1
|
Rojas-Gulloso A, Sánchez-Lerma L, Montilla M, Morales-Pulecio F, Sarmiento-Rudolf E, Tapia-Reales R. Infectious diseases in migrant pregnant women from an area of the Colombian Caribbean. Travel Med Infect Dis 2023; 55:102629. [PMID: 37586652 DOI: 10.1016/j.tmaid.2023.102629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Human migration is an activity that affects society in economic and political aspects and as a social determinant because of its differential impact on individual's health. OBJECTIVE To describe the situation of health and infectious diseases of vertical transmission risk in migrant pregnant women from an area of the Colombian Caribbean from 2019 to 2021. METHODS A descriptive cross-sectional study was carried out on pregnant irregular migrants in the Riohacha and Santa Marta municipalities in Colombia. Hemogram, uranalysis, toxoplasma, FTA-ABS, VDRL, rubella, hepatitis B, HIV (TORCHs), vaginal swab, basal glycemia, and transaminases, among other paraclinical tests, were done on pregnant women. Data was arranged, tabulated, and analyzed in SPSS v.23.0. A descriptive statistical analysis with measures of central tendency and dispersion for quantitative variables, and proportions analysis was done for qualitative variables. RESULTS A total of 555 clinical records were analyzed. Of the infectious agents with a risk of vertical transmission, syphilis was the most frequent with 3.6%. Regarding toxoplasmosis, 2.5% were IgM-positive. 4.2% of the pregnant women had IgG antibodies against Rubella and 2 women showed antibodies against HIV. CONCLUSIONS Our results reflect the need for the implementation of educational, prevention, and detection health programs with the aim to decrease the number of prenatal infections in the pregnant migrant population for preventing fatal complications both in mothers and newborns.
Collapse
Affiliation(s)
- A Rojas-Gulloso
- Grupo de Investigación de Ciencias y Pedagogía, Facultad de Medicina, Universidad Cooperativa de Colombia, Santa Marta, Magdalena, Colombia.
| | - L Sánchez-Lerma
- Grupo de Investigación de Villavicencio-GRIVI, Facultad de Medicina, Universidad Cooperativa de Colombia, Villavicencio, Meta, Colombia
| | - Marcela Montilla
- Grupo de Investigación de Villavicencio-GRIVI, Facultad de Medicina, Universidad Cooperativa de Colombia, Villavicencio, Meta, Colombia
| | - F Morales-Pulecio
- Malteser International America, agencia de ayuda humanitaria de la orden de Malta, Riohacha, La Guajira, Colombia
| | - E Sarmiento-Rudolf
- Malteser International America, agencia de ayuda humanitaria de la orden de Malta, Riohacha, La Guajira, Colombia
| | - Ricardo Tapia-Reales
- Malteser International America, agencia de ayuda humanitaria de la orden de Malta, Riohacha, La Guajira, Colombia
| |
Collapse
|
2
|
Camacho-Montaño AM, Niño-Alba R, Páez-Castellanos E. Congenital syphilis with hydrops fetalis: report of four cases in a general referral hospital in Bogota, Colombia between 2016- 2020. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2021; 72:149-161. [PMID: 34506702 PMCID: PMC8425360 DOI: 10.18597/rcog.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 06/15/2021] [Indexed: 11/04/2022]
Abstract
Objective To report four cases of hydrops fetalis secondary to congenital syphilis and carry out a review of the literature to answer the question, What is the antibiotic regimen used in cases of gestational syphilis with hydrops fetalis as a complication? Materials and Methods Four cases of congenital syphilis with hydrops fetalis are presented. Maternal age ranged between 17 and 28 years, gestational age at the time of diagnosis varied between 25 and 30 weeks, and two of the mothers had not initiated prenatal care at that time. Treatment with crystalline penicillin for gestational syphilis was given immediately 6 to 12 weeks before delivery in three cases and partners were prescribed treatment with benzathine penicillin. As for the neonates, two had no active infection or sequelae and one of them was considered to have congenital syphilis based on non-treponemal test titers. In one case, the patient was unable to receive syphilis treatment before delivery and her newborn had signs of active infection. A review of the literature was conducted in the Medline, LILACS and Google Scholar databases using the search terms “hydrops fetalis,” “Lues”, “syphilis – prenatal diagnosis - ultrasound - penicillin – treatment”. The search included case reports and case series or cohorts of newborns with gestational syphilis and hydrops fetalis. Information regarding treatment in the mothers and in the newborns was extracted. Results Overall, 119 articles were identified. Of these, 13 met the inclusion criteria, three were discarded because the full text could not be accessed. Ten studies with a total of 16 reported cases of hydrops fetalis secondary to congenital infection were reported. Of these, three presented with severe fetal anemia and required intrauterine transfusion; 5 cases received intrauterine penicillin treatment. In four cases the mother received weekly intramuscular injections of benzathine penicillin for 3 weeks, one received additional intravenous crystalline penicillin for 13 days, while another one received intravenous crystalline penicillin for 14 days. Treatment during gestation was not given in a total of 11 cases; and 6 of the 16 cases (37.5%) resulted in perinatal death. Conclusion Delays in prenatal care and late diagnosis and treatment of gestational syphilis are important causes of persistent congenital syphilis. Randomized studies are required to identify the best treatment in fetuses with congenital syphilis 30 days before delivery and in fetuses with systemic compromise during the second half of gestation.
