The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes.

Maternal infection by Leishmania braziliensis in hamster does not influence the course of disease in progeny / A infecção materna por Leishmania braziliensis em hamster não influencia o curso da doença na prole

Introduction: Immunoglobulins, soluble antigens, cells, cytokines and other immune system products can be transferred from infected mother to her offspring, leading to suppression or stimulation of immune response. Objective: To evaluate the influence of gender and maternal infection with Leishmania braziliensis in the course of the disease in the offspring of hamsters. Methods: Offspring born from infected mother (IMO) or non-infected mother (NIMO) by Leishmania braziliensis, both sexes, was infected with the same strain of the mother after 30 days of life and followed for 18 weeks. We evaluated the thickness of the lesion, parasite load and histology of the lesions. Results: The number of parasite in both lesions and lymph node of IMO offspring showed a significant reduction in the 5th week post-infection compared to the NIMO offspring; however, this did not correspond to clinical symptoms. Histopathological analysis revealed that in the IMO offspring, the inflammatory process was more prominent. In relation to gender, it was observed that the male offspring showed lesion thickness and higher parasite burden than females. Conclusion: Maternal infection by L. braziliensis in hamsters does not appear to influence the course of the disease in the homologous offspring infection, as well as the male offspring presented augmented susceptibility to L. braziliensis infection regardless of whether they were born from IMO or NIMO. Also, the reduction of the granuloma index in the IMO offspring, together with the higher inflammatory response, suggests a less effective cellular response in the chronic phase of the disease in these animals. (AU)

Introdução: Imunoglobulinas, antígenos solúveis, células, citocinas e outros produtos do sistema imune podem ser transferidos de mãe infectada para a sua prole, levando à supressão ou estimulação da resposta imune. Objetivo: Avaliar a influência do gênero e a infecção materna por Leishmania braziliensis no curso da doença na prole de hamsters. Métodos: Filhotes nascidos de mãe infectada (MI) e mãe não infectada (MNI) por L. braziliensis, ambos os sexos, foram infectados com a mesma cepa da mãe após 30 dias de vida e acompanhados por 18 semanas. Avaliou-se a espessura da lesão, a carga parasitária e os aspectos histopatológicos das lesões. Resultados: A carga parasitária (lesões e linfonodo de drenagem das lesões) da prole nascida de MI mostrou diminuição significativa na 5a semana pós-infecção, comparada àquela nascida de MNI, no entanto, esta diminuição não correspondeu aos sintomas clínicos. A análise histopatológica revelou que na prole nascida de MI, o processo inflamatório mostrou-se mais proeminente. Em relação ao gênero observou-se que os filhotes machos apresentaram espessura das lesões e carga parasitária maiores do que as fêmeas. Conclusão: A infecção materna por L. braziliensis parece não influenciar o curso da doença na infecção homóloga da prole, bem como os filhotes machos apresentaram aumentada susceptibilidade à infecção por L. braziliensis, independente se eles nasceram de MI ou MNI. Além disso, a redução no index de granulomas na prole nascida de MI, em conjunto com a maior resposta inflamatória, sugere uma resposta celular menos efetiva na fase crônica da doença nestes animais. (AU)

Sífilis congenita presentación de un caso clínico radiológico / Congenital syphilis radiological presentation of a clinical case

La sífilis congénita tiene origen en la infección materna y se debe a la transmisión que sufre el feto por vía transplacentaria durante el embarazo. En paises subdesarrollados se puede mencionar como factor de riesgo la ausencia de un diagnóstico precoz en los controles prenatales y la poca información sobre todo en las madres adolescentes hacia esta enfermedad, la misma que avanza hacia la muerte in útero del feto, o al nacimiento con múltiples alteraciones del recien nacido. Se presenta el caso de un neonato cuya madre infectada no recibio tratamiento y posterior al nacimiento el neonato presentó clínica significativa por lo que se le realizaron una serie de exámenes, dentro de los que destacan los radiológicos en huesos largos, donde se advierten alteraciones típicas de esta enfermedad.

Congenital syphilis originates by maternal infection and is due to the transplacental transmission which the fetus suffers during pregnancy. In underdeveloped countries, the absence of an early diagnostic test during prenatal care has to be mentioned as a risk factor as well as the poor information on this disease that exists among mothers, especially teenage mothers. Due to these facts the progression of the disease frequently leads to death in uterus of the fetus or to multiple birth defects when the baby is born.We present the case of a newborn baby whose infected mother was not treated, and who after birth presented important clinical signs due to which a series of tests were carried out among which the radiology of the long bones stands out where the typical alterations of the disease are seen.