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Modrzejewska M, Połubiński P, Zdanowska O. Ophthalmic Complications, Diagnosis, and Treatment of Congenital Human Cytomegalovirus Infection. J Clin Med 2024; 13:3379. [PMID: 38929909 PMCID: PMC11203846 DOI: 10.3390/jcm13123379] [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: 05/08/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Human cytomegalovirus (hCMV) is the most common etiological agent of congenital infections seen in newborns. Among the most commonly observed complications in children with congenital human cytomegalovirus infection are those affecting the visual system. Ocular complications of congenital CMV (cCMV) are a topic rarely addressed in the literature, which prompted the authors to update the available knowledge with the latest data. Methodology: English-language literature published between April 2000 and November 2023 (PubMed, NIH, Google Scholar) was analyzed for ocular complications of cCMV. The data obtained were categorized according to the ocular area involved and the incidence. A compilation of criteria for the symptomatic form of cCMV was also created. Results: The cCMV complications described in the literature affect all parts of the visual system: the anterior segment, the posterior segment, the posterior visual pathways, and the visual cortex. The most commonly described ocular complication of cCMV is choroidal and retinal scarring. Conclusions: Ophthalmic complications of cCMV can cause severe visual disturbances. Ophthalmic diagnosis in newborns should include hCMV PCR testing, which has the highest sensitivity and specificity. In the symptomatic form of cCMV, treatment should be instituted according to recommendations. A consensus should be established for screening of primary hCMV infection in pregnant women, the way in which to define the symptomatic form of cCMV, and the appropriateness and standards of treatment for primary hCMV infection in pregnant women.
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Affiliation(s)
- Monika Modrzejewska
- 2nd Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Piotr Połubiński
- Scientific Association of Students 2nd Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Oliwia Zdanowska
- University Hospital of Karol Marcinkowski in Zielona Góra, 65-046 Zielona Góra, Poland
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2
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Auger N, Arbour L, Lewin A, Brousseau É, Healy-Profitós J, Luu TM. Congenital anomalies during Covid-19: artifact of surveillance or a real TORCH? Eur J Epidemiol 2024; 39:613-621. [PMID: 38589643 DOI: 10.1007/s10654-024-01122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
Infections in the first trimester of pregnancy can be teratogenic, but the possibility that Covid-19 could lead to birth defects is unclear. We examined whether SARS-CoV-2 infection during pregnancy or exposure to pandemic conditions were associated with the risk of congenital anomalies. We carried out a retrospective study of 420,222 neonates born in Quebec, Canada in two time periods: prepandemic (January 1, 2017 to March 12, 2020) vs. pandemic (March 13, 2020 to March 31, 2022). We classified pandemic births as early (first trimester completed before the pandemic) or late (first trimester during the pandemic), and identified patients with SARS-CoV-2 infections during pregnancy. We applied (1) adjusted log-binomial regression models to assess the association between SARS-CoV-2 infection and congenital anomalies, and (2) autoregressive interrupted time series regression to analyze temporal trends in the monthly number of defects in all patients regardless of infection. In total, 29,263 newborns (7.0%) had a congenital anomaly. First trimester SARS-CoV-2 infections were not associated with a greater risk of birth defects compared with no infection (RR 1.07, 95% CI 0.59-1.95). However, births during the late pandemic period were more likely to be diagnosed with congenital microcephaly compared with prepandemic births (RR 1.44, 95% CI 1.21-1.71). Interrupted time series analysis confirmed that the frequency of microcephaly increased during the late pandemic period, whereas other anomalies did not. We conclude that Covid-19 is likely not teratogenic, but enhanced surveillance of anomalies among late pandemic births may have heightened the detection of infants with microcephaly.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Institut national de santé publique du Québec, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Montreal, QC, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, QC, Canada
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Abdelmalek CM, Singh S, Fasil B, Horvath AR, Mulkey SB, Curé C, Campos M, Cavalcanti DP, Tong VT, Mercado M, Daza M, Marcela Benavides M, Acosta J, Gilboa S, Valencia D, Sancken CL, Newton S, Scalabrin DMF, Mussi-Pinhata MM, Vasconcelos Z, Chakhtoura N, Moye J, Leslie EJ, Bulas D, Vezina G, Marques FJP, Leyser M, Del Campo M, Vilain E, DeBiasi RL, Wang T, Nath A, Haydar T, Muenke M, Mansour TA, du Plessis AJ, Murray JC, Cordero JF, Kousa YA. Building a growing genomic data repository for maternal and fetal health through the PING Consortium. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.24.24307899. [PMID: 38826415 PMCID: PMC11142296 DOI: 10.1101/2024.05.24.24307899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Prenatally transmitted viruses can cause severe damage to the developing brain. There is unexplained variability in prenatal brain injury and postnatal neurodevelopmental outcomes, suggesting disease modifiers. Discordant outcomes among dizygotic twins could be explained by genetic susceptibly or protection. Among several well-recognized threats to the developing brain, Zika is a mosquito-borne, positive-stranded RNA virus that was originally isolated in Uganda and spread to cause epidemics in Africa, Asia, and the Americas. In the Americas, the virus caused congenital Zika syndrome and a multitude of neurodevelopmental disorders. As of now, there is no preventative treatment or cure for the adverse outcomes caused by prenatal Zika infection. The Prenatal Infection and Neurodevelopmental Genetics (PING) Consortium was initiated in 2016 to identify factors modulating prenatal brain injury and postnatal neurodevelopmental outcomes for Zika and other prenatal viral infections. Methods The Consortium has pooled information from eight multi-site studies conducted at 23 research centers in six countries to build a growing clinical and genomic data repository. This repository is being mined to search for modifiers of virally induced brain injury and developmental outcomes. Multilateral partnerships include commitments with Children's National Hospital (USA), Instituto Nacional de Salud (Colombia), the Natural History of Zika Virus Infection in Gestation program (Brazil), and Zika Instituto Fernandes Figueira (Brazil), in addition to the Centers for Disease Control and Prevention and the National Institutes of Health. Discussion Our goal in bringing together these sets of patient data was to test the hypothesis that personal and populational genetic differences affect the severity of brain injury after a prenatal viral infection and modify neurodevelopmental outcomes. We have enrolled 4,102 mothers and 3,877 infants with 3,063 biological samples and clinical data covering over 80 phenotypic fields and 5,000 variables. There were several notable challenges in bringing together cohorts enrolled in different studies, including variability in the timepoints evaluated and the collected clinical data and biospecimens. Thus far, we have performed whole exome sequencing on 1,226 participants. Here, we present the Consortium's formation and the overarching study design. We began our investigation with prenatal Zika infection with the goal of applying this knowledge to other prenatal infections and exposures that can affect brain development.
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Randhawa HS, Randhawa J, More A, Jain A. A Rare Case of Unilateral Fetal Cataract and Coincidental Polydactyly in Congenital Toxoplasmosis. Cureus 2024; 16:e61058. [PMID: 38915958 PMCID: PMC11195811 DOI: 10.7759/cureus.61058] [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] [Accepted: 05/25/2024] [Indexed: 06/26/2024] Open
Abstract
Congenital toxoplasmosis is caused by transplacental infection of Toxoplasma gondii during pregnancy. We present a case of a congenital toxoplasma with intracranial calcifications, microcephaly, growth restriction, a unilateral cataract that developed in the third trimester, and a coincidental post-axial-polydactyly. Antenatal imaging findings are important to guide further testing and confirmation of diagnosis, it is important to know all possible associations and prognoses for timely counseling, testing, and intervention. To our knowledge, no case has been published with findings of unilateral cataract in congenital toxoplasmosis and associated coincidental polydactyly. Therefore, we wish to add this case to the current scientific literature.
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Affiliation(s)
- Harneet S Randhawa
- Department of Radiology, Sassoon General Hospital, Pune, IND
- Department of Radiology, Government Medical College, Baramati, Baramati, IND
| | - Jasneet Randhawa
- Cardiology, Park Slope Cardiology, Brooklyn, USA
- Cardiology, Aulakh Hospital, Amritsar, IND
| | - Akshay More
- Interventional Radiology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, IND
| | - Akshay Jain
- Radiology, Government Medical College Kolhapur, Kolhapur, IND
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Seppey C, Schlingemann R, Guex-Crosier Y. Suspected Congenital Rubella Retinopathy: A Spectrum of the TORCH Syndrome. Klin Monbl Augenheilkd 2024; 241:525-528. [PMID: 38653283 DOI: 10.1055/a-2212-2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Claire Seppey
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Lausanne, Switzerland
| | - Reinier Schlingemann
- Jules-Gonin Eye Hospital, Research Department, Lausanne, Switzerland
- Department of Ophthalmology & Ocular Angiogenesis Research Group, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Yan Guex-Crosier
- Jules-Gonin Eye Hospital, FAA, University of Lausanne, Lausanne, Switzerland
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6
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Bonato FCS, Rivero RLM, Garcia HH, Vidal JE. Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up. Rev Inst Med Trop Sao Paulo 2024; 66:e15. [PMID: 38511804 PMCID: PMC10946419 DOI: 10.1590/s1678-9946202466015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/23/2024] [Indexed: 03/22/2024] Open
Abstract
Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.
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Affiliation(s)
| | - René Leandro Magalhães Rivero
- Instituto de Infectologia Emílio Ribas, Divisão de Apoio ao Diagnóstico e Terapêutica, Setor de Radiologia, São Paulo, São Paulo, Brazil
| | - Hector Hugo Garcia
- Universidad Peruana Cayetano Heredia, Centro de Salud Global, Lima, Peru
- Instituto de Ciencias Neurológicas, Unidad de Cisticercosis, Lima, Peru
| | - José Ernesto Vidal
- Instituto de Infectologia Emílio Ribas, Departamento de Neurologia, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Moléstias Infecciosas, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo (LIM-49), São Paulo, São Paulo, Brazil
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Hunsperger E, Osoro E, Munyua P, Njenga MK, Mirieri H, Kikwai G, Odhiambo D, Dayan M, Omballa V, Agogo GO, Mugo C, Widdowson MA, Inwani I. Seroconversion and seroprevalence of TORCH infections in a pregnant women cohort study, Mombasa, Kenya, 2017-2019. Epidemiol Infect 2024; 152:e68. [PMID: 38305089 PMCID: PMC11077605 DOI: 10.1017/s0950268824000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Women infected during pregnancy with TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, and Herpes simplex viruses) pathogens have a higher risk of adverse birth outcomes including stillbirth / miscarriage because of mother-to-child transmission. To investigate these risks in pregnant women in Kenya, we analyzed serum specimens from a pregnancy cohort study at three healthcare facilities. A sample of 481 participants was selected for TORCH pathogen antibody testing to determine seroprevalence. A random selection of 285 from the 481 participants was selected to measure seroconversion. These sera were tested using an IgG enzyme-linked immunosorbent assay against 10 TORCH pathogens. We found that the seroprevalence of all but three of the 10 TORCH pathogens at enrollment was >30%, except for Bordetella pertussis (3.8%), Treponema pallidum (11.4%), and varicella zoster virus (0.5%). Conversely, very few participants seroconverted during their pregnancy and were herpes simplex virus type 2 (n = 24, 11.2%), parvovirus B19 (n = 14, 6.2%), and rubella (n = 12, 5.1%). For birth outcomes, 88% of the participant had live births and 12% had stillbirths or miscarriage. Cytomegalovirus positivity at enrolment had a statistically significant positive association with a live birth outcome (p = 0.0394). Of the 10 TORCH pathogens tested, none had an association with adverse pregnancy outcome.
