Prevalencia de anticuerpos anti-Toxoplasma gondii en embarazadas en siete hospitales de Buenos Aires: Comparación entre 2006 y 2017 / Prevalence of anti-Toxoplasma gondii antibodies in pregnant women in seven hospitals in Buenos Aires area. Comparison 2006 vs. 2017

Se analizó; de forma retrospectiva la presencia de anticuerpos só;©ricos IgG e IgM anti-Toxoplasma gondii en las embarazadas que concurrieron a siete hospitales del ó;rea Metropolitana de Buenos Aires durante 2006 y 2017. La prevalencia de infecció;n, medida como presencia de anticuerpos, en 2006 vs. 2017, fue: Hospital Alemán: 22 y 17% (p = 0.004), Hospital Fiorito: 44 y 33% (p < 0.001), Hospital Gandulfo: 30 y 34% (p 0.025), Hospital Grierson: 60 y 44% (p < 0.001), Hospital Rivadavia: 59 y 51% (p=0.003), Maternidad Sardá 47 y 39% (p < 0.001) y Hospital Thompson: 61 y 51% (p < 0.001). La comparació;n demostró; una disminució;n estadísticamente significativa de la seroprevalencia en seis hos pitales. Tambín disminuyeron significativamente la reactividad para IgM en 2017 respecto de 2006 y la seroprevalencia para T. gondii en el total de la població;n de embarazadas estudiadas, lo que significa un mayor nó;ºmero de mujeres susceptible de desarrollar infecció;n aguda durante el embarazo.

We analyzed the presence of IgG and IgM anti- Toxoplasma gondii, as a measure of infection, in pregnant women attending seven hospitals in the Metropolitan Area of Buenos Aires during 2006 and 2017. T. gondii seroprevalence in 2006 vs. 2017, was: Hospital Alemán: 22 and 17% (p = 0.004), Hospital Fiorito: 44 and 33% (p < 0.001), Hospital Gandulfo: 30 and 34% (p 0.025), Hospital Grierson 60 and 44% (p < 0.001), Hospital Rivadavia: 59 and 51% (p = 0.003), Hospital Sardá: 47 and 39% (p < 0. 001), and Hospital Thompson: 61 and 51% (p < 0.001). The comparison showed a significant decrease in seroprevalence in six hospitals. We also observed a significant decrease in the reactivity for IgM in 2017 compared to 2006 and in the seroprevalence for T. gondii in the overall population of pregnant women in the study. This means that a greater number of women are susceptible to develop acute infection during pregnancy.

Serosurveillance for vaccine-preventable diseases: A look inside the pertussis experience / Serovigilancia de enfermedades prevenibles por vacunación: una mirada desde la experiencia con la tosferina

Abstract Introduction: Serological surveillance (serosurveillance) provides the most direct measure of herd immunity of vaccine-preventable diseases. Little is known about the opportunities and challenges of serosurveillance experiences, particularly pertussis. Objective: To describe the process of serosurveillance for vaccine-preventable diseases with an emphasis on the experience of pertussis in the metropolitan area of Antioquia (Valle de Aburrá) in 2015 and 2016 and analyze the contributions and challenges for its sustainability. Materials and methods: We described the planning and conduction of serosurveillance of pertussis antibodies of mothers and in the umbilical cord at the time of delivery in eight hospitals based on random sampling and their capacity to advance the serosurveillance periodically. We compared the contributions and the challenges of this experience with other probabilistic and non-probabilistic programs. Results: We achieved the participation of hospitals and mothers respecting the delivery care process. We established a serum bank following ethical and technical guidelines. This program based on the random selection of hospitals and mothers has enabled the estimation of antibodies prevalence in mothers and in the umbilical cord, which has been possible given the high coverage of hospital care during childbirth at a lower cost and fewer risks than a population-based survey in conflictive areas. The main challenges for the sustainability of this program are the creation of stable jobs and access to funding and legal and methodological long-term frameworks. Conclusions: Hospital serosurveillance as described is an option to monitor the impact of vaccination on the population. Our experience could be reproduced in other regions under similar conditions if the above-mentioned challenges are solved.

