a new pathogenic agent within the Toxoplasma gondii, Rubella virus, Cytomegalovirus, and Herpes simplex (TORCH) virus family: where do we stand? Pediatr Radiol 2024:10.1007/s00247-024-05944-2. [PMID: 38822063 DOI: 10.1007/s00247-024-05944-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 06/02/2024]
Abstract
Viral infections in low-income countries such as Brazil pose a significant challenge for medical authorities, with epidemics such as Zika virus infection having lasting effects. The increase in microcephaly among newborns has prompted investigations into the association between Zika virus and this congenital syndrome. The severity and prevalence of microcephaly led to the declaration of national and international emergencies. Extensive research has been conducted to understand the teratogenic effects of Zika virus, particularly its impact on neural progenitor cells in the fetal brain. Various pre- and postnatal imaging techniques, such as ultrasound, magnetic resonance imaging (MRI), and postnatal computed tomography (CT), have played crucial roles in diagnosing and monitoring malformations linked to congenital Zika virus infection in the central nervous system (CNS). These modalities can detect brain parenchymal abnormalities, calcifications, cerebral atrophy, and callosal anomalies. Additionally, three-dimensional ultrasound and fetal MRI provide detailed anatomical images, while CT can identify calcifications that are not easily detected by other methods. Despite advancements in imaging, there are still unanswered questions and ongoing challenges in comprehending the long-term effects and developmental impairments in children affected by Zika virus. Radiologists continue to play a crucial role in diagnosing and assisting in the management of these cases.
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Affiliation(s)
- Tatiana Fazecas
- Radiology Department, Dasa, Rio de Janeiro, RJ, Brazil.
- Imaging Department, Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil.
| | | | - Bianca Guedes
- Radiology Department, Dasa, Rio de Janeiro, RJ, Brazil
| | - Pedro Castro
- Radiology Department, Dasa, Rio de Janeiro, RJ, Brazil
| | | | - Heron Werner
- Radiology Department, Dasa, Rio de Janeiro, RJ, Brazil
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Hcini N, Lambert V, Picone O, Carod JF, Carles G, Pomar L, Epelboin L, Nacher M. Arboviruses and pregnancy: are the threats visible or hidden? Trop Dis Travel Med Vaccines 2024; 10:4. [PMID: 38355934 PMCID: PMC10868105 DOI: 10.1186/s40794-023-00213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/22/2023] [Indexed: 02/16/2024] Open
Abstract
Mosquito-borne arboviral diseases are a global concern and can have severe consequences on maternal, neonatal, and child health. Their impact on pregnancy tends to be neglected in developing countries. Despite hundreds of millions of infections, 90% pregnancies being exposed, scientific data on pregnant women is poor and sometimes non-existent. Recently and since the 2016 Zika virus outbreak, there has been a newfound interest in these diseases. Through various neuropathogenic, visceral, placental, and teratogenic mechanisms, these arbovirus infections can lead to fetal losses, obstetrical complications, and a wide range of congenital abnormalities, resulting in long-term neurological and sensory impairments. Climate change, growing urbanization, worldwide interconnectivity, and ease of mobility allow arboviruses to spread to other territories and impact populations that had never been in contact with these emerging agents before. Pregnant travelers are also at risk of infection with potential subsequent complications. Beyond that, these pathologies show the inequalities of access to care on a global scale in a context of demographic growth and increasing urbanization. It is essential to promote research, diagnostic tools, treatments, and vaccine development to address this emerging threat.Background The vulnerability of pregnant women and fetuses to emergent and re-emergent pathogens has been notably illustrated by the outbreaks of Zika virus. Our comprehension of the complete scope and consequences of these infections during pregnancy remains limited, particularly among those involved in perinatal healthcare, such as obstetricians and midwives. This review aims to provide the latest information and recommendations regarding the various risks, management, and prevention for pregnant women exposed to arboviral infections.
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Affiliation(s)
- Najeh Hcini
- Department of Obstetrics and Gynecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana.