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Affiliation(s)
- Elizabeth Hunsperger
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Peninah Munyua
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - M. Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Gilbert Kikwai
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Dennis Odhiambo
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Moshe Dayan
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Victor Omballa
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - George O. Agogo
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Cyrus Mugo
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Irene Inwani
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
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Abu Shqara R, Or S, Abu Zraki A, Rizik J, Glikman D, Rechnitzer H, Lowenstein L, Frank Wolf M. The Utility of Maternal TORCH Screening Due to Obstetrical Indications in Detecting Congenital Infections: A Retrospective Observational Study. Pediatr Infect Dis J 2024; 43:69-73. [PMID: 37725823 DOI: 10.1097/inf.0000000000004107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The diagnostic yield of TORCH screening for obstetrical indications is unclear. We evaluated TORCH testing results among women with intrauterine growth restriction (IUGR), polyhydramnios and oligohydramnios; and associations with congenital infections in neonates. METHOD This retrospective single-center study included all the women diagnosed with IUGR, polyhydramnios or oligohydramnios who underwent serological TORCH testing during 2010-2019. TORCH screening included Toxoplasma, cytomegalovirus (CMV), rubella IgM and IgG. The data, which were cross-referenced with data of neonates with congenital TORCH infections during the same period, included indications for neonatal testing, sonographic findings and neonatal ophthalmologic and hearing findings. RESULT Six women of 771 (0.8%) were diagnosed with primary TORCH infection: 4 (0.5%) with toxoplasmosis, and 2 (0.3%) with CMV. None had a confirmed congenital infection. The rates of positive maternal TORCH screening in IUGR and polyhydramnios were 2.1% and 0.6%, respectively. Maternal TORCH infection was not identified in any woman with oligohydramnios or severe polyhydramnios. None of the neonates with congenital infection were screened for TORCH during pregnancy due to polyhydramnios, oligohydramnios or IUGR. Among the neonates with congenital CMV, the most common indication for performing neonatal CMV polymerase chain reaction was suspected primary maternal infection during pregnancy due to symptomatic CMV. No incidences of congenital rubella were noted in the last decade in our medical center. CONCLUSION Our results suggest that routine TORCH screening in pregnancies complicated with IUGR, polyhydramnios or oligohydramnios should be avoided. Suggestive maternal symptoms and specific fetal sonographic features should prompt testing for CMV and Toxoplasma infection.
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Affiliation(s)
- Raneen Abu Shqara
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shany Or
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Abdallah Abu Zraki
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
| | - Jeries Rizik
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
| | - Daniel Glikman
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Hagai Rechnitzer
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
| | - Lior Lowenstein
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- From the Obstetrics and Gynecology department, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Calado AM, Seixas F, Pires MDA. Updating an Overview of Teratology. Methods Mol Biol 2024; 2753:1-38. [PMID: 38285332 DOI: 10.1007/978-1-0716-3625-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
In this chapter, the authors aim to update an overview of the principles of teratology, beginning with the definition of teratology, the critical point at which this process occurs, and some of the most common etiological agents that improve our understanding of teratology.Modern teratology has greatly improved in recent years with advances in new methods in molecular biology, toxicology, animal laboratory science, and genetics, increasing our knowledge of ambient influences. Nevertheless, there is a lot to do to reduce the influence of hazardous intervening agents, whether they target our genetics or not, that can negatively affect pregnancy and induce congenital development disorders, including morphological, biochemical, or behavioral defects.Certain agents might indeed be related to certain defects, but we have not been able to identify the cause of most congenital defects, which highlights the importance of finding and testing out new genetics techniques and conducting laboratory animal science to unravel the etiology and pathogenicity of each congenital defect.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Patel N, Chaudhari K, Patel DJ, Joshi JS, Jyotsna G. TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes Simplex Virus) Infection and the Enigma of Anomalous Fetal Development: Pregnancy Puzzles. Cureus 2024; 16:e51534. [PMID: 38304637 PMCID: PMC10834030 DOI: 10.7759/cureus.51534] [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: 12/01/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
The cytomegalovirus (CMV), a common DNA virus with a high global seroprevalence, is the primary cause of teratogenic congenital infections, which presents a serious risk to public health. Maternal CMV infection is linked to congenital CMV (cCMV), a major contributor to non-genetic sensorineural hearing loss, cognitive developmental impairments, and cerebral palsy in infants. Transmission might occur through direct contact with infected bodily fluids, with higher transmission rates after primary infection and an increased risk of severe fetal effects before 20 weeks. The mother and fetus do not get immunity from a prior infection. Fetal growth restriction, fetal loss, and cerebral or extra-cerebral abnormalities that can be detected by ultrasonography are possible presentations of cCMV. Specific antibody detection or seroconversion is required for the diagnosis of maternal CMV during pregnancy. Amniocentesis is used to diagnose fetal CMV during pregnancy after eight weeks of presumed maternal infection and 17 weeks of gestation. The main preventive measure is hygiene education, as the effectiveness of immunoglobulins, antiviral medications, and vaccines is still up for debate. The focus is particularly directed toward the anomalous fetal outcomes observed during the course of the pregnancy.
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Affiliation(s)
- Nainita Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dharmesh J Patel
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jalormy S Joshi
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Garapati Jyotsna
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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11
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Chien SC, Chen CP. Genetic Counseling of Fetal Microcephaly. J Med Ultrasound 2024; 32:1-7. [PMID: 38665355 PMCID: PMC11040482 DOI: 10.4103/jmu.jmu_18_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 04/28/2024] Open
Abstract
Fetal microcephaly is a small head with various losses of cerebral cortical volume. The affected cases may suffer from a wide range in severity of impaired cerebral development from slight to severe mental retardation. It can be an isolated finding or with other anomalies depending on the heterogeneous causes including genetic mutations, chromosomal abnormalities, congenital infectious diseases, maternal alcohol consumption, and metabolic disorders during pregnancy. It is often a lifelong and incurable condition. Thus, early detection of fetal microcephaly and identification of the underlying causes are important for clinical staff to provide appropriate genetic counseling to the parents and accurate management.
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Affiliation(s)
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Biotechnology, Asia University, Taichung, Taiwan
- Institute of Clinical and Community Health Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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12
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Chitre SD, Crews CM, Tessema MT, Plėštytė-Būtienė I, Coffee M, Richardson ET. The impact of anthropogenic climate change on pediatric viral diseases. Pediatr Res 2024; 95:496-507. [PMID: 38057578 PMCID: PMC10872406 DOI: 10.1038/s41390-023-02929-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.
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Affiliation(s)
- Smit D Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Cecilia M Crews
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mesfin Teklu Tessema
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.
- International Rescue Committee, New York, NY, USA.
| | | | - Megan Coffee
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- International Rescue Committee, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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13
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Creisher PS, Perry JL, Zhong W, Lei J, Mulka KR, Ryan WH, Zhou R, Akin EH, Liu A, Mitzner W, Burd I, Pekosz A, Klein SL. Adverse outcomes in SARS-CoV-2-infected pregnant mice are gestational age-dependent and resolve with antiviral treatment. J Clin Invest 2023; 133:e170687. [PMID: 37581940 PMCID: PMC10575736 DOI: 10.1172/jci170687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Abstract
SARS-CoV-2 infection during pregnancy is associated with severe COVID-19 and adverse fetal outcomes, but the underlying mechanisms remain poorly understood. Moreover, clinical studies assessing therapeutics against SARS-CoV-2 in pregnancy are limited. To address these gaps, we developed a mouse model of SARS-CoV-2 infection during pregnancy. Outbred CD1 mice were infected at E6, E10, or E16 with a mouse-adapted SARS-CoV-2 (maSCV2) virus. Outcomes were gestational age-dependent, with greater morbidity, reduced antiviral immunity, greater viral titers, and impaired fetal growth and neurodevelopment occurring with infection at E16 (third trimester equivalent) than with infection at either E6 (first trimester equivalent) or E10 (second trimester equivalent). To assess the efficacy of ritonavir-boosted nirmatrelvir, which is recommended for individuals who are pregnant with COVID-19, we treated E16-infected dams with mouse-equivalent doses of nirmatrelvir and ritonavir. Treatment reduced pulmonary viral titers, decreased maternal morbidity, and prevented offspring growth restriction and neurodevelopmental impairments. Our results highlight that severe COVID-19 during pregnancy and fetal growth restriction is associated with heightened virus replication in maternal lungs. Ritonavir-boosted nirmatrelvir mitigated maternal morbidity along with fetal growth and neurodevelopment restriction after SARS-CoV-2 infection. These findings prompt the need for further consideration of pregnancy in preclinical and clinical studies of therapeutics against viral infections.
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Affiliation(s)
- Patrick S. Creisher
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jamie L. Perry
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Weizhi Zhong
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jun Lei
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen R. Mulka
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - W. Hurley Ryan
- Department of Environmental Health and Engineering, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruifeng Zhou
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elgin H. Akin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anguo Liu
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Wayne Mitzner
- Department of Environmental Health and Engineering, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Irina Burd
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Environmental Health and Engineering, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Devaraju M, Li A, Ha S, Li M, Shivakumar M, Li H, Nishiguchi EP, Gérardin P, Waldorf KA, Al-Haddad BJS. Beyond TORCH: A narrative review of the impact of antenatal and perinatal infections on the risk of disability. Neurosci Biobehav Rev 2023; 153:105390. [PMID: 37708918 PMCID: PMC10617835 DOI: 10.1016/j.neubiorev.2023.105390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health disorders. There is strong evidence that TORCH infections (i.e., Treponema pallidum, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus) alter fetal neurodevelopment across multiple developmental domains and contribute to motor and cognitive disabilities. However, the impact of a broader range of viral and bacterial infections on fetal development and disability is less well understood. We performed a literature review of human studies to identify gaps in the link between maternal infections, inflammation, and several neurodevelopmental domains. We found strong and moderate evidence respectively for a higher risk of motor and cognitive delays and disabilities in offspring exposed to a range of non-TORCH pathogens during fetal life. In contrast, there is little evidence for an increased risk of language and sensory disabilities. While guidelines for TORCH infection prevention during pregnancy are common, further consideration for prevention of non-TORCH infections during pregnancy for fetal neuroprotection may be warranted.
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Affiliation(s)
- Monica Devaraju
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Amanda Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA; Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA
| | - Sandy Ha
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Miranda Li
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Megana Shivakumar
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Hanning Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Erika Phelps Nishiguchi
- University of Hawaii, Department of Pediatrics, Division of Community Pediatrics, 1319 Punahou St, Honolulu, HI, USA
| | - Patrick Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion, France; Platform for Clinical and Translational Research, Centre Hospitalier Universitaire, Saint Pierre, Réunion, France
| | - Kristina Adams Waldorf
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Benjamin J S Al-Haddad
- University of Minnesota, Department of Pediatrics, Division of Neonatology, Academic Office Building, 2450 Riverside Ave S AO-401, Minneapolis, MN 55454, USA; Masonic Institute for the Developing Brain, 2025 E River Pkwy, Minneapolis, MN 55414, USA.
