SARS-CoV-2 Infection and Placental Pathology Infecção por SARS-CoV-2 e patologia placentária

Abstract Placental pathophysiology in SARS-CoV-2 infection can help researchers understand more about the infection and its impact on thematernal/neonatal outcomes. This brief review provides an overview about some aspects of the placental pathology in SARSCoV- 2 infection. In total, 11 papers were included. The current literature suggests that there are no specific histopathological characteristics in the placenta related to SARSCoV- 2 infection, but placentas frominfected women aremore likely to show findings of maternal and/or fetal malperfusion. The most common findings in placentas from infected women were fibrin deposition and intense recruitment of inflammatory infiltrates. The transplacental transmission of this virus is unlikely to occur, probably due to low expression of the receptor for SARS-CoV-2 in placental cell types. Further studies are needed to improve our knowledge about the interaction between the virus and the mother-fetus dyad and the impact on maternal and neonatal/fetal outcomes.

Resumo A fisiopatologia da placenta na infecção por SARS-CoV-2 pode ajudar os pesquisadores a entender mais sobre a infecção e seu impacto nos resultados maternos/neonatais. Esta revisão breve fornece uma visão geral sobre alguns aspectos da patologia placentária na infecção por SARS-CoV-2. Ao todo, 11 artigos foram incluídos. A literatura atual sugere que não há características histopatológicas específicas nas placentas relacionadas à infecção por SARS-CoV-2, mas as placentas de mulheres infectadas têm maior probabilidade de apresentar achados de má perfusão materna e/ou fetal. Os achados mais comuns em placentas de mulheres infectadas foram deposição de fibrina e intenso recrutamento de infiltrado inflamatório. A transmissão transplacentária deste vírus é improvável, devido à baixa expressão do receptor para SARS-CoV-2 em tipos de células da placenta. Mais estudos são necessários para melhorar nosso conhecimento sobre a interação entre o vírus e a díade mãe-feto e o impacto nos resultados maternos e neonatais/fetais.

Complicaciones neonatales asociadas al diagnóstico de corioamnionitis histológica en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad en Colombia / Neonatal complications associated with the diagnosis of histological chorioamnionitis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia

INTRODUCCIÓN: La corioamnionitis histológica (CH) es causa importante de parto pretérmino y se asocia a resultados neonatales adversos, con secuelas del neurodesarrollo. Ocurre en alrededor de un 20% de embarazos a término y 60% de pretérmino. Este proceso está asociado a varias complicaciones neonatales, entre las más frecuentes: sepsis neonatal temprana, menor edad gestacional y mayor estancia hospitalaria. OBJETIVO: Establecer la asociación de complicaciones neonatales con el diagnóstico de CH en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad. MÉTODOS: Estudio retrospectivo, se incluyeron 160 pacientes con parto pretérmino espontáneo con estudio histopatológico de la placenta según protocolo institucional. Se recolectan las características basales de la gestante y complicaciones neonatales. Se calcula la prevalencia de CH, y se comparan dos grupos (con y sin) la asociación de complicaciones neonatales, distribuidas por edad gestacional y peso neonatal. RESULTADOS: La prevalencia de CH es de 69% (IC95%: 61-76). Al distribuir por edad gestacional se reporta: 87% en 34 (IC 95%: 45 -67). La CH entre las 28 - 34 y > 34 semanas, se asocia a mayor sepsis neonatal temprana (p 2000 g se asocia con sepsis neonatal (p<0.05). CONCLUSIÓN: La prevalencia de CH es alta, principalmente a menor edad gestacional, se asocia a complicaciones neonatales como la sepsis neonatal temprana.

INTRODUCTION: Histological chorioamnionitis (HC) is an important cause of preterm delivery and is associated with adverse neonatal outcomes, with sequelae of neurodevelopment. It occurs in about 20% of full-term and 60% preterm pregnancies. This process is associated with several neonatal complications, among the most frequent: early neonatal sepsis, younger gestational age, and longer hospital stay. OBJECTIVE: To establish the association of neonatal complications with HC diagnosis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia. RESULTS: The prevalence of HC is 69% (95% CI: 61-76). When distributed by gestational age, it is reported: 87% in 34 (95% CI: 45-67). HC between 28 - 34 and > 34 weeks, is associated with higher early neonatal sepsis (p 2000 g is associated with early neonatal sepsis (p <0.05). CONCLUSION: The prevalence of HC is high, mainly at a lower gestational age, it is associated with neonatal complications such as early neonatal sepsis.