- CIC Inserm 1424 and DFR Santé Université Guyane, Cayenne, French Guiana, France.
| | - Véronique Lambert
- Department of Obstetrics and Gynecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Olivier Picone
- Department of Obstetrics and Gynecology, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique : Hôpitaux de Paris, Université Paris Diderot, CEDEX, Colombes, France
| | - Jean-Francois Carod
- Department of Biology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Gabriel Carles
- Department of Obstetrics and Gynecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Department "Woman-Mother-Child", Lausanne University Hospital, Lausanne, Switzerland
| | - Loïc Epelboin
- Department of Infectious and Tropical Diseases, Cayenne General Hospital, Cayenne, French Guiana, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
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Hindle S, Depatureaux A, Fortin-Dion S, Dieumegard H, Renaud C, Therrien C, Fallet-Bianco C, Lamarre V, Soudeyns H, Boucoiran I. Zika virus infection during pregnancy and vertical transmission: case reports and peptide-specific cell-mediated immune responses. Arch Virol 2024; 169:32. [PMID: 38243006 DOI: 10.1007/s00705-023-05952-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/07/2023] [Indexed: 01/21/2024]
Abstract
Zika virus (ZIKV) infection in pregnant women is associated with birth defects, which are more prevalent and severe the earlier in pregnancy the infection occurs. Pregnant women at risk of possible ZIKV exposure (n = 154) were screened using ELISA for ZIKV IgM and IgG. Nine of 154 (5.84%) pregnant women who underwent screening exhibited positive ZIKV serology. Of these, two maternal infections were confirmed by real-time RT-PCR and five were considered probable, but only three of those were retained for further analysis based on strict diagnostic criteria. Plaque reduction neutralization tests (PRNT) confirmed ZIKV infection in nine cases (5.84%). Two cases of vertical ZIKV transmission were confirmed by PCR. One infant showed no signs of congenital ZIKV syndrome and had a normal developmental profile despite first-trimester maternal infection. In the second case, pregnancy was terminated. Production of interferon γ (IFN-γ) by peripheral blood mononuclear cells obtained from pregnant women and umbilical cord blood was measured using enzyme-linked immunospot assay (ELISpot) after stimulation with panels of synthetic peptides derived from the sequence of ZIKV proteins. This analysis revealed that, among all peptide pools tested, those derived from the ZIKV envelope protein generated the strongest IFN-γ response.
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Affiliation(s)
- Stéphanie Hindle
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Room 7. 9. 61, Montreal, Quebec, H3T 1C5, Canada
- Faculty of Medicine, Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Agnès Depatureaux
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Samuel Fortin-Dion
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Hinatea Dieumegard
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Renaud
- Faculty of Medicine, Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada
- Department of Microbiology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Christian Therrien
- Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Catherine Fallet-Bianco
- Departement of Pathology, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Pathology and Cell Biology, Université de Montréal, Montreal, Quebec, Canada
| | - Valérie Lamarre
- Infectious Diseases Service, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Hugo Soudeyns
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Room 7. 9. 61, Montreal, Quebec, H3T 1C5, Canada.
- Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montreal, Quebec, Canada.
- Faculty of Medicine, Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Quebec, Canada.
- Faculty of Medicine, Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada.
| | - Isabelle Boucoiran
- Centre d'infectiologie mère-enfant (CIME), Centre de recherche du CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Room 7. 9. 61, Montreal, Quebec, H3T 1C5, Canada
- Obstetrics and Gynecology Service, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Quebec, Canada
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Schwartz DA, Ha S, Dashraath P, Baud D, Pittman PR, Adams Waldorf K. Mpox Virus in Pregnancy, the Placenta, and Newborn. Arch Pathol Lab Med 2023; 147:746-757. [PMID: 36857117 DOI: 10.5858/arpa.2022-0520-sa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
CONTEXT.— Before its eradication, the smallpox virus was a significant cause of poor obstetric outcomes, including maternal and fetal morbidity and mortality. The mpox (monkeypox) virus is now the most pathogenic member of the Orthopoxvirus genus infecting humans. The 2022 global mpox outbreak has focused attention on its potential effects during pregnancy. OBJECTIVE.— To understand the comparative effects of different poxvirus infections on pregnancy, including mpox virus, variola virus, vaccinia virus, and cowpox virus. The impact on the pregnant individual, fetus, and placenta will be examined, with particular attention to the occurrence of intrauterine vertical transmission and congenital infection. DATA SOURCES.— The data are obtained from the authors' cases and from various published sources, including early historical information and contemporary publications. CONCLUSIONS.— Smallpox caused maternal and perinatal death, with numerous cases reported of intrauterine transmission. In endemic African countries, mpox has also affected pregnant individuals, with up to a 75% perinatal case fatality rate. Since the start of the 2022 mpox outbreak, increasing numbers of pregnant women have been infected with the virus. A detailed description is given of the congenital mpox syndrome in a stillborn fetus, resulting from maternal-fetal transmission and placental infection, and the potential mechanisms of intrauterine infection are discussed. Other poxviruses, notably vaccinia virus and, in 1 case, cowpox virus, can also cause perinatal infection. Based on the historical evidence of poxvirus infections, mpox remains a threat to the pregnant population, and it can be expected that additional cases will occur in the future.