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15
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Castro-Fonseca E, Rosa B, Silva VR, Andrade CV, Praxedes I, Guastavino AB, Esteves CG, Chalfun G, Prata-Barbosa A, Chimelli L, Garcez PP, Lent R. Pronounced decline of absolute cell numbers in the brain of a newborn with congenital syphilis. J Neuropathol Exp Neurol 2023; 82:887-890. [PMID: 37550256 DOI: 10.1093/jnen/nlad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Affiliation(s)
- Emily Castro-Fonseca
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Barbara Rosa
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Viviane R Silva
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cecilia V Andrade
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Inês Praxedes
- Department of Pathology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa B Guastavino
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia G Esteves
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Georgia Chalfun
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arnaldo Prata-Barbosa
- Department of Neonatology, Maternity School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Pediatrics, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Leila Chimelli
- Laboratory of Neuropathology, Rio de Janeiro State Brain Institute, Rio de Janeiro, Brazil
| | - Patricia P Garcez
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Lent
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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16
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Han L, Li R, Xiong W, Hu Y, Wu J, Liu X, Nie H, Qin W, Ling L, Li M. Prevalence of preconception TORCH infections and its influential factors: evidence from over 2 million women with fertility desire in southern China. BMC Womens Health 2023; 23:425. [PMID: 37563634 PMCID: PMC10416474 DOI: 10.1186/s12905-023-02560-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND TORCH (Toxoplasma gondii [TOX], Cytomegalovirus [CMV], Rubella virus [RV], and Herpes simplex virus [HSV]) represents pathogens known to traverse the maternal-fetal barrier and cause severe neonatal anomalies. We aimed to assess the prevalence of preconception TOX, CMV, and RV infections among women with fertility desire in southern China, and identify related risk factors. METHODS Data were obtained from a population-based cross-sectional study conducted as part of the National Free Preconception Health Examination Project. Women planning to conceive within the next 6 months in Guangdong Province were enrolled between 2014 and 2019. Information on sociodemographic, gynecological, and obstetric characteristics was collected. Sera were analyzed for TOX IgG, CMV IgG, and RV IgG antibodies using an enzyme-linked immunosorbent assay. Descriptive, univariate, and multivariate logistic regression analyses were performed to assess the association between TORCH infections and related factors. RESULTS Among 2,409,137 participants, the prevalence of IgG antibodies for TOX, CMV, and RV was 3.20% (95% CI: 3.18-3.22%), 77.67% (95% CI: 77.62-77.71%) and 76.03% (95% CI: 75.98-76.07%), respectively. Of all participants, 141,047 women (5.85%, 95% CI:5.83-5.88%) reported a history of immunization for RV. Women living in the Pearl River Delta, a more developed region, have significantly lower vaccination rates than those living in other regions. The seropositivity of TOX IgG was highest among women aged 35 years and above, with primary or lower education levels, and rural registration. Factors such as being older, having a higher educational level, and being of other ethnicities were associated with a higher prevalence of naturally acquired CMV and RV infections. Women living in the Pearl River Delta showed a higher risk of TOX, CMV, and RV infections, with aORs of 2.21, 4.45, and 1.76, respectively. A history of pregnancy, gynecological diseases, and sexually transmitted infections were potentially associated with TORCH infections, but this association varied across pathogens. CONCLUSION The findings of this study update the baseline of preconception TORCH infections among women with fertility desire in southern China, helping to estimate the risk of congenital infection and guide the development and implementation of effective prevention measures for preconception TORCH infections.
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Affiliation(s)
- Lu Han
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Rui Li
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, Guangdong, China
| | - Wenxue Xiong
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, Guangdong, China
| | - Yang Hu
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Jiabao Wu
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Xiaohua Liu
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Hua Nie
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Weibing Qin
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, Guangdong, China.
- Clinical research design division, Clinical research center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Mingzhen Li
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China.
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17
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Park L, Reyes-Hadsall S, Dhillon R, Frauenfelder A, Graneiro A, Fayiga FF, Lange C, Duarte AM. Concerning Newborn Rashes and Developmental Abnormalities: Part II: Congenital Infections, Ichthyosis, Neurocutaneous Disorders, Vascular Malformations, and Midline Lesions. Pediatr Rev 2023; 44:447-465. [PMID: 37525307 DOI: 10.1542/pir.2022-005640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Lily Park
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
| | - Sophia Reyes-Hadsall
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Rummit Dhillon
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
| | | | - Ana Graneiro
- Department of Allergy and Immunology, Nicklaus Children's Hospital, Miami, FL
| | - Folasade F Fayiga
- University of Miami Miller School of Medicine, Miami, FL
- Wright State University Boonshoft School of Medicine, Fairborn, OH
- Children's Skin Center, Miami, FL
| | - Carlos Lange
- Children's Skin Center, Miami, FL
- Florida International University, Miami, FL
| | - Ana M Duarte
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Children's Skin Center, Miami, FL
- Florida International University, Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
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18
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Ferreira AP, Santana DS, Figueiredo ERL, Simões MC, de Morais DF, Tavares VB, de Sousa JG, Silva MJA, de Campos Gomes F, de Melo Neto JS. Sociodemographic and Clinical Factors for Microcephaly Secondary to Teratogenic Infections in Brazil: An Ecological Study. Viruses 2023; 15:1675. [PMID: 37632018 PMCID: PMC10457789 DOI: 10.3390/v15081675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Microcephaly is a neurological condition characterized by anomalies in the growth of the cranial circumference. This study aims to examine the association between sociodemographic and clinical variables and the occurrence of secondary microcephaly in newborns in Brazil. It also aims to investigate the association between this congenital anomaly and teratogenic infections. This research adopts an observational approach with an ecological, descriptive, and analytical design. The sample includes infants aged ≤28 days and registered in the country's Live Births Information System from January 2015 to December 2021. Newborns were categorized into G1, consisting of newborns with one of the three infections (Zika, toxoplasmosis, or syphilis), and G2, consisting of newborns with two of the three infections. A total of 1513 samples were analyzed and divided into two groups: one infection (syphilis n = 423; toxoplasmosis n = 295; or Zika n = 739) and two infections (n = 56). The northeastern region of Brazil has the highest prevalence of microcephaly. Regarding the population profile, the Zika virus infection is more common among white mothers, while the syphilis infection is more common among black mothers. Among newborns with microcephaly, boys have a lower prevalence of toxoplasmosis infection, while girls have a lower prevalence of Zika virus infection. This study provides pertinent information on each infection and contributes to the epidemiologic understanding of the association between teratogenic infections and microcephaly.
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Affiliation(s)
- Arlison Pereira Ferreira
- Unidade de Pesquisa Clínica e Experimental do Sistema Urogenital (UPCEURG), Instituto de Ciências da Saúde, Universidade Federal do Pará (UFPA), Belém 66075-110, PA, Brazil; (A.P.F.); (D.S.S.); (E.R.L.F.); (V.B.T.); (J.G.d.S.)
| | - Davi Silva Santana
- Unidade de Pesquisa Clínica e Experimental do Sistema Urogenital (UPCEURG), Instituto de Ciências da Saúde, Universidade Federal do Pará (UFPA), Belém 66075-110, PA, Brazil; (A.P.F.); (D.S.S.); (E.R.L.F.); (V.B.T.); (J.G.d.S.)
| | - Eric Renato Lima Figueiredo
- Unidade de Pesquisa Clínica e Experimental do Sistema Urogenital (UPCEURG), Instituto de Ciências da Saúde, Universidade Federal do Pará (UFPA), Belém 66075-110, PA, Brazil; (A.P.F.); (D.S.S.); (E.R.L.F.); (V.B.T.); (J.G.d.S.)
| | - Marcelo Coelho Simões
- Programa de Pós-Graduação em Ciências Ambientais, Universidade do Estado do Pará (UEPA), Belém 66095-100, PA, Brazil;
| | - Dionei Freitas de Morais
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil;
| | - Victória Brioso Tavares
- Unidade de Pesquisa Clínica e Experimental do Sistema Urogenital (UPCEURG), Instituto de Ciências da Saúde, Universidade Federal do Pará (UFPA), Belém 66075-110, PA, Brazil; (A.P.F.); (D.S.S.); (E.R.L.F.); (V.B.T.); (J.G.d.S.)
| | - Juliana Gonçalves de Sousa
- Unidade de Pesquisa Clínica e Experimental do Sistema Urogenital (UPCEURG), Instituto de Ciências da Saúde, Universidade Federal do Pará (UFPA), Belém 66075-110, PA, Brazil; (A.P.F.); (D.S.S.); (E.R.L.F.); (V.B.T.); (J.G.d.S.)
| | | | | | - João Simão de Melo Neto
- Unidade de Pesquisa Clínica e Experimental do Sistema Urogenital (UPCEURG), Instituto de Ciências da Saúde, Universidade Federal do Pará (UFPA), Belém 66075-110, PA, Brazil; (A.P.F.); (D.S.S.); (E.R.L.F.); (V.B.T.); (J.G.d.S.)
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19
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Santos-Baltuilhe S, Mallmann GS, França ALN, Azambuja KCO, Andrade PHM, Oliveira EF, Soares-Marangoni DA. Motor repertoire in 3- to 5- month-old infants with prenatal exposure to syphilis and toxoplasmosis. Early Hum Dev 2023; 183:105822. [PMID: 37454445 DOI: 10.1016/j.earlhumdev.2023.105822] [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: 05/25/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
AIM To characterize the motor repertoire of 3- to 5-month-old infants who were prenatally exposed to the infectious agents of syphilis and toxoplasmosis. METHODS Exploratory observational study that evaluated 15 exposed infants (34.4 ± 3.5 weeks gestation) recruited from a referral center. Age assessment ranged 12-20 (median 12) weeks post-term. General Movement Assessment, including the Motor Optimality Score-Revised (MOS-R), was used to assess the global quality of fidgety movements (FMs) and to quantify and detail coexisting motor patterns. Clinical variables were also collected. Later motor outcomes were obtained from medical reports when possible. RESULTS MOS-R ranged 10-26 (median 24). There was a higher proportion of infants with normal (80.0 %) than aberrant FMs, but the proportion of infants with reduced MOS-R (80.0 %) was higher compared to optimal MOS-R. One infant with aberrant FMs was later diagnosed with cerebral palsy. Only 13.3 % of the infants showed smooth and fluent movement character. All observed tongue movements were abnormal. CONCLUSION Infants had predominantly normal FMs, but with reduced MOS-R and abnormalities in the coexisting motor repertoire.
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Affiliation(s)
- Sarita Santos-Baltuilhe
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil; Specialized Rehabilitation Center, Association of Parents and Friends of Exceptional Children, Campo Grande, MS, Brazil
| | - Geruza Souza Mallmann
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Andressa Lagoa Nascimento França
- Graduate Program in Health and Development, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Paulo Henrique Muleta Andrade
- Specialized Rehabilitation Center, Association of Parents and Friends of Exceptional Children, Campo Grande, MS, Brazil
| | - Everton Falcão Oliveira
- Graduate Program in Infectious and Parasitic Diseases, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Daniele Almeida Soares-Marangoni
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil; Graduate Program in Health and Development, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
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20
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George EA, Nwankwo C, Castelo-Soccio L, Oboite M. Disorders in Children. Dermatol Clin 2023; 41:491-507. [PMID: 37236717 DOI: 10.1016/j.det.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pediatric dermatoses can present at birth or develop over time. When managing dermatology conditions in children, caregiver involvement is important. Patients may have lesions that need to be monitored or need assistance with therapeutic administration. The following section provides a subset of pediatric dermatoses and notable points for presentation in skin of color patients. Providers need to be able to recognize dermatology conditions in patients of varying skin tones and provide therapies that address the condition and any associated pigmentary alterations.