Late stillbirth due to listeriosis

Listeriosis is a sporadic infectious disease, which affects high-risk populations, such as the elderly, pregnant women, newborns, and immunocompromised patients. During pregnancy, listeriosis usually presents like a mild non-specific infection, but it may be responsible for fetal loss, preterm labor, early onset neonatal sepsis, and neonatal death. We report the case of a late stillbirth secondary to maternal chorioamnionitis. Listeria monocytogenes was isolated from the amniotic fluid and the fetal pleural fluid. The fetal autopsy revealed a disseminated inflammatory response with multi-organ involvement. This case illustrates the importance of the prevention and the diagnosis of listeriosis during gestation and may help us to understand the physiopathology of fetal loss due to listeriosis.

Cutaneous neonatal herpes simplex virus infection type 2: a case report

Abstract Neonatal herpes is a serious condition. Newborns can be contaminated in utero via transplacental hematogenic transmission, upon delivery (the most frequent route), or during the postnatal period (indirect transmission). Optimal management requires prompt and accurate recognition, particularly in newborns, in order to prevent complications. Acyclovir is the treatment of choice, but its implementation is often delayed while awaiting test results, such as PCR and serology. Cytology for diagnostic purposes is rarely used in dermatology, despite the quick and reliable results. We report a case of neonatal herpes caused by type 2 herpes simplex virus diagnosed by cytology.

Osteonecrosis Related to Once-Yearly Zoledronic Acid Treatment in an Osteoporotic Patient after Dental Implant

This paper presents a case of osteonecrosis of the jaw related to zoledronic acid (5 mg) administered once yearly to treat osteoporosis. A 79-year-old woman who has been treated for osteoporosis for 5 years with 5 applications of zoledronic acid was referred for evaluation. The patient had been submitted to dental implant placement and there was no osseointegration. On clinical examination, suppuration and exposed bone on the alveolar ridge were observed. Radiographic examination revealed an osteolytic area and bone sequestration. Both clinical and radiological features were suggestive of osteonecrosis. The treatment consisted of surgery to remove the affected bone completely. The patient is asymptomatic at 9 months after surgery. Dentists and oral surgeons should be alert to the possibility of osteonecrosis related to the use of once-yearly injections of zoledronic acid for the treatment of postmenopausal osteoporosis.

O presente estudo teve como objetivo apresentar um caso de osteonecrose dos maxilares associada ao uso de ácido zoledrônico (5 mg) administrado uma vez ao ano para tratar a osteoporose. Uma mulher de 79 anos de idade estava em tratamento de osteoporose por 5 anos com 5 aplicações do ácido zoledrônico foi encaminhada para nossa avaliação. A paciente tinha sido submetida à colocação de implante dental e não houve osseointegração. Ao exame clínico, supuração e osso exposto no rebordo alveolar foram observados. Os exames radiográficos revelaram uma área osteolítica e sequestro ósseo. Ambos os aspectos clínicos e radiográficos eram sugestivos de osteonecrose. O tratamento consistiu de cirurgia para remover todo o osso afetado. A paciente está assintomática há 9 meses (desde a cirurgia). Cirurgiões-dentistas e cirurgiões orais devem estar atentos para a possibilidade de osteonecrose relacionada ao uso de injeções anuais de ácido zoledrônico para tratamento da osteoporose pós-menopausa.

Pustular psoriasis of pregnancy (Impetigo herpetiformis) - case report / Psoriase pustulosa da gestacao (Impetigo herpetiforme) - relato de caso

Impetigo herpetiformis is a rare dermatosis of pregnancy with typical onset during the last trimester of pregnancy and rapid resolution in the postpartum period. Clinically and histologically, it is consistent with pustular psoriasis. This similarity has led some authors to name the disease "the pustular psoriasis of pregnancy". We report the case of a patient who developed impetigo herpetiformis in two sucessive pregnancies.