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Affiliation(s)
- David A Schwartz
- From Perinatal Pathology Consulting, Atlanta, Georgia (Schwartz)
| | - Sandy Ha
- The Department of Obstetrics and Gynecology, University of Washington, Seattle (Ha)
| | - Pradip Dashraath
- The Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Dashraath)
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland (Baud)
| | - Phillip R Pittman
- The Department of Clinical Research, US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland (Pittman)
| | - Kristina Adams Waldorf
- The Departments of Obstetrics and Gynecology and Global Health, University of Washington School of Medicine, Seattle (Adams Waldorf)
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Chui YC, Baud D, Fahmi A, Zumkehr B, Vouga M, Pomar L, Musso D, Thuong BC, Alves M, Stojanovic M. Absence of Zika virus among pregnant women in Vietnam in 2008. Trop Dis Travel Med Vaccines 2023; 9:4. [PMID: 36855197 PMCID: PMC9976504 DOI: 10.1186/s40794-023-00189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Despite being first identified in 1947, Zika virus-related outbreaks were first described starting from 2007 culminating with the 2015 Latin American outbreak. Hypotheses indicate that the virus has been circulating in Asia for decades, but reports are scarce. METHODS We performed serological analysis and screened placental samples isolated in 2008 for the presence of Zika virus from pregnant women in Ho Chi Minh City (Vietnam). RESULTS None of the placental samples was positive for Zika virus. Four serum samples out of 176 (2.3%) specifically inhibited Zika virus, with variable degrees of cross-reactivity with other flaviviruses. While one of the four samples inhibited only Zika virus, cross-reactivity with other flaviviruses not included in the study could not be ruled out. CONCLUSION Our results support the conclusion that the virus was not present among pregnant women in the Vietnamese largest city during the initial phases of the epidemic wave.
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Affiliation(s)
- Y.-C. Chui
- grid.8515.90000 0001 0423 4662Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - D. Baud
- grid.8515.90000 0001 0423 4662Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - A. Fahmi
- grid.438536.fInstitute of Virology and Immunology, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - B. Zumkehr
- grid.438536.fInstitute of Virology and Immunology, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - M. Vouga
- grid.8515.90000 0001 0423 4662Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - L. Pomar
- grid.8515.90000 0001 0423 4662Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - D. Musso
- Aix Marseille Université, Institut de Recherche Pour Le Développement (IRD), Assistance Publique–Hôpitaux de Marseille, Service de Santé Des Armées, Vecteurs–Infections Tropicales et Méditerranéennes (VITROME), and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France ,Laboratoire Eurofins Labazur Guyane, Eurofins, Cayenne, French Guiana
| | - B. C. Thuong
- Tu Du Hospital, District 1, Ho Chi Minh City, Vietnam
| | - M.P. Alves
- grid.438536.fInstitute of Virology and Immunology, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Multidisciplinary Center for Infectious Diseases (MCID), University of Bern, Bern, Switzerland
| | - M. Stojanovic
- grid.8515.90000 0001 0423 4662Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Novel Therapeutic Nutrients Molecules That Protect against Zika Virus Infection with a Special Note on Palmitoleate. Nutrients 2022; 15:nu15010124. [PMID: 36615782 PMCID: PMC9823984 DOI: 10.3390/nu15010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Zika virus (ZIKV) is a Flavivirus from the Flaviviridae family and a positive-sense single strand RNA virus. ZIKV infection can cause a mild infection to the mother but can be vertically transmitted to the developing fetus, causing congenital anomalies. The prevalence of ZIKV infections was relatively insignificant with sporadic outbreaks in the Asian and African continents until 2006. However, recent epidemic in the Caribbean showed significant increased incidence of Congenital Zika Syndrome. ZIKV infection results in placental pathology which plays a crucial role in disease transmission from mother to fetus. Currently, there is no Food and Drug Administration (FDA) approved vaccine or therapeutic drug against ZIKV. This review article summarizes the recent advances on ZIKV transmission and diagnosis and reviews nutraceuticals which can protect against the ZIKV infection. Further, we have reviewed recent advances related to the novel therapeutic nutrient molecules that have been shown to possess activity against Zika virus infected cells. We also review the mechanism of ZIKV-induced endoplasmic reticulum and apoptosis and the protective role of palmitoleate (nutrient molecule) against ZIKV-induced ER stress and apoptosis in the placental trophoblasts.