Collapse
Affiliation(s)
| | - Reinaldo Niño-Alba
- Subred integrada de servicios de salud centro oriente. E.S.E. Bogotá (Colombia). .
| | | |
Collapse
|
3
|
Costa ML, de Moraes Nobrega G, Antolini-Tavares A. Key Infections in the Placenta. Obstet Gynecol Clin North Am 2019; 47:133-146. [PMID: 32008664 DOI: 10.1016/j.ogc.2019.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Congenital infections are an important cause of morbidity and mortality worldwide, especially in low-income settings. This review discusses the main pathways of infections and associated adverse maternal and fetal outcomes, considering the TORCH pathogens, including Zika virus; the acronym stands for Toxoplasma gondii infection, other (Listeria monocytogenes, Treponema pallidum, and parvovirus B19, among others, including Zika virus), rubella virus, cytomegalovirus, and herpes simplex viruses type 1 and type 2.
Collapse
Affiliation(s)
- Maria Laura Costa
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo 13084-881, Brazil.
| | - Guilherme de Moraes Nobrega
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo 13084-881, Brazil
| | - Arthur Antolini-Tavares
- Department of Pathological Anatomy, School of Medicine, University of Campinas, Rua Alexander Fleming 101, Campinas, São Paulo 13084-881, Brazil
| |
Collapse
|
4
|
Maisonneuve E, Ben M'Barek I, Leblanc T, Da Costa L, Friszer S, Pernot F, Thomas P, Castaigne V, Toly N'Dour C, Mailloux A, Cortey A, Jouannic JM. Managing the Unusual Causes of Fetal Anemia. Fetal Diagn Ther 2019; 47:156-164. [PMID: 31505487 DOI: 10.1159/000501554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 06/18/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Rare causes of fetal anemia requiring intrauterine transfusion (IUT) are challenging for fetal medicine specialists. OBJECTIVES The aim of this study was to describe the perinatal patterns and prognosis in a consecutive series of fetuses transfused for fetal anemia of rare or unknown etiology, and to propose a protocol of investigation for fetal anemia of undetermined cause and for the management of subsequent pregnancies. METHOD We conducted a retrospective descriptive study on fetuses transfused for severe anemia of rare or unknown etiology managed in our national referral center (Centre National de Référence d'Hémobiologie Périnatale) and born between 2010 and 2017. RESULTS During the study period, 584 IUT were performed in 253 fetuses. Among those IUT, 23 (3.9%) were performed for a rare or unknown cause of anemia in 13 fetuses (5.1% of transfused fetuses). The median gestational age at diagnosis was 26 weeks of gestation (WG; range 21-33). Hemoglobin levels ranged from 1.6 to 9.1 g/dL (0.18-0.83 multiples of median) before the first IUT. The fetuses received between 1 and 6 IUT (39% received at least 2 IUT). The definitive etiologies for central anemia were: congenital syphilis, neonatal poikilocytosis, type II congenital dyserythropoietic anemia (CDA), and neonatal hemochromatosis. There was 1 case with suspected type I CDA and 1 with suspected Diamond-Blackfan anemia. There was 1 case of peripheral anemia, secondary to cerebral hemorrhages of different ages, related to a variant of the COL4A1 gene. In 6 fetuses corresponding to 4 mothers, no precise diagnosis was found despite a complete workup. In our series, there were 8 live births, 4 terminations of pregnancy, and 1 intrauterine fetal death. CONCLUSIONS Fetal anemia of rare or unknown diagnosis represents 5% of all transfused fetuses in our cohort. Fetal and neonatal anemias can be recurrent in further pregnancies, with variable expressivity.
