Zika como causa de aborto espontáneo en zonas endémicas / Zika as a cause of spontaneous abortion in endemic areas

Resumen Introducción: Aunque en la mayoría de los casos la infección por el virus del Zika (ZIKV) causa enfermedad febril sin complicaciones, en mujeres embarazadas es causa reconocida de alteraciones congénitas y muerte fetal. La microcefalia es la característica descrita con mayor frecuencia en el síndrome congénito por este virus. Caso clínico: Paciente de sexo femenino de 23 años de edad que cursaba la novena semana de gestación (SDG) por la fecha de la última menstruación y la 10.3 SDG por ultrasonido. Acudió a los servicios de salud por presentar un cuadro clínico compatible con infección por el ZIKV, la cual se confirmó por estudios de laboratorio. A las 18.6 SDG se documentó feto único sin movimientos, con datos de microcefalia, tórax con área cardiaca sin actividad, placenta corporal anterior con calcificación en el 30% e imagen probable de lago venoso versus quiste placentario. La paciente ingresó en urgencias por aborto diferido. Se indujo el trabajo de parto y se obtuvo por vía vaginal un producto masculino de 80 g, con perímetro cefálico de 9 cm. El análisis del cordón umbilical por la reacción en cadena de la polimerasa con retrotranscriptasa confirmó el diagnóstico de síndrome congénito por ZIKV. Conclusiones: Durante el embarazo debe sospecharse la infección por ZIKV para realizar un diagnóstico oportuno y ofrecer una atención integral. La pérdida del producto de la concepción en estas pacientes se ha documentado, y se ha encontrado ARN del ZIKV en las biopsias de las vellosidades coriónicas, lo que podría sugerir el aborto espontáneo de manera temprana durante la viremia.

Abstract Background: Although in most cases Zika is an uncomplicated febrile disease, in pregnant women is a recognized cause of congenital disorders. Microcephaly is the characteristic most frequently described in the congenital Zika virus syndrome, and the diagnosis requires laboratory confirmation. Case report: A 23-year-old female on the ninth week of pregnancy by date of last menstrual period and 10.3 weeks by ultrasound, attended to Health Services, presenting clinical manifestations of Zika infection, which was later confirmed by laboratory tests. In her 18.6 weeks of pregnancy, a non-mobile single fetus was documented. Additional findings were microcephaly, lack of thorax with cardiac activity, anterior corporal placenta with 30% calcification, and an image of probable venous lake versus placental cyst. She was admitted to the emergency room for late abortion and labor was induced, obtaining an 80 g male product with head circumference of 9 cm. Reverse transcription polymerase chain reaction analysis on the umbilical cord was positive for Zika virus. Conclusions: Zika infection during pregnancy must be suspected and diagnosed promptly to offer comprehensive care. The loss of conception in these patients has been documented with results of chorionic villus biopsies, finding Zika virus RNA and suggesting spontaneous abortion early during viremia.

Abortion in cases of zika virus congenital infection / Aborto nos casos de infecção congênita pelo vírus Zika

Abstract The emergency in international public health caused by the Zika virus gave rise to the discussion about abortion in cases of congenital Zika virus syndrome (CZS). Therefore, we propose to carry out a bibliographic review on abortion in these cases. Five databases were searched using the following terms: abortion, miscarriage, and zika, with the interposition of the Boolean operator "AND." In the selected literature, we found references to the lack of information concerning the risks and severity of CZS, to the great psychological distress suffered by pregnant women, and to the risk of unsafe abortions as a justification for abortion in cases of CZS. However, it is necessary to have available tests that could diagnose, in the first trimester of pregnancy, that the fetus has been affected by the virus, and that it may have important limitations, in order to subsidize the qualified discussion about abortion in these cases.