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Affiliation(s)
| | - Christy Nwankwo
- University of Missouri, Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Michelle Oboite
- University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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21
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Palazzotto E, Bonura F, Calà C, Capra G, Pistoia D, Mangione D, Mascarella C, Minì G, Enea M, Giammanco GM, Ferraro D, De Grazia S. Serological status for TORCH in women of childbearing age: a decade-long surveillance (2012-2022) in Italy. J Med Microbiol 2023; 72. [PMID: 37458733 DOI: 10.1099/jmm.0.001733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Introduction. Serological screening and seroprevalence data for TORCH infections represent a key instrument to estimate immunity and vaccination levels and exposure rates to prevent and treat TORCH congenital infections.Hypothesis. Serology allows us to identify women susceptible to primary infection.Aim. Assess the prevalence of women at risk of primary infections by TORCH pathogens in Palermo, Sicily, Italy, in the decade 2012-2022.Methodology. A retrospective study was performed to evaluate the serological status (IgG and/or IgM) of 2359 women of childbearing age (WCBA), ranging from 16 to 46 years, attending the AOUP 'P. Giaccone' University Hospital of Palermo.Results. The results showed an overall prevalence of anti-TORCH IgG of 90.5 % for herpesvirus (HSV), 81.2 % for rubella virus (RV), 72.1 % for cytomegalovirus (CMV), 20.9 % for Toxoplasma gondii (TOX) and 4.8 % for Treponema pallidum (TP). IgM positivity was 16.9 % for HSV2, 10.3 % for TOX, 4 % for CMV and, 2 % for RV. A recent/active infection by TP was confirmed in 28.3 % of the seropositive women. Our results indicate that only a small percentage of WCBA were subjected to a comprehensive TORCH serological screening, while most WCBA were only tested for a single pathogen. In addition, no significant differences were found in terms of the overall TORCH IgG seroprevalence among different age groups (P>0.05).Conclusion. Identifying WCBA at risk of exposure during pregnancy allows us to prevent and reduce possible congenital infections, providing detailed guidelines and instructions. The results of this study showed that in Italy the risk of acquiring a primary infection by a TORCH agent is still high, therefore effective prevention strategies, including serological screening, should be implemented.
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Affiliation(s)
- Emilia Palazzotto
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Floriana Bonura
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Cinzia Calà
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Giuseppina Capra
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Daniela Pistoia
- Unit of Microbiology and Virology, University Hospital 'P. Giaccone', Palermo, Italy
| | - Donatella Mangione
- Gynecology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Chiara Mascarella
- Unit of Microbiology and Virology, University Hospital 'P. Giaccone', Palermo, Italy
| | - Giuseppe Minì
- Unit of Microbiology and Virology, University Hospital 'P. Giaccone', Palermo, Italy
| | - Marco Enea
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Giovanni M Giammanco
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Donatella Ferraro
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
| | - Simona De Grazia
- Microbiology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Palermo, Italy
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22
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Creisher PS, Perry JL, Zhong W, Lei J, Mulka KR, Ryan H, Zhou R, Akin EH, Liu A, Mitzner W, Burd I, Pekosz A, Klein SL. Adverse outcomes in SARS-CoV-2 infected pregnant mice are gestational age-dependent and resolve with antiviral treatment. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.23.533961. [PMID: 36993658 PMCID: PMC10055386 DOI: 10.1101/2023.03.23.533961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
SARS-CoV-2 infection during pregnancy is associated with severe COVID-19 and adverse fetal outcomes, but the underlying mechanisms remain poorly understood. Moreover, clinical studies assessing therapeutics against SARS-CoV-2 in pregnancy are limited. To address these gaps, we developed a mouse model of SARS-CoV-2 infection during pregnancy. Outbred CD1 mice were infected at embryonic day (E) 6, E10, or E16 with a mouse adapted SARS-CoV-2 (maSCV2) virus. Outcomes were gestational age-dependent, with greater morbidity, reduced anti-viral immunity, greater viral titers, and more adverse fetal outcomes occurring with infection at E16 (3rd trimester-equivalent) than with infection at either E6 (1st trimester-equivalent) or E10 (2nd trimester-equivalent). To assess the efficacy of ritonavir-boosted nirmatrelvir (recommended for pregnant individuals with COVID-19), we treated E16-infected dams with mouse equivalent doses of nirmatrelvir and ritonavir. Treatment reduced pulmonary viral titers, decreased maternal morbidity, and prevented adverse offspring outcomes. Our results highlight that severe COVID-19 during pregnancy and adverse fetal outcomes are associated with heightened virus replication in maternal lungs. Ritonavir-boosted nirmatrelvir mitigated adverse maternal and fetal outcomes of SARS-CoV-2 infection. These findings prompt the need for further consideration of pregnancy in preclinical and clinical studies of therapeutics against viral infections.
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23
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Hicks VJ, Sánchez C, López MR, Gottschlich A, Grajeda LM, Balish A, Gómez A, Nuñez N, Juárez J, López B, Freitas-Ning M, Cordón-Rosales C, Sagastume M, McCracken JP, Espinosa-Bode A, Cadena L, Lo TQ. Seroprevalence of high incidence congenital infections among pregnant women in Coatepeque, Guatemala and surrounding areas, 2017-2018. PLoS Negl Trop Dis 2023; 17:e0011248. [PMID: 37093863 PMCID: PMC10159341 DOI: 10.1371/journal.pntd.0011248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/04/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
Maternal infections during pregnancy can potentially cause birth defects and severe adverse effects in infants. From 2017 to 2018, we investigated the seroprevalence of five antibodies among 436 mother-infant pairs enrolled in a pregnancy cohort study in Coatepeque, Guatemala. Upon enrollment (< 20 weeks gestational age) and shortly after delivery, we measured the prevalence of IgG and IgM antibodies against Toxoplasma gondii (T. gondii), rubella, and cytomegalovirus (CMV) in mothers and newborns and used rapid tests to detect HIV and syphilis (Treponema pallidum) in mothers. The mean cohort age was 24.5 years. Maternal T. gondii IgM and IgG seropositivity was 1.9% and 69.7%, respectively. No women were positive for HIV, syphilis, or rubella IgM. Maternal rubella IgG seropositivity was 80.8% and significantly increased with age. Maternal CMV IgM and IgG seropositivity were 2.3% and 99.5%, respectively. Of the 323 women tested at both timepoints, IgM reactivation occurred in one woman for T. gondii infection and in eight for CMV. No newborn was seropositive for CMV IgM or rubella IgM. One newborn was seropositive for T. gondii IgM. Congenital T. gondii and CMV infections are important public health issues for pregnant women, newborns, and healthcare providers in Coatepeque and Guatemala.
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Affiliation(s)
- Victoria J Hicks
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Central America Region Office, Guatemala City, Guatemala
| | - César Sánchez
- Departamento de Epidemiología, Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala
| | - María Reneé López
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Anna Gottschlich
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Central America Region Office, Guatemala City, Guatemala
| | - Laura M Grajeda
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States of America
| | - Amanda Balish
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ana Gómez
- Departamento de Epidemiología, Área de Salud de Quetzaltenango; Ministerio de Salud Pública y Asistencia Social, Quetzaltenango, Guatemala
| | - Nevis Nuñez
- Hospital Regional "Dr. Juan José Ortega" de Coatepeque, Ministerio de Salud Pública y Asistencia Social, Coatepeque, Guatemala
| | - Julio Juárez
- Unidad de Atención Integral del VIH e Infecciones Crónicas "Dr. Carlos Rodolfo Mejia" del Hospital Roosevelt, Guatemala City, Guatemala
| | - Beatriz López
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Central America Region Office, Guatemala City, Guatemala
| | - Mariangeli Freitas-Ning
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Central America Region Office, Guatemala City, Guatemala
| | - Celia Cordón-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Manuel Sagastume
- Departamento de Epidemiología, Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala
| | - John P McCracken
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Andrés Espinosa-Bode
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Central America Region Office, Guatemala City, Guatemala
| | - Loren Cadena
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Central America Region Office, Guatemala City, Guatemala
| | - Terrence Q Lo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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24
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Li R, Han L, Xiong W, Wang W, Fan C, Li M, Liu X, Ling L. The impact of migration-related characteristics on the risk of TORCH infections among women of childbearing age: a population-based study in southern China. BMC Public Health 2023; 23:351. [PMID: 36797787 PMCID: PMC9933307 DOI: 10.1186/s12889-023-15238-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND TORCH infections are the most common prenatal infections causing congenital malformation and infant mortality, especially in developing countries. Migrant women might be vulnerable to TORCH infections, but little is known about the association between migration-related characteristics and TORCH infection risk. This study aimed to investigate the impact of migrant status, migration distance, and the spouse's migrant status on the TORCH epidemic among women of childbearing age. METHODS Based on the National Free Preconception Health Examination Project, we analyzed a representative dataset of TORCH infections among women of childbearing age (15-49 years old) in Guangdong Province of China (2014-2019, n = 2,451,297). The past and/or recent infection status of TORCH infections (Toxoplasma gondii [TOX], Cytomegalovirus [CMV], and Rubella virus [RV]) were identified. Demographic and migration-related characteristics were collected. We thoroughly assessed the prevalence of TORCH infections in both migrant and native women and estimated adjusted odd ratios (aOR) for migration-related characteristics using multivariable logistic regression after adjusting the other sociodemographic factors. RESULTS Among all 2,451,297 participants, 443,725 (18.1%) were migrant women. Migrant women presented a lower risk of past TOX infection (aOR: 0.89, 0.88-0.91) suggesting a healthy migrant effect (HME), but a higher risk of recent TOX infection (aOR: 1.88, 1.77-1.99), past CMV infection (aOR: 1.26, 1.25-1.28) and RV infection in natural ways (aOR: 1.05, 1.04-1.06). Compared with intra-provincial migrants, inter-provincial migrants had a lower past TOX infection (aOR: 0.88, 0.85-0.91), but a higher risk of recent TOX infection (aOR: 1.16, 1.05-1.27) and RV infection (aOR: 1.33, 1.31-1.36). In addition, having a migrant spouse was associated with a higher risk for all types of infection. CONCLUSION This study reported the association of migrant status and migration distance with TORCH infections, although the significance and directionality of these associations varied between pathogens. The spouse's migrant status further amplified the infection risk for all types of pathogens. Our findings suggested interventions for preventing the spread of CMV and RV infection and new acquisition of TOX infection for migrants in southern China, to narrow the native-migrant health inequity and decrease the incidence of prenatal infections and related adverse outcomes.