Impetigo herpetiforme é uma dermatose gestacional rara que se inicia tipicamente durante o último trimestre e evolui com rápida resolução no período pós-parto. Clinica e histologicamente é consistente com psoríase pustulosa. Essa similaridade tem levado alguns autores a nomearem a doença como "psoríase pustulosa da gestação". Relatamos o caso de uma paciente que apresentou impetigo herpetiforme em duas gestações subsequentes.

Hialohifomicosis cutánea en un paciente con leucemia linfoblástica / Cutaneous hyalohyphomycosis in a patient with acute lymphoblastic leukemia

Las infecciones fúngicas causadas por Aspergillus sp. y Candida sp. son causa importante de morbilidad y mortalidad en pacientes gravemente inmunodeficientes, especialmente en aquellos con neutropenia o receptores de trasplante de médula ósea o de órganos sólidos. Informamos sobre una hialohifomicosis cutánea en una mujer de 24 años de edad con leucemia linfoblástica.

Invasive fungal infections most frequently caused by Aspergillus sp. and Candida sp. are significant causes of morbidity and mortality in severely immunocompromised patients, especially those who are neutropenic or who have undergone bone marrow or solid-organ transplant. We report a case of cutaneous hyalohyphomycosis in a 24-year-old female with acute lymphoblastic leukemia.

Co-infections associated with human immunodeficiency virus type 1 in pregnant women from southern Brazil: high rate of intraepithelial cervical lesions

Human immunodeficiency virus type 1 (HIV-positive) pregnant women require specific prophylactic and therapeutic approaches. The efficacy of established approaches is further challenged by co-infection with other sexually transmitted diseases (STDs). The objective of this study was to determine the prevalence of co-infections in pregnant women infected with different HIV-1 subtypes and to relate these findings, together with additional demographic and clinical parameters, to maternal and infant outcomes. Blood samples from pregnant women were collected and tested for syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV). Human papillomavirus (HPV) diagnosis was evaluated by the presence of alterations in the cervical epithelium detected through a cytopathological exam. Medical charts provided patient data for the mothers and children. Statistical analyses were conducted with STATA 9.0. We found a prevalence of 10.8 percent for HCV, 2.3 percent for chronic HBV, 3.1 percent for syphilis and 40.8 percent for HPV. Of those co-infected with HPV, 52.9 percent presented high-grade intraepithelial lesions or in situ carcinoma. Prematurity, birth weight, Apgar 1' and 5' and Capurro scores were similar between co-infected and non-co-infected women. The presence of other STDs did not impact maternal and concept outcomes. More than half of the patients presenting cervical cytology abnormalities suggestive of HPV had high-grade squamous intraepithelial lesions or cervical cancer, evidencing an alarming rate of these lesions.

Prevalencia de la infección por citomegalovirus en mujeres fértiles de comunidades indígenas Yukpa, estado Zulia, Venezuela / Prevalence of cytomegalovirus infection among fertile women from Yukpa amerindians communities, State of Zulia, Venezuela

La infección por Citomegalovirus (CMV) es considerada un problema de salud en mujeres fértiles cuando la infección es adquirida durante el embarazo. Con el fin de conocer la prevalencia de CMV en mujeres fértiles de algunas comunidades Yukpa, durante el año 2007 se seleccionaron 112 mujeres de un total de 151, procedentes de las comunidades del Tokuko (n=41), Kasmera (n=35), Yasa (n=20) y Neremú (n=16), en edades entre 16 - 45 años. La determinación de anticuerpos de tipo IgG e IgM anti-CMV se realizó por la técnica de inmunoensayo enzimático (ELISA). La presencia de anticuerpos IgG-anti-CMV fue detectada en el 72,3 por ciento (81/112) de la población estudiada. El 8,6 por ciento (7/81) de las muestras reactivas para IgG fueron positivas para IgM anti-CMV. El análisis por comunidad indica una diferencia significativa (p<0,001) en la prevalencia de CMV en la comunidad del Tokuko con respecto a la comunidad de Yasa. Factores como edad, hacinamiento, número de pareja, número de hijos y abortos, no presentaron asociación con la presencia de anticuerpos para CMV. La prevalencia encontrada en esta población está por debajo a la indicada en mujeres fértiles en otros países y homogéneamente distribuida en las comunidades evaluadas. El porcentaje de mujeres susceptibles debe ser considerado a través de controles pre y durante el embarazo