Resumo A emergência provocada na saúde pública internacional por causa do vírus Zika trouxe à tona a discussão do aborto em casos de síndrome congênita de Zika. Portanto, propomos a realização de uma revisão bibliográfica sobre o aborto nesses casos. Foram pesquisados cinco bancos de dados utilizando os seguintes termos: aborto, aborto espontâneo, e zika, com interposição do operador booleano "E". Na literatura selecionada, encontramos referências à falta de informações sobre os riscos e a gravidade da síndrome congénita de Zika, bemcomo ao grande sofrimento psicológico de mulheres grávidas e ao risco de aborto inseguro como justificativa para o aborto em casos de síndrome congênita de Zika. No entanto, é necessário ter testes disponíveis que possam diagnosticar, no primeiro trimestre da gravidez, que o feto foi afetada pelo vírus, e que ele pode ter limitações importantes, para subsidiar a discussão qualificada sobre o aborto nesses casos.

Seroprevalencia contra agentes ToRCH en mujeres indígenas en edad fértil, estado Zulia, Venezuela / Prevalence of infectious agents in indigenous women of childbearing age in Venezuela

Introducción. El termino ToRCH comprende a los patógenos Toxoplasma gondii, virus de la rubéola, citomegalovirus y virus herpes simple 1 y 2. En mujeres embarazadas expuestas pueden ser causa de abortos y malformaciones congénitas en el neonato. Objetivo. Determinar la seroprevalencia de infección por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de algunas comunidades indígenas yukpa de Venezuela. Materiales y métodos. En el año 2007 fueron seleccionadas 109 muestras de 151 mujeres, en edades comprendidas entre 14 y 40 años. La detección de anticuerpos se hizo por el método de inmunoensayo enzimático indirecto o ELISA de Smartest Diagnostics™. Resultados. El 85,5 % presentó anticuerpos contra T. gondii, el 95,4 % para rubéola, el 75,2 % para citomegalovirus y el 97,2 % para el virus herpes simple 1 y 2. Se observa que el 21,1 % y el 30,2 % presentaron relación entre la variable aborto y las infecciones por citomegalovirus y virus herpes simple 1 y 2, respectivamente. Conclusiones. Existe alta seroprevalencia de infecciones por los agentes causantes del síndrome ToRCH en mujeres en edad fértil de la etnia indígena yukpa. Las condiciones sanitarias precarias y el consumo de agua contaminada con ooquistes, favorecen la adquisición de la infección por T. gondii. El hacinamiento, el inicio a temprana de edad de la actividad sexual y el número de parejas, pueden incidir en la presencia de citomegalovirus y virus herpes simple 1 y 2.

Introduction. The ToRCH syndrome includes the following infectious pathogens: Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus 1 and 2. In susceptible pregnant women, these pathogens can cause abortions and congenital malformation in the newborn babies. Objective. The seroprevalence of infection by ToRCH agents was determined in women of childbearing age in several Venezuelan Yukpa indigenous communities. Material and methods. In 2007, 109 samples were selected from 151 women with an age range of 14 to 40 years old. The determination of antibodies against ToRCH agents was carried out through the indirect enzyme immunoassay technique by ELISA´s technique of Smartest Diagnostics. Results. Of the 109 samples, 85.5% presented antibodies against T. gondii, 95.4% for rubella, 75.2% for cytomegalovirus and 97.2% for and herpes simplex virus 1 and 2. A relationship between abortion and infection by cytomegalovirus and herpes simplex virus 1and 2 was noted in 21.1% and 30.2% of women presented, respectively. Conclusions. The findings show a high prevalence of ToRCH agents in women in childbearing age in Yukpa indigenous communities in Venezuela. Poor sanitary conditions and consumption of water contaminated with oocysts may be an important way of transmission of T. gondii. Overcrowding in the communities, sexual activity at an early age and number of partners and may be related to the presence of cytomegalovirus and herpes simplex virus HSV-1 and 2.

Detection of Antibodies against hepatitis C virus in serum from Sudanese aborted women

This study was carried out to identify hepatitis type C in aborted women in Khartoum state. Eighty two [82] samples of blood serum of aborted women at last month of delivery were collected from Maternity Hospital, located at Omdurman, Khartoum state, during November and December 2009. Samples were collected in sterile containers and then transported to be diagnosed in the laboratory. Samples were preserved in refrigerator at -4c before use. The samples were checked to detect the Anti IgG for hepatitis C in serum of aborted women by using ELISA test. The test showed that one of these samples is positive [0.82%] and the rest of the 81 samples were negative. The study remarked that frequency of hepatitis C is rather low in Khartoum state among aborted women