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Affiliation(s)
- Rui Li
- grid.12981.330000 0001 2360 039XFaculty of Medical Statistic, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, Guangdong China
| | - Lu Han
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600 Guangzhou, China
| | - Wenxue Xiong
- grid.12981.330000 0001 2360 039XFaculty of Medical Statistic, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, Guangdong China
| | - Wenjuan Wang
- grid.12981.330000 0001 2360 039XFaculty of Medical Statistic, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, Guangdong China
| | - Chaonan Fan
- grid.12981.330000 0001 2360 039XFaculty of Medical Statistic, School of Public Health, Sun Yat-sen University, 510080 Guangzhou, Guangdong China
| | - Mingzhen Li
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600 Guangzhou, China
| | - Xiaohua Liu
- NHC Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), 510600, Guangzhou, China.
| | - Li Ling
- Faculty of Medical Statistic, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, Guangdong, China. .,Clinical research design division, Clinical research center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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25
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Besen E, Paiva KM, Cigana LB, Machado MJ, Samelli AG, Haas P. Prevalence of Congenital Infections in Newborns and Universal Neonatal Hearing Screening in Santa Catarina, Brazil. Audiol Res 2023; 13:107-115. [PMID: 36825949 PMCID: PMC9952221 DOI: 10.3390/audiolres13010011] [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: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE to verify the frequency of congenital infections in newborns and their possible associations with the universal-neonatal-hearing-screening (UNHS) results, and evaluate a reference UNHS service in the Unified Health System (Sistema Único de Saúde-SUS), according to quality indicators. METHODS Historical cohort study with data analysis of newborns attending prestigious hearing-health SUS services from January 2017 to December 2021, in Santa Catarina, Brazil. The quality of screening coverage was assessed based on the quality indicators proposed by the Brazilian neonatal-hearing-screening-care guidelines (Diretrizes de Atenção da Triagem Auditiva Neonatal-DATAN). Logistic-regression analysis, crude OR calculations, Cochran-Mantel-Haenszel OR calculation, and chi-square test were performed to estimate the association between risk indicators for hearing loss and UNHS failure. RESULTS In the last five years, the prestigious services performed UNHS on 34,801 newborns and met the DATAN quality indicators. Congenital syphilis was the most frequent (1.59%) congenital infection in newborns, followed by HIV (0.87%), whereas the least frequent was rubella (0.029%). CONCLUSION Prestigious UNHS services reached ≥95% hearing screening coverage. Considering all congenital infections, the prevalence was 2.87%, with congenital syphilis the most frequent. Newborns with congenital syphilis or HIV are more likely to fail UNHS.
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Affiliation(s)
- Eduarda Besen
- Department of Speech Therapy, Federal University of Santa Catarina, Florianópolis 88040-970, Brazil
| | - Karina Mary Paiva
- Department of Speech Therapy, Federal University of Santa Catarina, Florianópolis 88040-970, Brazil
| | | | - Marcos José Machado
- Clinical Analysis Department, Federal University of Santa Catarina, Florianópolis 88040-970, Brazil
| | | | - Patrícia Haas
- Department of Speech Therapy, Federal University of Santa Catarina, Florianópolis 88040-970, Brazil
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26
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TORCH Congenital Syndrome Infections in Central America's Northern Triangle. Microorganisms 2023; 11:microorganisms11020257. [PMID: 36838223 PMCID: PMC9964893 DOI: 10.3390/microorganisms11020257] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
TORCH pathogens are a group of globally prevalent infectious agents that may cross the placental barrier, causing severe negative sequalae in neonates, including fetal death and lifelong morbidity. TORCH infections are classically defined by Toxoplasma gondii, other infectious causes of concern (e.g., syphilis, Zika virus, malaria, human immunodeficiency virus), rubella virus, cytomegalovirus, and herpes simplex viruses. Neonatal disorders and congenital birth defects are the leading causes of neonatal mortality in Central America's Northern Triangle, yet little is known about TORCH congenital syndrome in this region. This review synthesizes the little that is known regarding the most salient TORCH infections among pregnant women and neonates in Central America's Northern Triangle and highlights gaps in the literature that warrant further research. Due to the limited publicly available information, this review includes both peer-reviewed published literature and university professional degree theses. Further large-scale studies should be conducted to clarify the public health impact these infections in this world region.
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27
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Dos Santos PV, de Toledo DNM, de Souza DMS, Menezes TP, Perucci LO, Silva ZM, Teixeira DC, Vieira EWR, de Andrade-Neto VF, Guimarães NS, Talvani A. The imbalance in the relationship between inflammatory and regulatory cytokines during gestational toxoplasmosis can be harmful to fetuses: A systematic review. Front Immunol 2023; 14:1074760. [PMID: 36742306 PMCID: PMC9889920 DOI: 10.3389/fimmu.2023.1074760] [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: 10/19/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
Objective To evaluate the available information on inflammatory and regulatory plasma mediators in pregnant women (PW) diagnosed with toxoplasmosis. Source: The PubMed, Embase, Scopus, and Lilacs databases were evaluated until October 2022. Study eligibility criteria: This review was carried out following the PRISMA and registered on the PROSPERO platform (CRD42020203951). Studies that reported inflammatory mediators in PW with toxoplasmosis were considered. Evaluation methods After excluding duplicate articles, two authors independently carried out the process of title and abstract exclusion, and a third resolved disagreements when necessary. The full text was evaluated to detect related articles. The extraction table was built from the following data: Author, year of publication, journal name and impact factors, country, study design, number of gestations and maternal age (years), gestational period, diagnosis of toxoplasmosis, levels of inflammatory markers, laboratory tests, and clinical significance. Methodological quality was assessed using Joanna Briggs Institute tools. Results Of the 1,024 studies reported, only eight were included. Of the 868 PW included in this review, 20.2% were IgM+/IgG- and 50.8% were IgM-/IgG+ to T. gondii, and 29.0% uninfected. Infected PW presented higher plasma levels ofIL-5, IL-6, IL-8, IL-17, CCL5, and IL-10. Regarding the methodological quality, four studies obtained high quality. Data from this review pointed out the maintenance of the inflammatory pattern during pregnancy with a closely related to the parasite. Conclusion Immune status in PW defined the course of the T. gondii infection, where the equilibrium between inflammatory and regulatory cytokines mitigated the harmful placenta and fetus effects. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD420203951.
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Affiliation(s)
- Priscilla Vilela Dos Santos
- Laboratory of the Immunobiology of Inflammation, Department of Biological Sciences/Institute of Exact and Biological Sciences (ICEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Graduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Débora Nonato Miranda de Toledo
- Laboratory of the Immunobiology of Inflammation, Department of Biological Sciences/Institute of Exact and Biological Sciences (ICEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Graduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Débora Maria Soares de Souza
- Laboratory of the Immunobiology of Inflammation, Department of Biological Sciences/Institute of Exact and Biological Sciences (ICEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Graduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Tatiana Prata Menezes
- Laboratory of the Immunobiology of Inflammation, Department of Biological Sciences/Institute of Exact and Biological Sciences (ICEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Graduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Luiza Oliveira Perucci
- Laboratory of the Immunobiology of Inflammation, Department of Biological Sciences/Institute of Exact and Biological Sciences (ICEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Zolder Marinho Silva
- Laboratory of the Immunobiology of Inflammation, Department of Biological Sciences/Institute of Exact and Biological Sciences (ICEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Graduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | | | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Valter Ferreira de Andrade-Neto
- Laboratory of Malaria and Toxoplasmosis Biology, Department of Microbiology and Parasitology, Federal University of the Rio Grande do Norte, Natal, RN, Brazil
| | - Nathalia Sernizon Guimarães
- Graduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - André Talvani
- Laboratory of the Immunobiology of Inflammation, Department of Biological Sciences/Institute of Exact and Biological Sciences (ICEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Graduate Program in Health and Nutrition, School of Nutrition, Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Graduate Program of Health Science, Infectiology and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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28
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Aoki H, Bitnun A, Kitano T. The cost-effectiveness of maternal and neonatal screening for congenital cytomegalovirus infection in Japan. J Med Virol 2023; 95:e28391. [PMID: 36484373 DOI: 10.1002/jmv.28391] [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: 08/08/2022] [Revised: 11/08/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Congenital cytomegalovirus infection is the most common congenital infection. Using a decision tree model, cost-effectiveness of maternal screening with subsequent prenatal valacyclovir treatment and newborn screening with neonatal valganciclovir treatment was evaluated. The incremental cost-effectiveness ratio (ICER) was calculated for (1) universal maternal antibody screening with prenatal valacyclovir treatment compared to targeted newborn screening, and (2) universal newborn screening with postnatal valganciclovir treatment compared to targeted newborn screening. We performed a one-way sensitivity analysis. Compared to targeted newborn screening, the ICERs for universal newborn screening and maternal screening were 2 966 296 Japanese Yen (JPY) (21 188 USD) and 1 026 984 JPY (7336 USD), respectively. In all scenarios in the one-way sensitivity analysis, the ICERs of the maternal screening and the universal newborn screening strategies were less than three gross domestic product per capita compared with the targeted newborn screening strategy. Both maternal and universal newborn screening strategies may be cost-effective than a targeted newborn screening program. The potential utility of the maternal screening with valacyclovir treatment strategy, while potentially cost effective in regions with lower baseline seroprevalence rates, requires further study as the modeling was based on limited evidence.
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Affiliation(s)
- Hirosato Aoki
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.,Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Ari Bitnun
- Department of Paediatrics, Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Taito Kitano
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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29
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Daniels BP, Oberst A. Outcomes of RIP Kinase Signaling During Neuroinvasive Viral Infection. Curr Top Microbiol Immunol 2023; 442:155-174. [PMID: 32253569 PMCID: PMC7781604 DOI: 10.1007/82_2020_204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neuroinvasive viral diseases are a considerable and growing burden on global public health. Despite this, these infections remain poorly understood, and the molecular mechanisms that govern protective versus pathological neuroinflammatory responses to infection are a matter of intense investigation. Recent evidence suggests that necroptosis, an immunogenic form of programmed cell death, may contribute to the pathogenesis of viral encephalitis. However, the receptor-interacting protein (RIP) kinases that coordinate necroptosis, RIPK1 and RIPK3, also appear to have unexpected, cell death-independent functions in the central nervous system (CNS) that promote beneficial neuroinflammation during neuroinvasive infection. Here, we review the emerging evidence in this field, with additional discussion of recent work examining roles for RIPK signaling and necroptosis during noninfectious pathologies of the CNS, as these studies provide important additional insight into the potential for specialized neuroimmune functions for the RIP kinases.
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Affiliation(s)
- Brian P Daniels
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, 08854, USA
| | - Andrew Oberst
- Department of Immunology, University of Washington, Seattle, WA, 98109, USA.
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30
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Clabout T, Maes L, Acke F, Wuyts W, Van Schil K, Coucke P, Janssens S, De Leenheer E. Negative Molecular Diagnostics in Non-Syndromic Hearing Loss: What Next? Genes (Basel) 2022; 14:genes14010105. [PMID: 36672845 PMCID: PMC9859074 DOI: 10.3390/genes14010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Congenital hearing loss has an impact on almost every facet of life. In more than 50% of cases, a genetic cause can be identified. Currently, extensive genetic testing is available, although the etiology of some patients with obvious familial hearing loss remains unknown. We selected a cohort of mutation-negative patients to optimize the diagnostic yield for genetic hearing impairment. In this retrospective study, 21 patients (17 families) with negative molecular diagnostics for non-syndromic hearing loss (gene panel analysis) were included based on a positive family history with a similar type of hearing loss. Additional genetic testing was performed using a whole exome sequencing panel (WESHL panel v2.0) in four families with the strongest likelihood of genetic hearing impairment. In this cohort (n = 21), the severity of hearing loss was most commonly moderate (52%). Additional genetic testing revealed pathogenic copy number variants in the STRC gene in two families. In summary, regular re-evaluation of hearing loss patients with presumably genetic etiology after negative molecular diagnostics is recommended, as we might miss newly discovered deafness genes. The switch from gene panel analysis to whole exome sequencing or whole genome sequencing for the testing of congenital hearing loss seems promising.