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Abstract
Importance A thickened placenta is easily identified on ultrasound and provides insight into maternal and fetal wellbeing as well as underlying structural and physiologic anomalies. Objectives The aim of this study was to review the literature to clarify what classifies a placenta as "thickened" and to review the associated incidence, maternal and fetal comorbidities, and management during pregnancy. Evidence Acquisition Electronic databases (PubMed and Web of Science) were searched from 2000 to 2020 in the English language. Studies were selected that examined associations between placental thickness, potential etiologies, and obstetric outcomes. Results There were 140 abstracts identified. After reviewing the articles, 60 were used in this review. Routine assessment of the placenta in the prenatal period is an easy and inexpensive way to assess the maternal and fetal patients. The criteria for a "thickened placenta" vary between studies based on gestational age, placental location, measurement technique, and maternal or fetal factors. Whereas most suggest thickness exceeding 4 cm is pathologic, a review had a threshold of 6 cm in the third trimester to classify placentomegaly. Several maternal and fetal conditions have been associated with a thickened placenta, such as obesity, parity, anemia, diabetes, preeclampsia, cardiac dysfunction, infection, assisted reproductive technology, multiple pregnancy, sacrococcygeal teratomas, and Beckwith-Wiedemann syndrome. A thickened placenta in pregnancy is associated with a higher incidence of adverse pregnancy outcomes and neonatal morbidity and mortality. Conclusions The literature is clear that early evaluation of the placenta using ultrasound should be a standard practice. A thickened placenta found on routine imaging should prompt a more thorough investigation to determine the etiology of the placentomegaly. At the time of this literature review, there are no recommendations regarding modality or frequency of antenatal surveillance in pregnancies complicated by a thickened placenta. However, serial ultrasounds and weekly antenatal testing in the third trimester should be considered. Relevance A thickened placenta has been associated with a variety of maternal and fetal conditions and increases the risk of adverse pregnancy outcomes and neonatal morbidity and mortality.
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Gurung S, Reuter D, Norris A, Dubois M, Maxted M, Singleton K, Castillo-Castrejon M, Papin JF, Myers DA. Early and mid-gestation Zika virus (ZIKV) infection in the olive baboon (Papio anubis) leads to fetal CNS pathology by term gestation. PLoS Pathog 2022; 18:e1010386. [PMID: 35969617 PMCID: PMC9410558 DOI: 10.1371/journal.ppat.1010386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/25/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Zika virus (ZIKV) infection in pregnancy can produce catastrophic teratogenic damage to the developing fetus including microcephaly and congenital Zika syndrome (CZS). We previously described fetal CNS pathology occurring by three weeks post-ZIKV inoculation in Olive baboons at mid-gestation, including neuroinflammation, loss of radial glia (RG), RG fibers, neuroprogenitor cells (NPCs) resulting in disrupted NPC migration. In the present study, we explored fetal brain pathologies at term gestation resulting from ZIKV exposure during either first or second trimester in the Olive baboon. In all dams, vRNA in whole blood resolved after 7 days post inoculation (dpi). One first trimester infected dam aborted at 5 dpi. All dams developed IgM and IgG response to ZIKV with ZIKV IgG detected in fetal serum. Placental pathology and inflammation were observed including disruption of syncytiotrophoblast layers, delayed villous maturation, partially or fully thrombosed vessels, calcium mineralization and fibrin deposits. In the uterus, ZIKV was detected in ¾ first trimester but not in second trimester infected dams. While ZIKV was not detected in any fetal tissue at term, all fetuses exhibited varying degrees of neuropathology. Fetal brains from ZIKV inoculated dams exhibited a range of gross brain pathologies including irregularities of the major gyri and sulci of the cerebral cortex and cerebellar pathology. Frontal cortices of ZIKV fetuses showed a general disorganization of the six-layered cortex with degree of disorganization varying among the fetuses from the two groups. Frontal cortices from ZIKV inoculation in the first but not second trimester exhibited increased microglia, and in both trimester ZIKV inoculation, increased astrocyte numbers (white matter). In the cerebellum, increased microglia were observed in fetuses from both first and second trimester inoculation. In first trimester ZIKV inoculation, decreased oligodendrocyte precursor cell populations were observed in fetal cerebellar white matter. In general, our observations are in accordance with those described in human ZIKV infected fetuses.