Infection by Cytomegalovirus (CMV) is considered a health problem in fertile women when the infection is acquired during pregnancy. In order to find the prevalence of CMV among fertile women in Yukpa communities,112 women out of 151, ages 16 - 45, were selected during 2007, coming from Tokuko (n=41), Kasmera (n=35), Yasa (n=20) and Neremu (n=16). IgG and IgM antibodies for CMV were determined by enzymatic immunoassay technique (EIA). The presence of CMV antibodies was detected in 72, 3 percent (81/112) of the population studied. The 8, 6 percent (7/81) of those reactive for IgG were positive for anti-CMV IgM. A significant difference (p<0,001) in CMV prevalence was detected in the Tokuko community compared to the Yasa community. Factors such as age, overcrowding, number of partner, number of children and abortions, were not association with the presence of CMV antibodies. CMV prevalence in this population is below that indicated for fertile women in other countries and is distributed homogeneously among the communities studied. The percentage of susceptible women must be taken into account through controls before and during pregnancy

Clinical manifestations of adolescents with HIV/AIDS in Jamaica / Manifestaciones clínicas de los adolescentes infectados por el VIH en Jamaica

OBJECTIVE: To characterize the clinicopathological manifestations and outcomes of a cohort of HIV-infected Jamaican adolescents. METHODS: This is a retrospective cohort study to determine demographic, clinical, immunological characteristics, antiretroviral uptake and mortality in 94 adolescents aged 10-19 years followed in the Kingston Paediatric and Perinatal HIV/AIDS Programme (KPAIDS) between September 2002 and May 2007. Parametric and non-parametric tests are used to compare variables. RESULTS: The median age at initial presentation was 10.0 years (interquartile range (IQR) 7.0-12.0 years), 54.3% (51) were female (p = 0.024), transmission was primarily mother-to-child (70, 73.4%), with 87% (61) of the latter presenting as slow progressors. Sexual transmission accounted for 19.1% and there was significant female predominance (n = 15; p = 0.024). At most recent visit, perinatally infected adolescents were more likely (p < 0.0001) to reside with a non-parent (n = 42) than a biological parent (n = 19) and most had Centers for Disease Control and Prevention (CDC) category C (35/50%) disease, whereas the majority of non-perinatally infected children were classified CDC category A. Mean z scores for height-for-age was -1.47 ± 1.21 (n = 77), weight-for-age -1.06 ± 1.44 (n = 80) and BMI-for-age -0.34 ± 1.21 (n = 76) respectively; females (n = 41) were taller than males (n = 36) at their current height (p = 0.031). Lymphadenopathy (82%), dermatitis (72.0%), hepatomegaly (48%) and parotitis (48%) were the most common clinical manifestations, with significant predilection for lymphadenopathy (p # 0.0001), dermatitis (p = 0.010), splenomegaly (p = 0.008), hepatomegaly (p = 0.001) and parotitis (p = 0.007) among perinatally infected children. Median baseline CD4+ cell count was 256.0/µL (IQR 71.0 - 478.0 cells/µL); median most recent CD4+ cell count was 521/µL (IQR 271.0 - 911.0 cells/µL). Seventy-six per cent (n = 71) were initiated with highly active antiretroviral therapy (HAART) and 62 (87.3%) were currently receiving first-line therapy. Six behaviourally infected females became pregnant, resulting in five live births. There were seven deaths (7.4%). CONCLUSIONS: This study comprehensively characterizes HIV infection among perinatally infected teens with predominantly slow-progressor disease and an increasing population of sexually-infected adolescents. As the cohort transitions to adulthood, adolescent developmental, mental health and life planning issues must be emergently addressed.