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Affiliation(s)
- Thomas Clabout
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Laurence Maes
- Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Frederic Acke
- Department of Otorhinolaryngology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Wim Wuyts
- Center of Medical Genetics, Antwerp University Hospital and University of Antwerp, Prins Boudewijnlaan 43, B-2650 Edegem, Belgium
| | - Kristof Van Schil
- Center of Medical Genetics, Antwerp University Hospital and University of Antwerp, Prins Boudewijnlaan 43, B-2650 Edegem, Belgium
| | - Paul Coucke
- Center for Medical Genetics, Ghent University, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Sandra Janssens
- Center for Medical Genetics, Ghent University, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Els De Leenheer
- Department of Otorhinolaryngology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
- Correspondence: ; Tel.: +32-93322332
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31
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An automated microfluidic system with one-dimensional beads array for multiplexed torch detection at point-of-care testing. Biomed Microdevices 2022; 24:38. [DOI: 10.1007/s10544-022-00629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/05/2022]
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32
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Venancio FA, Quilião ME, de Almeida Moura D, de Azevedo MV, de Almeida Metzker S, Mareto LK, de Medeiros MJ, Santos-Pinto CDB, de Oliveira EF. Congenital anomalies during the 2015–2018 Zika virus epidemic: a population-based cross-sectional study. BMC Public Health 2022; 22:2069. [DOI: 10.1186/s12889-022-14490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them.
Methods
This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories.
Results
In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61–11.84) and Indigenous (OR 1.32, 95% CI 1.03–1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39–3.13).
Conclusions
We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.
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The epidemiology and disease burden of congenital TORCH infections among hospitalized children in China: A national cross-sectional study. PLoS Negl Trop Dis 2022; 16:e0010861. [PMID: 36240247 PMCID: PMC9604879 DOI: 10.1371/journal.pntd.0010861] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/26/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Congenital TORCH (Toxoplasma gondii (T. gondii), rubella virus (RV), cytomegalovirus (CMV), and herpes simplex virus (HSV)) infections are associated with a variety of adverse prenatal and neonatal events, including miscarriage, malformations and developmental abnormalities, and they remain an issue that cannot be neglected in China. However, the current research focuses more on the general screening of TORCH in women of childbearing age, and the medical information of children hospitalized due to congenital and perinatal TORCH infections has not been described in detail. This study summarized and analyzed the epidemiological characteristics, clinical manifestations, length of stay (LOS), and the disease burden of hospitalized children diagnosed with congenital TORCH infections in 27 children's hospitals in China. METHODOLOGY Based on the face sheet of discharge medical records (FSMRs) of hospitalized children in 27 tertiary children's hospitals collected in the Futang Research Center of Pediatric Development and aggregated into FUTang Update medical REcords (FUTURE), we summarized and analyzed the epidemiological characteristics, clinical manifestations, LOS, the disease burden (in US dollars, USD) and potential risk factors for hospitalized children diagnosed with congenital toxoplasmosis, congenital rubella syndrome, congenital cytomegalovirus infection, and congenital HSV in 27 children's hospitals in China from 2015 to 2020. RESULTS One hundred seventy-three patients aged 0-<1 year were hospitalized for congenital TORCH infections. Among infections with TORCH, hospitalization with congenital toxoplasmosis was the least common, with only five cases were reported (2.89%), while the LOS was the highest. The proportion of patients with congenital rubella syndrome (CRS) was 15.61%, and 86% of children hospitalized with CRS had cardiovascular malformations, and the economic burden was the highest. Congenital CMV infection cases accounted for the largest proportion (76.30%). Overall, 5.20% of patients were infected with HSV, and the expense of hospitalization for congenital HSV infection was relatively low. CONCLUSION In the present study, the hospitalization proportion due to congenital TORCH infection was extremely low (17.56 per 100,000 neonates), indicating that China's congenital TORCH infection prevention and control policies remain effective. The lowest proportion of patients was hospitalized with congenital toxoplasmosis, while the LOS was the longest. The economic burden of CRS was heavy, and infants are recommended be vaccinated against RV in a timely manner. Congenital CMV infections accounted for the largest proportion of patients, suggesting that the disease burden of congenital CMV infection cannot be ignored, and the prevention of congenital CMV infection during pregnancy is still an important issue that needs to pay attention. The expense of hospitalization for congenital HSV infection was relatively low, while the disease burden increases significantly when patients develop complications. These data illustrate the importance of improving screening for congenital TORCH infections in the early diagnosis and treatment of neonatal patients.
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Lino JF, Diniz LMO, Rezende LG, Costa VFT, Romanelli RMC. Diagnosis of congenital infections in premature, low-birthweight newborns with intrauterine growth restriction caused by cytomegalovirus (CMV), herpes simplex virus (HSV), Parvo-B 19, and Zika virus: a systematic review. J Perinat Med 2022; 50:993-1000. [PMID: 35427445 DOI: 10.1515/jpm-2021-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify the prevalence of viral congenital infections in newborns classified as premature, low-birthweight, small for gestational age or intrauterine growth restriction. METHODS The definition considered for selecting papers were: P as newborns younger than 28 days; V as low-birthweight, prematurity and intrauterine growth restriction; O as frequency of congenital infections with Cytomegalovirus, Parvovirus B19, Herpes Simplex, and Zika virus. The research was performed using EMBASE, LILACS, SCOPUS and MEDLINE databases, with no limitations on date and language. RESULTS Eight studies were included. Manuscripts including Herpes Simplex, Zika virus or Parvovirus B19 did not fulfill the defined criteria. A wide variation in the frequency of CMV congenital infection (0-4.8%) was found, which might be attributed to regional and methodological differences between investigations. CONCLUSIONS Newborn characteristics associated with CMV congenital infections may direct investigations towards these patients with a higher probability of infection. However, as data are controversial, studies concerning screening of infection are important to define recommendations of diagnosis.
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Affiliation(s)
- Janaina F Lino
- Pediatrics Department of Federal University of Minas Gerais School Medicine, Belo Horizonte, Brazil
| | - Lilian M O Diniz
- Pediatrics Department of Federal University of Minas Gerais School Medicine, Belo Horizonte, Brazil
| | - Larissa G Rezende
- Federal University of Minas Gerais School Medicine, Belo Horizonte, Brazil
| | - Victoria F T Costa
- Federal University of Minas Gerais School Medicine, Belo Horizonte, Brazil
| | - Roberta M C Romanelli
- Pediatrics Department of Federal University of Minas Gerais School Medicine, Belo Horizonte, Brazil
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Islek A, Tumgor G. Biliary atresia and congenital disorders of the extrahepatic bile ducts. World J Gastrointest Pharmacol Ther 2022; 13:33-46. [PMID: 36051179 PMCID: PMC9297290 DOI: 10.4292/wjgpt.v13.i4.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/10/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Biliary atresia (BA) and choledochal cysts are diseases of the intrahepatic and extrahepatic biliary tree. While their exact etiopathogeneses are not known, they should be treated promptly due to the potential for irreversible parenchymal liver disease. A diagnosis of BA may be easy or complicated, but should not be delayed. BA is always treated surgically, and performing the surgery before the age of 2 mo greatly increases its effectiveness and extends the time until the need for liver transplantation arises. While the more common types of choledochal cysts require surgical treatment, some can be treated with endoscopic retrograde cholangiopancreatography. Choledochal cysts may cause recurrent cholangitis and the potential for malignancy should not be ignored.
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Affiliation(s)
- Ali Islek
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
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Prevalence of congenital cytomegalovirus infection in preterm, small for gestational age and low birth weight newborns: characteristics and cytokines profile. World J Pediatr 2022; 18:498-504. [PMID: 35503595 DOI: 10.1007/s12519-022-00551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
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Bianchin MM, Snow Z. Primary microglia dysfunction or microgliopathy: A cause of dementias and other neurological or psychiatric disorders. Neuroscience 2022; 497:324-339. [PMID: 35760218 DOI: 10.1016/j.neuroscience.2022.06.032] [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: 02/09/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
Microglia are unique cells in the central nervous system (CNS), being considered a sub-type of CNS macrophage. These cells monitor nearby micro-regions, having roles that far exceed immunological and scavengering functions, being fundamental for developing, protecting and maintaining the integrity of grey and white matter. Microglia might become dysfunctional, causing abnormal CNS functioning early or late in the life of patients, leading to neurologic or psychiatric disorders and premature death in some patients. Observations that the impairment of normal microglia function per se could lead to neurological or psychiatric diseases have been mainly obtained from genetic and molecular studies of Nasu-Hakola disease, caused by TYROBP or TREM2 mutations, and from studies of adult-onset leukoencephalopathy with axonal spheroids (ALSP), caused by CSF1R mutations. These classical microgliopathies are being named here Microgliopathy Type I. Recently, mutations in TREM2 have also been associated with Alzheimer Disease. However, in Alzheimer Disease TREM2 allele variants lead to an impaired, but functional TREM2 protein, so that patients do not develop Nasu-Hakola disease but are at increased risk to develop other neurodegenerative diseases. Alzheimer Disease is the prototype of the neurodegenerative disorders associated with these TREM2 variants, named here the Microgliopathies Type II. Here, we review clinical, pathological and some molecular aspects of human diseases associated with primary microglia dysfunctions and briefly comment some possible therapeutic approaches to theses microgliopathies. We hope that our review might update the interesting discussion about the impact of intrinsic microglia dysfunctions in the genesis of some pathologic processes of the CNS.
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Affiliation(s)
- Marino Muxfeldt Bianchin
- Basic Research and Advanced Investigations in Neurosciences (BRAIN), Universidade Federal do Rio Grande do Sul, Brazil; Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil.
| | - Zhezu Snow
- Basic Research and Advanced Investigations in Neurosciences (BRAIN), Universidade Federal do Rio Grande do Sul, Brazil
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Shikanai Yasuda MA. Emerging and reemerging forms of Trypanosoma cruzi transmission. Mem Inst Oswaldo Cruz 2022; 117:e210033. [PMID: 35584508 PMCID: PMC9113729 DOI: 10.1590/0074-02760210033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/13/2023] Open
Abstract
This review aims to update and discuss the main challenges in controlling emergent and reemergent forms of Trypanosoma cruzi transmission through organ transplantation, blood products and vertical transmission in endemic and non-endemic areas as well as emergent forms of transmission in endemic countries through contaminated food, currently representing the major cause of acute illness in several countries. As a neglected tropical disease potentially controllable with a major impact on morbimortality and socioeconomic aspects, Chagas disease (CD) was approved at the WHO global plan to interrupt four transmission routes by 2030 (vector/blood transfusion/organ transplant/congenital). Implementation of universal or target screening for CD are highly recommended in blood banks of non-endemic regions; in organ transplants donors in endemic/non-endemic areas as well as in women at risk from endemic areas (reproductive age women/pregnant women-respective babies). Moreover, main challenges for surveillance are the application of molecular methods for identification of infected babies, donor transmitted infection and of live parasites in the food. In addition, the systematic recording of acute/non-acute cases and transmission sources is crucial to establish databases for control and surveillance purposes. Remarkably, antiparasitic treatment of infected reproductive age women and infected babies is essential for the elimination of congenital CD by 2030.