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Affiliation(s)
- Sunam Gurung
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Darlene Reuter
- Division of Comparative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Abby Norris
- Division of Comparative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Molly Dubois
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Marta Maxted
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Krista Singleton
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Marisol Castillo-Castrejon
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - James F. Papin
- Division of Comparative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
| | - Dean A. Myers
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, United States of America
- * E-mail:
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Racher ML, Morris M, Scott AP, Ounpraseuth ST, Hu Z, Whittington JR, Quick CM, Magann EF. Placental location site and adverse antepartum pregnancy complications: a meta-analysis and review of the literature. Arch Gynecol Obstet 2021; 305:1265-1277. [PMID: 34590170 DOI: 10.1007/s00404-021-06253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose to the study was to determine the relationship, if any, between the placental location site and antepartum complications of pregnancy. METHODS A University research librarian conducted a comprehensive literature search using the search engines PubMed and Web of Science. The search terms were "placental location" AND "pregnancy complications" OR "perinatal complications. There were no limits put on the years of the search. RESULTS The search identified 110 articles. After reviewing all the abstracts, relevant full articles, and references of full articles, there were 22 articles identified specific to antepartum complications. Central + fundal locations compared to all lateral were associated with a lower risk of hypertension during pregnancy RR = 0.47, 95% CI: 0.31-0.71]. Central location compared to all lateral was also associated with lower risk of hypertension during pregnancy [RR = 0.39, 95% CI: 0.26-0.59]. Placenta locations in the lower uterine segment were associated with greater risk of antepartum hemorrhage (APH) [RR = 2.99, 95% CI: 1.16-7.75] compared to above the lower uterine segment. No differences were observed in placental locations and gestational diabetes (GDM), preterm prelabor rupture of membranes (PPROM), preterm delivery (PTD) or on a placental abruption. CONCLUSION Central and fundal location sites and central location alone decreased the risk of hypertension during pregnancy. Low uterine segment location sites increased the risk for APH. There were no effects of placenta location sites on the development of GDM, PPROM, PTD or abruption.
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Affiliation(s)
- M Luann Racher
- Departments of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 W. Markham, Little Rock, AR, 72205-7199, USA
| | - Madison Morris
- Departments of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 W. Markham, Little Rock, AR, 72205-7199, USA
| | - Amy P Scott
- Departments of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 W. Markham, Little Rock, AR, 72205-7199, USA
| | - Songthip T Ounpraseuth
- Departments of Biostatistics, University of Arkansas for the Medical Sciences, 4301 W. Markham, Little Rock, AR, USA
| | - Zhuopei Hu
- Departments of Biostatistics, University of Arkansas for the Medical Sciences, 4301 W. Markham, Little Rock, AR, USA
| | - Julie R Whittington
- Naval Medical Center Portsmouth, Portsmouth, VA, USA.,Uniformed Services University of Health Sciences, Bethesda, USA
| | - Charles M Quick
- Departments of Pathology, University of Arkansas for the Medical Sciences, 4301 W. Markham, Little Rock, AR, USA
| | - Everett F Magann
- Departments of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 W. Markham, Little Rock, AR, 72205-7199, USA.
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Pomar L, Lambert V, Matheus S, Pomar C, Hcini N, Carles G, Rousset D, Vouga M, Panchaud A, Baud D. Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes. Emerg Infect Dis 2021; 27:490-498. [PMID: 33496246 PMCID: PMC7853546 DOI: 10.3201/eid2702.200684] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Whether prolonged maternal viremia after Zika virus infection represents a risk factor for maternal–fetal transmission and subsequent adverse outcomes remains unclear. In this prospective cohort study in French Guiana, we enrolled Zika virus–infected pregnant women with a positive PCR result at inclusion and noninfected pregnant women; both groups underwent serologic testing in each trimester and at delivery during January–July 2016. Prolonged viremia was defined as ongoing virus detection >30 days postinfection. Adverse outcomes (fetal loss or neurologic anomalies) were more common in fetuses and neonates from mothers with prolonged viremia (40.0%) compared with those from infected mothers without prolonged viremia (5.3%, adjusted relative risk [aRR] 7.2 [95% CI 0.9–57.6]) or those from noninfected mothers (6.6%, aRR 6.7 [95% CI 3.0–15.1]). Congenital infections were confirmed more often in fetuses and neonates from mothers with prolonged viremia compared with the other 2 groups (60.0% vs. 26.3% vs. 0.0%, aRR 2.3 [95% CI 0.9–5.5]).