Resumen Introducción. La vigilancia serológica es la forma más directa de medir la inmunidad de rebaño frente a las enfermedades prevenibles por vacunación. Poco se sabe acerca de las oportunidades y los desafíos de las experiencias de serovigilancia, en general y, específicamente, la de la tosferina. Objetivo. Describir el proceso de serovigilancia de enfermedades prevenibles por vacunación con énfasis en la experiencia en el caso de la tosferina en el área metropolitana de Antioquia (Valle de Aburrá) en el 2015 y el 2016 y analizar lo que dicha experiencia ha aportado y los desafíos que persisten para su sostenibilidad. Materiales y métodos. Se describió el proceso de planeación y el desarrollo de la serovigilancia de tosferina en el momento del parto en ocho hospitales seleccionados al azar, así como la capacidad para adelantar el programa de manera periódica. Se compararon los aportes y los desafíos en el curso de esta experiencia con los de otros programas poblacionales probabilistas e institucionales no probabilistas. Resultados. Se logró la participación de los hospitales y de las madres con pleno respeto del proceso de atención del parto, y se conformó un banco de sueros siguiendo lineamientos éticos y técnicos. El programa permitió estimar la prevalencia de anticuerpos en la madre y en el cordón umbilical, lo que se facilitó por la alta cobertura de atención hospitalaria del parto, a un menor costo y menos riesgos que los programas poblacionales en zonas conflictivas. Los principales desafíos para la sostenibilidad del programa son la estabilidad laboral del personal de salud, así como normas y una financiación de largo plazo. Conclusiones. La serovigilancia hospitalaria es una opción para monitorizar el impacto poblacional de la vacunación. Esta experiencia se podría extender a otras regiones en condiciones similares si se resuelven los retos mencionados.

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.

Febrile neutropenia following parvovirus B19 infection and cross anti-kell reaction to E. coli in pregnancy / Infeção por parvovírus B19 causando neutropenia febril e reação cruzada anti-Kell com E. coli na gravidez

Abstract Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient's lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.

Resumo O parvovírus B19 tem tropismo para as células sanguíneas da linha vermelha, causando hidropsia imune durante a gravidez. O teste Coombs anti-Kell positivo ocorre durante a gravidez quando há produção de anticorpos contra os antígenos de Kell, mas pode haver reações cruzadas para outros antígenos. Uma grávida primigesta de etnia cigana, de 24 anos, 0 Rhesus positivo, recorreu ao hospital às 19 semanas de gestação por hipertermia isolada persistente por 2 semanas e umteste Coombs indireto positivo por anticorpos anti-Kell em testes de rotina da gravidez. O estudo analítico revelou bicitopenia com anemia ferropênica, leucopenia com neutropenia, e elevação da proteína C-reativa. A paciente foi medicada com imipenem, e teve uma recuperação clínica lenta. Foram colhidas amostras de sangue, urina e expectoração para culturas bacterianas. Na urina, foi isolada Escherichia coli, o que provavelmente causou a reação anti-Kell cruzada transitória. Na expectoração, foi isolada Haemophilus influenza, e foi confirmada seroconversão para o parvovírus B19, que causou um déficit incomum na linhagem sanguínea branca, culminando com neutropenia febril. Apesar da má adesão aos cuidados médicos, os desfechos materno e fetal/neonatal foram bons. Este é um caso de 2 fenômenos raros, uma reação cruzada anti-Kell à infecção por E. coli, e parvovírus B19 comtropismo para células brancas causando neutropenia febril, ambos ocorrendo simultaneamente durante a gravidez.