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Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Ptarasitárias, São Paulo, SP, Brasil,Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina, Laboratório de Imunologia, São Paulo, SP, Brasil,WHO Technical Group IVb on Prevention and Control of Transmission and Case Management of Trypanosoma cruzi Infections, WHO, Geneva, Switzerland,+ Corresponding author:
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Wang H, Yang L, Wang J. Etiology of neonatal cholestasis after emerging molecular diagnostics. Transl Pediatr 2022; 11:359-367. [PMID: 35378957 PMCID: PMC8976681 DOI: 10.21037/tp-21-503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the pediatric group, most cholestatic patients had disease onset at 0-3 months of age, and more and more are found to have specific genetic defects after failing to obtain a definite diagnosis by routine evaluation. To investigate the etiological diagnosis for the newborns with cholestasis during the neonatal period after emerging molecular tests comprehensively. METHODS We conducted a retrospective study to evaluate clinical characteristics, etiologies and outcomes in infants with neonatal cholestasis after emerging molecular diagnostics from January 1st to December 31st, 2019 in Children's Hospital of Fudan University. RESULTS There were 160 cases of neonatal cholestasis with mean gestational age (GA) 32.6±4.8 weeks and birth weight (BW) 1,880±991 g, composing 3.4% of total neonatal admissions in 2019. Overall 97.5% (n=156) patients had a definite diagnosis, including 9 obtaining a genetic diagnosis after adding molecular test in routine evaluation, which made the diagnosis rate for cholestasis increased by 5.6%. The most common etiology of cholestasis in the neonatal period was parenteral nutrition-associated cholestasis (PNAC) 48.8% (n=78), followed by cardiovascular and circulatory disorders 18.1%, biliary anatomic obstruction 12.5%, infection 8.7% and genetic disorders 5.6%. PNAC and biliary anatomic obstruction were the most common etiology of cholestasis for preterm and term infants respectively. The mortality rate is 2.5% (n=4) and 91.9% (n=147) patients totally recovery or improve in follow-up. CONCLUSIONS The causes of cholestasis in neonates are complicated, molecular diagnostics can improve the etiological diagnosis for newborns with cholestasis. But still, quite amount of causes are remediable and transient during the neonatal period, gene test may help to rule out genetic causes and enhance confidence in judging prognosis.
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Affiliation(s)
- Huanhuan Wang
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lin Yang
- Department of Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jin Wang
- Division of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Ihunwo AO, Perego J, Martino G, Vicenzi E, Panina-Bordignon P. Neurogenesis and Viral Infection. Front Immunol 2022; 13:826091. [PMID: 35251006 PMCID: PMC8891128 DOI: 10.3389/fimmu.2022.826091] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/20/2022] [Indexed: 12/26/2022] Open
Abstract
Neural stem cells (NSCs) are multipotent stem cells that reside in the fetal and adult mammalian brain, which can self-renew and differentiate into neurons and supporting cells. Intrinsic and extrinsic cues, from cells in the local niche and from distant sites, stringently orchestrates the self-renewal and differentiation competence of NSCs. Ample evidence supports the important role of NSCs in neuroplasticity, aging, disease, and repair of the nervous system. Indeed, activation of NSCs or their transplantation into injured areas of the central nervous system can lead to regeneration in animal models. Viral invasion of NSCs can negatively affect neurogenesis and synaptogenesis, with consequent cell death, impairment of cell cycle progression, early differentiation, which cause neural progenitors depletion in the cortical layer of the brain. Herein, we will review the current understanding of Zika virus (ZIKV) infection of the fetal brain and the NSCs, which are the preferential population targeted by ZIKV. Furthermore, the potential neurotropic properties of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may cause direct neurological damage, will be discussed.
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Affiliation(s)
- Amadi Ogonda Ihunwo
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jessica Perego
- Neuroimmunology Unit, Division of Neuroscience, San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianvito Martino
- Neuroimmunology Unit, Division of Neuroscience, San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Elisa Vicenzi
- Viral Pathogenesis and Biosafety Unit, Division of Immunology, Transplantation and Infectious Disesases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paola Panina-Bordignon
- Neuroimmunology Unit, Division of Neuroscience, San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
- *Correspondence: Paola Panina-Bordignon,
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Fakonti G, Pantazi P, Bokun V, Holder B. Placental Macrophage (Hofbauer Cell) Responses to Infection During Pregnancy: A Systematic Scoping Review. Front Immunol 2022; 12:756035. [PMID: 35250964 PMCID: PMC8895398 DOI: 10.3389/fimmu.2021.756035] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Congenital infection of the fetus via trans-placental passage of pathogens can result in severe morbidity and mortality. Even without transmission to the fetus, infection of the placenta itself is associated with pregnancy complications including pregnancy loss and preterm birth. Placental macrophages, also termed Hofbauer cells (HBCs), are fetal-origin macrophages residing in the placenta that are likely involved in responding to placental infection and protection of the developing fetus. As HBCs are the only immune cell present in the villous placenta, they represent one of the final opportunities for control of infection and prevention of passage to the developing fetus. OBJECTIVE AND RATIONALE The objective of this review was to provide a systematic overview of the literature regarding HBC responses during infection in pregnancy, including responses to viral, bacterial, and parasitic pathogens. METHODS PubMed and Scopus were searched on May 20th, 2021, with no limit on publication date, to identify all papers that have studied placental macrophages/Hofbauer cells in the context of infection. The following search strategy was utilized: (hofbauer* OR "hofbauer cells" OR "hofbauer cell" OR "placental macrophage" OR "placental macrophages") AND [infect* OR virus OR viral OR bacteri* OR parasite* OR pathogen* OR LPS OR "poly(i:c)" OR toxoplasm* OR microb* OR HIV)]. OUTCOMES 86 studies were identified for review. This included those that investigated HBCs in placentas from pregnancies complicated by maternal infection and in vitro studies investigating HBC responses to pathogens or Pathogen-Associated Molecular Patterns (PAMPs). HBCs can be infected by a variety of pathogens, and HBC hyperplasia was a common observation. HBCs respond to pathogen infection and PAMPs by altering their transcriptional, translational and secretion profiles. Co-culture investigations demonstrate that they can replicate and transmit pathogens to other cells. In other cases, they may eliminate the pathogen through a variety of mechanisms including phagocytosis, cytokine-mediated pathogen elimination, release of macrophage extracellular traps and HBC-antibody-mediated neutralization. HBC responses differ across gestation and may be influenced by pre-existing immunity. Clinical information, including gestational age at infection, gestational age of the samples, mode of sample collection and pregnancy outcome were missing for the majority of studies.
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Affiliation(s)
| | | | | | - Beth Holder
- Institute of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
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Schwartz DA, Avvad-Portari E, Babál P, Baldewijns M, Blomberg M, Bouachba A, Camacho J, Collardeau-Frachon S, Colson A, Dehaene I, Ferreres JC, Fitzgerald B, Garrido-Pontnou M, Gerges H, Hargitai B, Helguera-Repetto AC, Holmström S, Irles CL, Leijonhfvud Å, Libbrecht S, Marton T, McEntagart N, Molina JT, Morotti R, Nadal A, Navarro A, Nelander M, Oviedo A, Oyamada Otani AR, Papadogiannakis N, Petersen AC, Roberts DJ, Saad AG, Sand A, Schoenmakers S, Sehn JK, Simpson PR, Thomas K, Valdespino-Vázquez MY, van der Meeren LE, Van Dorpe J, Verdijk RM, Watkins JC, Zaigham M. Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries. Arch Pathol Lab Med 2022; 146:660-676. [PMID: 35142798 DOI: 10.5858/arpa.2022-0029-sa] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Perinatal death is an increasingly important problem as the COVID-19 pandemic continues, but the mechanism of death has been unclear. OBJECTIVE.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for SARS-CoV-2. DESIGN.— Case-based retrospective clinico-pathological analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. RESULTS.— All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25/68) and chronic villitis (32%; 22/68). The majority (19, 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. CONCLUSIONS.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.
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Affiliation(s)
| | - Elyzabeth Avvad-Portari
- Department of Pathology, Fernandes Figueira Institute, FIOCRUZ - Rio de Janeiro, Brazil (Avvad-Portari)
| | - Pavel Babál
- Department of Pathology, Faculty of Medicine, Comenius University, Bratislava, Slovakia (Babál)
| | - Marcella Baldewijns
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns)
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden (Blomberg)
| | - Amine Bouachba
- Institut de Pathologie Multisite des Hospices Civils de Lyon, Lyon, France; SOFFOET-Société Française de Foetopathologie, Paris, France (Bouachba)
| | - Jessica Camacho
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Camacho)
| | - Sophie Collardeau-Frachon
- Department of Pathology, Hopital Femme-Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 and SOFFOET-Société Française de Foetopathologie, Paris France (Collardeau-Frachon)
| | - Arthur Colson
- Department of Obstetrics, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium (Colson)
| | - Isabelle Dehaene
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium (Dehaene)
| | - Joan Carles Ferreres
- Pathology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Barcelona, Spain (Ferreres)
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Republic of Ireland (Fitzgerald)
| | - Marta Garrido-Pontnou
- Pathology Department, Hospital Universitari Vall d'Hebron, Department of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain (Garrido-Pontnou)
| | - Hazem Gerges
- Department of Obstetrics and Gynaecology, Doncaster and Bassetlaw NHS Teaching Hospitals, Women's Hospital, Doncaster, United Kingdom (Gerges)
| | - Beata Hargitai
- Division of Perinatal Pathology, Department of Cellular Pathology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom (Hargitai)
| | - A Cecilia Helguera-Repetto
- Immunobiochemistry Department, National Institute of Perinatology, Mexico City, Mexico (Helguera-Repetto)
| | - Sandra Holmström
- Department of Obstetrics and Gynaecology, Halland Hospital, Varberg, Sweden (Holmström)
| | - Claudine Liliane Irles
- Department of Physiology and Cellular Development, National Institute of Perinatology "Isidro Espinosa de los Reyes", Mexico City, Mexico (Irles)
| | - Åsa Leijonhfvud
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Department of Clinical Science Helsingborg, Lund University, Lund, Sweden (Leijonhfvud)
| | - Sasha Libbrecht
- Department of Pathological Anatomy, Antwerp University Hospital, Edegem, Belgium (Libbrecht)
| | - Tamás Marton
- Cellular Pathology Department, Birmingham Women's Hospital, Birmingham, United Kingdom (Marton)
| | - Noel McEntagart
- Histopathology, Rotunda Hospital, Dublin, Republic of Ireland (McEntagart)
| | - James T Molina
- Pathology and Laboratory Medicine, CHRISTUS Hospital St. Elizabeth, 2830 Calder St, Beaumont, Texas (Molina)
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, Connecticut (Morotti)
| | - Alfons Nadal
- Pathology Department, Hospital Clínic, Barcelona, Spain (Nadal).,Department of Basic Clinical Practice, School of Medicine, Universitat de Barcelona, and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (Nadal)
| | - Alexandra Navarro
- Pathology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (Navarro)
| | - Maria Nelander
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Nelander)
| | - Angelica Oviedo
- Department of Pathology and Laboratory Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico (Oviedo)
| | | | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Department of Pathology, Karolinska University Hospital, Stockholm, Sweden (Papadogiannakis)
| | - Astrid C Petersen
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark (Petersen)
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Roberts)
| | - Ali G Saad
- Pediatric Pathology and Neuropathology, Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, Florida (Saad)
| | - Anna Sand
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Karolinska University Hospital, Solna, Stockholm, Sweden (Sand)
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Schoenmakers)
| | - Jennifer K Sehn
- Department of Pathology, St. Louis University School of Medicine, St. Louis, Missouri (Sehn)
| | - Preston R Simpson
- Department of Pathology, CHRISTUS Hospital St. Elizabeth, 2830 Calder St., Beaumont, Texas (Simpson)
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health - Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas)
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands (van der Meeren).,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands (van der Meeren)
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium (Van Dorpe)
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands (Verdijk)
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Watkins)
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Institution of Clinical Sciences Lund, Lund University, Sweden (Zaigham).,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden (Zaigham)
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43
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Cervantes J, Dudrey E, Baatar D, Lyn H, Sambalingam D, Wojciechowska J, Hernan LJ. Improving Integration of Basic Science into Clinical Medicine: Vertical Integration into Clinical Education (VICE) Activity. MEDICAL SCIENCE EDUCATOR 2022; 32:47-50. [PMID: 35186430 PMCID: PMC8814280 DOI: 10.1007/s40670-021-01485-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
UNLABELLED The integration of basic science into clinical clerkships continues to be a challenge in medical curricula. We developed an integrated session for 3rd year medical students enrolled in OB-Gyn/Pediatric Block. The session focused on transplacental and perinatal infections, and consisted of a student-driven pedagogy activity in which students were required to explain the basic science principles behind the pathophysiology of the clinical presentations, the work-up, and the treatment of the infections. This approach helps students understand how basic science knowledge informs clinical practice and potential increase clerkship-level students' confidence as it makes them serve as leaders of active learning modules. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01485-7.