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Branco RCC, Brasil P, Araújo JMG, Cardoso FO, Batista ZS, Leitão VMS, da Silva MACN, de Castro LO, Valverde JG, Jeronimo SMB, Lima JA, Ribeiro da Silva R, Barbosa MDCL, Brito LMO, Xavier MAP, Nascimento MDDSB. Evidence of Zika virus circulation in asymptomatic pregnant women in Northeast, Brazil. PLoS Negl Trop Dis 2021; 15:e0009412. [PMID: 34111119 PMCID: PMC8219130 DOI: 10.1371/journal.pntd.0009412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 06/22/2021] [Accepted: 04/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background Zika virus (ZIKV) is a flavivirus associated with microcephaly and other fetal anormalities. However, evidence of asymptomatic ZIKV infection in pregnant women is still scarce. This study investigated the prevalence of Zika infection in asymptomatic pregnant women attending two public maternities in Maranhão state, Northeast Brazil. Methods A total of 196 women were recruited at the time of delivery by convenience sampling from two maternity clinics in São Luís, Maranhão, Brazil, between April 2017 and June 2018. Venous blood, umbilical cord blood and placental fragments from maternal and fetal sides were collected from each subject. ZIKV infection was determined by reverse transcription polymerase chain reaction (RT-qPCR) for ZIKV and by serology (IgM and IgG). Nonspecific laboratory profiles (TORCH screen) were obtained from medical records. Results The participants were mostly from São Luís and were of 19–35 years of age. They had 10–15 years of schooling and they were of mixed race, married, and Catholic. ZIKV was identified in three umbilical cord samples and in nine placental fragments. Mothers with positive ZIKV RT-qPCR were in the age group older than 19 years. Of the 196 women tested by ZIKV rapid test, 6 and 117 women were positive for anti-ZIKV IgM and anti-ZIKV IgG antibodies, respectively. Placental Immunohistochemistry study detected ZIKV in all samples positive by RT-PCR. The newborns did not show any morphological and/or psychomotor abnormalities at birth. Conclusions Asymptomatic ZIKV infection is frequent, but it was not associated to morphological and/or psychomotor abnormalities in the newborns up to 6 months post-birth. Although pathological abnormalities were not observed at birth, we cannot rule out the long term impact of apparent asymptomatic congenital ZIKV infection. Zika virus (ZIKV) belongs to family Flaviviridae, genus Flavivirus and it is transmitted by the bite of female Aedes mosquitoes. In October 2015 an unexpected increase in the number of newborns with microcephaly in Brazil. After investigation, Zika virus was strongly related to microcephaly. Considering the epidemiological importance of ZIKV infection during pregnancy and its repercussions on the mother-fetus pair, the aim of the present study was to investigate ZIKV infection in the placenta and umbilical cord blood of women served by the Brazilian Health System in São Luís, state of Maranhão, Northeast, Brazil, after the first ZIKV epidemic. This study investigated the prevalence of Zika infection in asymptomatic pregnant women attending two public maternities in Maranhão state, Northeast Brazil. We believe that these findings will contribute to the need of continuous awareness of the risk of ZIKV infection in pregnancy and the need to improving the health care and strategic planning of public policies regarding obstetric and neonatal care.
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Affiliation(s)
| | - Patrícia Brasil
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Josélio Maria Galvão Araújo
- Microbiology and Parasitology Department, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Flávia Oliveira Cardoso
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (FOC); (MDSBN)
| | - Zulmira Silva Batista
- Post-Graduate Program in Adult Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | - Joanna Gardel Valverde
- Biochemistry Department and Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Selma Maria Bezerra Jeronimo
- Biochemistry Department and Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Josélia Alencar Lima
- Post-Graduate Program in Adult Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
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12
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Hcini N, Kugbe Y, Rafalimanana ZHL, Lambert V, Mathieu M, Carles G, Baud D, Panchaud A, Pomar L. Association between confirmed congenital Zika infection at birth and outcomes up to 3 years of life. Nat Commun 2021; 12:3270. [PMID: 34075035 PMCID: PMC8169933 DOI: 10.1038/s41467-021-23468-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/29/2021] [Indexed: 12/13/2022] Open
Abstract
Little is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5–29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2–20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9–10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results. Here, using diagnostic tools in a longitudinal cohort of ZIKV-infected pregnant women of the French Guiana Western Hospital Center (CHOG) and their infants, the authors investigate the long term neuropathological effects of congenital infection, finding that a laboratory confirmed congenital ZIKV infection at birth is associated with higher risks of adverse neurological outcomes up to three years of life.