Social conditions and immune response in human immunodeficiency virus-seropositive pregnant women: a cross-sectional study in Brazil

Abstract INTRODUCTION The functioning of the immune system during pregnancy is altered in both human immunodeficiency virus (HIV)-infected and uninfected women. Unfavorable socioeconomic conditions have been indicative of higher morbidity and mortality and worsening of the immune system. The aim of this study was to correlate social status with levels of interleukin (IL)-10 (non-inflammatory) and interferon-gamma (IFN-γ; inflammatory) cytokines. METHODS A cross-sectional study was conducted with three groups of women: 33 pregnant HIV-infected (G1); 40 non-pregnant, HIV-infected (G2); and 35 pregnant, HIV-uninfected. To measure the social status, a compound indicator called the social status index (SSI), was established using sociodemographic variables (i.e., education level, housing conditions, per capita income, and habitation and sanitary conditions). RESULTS The HIV-infected women had a higher proportion of unfavorable SSI (73% and 75% of G1 and G2, respectively). There were significantly lower IL-10 levels in the G1 group with both unfavorable and favorable SSI than in the other groups. No significant difference in IFN-γ levels was observed among groups. However, the G1 group had higher IFN-γ values among both favorable and unfavorable SSI groups. CONCLUSIONS Higher rates of unfavorable conditions, including lower education levels, IL-10 levels, and a trend for higher IFN-γ levels, were identified among HIV-infected women, pregnant and non-pregnant. These factors may interfere in health care and lead to poor outcomes during pregnancy. Therefore, we suggest that health policies could be created to specifically address these factors in this population.

Immune development in HIV-exposed uninfected children born to HIV-infected women

ABSTRACT Immunological and clinical findings suggestive of some immune dysfunction have been reported among HIV-exposed uninfected (HEU) children and adolescents. Whether these defects are persistent or transitory is still unknown. HEU pediatric population at birth, 12 months, 6-12 years were evaluated in comparison to healthy age-matched HIV-unexposed controls. Plasma levels of LPS, sCD14, cytokines, lymphocyte immunophenotyping and T-cell receptor excision circles (TREC) were assessed. HEU and controls had similar LPS levels, which remained low from birth to 6-12 years; for plasma sCD14, IL-2, IL-6, IL-7, IL-10, IL-12p70, IL-13, IL-17, IFN-γ, TNF-α, G-CSF, GM-CSF and MCP-1, which increased from birth to 12 months and then decreased at 6-12 years; and for TREC/106 PBMC at birth in HEU and controls. By contrast, plasma MIP-1β levels were lower in HEU than in controls (p=0.009) at 12 months, and IL-4 levels were higher in HEU than controls (p=0.04) at 6-12 years. Immune activation was higher in HEU at 12 months and at 6-12 years than controls based on frequencies of CD38+HLA-DR+CD8+T cells (p=0.05) and of CD38+HLA-DR+CD4+T cells (p=0.006). Resting memory and activated mature B cells increased from birth to 6-12 years in both groups. The development of the immune system in vertically HEU individuals is comparable to the general population in most parameters, but subtle or transient differences exist. Their role in influencing clinical incidences in HEU is unknown.

Respuesta humoral y consecuencias reproductivas en ovejas desafiadas con Brucella ovis al final de la gestación / Immune response and reproductive consequences in experimentally infected ewes with Brucella ovis during late pregnancy