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Affiliation(s)
- Jorge Cervantes
- Dept. Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Ellen Dudrey
- Dept. Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Dolgor Baatar
- Department of Biomedical Science, Kaiser Permanente. Bernard J. Tyson School of Medicine, Pasadena, CA USA
| | - Heidi Lyn
- Dept. Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Devaraj Sambalingam
- Dept. Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Joanna Wojciechowska
- Dept. Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Lynn J. Hernan
- Dept. Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
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44
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Rodrigues JP, Junior HFDA. Efficiency of a Single well IgG, IgM and IgA Anti T. gondii Fluorimetric Assay for Pre-natal Screening for Congenital Toxoplasmosis. J Fluoresc 2022; 32:661-667. [PMID: 35032281 DOI: 10.1007/s10895-022-02892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022]
Abstract
Toxoplasmosis, worldwide protozoan disease, is usually benign, except when acute disease occurs in pregnant women, resulting in fetal infection with deaths or high morbidity after birth. Treatment blocks fetal infection or damage after infection, imposing a quick and effective diagnosis. Maternal infection is mostly asymptomatic thus regular serology are the main tool for detect seroconversion and acute infection in prenatal care. Screening test for specific anti T. gondii IgG, IgM and IgA must be quick, cheaper and available for the prenatal care. Fluorescent solid phase assays appears as a good alternative as they allow one well detection of IgG and IgM aside to allow high throughput in 384 wells. Here, we standardize and analyze a single well anti-T. gondii IgG, IgM and IgA immunosorbent fluorescent assay in a large sample of a public hospital. We construct conjugates for each immunoglobulin with specific fluorophores, which allows concomitant detection in a microplate fluorimeter, with stability and reproducibility, allowing cheaper 384 wells use. Tested in our 600 mother samples from a large public hospital, they presented the same reactivity as standard routine tests, but with adequate IgM and IgA screening, as adequately standardized in house ELISA, while the design of most commercial assays give false positive results. The few TFISA positive IgG, IgM and IgA samples also had low avidity IgG, confirming recent infection. TFISA will help a screening toxoplasmosis in pregnancy program in large cities, with , allowing testing large numbers of samples at low cost and must be considered for other serological purposes.
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Affiliation(s)
- Jaqueline Polizeli Rodrigues
- Lab. Protozoology, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Pathology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Heitor Franco de Andrade Junior
- Lab. Protozoology, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil.
- Pathology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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45
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Caudrelier N, Cyr P, Kokta V, McCuaig C. Extramedullary hematopoiesis secondary to COVID-19: A first case report in a newborn. SAGE Open Med Case Rep 2022; 10:2050313X221117643. [PMID: 36003893 PMCID: PMC9393489 DOI: 10.1177/2050313x221117643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 39 weeks newborn baby was born with blueberry muffin macules and papules on her back. Skin biopsy was performed and showed extramedullary hematopoiesis. The mother who was infected by COVID-19 infection at 35 weeks of pregnancy did not have any other risk factor for extramedullary hematopoiesis, thus making this viral infection the most likely cause of blueberry muffin rash.
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Affiliation(s)
- Nicolas Caudrelier
- Department of Dermatology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Patrick Cyr
- Department of Dermatology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Victor Kokta
- Department of Pathology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Catherine McCuaig
- Department of Dermatology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
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46
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Quintans MDS, Bueno AC, Cardoso CAA. Microcephaly caused by or associated with congenital infections in the last 20 years in Brazil: a systematic review. Rev Inst Med Trop Sao Paulo 2022; 64:e7. [PMID: 35137901 PMCID: PMC8815834 DOI: 10.1590/s1678-9946202264007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022] Open
Abstract
This systematic review aimed to identify the pathogens causing or associated with congenital microcephaly in Brazil in the last 20 years due to the lack of official information by the Health Authorities and, as a consequence the uncertainty on the real infectious etiology of congenital microcephaly. A review protocol was prepared according to the PRISMA recommendation, using the PubMed, SciELO and LILACS databases to search for references presenting original data on microcephaly caused by or associated with congenital infectious in Brazil, using the descriptors “MICROCEPHALY AND INFECTION”. The search ended on 30/Jun/2020. All selected titles were read in full and analyzed independently by the three reviewers. After searching the databases, 2,389 articles were selected for title review. Of these, 109 were excluded due to duplicates and 2,236 according to the criteria defined in the review. Only 44 met the eligibility criteria and were therefore read in full. Data extraction was performed on 10 articles, all published after 2015. Seven studies were literature reviews or case series, only two were case-control, and one was a cross-sectional study. As the studies focused on the period of the ZIKV epidemic in Brazil, the cases of congenital microcephaly between 2015 and 2017 were attributed to maternal infection by this virus when it was not possible to prove the presence of other etiological agents. Among the TORCH agents, a predominance of syphilis was observed. The analyzed studies did not add consistent information about the infectious causes or association of microcephaly in Brazil outside the period of ZIKV epidemic, revealing the need for more studies on the subject.
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Wintringham JA, Conran RM. Educational Case: Infections during pregnancy: Congenital cytomegalovirus infection. Acad Pathol 2022; 9:100020. [PMID: 35600745 PMCID: PMC9115722 DOI: 10.1016/j.acpath.2022.100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/12/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022] Open
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Sharma A, Sah N, Kannan S, Kannan RM. Targeted drug delivery for maternal and perinatal health: Challenges and opportunities. Adv Drug Deliv Rev 2021; 177:113950. [PMID: 34454979 PMCID: PMC8544131 DOI: 10.1016/j.addr.2021.113950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 12/18/2022]
Abstract
Pre-existing conditions at reproductive age, and complications arising during pregnancy can be detrimental to maternal and fetal health. Current therapies to combat obstetric disorders are limited due to the inherent complexity of pregnancy, and can have harmful effects on developing fetus. Emerging research shows intricate signaling between the cells from mother and fetus at maternal-fetal interface, providing unique opportunities for interventions specifically targeted to the mother, fetus, or placenta. Advancements in nanotechnology, stem-cell biology and gene therapy have resulted in target-specific treatments with promising results in pre-clinical maternal and fetal disorder models. Comprehensive understanding of the effect of physicochemical properties of delivery systems on their uptake, retention and accumulation across placenta will help in the better diagnosis and treatment of perinatal disorders. This review describes the factors leading to obstetric complications along with their effect on pregnancy outcomes, and discusses key targeted therapeutic strategies for addressing conditions related to maternal and fetal health.
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Affiliation(s)
- Anjali Sharma
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Nirnath Sah
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sujatha Kannan
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Hugo W. Moser Research Institute at Kennedy Krieger, Inc., Baltimore MD, 21205, USA
| | - Rangaramanujam M Kannan
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Hugo W. Moser Research Institute at Kennedy Krieger, Inc., Baltimore MD, 21205, USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore MD, 21218, USA.
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Sloan PE, Rodriguez C, Holtz LR. Viral prevalence by gestational age and season in a large neonatal cord blood cohort. J Matern Fetal Neonatal Med 2021; 35:8482-8487. [PMID: 34587860 PMCID: PMC8960461 DOI: 10.1080/14767058.2021.1983537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate viral prevalence in a large neonatal cohort and determine the impact on pregnancy and birth outcomes. STUDY DESIGN We prospectively collected 1044 neonatal samples from remnant neonatal cord blood RPR samples. We performed qRT-PCR/qPCR reactions for: adenovirus, anellovirus (alphatorquevirus and betatorquevirus), cytomegalovirus (CMV), Epstein-Barr virus (EBV), enterovirus, human herpesvirus 6 (HHV6), parechovirus, and parvovirus B19. RESULT Overall viral prevalence was 5.6% with 58 positive samples. Alphatorquevirus (2%) and HHV6 (1.2%) were the two most prevalent viruses detected. Viral detection was most common in samples collected in the fall (September-November) and least common in those collected in winter (December-February). There was no statistical difference detected in viral prevalence or viral load by gestational age, preterm delivery, pre-eclampsia or chorioamnionitis. CONCLUSION While there is seasonal variation in viral prevalence in neonatal cord blood samples, individual virus presence does not seem to effect pregnancy or birth outcomes.
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Affiliation(s)
- Patrick E Sloan
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Cynthia Rodriguez
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Lori R Holtz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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Cimica V, Galarza JM, Rashid S, Stedman TT. Current development of Zika virus vaccines with special emphasis on virus-like particle technology. Expert Rev Vaccines 2021; 20:1483-1498. [PMID: 34148481 DOI: 10.1080/14760584.2021.1945447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Zika virus disease received little attention until its recent explosive emergence around the globe. The devastating consequences of this pandemic include congenital Zika syndrome (CZS) and the neurological autoimmune disorder Guillain-Barré syndrome. These potential outcomes prompted massive efforts to understand the course of Zika infection and to develop therapeutic and prophylactic strategies for treatment and prevention of disease.Area covered: Preclinical and clinical data demonstrate that a safe and efficacious vaccine for protection against Zika virus infection is possible in the near future. Nevertheless, significant knowledge gaps regarding the outcome of a mass vaccination strategy exist and must be addressed. Zika virus circulates in flavivirus-endemic regions, an ideal Zika vaccine should avoid the potential of antibody-dependent enhancement from exposure to dengue virus. Prevention of CZS is the primary goal for immunization, and the vaccine must provide protection against intrauterine transmission for use during pregnancy and in women of childbearing age. Ideally, a vaccine should also prevent sexual transmission of the virus through mucosal protection.Expert opinion: This review describes current vaccine approaches against Zika virus with particular attention to the application of virus-like particle (VLP) technology as a strategy for solving the challenges of Zika virus immunization.
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Affiliation(s)
- Velasco Cimica
- American Type Culture Collection (ATCC), Manassas, VA, USA
| | | | - Sujatha Rashid
- American Type Culture Collection (ATCC), Manassas, VA, USA
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