OBJETIVO: Caracterizar las manifestaciones clínico-patológicas y la evolución clínica de una cohorte de adolescentes jamaicanos infectados por el VIH. MÉTODOS: El presente es un estudio de cohorte retrospectivo con el fin de determinar las características demográficas, clínicas, inmunológicas, así como el consumo de antiretrovirales y la mortalidad en 94 adolescentes de 10 a 19 años de edad, llevado a cabo como parte del Programa VIH/SIDA perinatal y pediátrico de Kingston (KPAIDS) entre septiembre de 2002 y mayo de 2007. Se usan pruebas paramétricas y no paramétricas para comparar las variables. RESULTADOS: La edad mediana en la presentación inicial fue 10.0 años (rango intercuartil (IQR) 7.0-12.0 años), 54.3% (51) eran hembras (p = 0.024), la transmisión fue fundamentalmente de madre a hijo (70, 73.4%), presentándose el 87% (61) de los últimos como progresores lentos. La transmisión sexual representó el 19.1% y hubo un predominio significativo de las hembras (n = 15; p = 0.024). En la visita más reciente, los adolescentes infectados perinatalmente presentaron una mayor probabilidad (p < 0.0001) de residir con personas distintas de sus padres (n = 42) que con un progenitor biológico (n = 19), y la mayor parte tenía la enfermedad categoría C (35/50%) de acuerdo con los Centros para el Control y la Prevención de las Enfermedades (CCPE), mientras que la mayoría de los niños infectados no perinatalmente fueron clasificados con la categoría A del CCE. Las puntuaciones z medias para altura por edad fue - 1.47 ± 1.21 (n = 77), peso por edad -1.06 ± 1.44 (n = 80), y el IMC por edad -0.34 ± 1.21 (n = 76) respectivamente; las hembras (n = 41) fueron más altas que los varones (n = 36) en altura corriente (p = 0.031). La linfadenopatía (82%), la dermatitis (72.0%), la hepato-megalia (48%) y la parotitis (48%) fueron las manifestaciones clínicas más comunes, con predilección significativa de la linfadenopatía (p # 0.0001), la dermatitis (p = 0.010), la esplenomegalia (p = 0.008), la hepatomegalia (p = 0.001) y la parotitis (p = 0.007) entre los niños perinatalmente infectados. La mediana de la línea de base del conteo celular CD4+ fue 256.0/µL (IQR 71.0 - 478.0 células/µL); la mediana del conteo celular CD4+ más reciente fue 521 /µL (IQR 271.0 - 911.0 células/µL). El setenta y seis por ciento (n = 71) fueron iniciadas con terapia antiretroviral altamente activa (TARAA) y 62 (87.3%) estuvieron corrientemente recibiendo terapia de primera línea. Seis hembras infectadas conductualmente fueron embarazadas, produciéndose como resultado cinco nacimientos. Hubo siete muertes (7.4%). CONCLUSIÓN: Este estudio presenta una caracterización integral de la infección por VIH entre adolescentes infectados perinatalmente predominantemente con la enfermedad de progresores lentos, y una población creciente de adolescentes infectados sexualmente. En la medida en que la cohorte transita a la adultez, el desarrollo del adolescente, la salud mental y los problemas de la planificación de la vida tienen que ser abordados con urgencia.

Gérmenes patógenos más frecuentes encontrados en tracto genital de embarazadas en trabajo de parto, entre 35 y 40 semanas de gestación y sus complicaciones materno fetales atendidas en el Hospital Fernando Vélez Paiz: noviembre- diciembre 2007 / Pathogen most frequently found in genital tract of pregnant women in labor, between 35 and 40 weeks of pregnancy and its complications maternal fetal served at the Hospital Fernando Velez Paiz: November-December 2007

El presente estudio realizado, es descriptivo corte transversal, en el periodo de noviembre a diciembre del 2007, con un universo de 601, tomando una muestra por conveniencia de 106 personas que cumplia con los criterios de inclusión y exclusión, que acudieron en trabajo de parto al hospital Fernando Vélez Paíz. Se utilizo el programa estadístico para ciencias sociales (SPSS) 12.0 de Windows para el cálculo de frecuencias simples de las variables cuantitativas, tales como; promedio, desviación estándar. La asociación entre las variables cualitativas se determino a través de pruebas de significancia estadísticas de Chi cuadrado con su estimador Odds Ratio (OR), valor de p, con un intervalo de confianza del 95 por ciento. Se realizó un análisis multivariado de regresión logística para determinar el valor real de los factores y controlar los probables factores de confusión asociados al proceso de infección...