Collapse
Affiliation(s)
- Emeline Maisonneuve
- Department of Fetal Medicine, Hôpital Trousseau, Paris, France, .,Centre National de Référence en Hémobiologie Périnatale (CNRHP) Clinique, Hôpital Trousseau, Paris, France,
| | | | - Thierry Leblanc
- Department of Clinic Hematology, Hôpital Robert-Debré, Paris, France
| | - Lydie Da Costa
- Department of Biologic Hematology, Hôpital Robert-Debré, Paris, France
| | - Stéphanie Friszer
- Department of Fetal Medicine, Hôpital Trousseau, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP) Clinique, Hôpital Trousseau, Paris, France
| | - Françoise Pernot
- Centre National de Référence en Hémobiologie Périnatale (CNRHP) Clinique, Hôpital Trousseau, Paris, France
| | - Pauline Thomas
- Department of Fetal Medicine, Hôpital Trousseau, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP) Clinique, Hôpital Trousseau, Paris, France
| | - Vanina Castaigne
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Créteil, Créteil, France
| | - Cécile Toly N'Dour
- Department of Immunohematology, Centre National de Référence en Hémobiologie Périnatale (CNRHP) Biologique, Hôpital Saint-Antoine, Paris, France
| | - Agnès Mailloux
- Department of Immunohematology, Centre National de Référence en Hémobiologie Périnatale (CNRHP) Biologique, Hôpital Saint-Antoine, Paris, France
| | - Anne Cortey
- Department of Fetal Medicine, Hôpital Trousseau, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP) Clinique, Hôpital Trousseau, Paris, France
| | - Jean-Marie Jouannic
- Department of Fetal Medicine, Hôpital Trousseau, Paris, France.,Centre National de Référence en Hémobiologie Périnatale (CNRHP) Clinique, Hôpital Trousseau, Paris, France
| |
Collapse
|
5
|
Heerema-McKenney A. Defense and infection of the human placenta. APMIS 2018; 126:570-588. [PMID: 30129129 DOI: 10.1111/apm.12847] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/22/2018] [Indexed: 12/14/2022]
Abstract
The placenta functions as a shield against infection of the fetus. The innate and adaptive immune defenses of the developing fetus are poorly equipped to fight infections. Infection by bacteria, viruses, and protozoa may cause infertility, spontaneous abortion, stillbirth, growth retardation, anomalies of development, premature delivery, neonatal morbidity, and mortality. However, appreciation of the human microbiome and host cell-microbe interactions must be taken into consideration as we try to determine what interactions are pathologic. Infection is typically recognized histologically by the presence of inflammation. Yet, several factors make comparison of the placenta to other human organs difficult. The placenta comprises tissues from two persons, complicating the role of the immune system. The placenta is a temporary organ. It must be eventually expelled; the processes leading to partuition involve maternal inflammation. What is normal or pathologic may be a function of timing or extent of the process. We now must consider whether bacteria, and even some viruses, are useful commensals or pathogens. Still, recognizing infection of the placenta is one of the most important contributions placental pathologic examination can give to care of the mother and neonate. This review provides a brief overview of placental defense against infection, consideration of the placental microbiome, routes of infection, and the histopathology of amniotic fluid infection and TORCH infections.
Collapse
Affiliation(s)
- Amy Heerema-McKenney
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
6
|
Abbasi N, Johnson JA, Ryan G. Fetal anemia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:145-153. [PMID: 28782230 DOI: 10.1002/uog.17555] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Affiliation(s)
- N Abbasi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J-A Johnson
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
| | - G Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Fuchs F, Michaux K, Rousseau C, Ovetchkine P, Audibert F. Syphilis Infection: An Uncommon Etiology of Infectious Nonimmune Fetal Hydrops with Anemia. Fetal Diagn Ther 2014; 39:74-7. [PMID: 25138225 DOI: 10.1159/000364804] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/22/2014] [Indexed: 11/19/2022]
Abstract
An increased prevalence of syphilis has been observed in many developed countries over the last decade. During pregnancy, syphilis can affect the fetus through development of nonspecific symptoms such as microcephaly, ascites, hepatosplenomegaly, dilated and echogenic bowel, placentomegaly, and, uncommonly, fetal hydrops. Congenital syphilis also leads to hematologic abnormalities such as anemia, thrombocytopenia, leukopenia, and leukocytosis. We present a case of nonimmune fetal hydrops with anemia related to syphilis infection. Diagnosis was confirmed by a maternal serological test and microbiological testing on amniotic fluid, umbilical cord, and placental tissues. The patient was treated with penicillin and the fetus received an intrauterine red blood cell transfusion, but fetal death occurred shortly after. Such a presentation is mostly related to parvovirus B19, and syphilis etiology is poorly mentioned because physicians have rarely seen early congenital syphilis in the past. However, given the increasing prevalence of this disease in the adult population, clinicians should remain alert to the various presentations of congenital syphilis.
Collapse
Affiliation(s)
- Florent Fuchs
- Department of Obstetrics and Gynecology, CHU Sainte Justine - Universitx00E9; de Montrx00E9;al, Montrx00E9;al, Qux00E9;., Canada
| | | | | | | | | |
Collapse
|