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Affiliation(s)
- Najeh Hcini
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guiana, France.,CIC Inserm 1424, Department of Health Training and Research, University of French Guiana, French Guiana, France
| | - Yaovi Kugbe
- Department of Pediatrics, West French Guiana Hospital Center, French Guiana, France
| | | | - Véronique Lambert
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guiana, France
| | - Meredith Mathieu
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guiana, France
| | - Gabriel Carles
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guiana, France
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Léo Pomar
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, French Guiana, France. .,Materno-Fetal and Obstetrics Research Unit, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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13
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Sun X, Shen J, Wang L. Insights into the role of placenta thickness as a predictive marker of perinatal outcome. J Int Med Res 2021; 49:300060521990969. [PMID: 33583234 PMCID: PMC7890726 DOI: 10.1177/0300060521990969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The placenta is a transitory organ indispensable for normal fetal maturation and growth. Recognition of abnormal placental variants is important in clinical practice, and a broader understanding of the significance of placental variants would help clinicians better manage affected pregnancies. Increased thickness of the placenta is reported to be a nonspecific finding but it is associated with many maternal and fetal abnormalities, including preeclampsia and abnormal fetal growth. In this review, we address the questions regarding the characteristics of placenta thickness and the relationship between thickened placenta and poor pregnancy outcomes.
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Affiliation(s)
| | | | - Liquan Wang
- Liquan Wang, Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, No. 88, Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province, 310000, People’s Republic of China.
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14
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Ramond A, Lobkowicz L, Clemente NS, Vaughan A, Turchi MD, Wilder-Smith A, Brickley EB. Postnatal symptomatic Zika virus infections in children and adolescents: A systematic review. PLoS Negl Trop Dis 2020; 14:e0008612. [PMID: 33006989 PMCID: PMC7556487 DOI: 10.1371/journal.pntd.0008612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/14/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. However, little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence. METHODS We conducted a systematic review on the clinical presentation and complications of children and adolescents aged 0 to 18 years with a robust diagnosis of ZIKV infection. We searched PubMed, Web of Science, LILACs, and EMBASE until 13 February 2020 and screened reference lists of eligible articles. We assessed the studies' risk of bias using pre-specified criteria. FINDINGS Our review collated the evidence from 2543 pediatric ZIKV cases representing 17 countries and territories, identified in 1 cohort study, 9 case series and 22 case reports. The most commonly observed signs and symptoms of ZIKV infection in children and adolescents were mild and included fever, rash, conjunctivitis and arthralgia. The frequency of neurological complications was reported only in the largest case series (identified in 1.0% of cases) and in an additional 14 children identified from hospital-based surveillance studies and case reports. ZIKV-related mortality was primarily accompanied by co-morbidity and was reported in one case series (<0.5% of cases) and three case reports. One death was attributed to complications of Guillain-Barré Syndrome secondary to ZIKV infection. CONCLUSIONS AND RELEVANCE Based on the current evidence, the clinical presentation of ZIKV infection in children and adolescents appears to be primarily mild and similar to the presentation in adults, with rare instances of severe complications and/or mortality. However, reliable estimation of the risks of ZIKV complications in these age groups is limited by the scarcity and quality of published data. Additional prospective studies are needed to improve understanding of the relative frequency of the signs, symptoms, and complications associated with pediatric ZIKV infections and to investigate any potential effects of early life ZIKV exposure on neurodevelopment.
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Affiliation(s)
- Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ludmila Lobkowicz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aisling Vaughan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil (Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil)
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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15
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Rabelo K, de Souza LJ, Salomão NG, Machado LN, Pereira PG, Portari EA, Basílio-de-Oliveira R, Dos Santos FB, Neves LD, Morgade LF, Provance DW, Higa LM, Tanuri A, de Carvalho JJ, Paes MV. Zika Induces Human Placental Damage and Inflammation. Front Immunol 2020; 11:2146. [PMID: 32983175 PMCID: PMC7490298 DOI: 10.3389/fimmu.2020.02146] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
In Brazil, an epidemic of Zika virus (ZIKV) infections was declared in 2015 that coincided with alarming reports of microcephaly in newborns associated with mother infection. Although the virus has placental tropism, changes in the tissue morphology and immunity of infected patients have not yet been elucidated. Here, we investigated the histopathological and ultrastructural changes along with the immunological profile and the BDNF expression in rare placental material. Tissues were obtained in the 2015–2016 Brazilian epidemic, of ten ZIKV-infected patients during pregnancy, five resulting in cases of fetal microcephaly and five non-microcephaly, compared to five non-infected control placentae. Viral antigens were only detected in samples from the ZIKV infected patients. Infected placentae presented histopathological severe damage, while the ultrastructural evaluation showed abnormal organelles, such as clusters of virus-like particles consistent with the ZIKV dimensions. Increased infiltration of CD68+ and TCD8+ cells, expression of MMPs, cytokines (IFN-γ and TNF-α) and other immunological mediators (RANTES/CCL5 and VEGFR-2) confirmed excessive inflammation and vascular permeability dysfunction. An evaluation of BDNF showed a decrease that could modulate neuronal damage in the developing fetus. The placental changes caused by ZIKV are not pathognomonic, however, the data provide evidence that this infection leads to severe placental injury.
