Long COVID-19 syndrome associated with Omicron XBB.1.5 infection: a case report

BACKGROUND There is interest in lingering non-specific symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, referred to as Long coronavirus disease 2019 (Long COVID-19). It remains unknown whether the risk of Long COVID-19 is associated with pre-existing comorbidities or initial COVID-19 severity, including infections due to new Omicron lineages which predominated in 2023. OBJECTIVES The aim of this case report was to characterize the clinical features of acute XBB.1.5 infection followed by Long COVID-19. METHODS We followed a 73-year old female resident of Rio de Janeiro with laboratory-confirmed SARS-CoV-2 during acute infection and subsequent months. The SARS-CoV-2 lineage was determined by genome sequencing. FINDINGS The participant denied comorbidities and had completed a two-dose vaccination schedule followed by two booster doses eight months prior to SARS-CoV-2 infection. Primary infection by viral lineage XBB.1.5. was clinically mild, but the participant subsequently reported persistent fatigue. MAIN CONCLUSIONS This case demonstrates that Long COVID-19 may develop even after mild disease due to SARS-CoV-2 in fully vaccinated and boosted individuals without comorbidities. Continued monitoring of new SARS-CoV-2 lineages and associated clinical outcomes is warranted. Measures to prevent infection should continue to be implemented including development of new vaccines and antivirals effective against novel variants.

Neurodevelopment in the third year of life in children with antenatal ZIKV-exposure

ABSTRACT We report cognitive, language and motor neurodevelopment, assessed by the Bayley-III test, in 31 non-microcephalic children at age 3 with PCR-confirmed maternal Zika virus exposure (Rio de Janeiro, 2015-2016). Most children had average neurodevelopmental scores, however, 8 children (26%) presented delay in some domain. Language was the most affected: 7 children (22.6%) had a delay in this domain (2 presenting severe delay). Moderate delay was detected in the cognitive (3.2%) and motor (10%) domains. Maternal illness in the third trimester of pregnancy and later gestational age at birth were associated with higher Bayley-III scores. Zika-exposed children require long-term follow-up until school age.

Trends in a Cohort of HIV-infected pregnant women in Rio de Janeiro, 1996-2004

OBJECTIVE: To describe trends in sociodemographic, immunological and virological profiles and interventions to decrease the risk of mother-to-child HIV transmission. METHODS: Retrospective cohort study conducted at a tertiary institution in Rio de Janeiro, Brazil from January 1996 to December 2004. Analysis was performed by stratification in three time periods: 1996-1998 (P1), 1999-2001 (P2) and 2002-2004 (P3). RESULTS: In 9 years, 622 pregnancies occurred. Complications included: maternal mortality 0.3 percent, stillbirths 2.5 percent, miscarriages 0.6 percent, neonatal mortality 1.1 percent, prematurity 9.9 percent, low birth weight (LBW) 16.5 percent, congenital malformations 2.2 percent. The number of HIV-infected pregnant patients grew threefold over time reflecting increased prevalence of disease and patient identification. HIV diagnosis before pregnancy increased from 30 percent in P1 to 45 percent in P3. The proportion of pregnant women receiving highly active antiretroviral therapy increased from none (P1) to 88 percent (P3) with a significant trend towards women delivering at undetectable viral loads in later years despite a higher frequency of advanced disease. Scheduled cesarean deliveries increased from 35 percent in P1 to 48 percent in P3. Perinatal transmission rates were 2.4 percent with a decline from 3.5 percent in P1 to 1.6 percent in P3. Neonatal outcomes tended to remain constant or improve with time. A slight rise in LBW and congenital malformations were observed. CONCLUSIONS: During the observational period, HIV+ pregnant women presented with more advanced disease and lower socio-economic status. However, improved management of HIV-infected patients (associated with increased identification and increased availability of treatment) resulted into very low transmission rates similar to those of developed countries with overall improvement of patient outcomes.

OBJETIVOS: Descrever as tendências temporais nas características sociodemográficas, imunológicas e virológicas e as das condutas utilizadas para reduzir o risco da transmissão mãe-filho do HIV. MÉTODOS: Estudo de coorte retrospectivo em uma instituição de saúde terciária no Rio de Janeiro de janeiro de 1996 a dezembro de 2004. A análise utilizou a estratificação em três períodos de tempo: 1996-1998 (P1), 1999-2001 (P2) e 2002-2004 (P3). RESULTADOS: Em 9 anos, 622 gestações foram acompanhadas. As complicações foram: mortalidade materna 0,3 por cento, natimortos 2,5 por cento, abortos 0,6 por cento, mortalidade neonatal 1,1 por cento, prematuridade 9,9 por cento, baixo peso ao nascer (BPN) 16,5 por cento, malformações congênitas 2,2 por cento. O número de gestantes HIV positivo triplicou ao longo do tempo, refletindo o aumento da prevalência da doença e a melhor identificação das pacientes. O diagnóstico da infecção pelo HIV antes da gestação aumentou de 30 por cento em P1 para 45 por cento em P3. A proporção de gestantes recebendo o tratamento combinado potente aumentou de zero em P1 para 88 por cento em P3 com uma tendência significativa a ter uma carga viral abaixo do limite de detecção no parto nos últimos anos apesar de uma maior proporção de pacientes com doença mais avançada. O índice de cesarianas eletivas aumentou de 35 por cento em P1 para 48 por cento em P3. A taxa de transmissão perinatal global foi de 2,4 por cento caindo de 3,5 por cento em P1 para 1,6 por cento em P3. Os desfechos neonatais tenderam a permanecer constantes ou a melhorar ao longo do tempo. Um discreto aumento dos índices de BPN e de malformações congênitas foi observado. CONCLUSÕES: Ao longo do período de estudo aumentou a proporção de gestantes HIV positivo com doença mais avançada e com padrão socioeconômico mais baixo. Por outro lado, a melhora da abordagem terapêutica dos pacientes infectados pelo HIV, associada a uma maior detecção de casos e maior acesso...