Prevalence of oral hairy leukoplakia and epithelial infection by Epstein-Barr virus in pregnant women and diabetes mellitus patients: cytopathologic and molecular study

Oral hairy leukoplakia (OHL) is generally reported in patients with severe immunosuppression, except for a few cases in individuals with moderate degree of immunodeficiency. It is a white lesion that appears mainly in the lateral border of the tongue, caused by Epstein-Barr virus (EBV). The nuclear changes caused by EBV (Cowdry A inclusion, ground glass and nuclear beading), observed in cytopathology, are specific and enough for the definitive diagnosis of OHL, independent of the identification of the virus. Here we investigated the prevalence of OHL and the presence of EBV-DNA in the lateral borders of the tongue from 90 pregnant women, 90 diabetes mellitus (DM) patients, 30 healthy individuals (negative group) and 30 HIV+ with OHL (positive group). Smears were analyzed by cytopathology and polymerase chain reaction (PCR). A case of subclinical OHL and candidiasis was identificated in a DM patient by cytopathologic analysis. PCR results demonstrated EBV-DNA in 65 percent of the pregnant women, in 35 percent of DM patients, and in 20 percent of the healthy individuals. We concluded that DM patients can develop OHL with a low prevalence. Furthermore, the prevalence of the EBV in lateral border of the tongue is larger in pregnant women than in healthy individuals.

Flora vaginal en adolescentes con embarazo a término y su relación con rotura prematura de membranas / Vaginal flora in pregnant adolescents with membrane premature failure

El objetivo de este trabajo fue determinar la relación existente entre flora vaginal y rotura prematura de membranas, en adolescentes embarazadas que acudieron a la consulta prenatal de la Maternidad “Dr. Armando Castillo Plaza” (MACP), perteneciente al Servicio Autónomo Hospital Universitario de Maracaibo. El diseño de este estudio fue explicativo, cuasi experimental. La población y muestra estuvo representada por 80 adolescentes embarazadas, en el último trimestre de gestación. El método de recolección de datos estuvo constituido por una entrevista personalizada y los datos fueron recogidos en un formulario conformado por preguntas abiertas. A todas las pacientes se les tomó muestra para cultivo de secreción vaginal identificándose la flora vaginal presente. Como resultados obtenidos se tuvo que la población mayormente afectada fueron las adolescentes mayores de 17 años; iniciando su actividad sexual entre los 15 y 17 años, las cuales viven en concubinato y pertenecen al Nivel V según Graffar. El diagnóstico de RPM se realizó a través de la maniobra de Tarnier y el Test de Nitrazina, con un periodo de latencia de 6-12 horas, la edad gestacional estuvo entre las 37-38 semanas. Los microorganismos reportados fueron bacilos Gram positivos en un 46%, combinación de bacilos Gram positivos y Gram negativos en el 16%, levaduras en el 15%, bacilos Gram negativos 8% y virus de papiloma humano (VPH) 3%. El cultivo de secreción vaginal fue positivo en el 57% de los casos, siendo Candida albicans el microorganismo predominante (25%). Se concluye que existe relación entre la flora vaginal patógena y RPM en las adolescentes con embarazo a término.

The objective of this work was to determine the existing relation between vaginal flora and membrane premature failure, in pregnant adolescents who went to the consultation of Maternity “Dr. Armando Castillo Plaza” (MACP), pertaining to the Independent Service University Hospital of Maracaibo. The design of this study was explanatory, cuasi experimental. The population was represented by 80 pregnant adolescents, in the last trimester of gestation. The method of data collection was constituted by a customized interview and the data were gathered in a form conformed by open questions. All the patients were taken vaginal secretion culture identifying the vaginal flora present. As obtained results it were had population mainly affected was the greater adolescents of 17 years; initiating its sexual activity between the 15 and 17 years, which live in concubines and belong at Level V according to Graffar. The diagnose of MPF was made through the maneuver of Tanier and Test of Nitrazina with a period of 6-12 latency hours; the gestacional age was between the 37-38 weeks. The reported microorganisms were Gram positive bacilli in a 46%, combination of Gram positive and Gram negative bacilli in 16%, yeast in 15%, bacilli Gram negative 8% and human papiloma virus (HPV) 3%. Vaginal secretion culture was positive in 57% of the cases, being Candida albicans predominant microorganism (25%). One concludes that relation between the pathogenic vaginal flora exists and MPF in the adolescents with pregnancy upon maturity.