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Affiliation(s)
- Kíssila Rabelo
- Laboratório de Ultraestrutura e Biologia Tecidual, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Natália Gedeão Salomão
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | - Priscila Gomes Pereira
- Laboratório de Ultraestrutura e Biologia Tecidual, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Laura Dias Neves
- Hospital Geral Dr. Beda, CEPLIN - Uti Neonatal Nicola Albano, Rio de Janeiro, Brazil
| | - Luciana Faes Morgade
- Hospital Geral Dr. Beda, CEPLIN - Uti Neonatal Nicola Albano, Rio de Janeiro, Brazil
| | - David William Provance
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.,Centro de Desenvolvimento Tecnológico em Saúde, Fiocruz, Rio de Janeiro, Brazil
| | - Luiza Mendonça Higa
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge José de Carvalho
- Laboratório de Ultraestrutura e Biologia Tecidual, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marciano Viana Paes
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
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16
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Venceslau EM, Guida JPS, Nobrega GDM, Samogim AP, Parise PL, Japecanga RR, de Toledo-Teixeira DA, Forato J, Antolini-Tavares A, Souza A, Altemani A, Consonni SR, Passini R, Amaral E, Proenca-Modena JL, Costa ML. Adequate Placental Sampling for the Diagnosis and Characterization of Placental Infection by Zika Virus. Front Microbiol 2020; 11:112. [PMID: 32153521 PMCID: PMC7047998 DOI: 10.3389/fmicb.2020.00112] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/17/2020] [Indexed: 11/13/2022] Open
Abstract
The detection of Zika virus (ZIKV) in immunoprivileged anatomical sites, potential sites for viral persistence, may guide the confirmation of undefined cases of ZIKV infection and also bring to light unknown pathways of viral transmission. Thus, this study aimed to characterize ZIKV infection in stratified, standardized placental samples in women with exanthematic febrile manifestations during pregnancy and compare findings to the standard investigation protocol of official health agencies. To this end, a case series of placental findings within a prospective cohort study was conducted over a period of 24 months. Serum/urine were obtained at the time of clinical case identification. Placental sampling was performed following standard investigation protocol (samples of 1.0 cm sent to a reference laboratory) and in a systematic way at various regions, such as chorionic plate, chorionic villi, basal plate, amniotic membrane, and umbilical cord, for subsequent ZIKV identification and quantification. Clinical information was obtained and histological preparation with hematoxylin–eosin staining for morphological evaluation was performed. This case series included 17 placentas systematically collected. Of these, 14 were positive by qRT-PCR for ZIKV, 5 in the umbilical cord, 7 in the amniotic membrane, 7 in the chorionic plate, 13 in the chorionic villi, and 7 in the basal plate, whereas none were reported by the reference laboratory. The most common morphological and anatomopathological findings were increased stromal cellularity, villitis, calcification, maternal vascular malperfusion, placental hypoplasia, and maternal–fetal hemorrhage (intervillous thrombi). Seven women presented positive testing for ZIKV in serological and/or molecular tests during gestation in urine. While viral quantification in urine ranged from 101 to 103 FFU eq/ml, that in different placental regions ranged from 103 to 108 FFU eq/g. Thus, ZIKV can infect different regions of the placenta and umbilical cord of pregnant women, showing that the systematic collection and adequate storage of the placenta is fundamental for the detection of ZIKV in this organ. The detection of ZIKV in the placenta after several months of initial symptoms suggests that this tissue may be a site for viral persistence during pregnancy.
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Affiliation(s)
- Emanuella Meneses Venceslau
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - José Paulo Siqueira Guida
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Guilherme de Moraes Nobrega
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Ana Paula Samogim
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Pierina Lorencini Parise
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Rodolfo Rosa Japecanga
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Julia Forato
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Arthur Antolini-Tavares
- Department of Pathological Anatomy, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Arethusa Souza
- Department of Pathological Anatomy, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Albina Altemani
- Department of Pathological Anatomy, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Silvio Roberto Consonni
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Renato Passini
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Eliana Amaral
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose Luiz Proenca-Modena
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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