La brucelosis ovina por Brucella ovis es una enfermedad de prevalencia alta en Argentina. Para evaluar la patogenicidad de B. ovis y la respuesta serológica durante el último mes de gestación, 6 ovejas se distribuyeron en dos grupos: G1, ovejas preñadas, n = 4 y G2, ovejas no preñadas, n = 2. Tres ovejas del G1 (15 días preparto) y una del G2 fueron inoculadas con B. ovis. Se analizaron muestras de suero mediante diferentes pruebas serológicas. Se realizó aislamiento y PCR a partir de mucus cérvico-vaginal (mcv), placenta y leche. En las muestras de placenta se realizó histopatología. Las hembras del G1 parieron corderos vivos; se detectaron anticuerpos en las ovejas desafiadas del G1 a partir de los 5 días posinoculación. El mcv de las ovejas desafiadas resultó negativo al aislamiento en ambos grupos. Las muestras de leche del G1 fueron positivas por cultivo y PCR a B. ovis. La técnica de PCR resultó positiva en las placentas de las ovejas desafiadas del G1. La histopatología reveló una placentitis necrótica supurativa en una de las ovejas desafiadas. El desafío con B. ovis preparto resultó en la invasión de la placenta y de la glándula mamaria, con la consecuente excreción de la bacteria por leche. La infección con B. ovis indujo una respuesta humoral temprana en las ovejas. La colonización de la placenta por B. ovis y la excreción de la bacteria por la leche sugieren un potencial riesgo de infección activa para los corderos y la posibilidad de que estos se comporten como portadores latentes de la infección.

Ovine brucellosis by Brucella ovis is a highly prevalent disease in Argentina. This study aimed to evaluate the pathogenicity of B. ovis and the serological response in ewes during late pregnancy and in their offspring. Six adult ewes were distributed in two groupsGI (pregnant females, n = 4) and G2 (nonpregnant females, n = 2). Three pregnant ewes at 15 days prepartum and one nonpregnant eve were inoculated with B. ovis. Sera of sheep and their offspring were analyzed by different serological tests. Samples of cervicovaginal mucus, placenta and milk were studied by bacteriology. A Brucella genus-specific PCR assay was carried out in placenta and milk samples. Placenta samples were hystopathologically processed. G1 females gave birth to live lambs, but one died hours postpartum. Serological techniques employed detected antibodies in serum of inoculated pregnant animal 5 days postchallenge. Sera of female controls G1 and G2 remained negative throughout the study. Cervicovaginal mucus of infected ewes in G1 and G2 yielded negative results to bacteriology, but B. ovis was isolated from milk. The PCR assay was positive for the placenta and milk from inoculated pregnant ewes. Histopathology revealed necrotic suppurative placentitis in one placenta. However, although results demonstrated that B. ovis can invade the placenta and mammary gland, this bacterium did not cause abortion when it was inoculated intravenously at 15 days prepartum. B. ovis infection induced an early humoral response in pregnant ewes, but their lambs remained seronegative, indicating that there was no transfer of antibodies in infancy. Placenta colonization and milk excretion of B. ovis involves a potential source of infection for lambs, which could play a role as latent carriers of infection.

Toxoplasma gondii antibody profile in HIV-1-infected and uninfected pregnant women and the impact on congenital toxoplasmosis diagnosis in Rio de Janeiro, Brazil

OBJECTIVE: Compare the anti-T. gondii IgG titer between HIV-1 infected and non HIV-1 infected pregnant women and report three cases of congenital toxoplasmosis resulting from reactivation of infection during pregnancy of HIV-1 infected women. METHODS: This study was conducted among 2,270 pregnant women with chronic Toxoplasma gondii infection (absence of IgM and presence of IgG), including 82 HIV-1 infected and 2,188 non-infected women. RESULTS: The average anti-T. gondii IgG titer was 127 for the 2,188 non-HIV-1 infected women, and 227 for the 82 HIV-1-infected women (p = 0,007). These results suggested that higher anti-T. gondii IgG titers in HIV-1-infected pregnant women may not be indicative of an elevated risk for fetal infection. In this study three cases of congenital toxoplasmosis that resulted from infection reactivation during pregnancy of HIV-1-infected women were manifested by fetal death, symptomatic infection, and infant without symptoms, respectively. In two of these women, a ten-fold increase in IgG levels above used cutoff was observed (2,320 UI/mL and 3,613 UI/mL, respectively). In the third pregnant women anti-T. gondii IgG titers during pregnancy did not rise despite the occurrence of congenital toxoplasmosis (204; 198; 172 UI/mL). CONCLUSIONS: Congenital toxoplasmosis resulting reactivation of infection during pregnancy in the studied group leads us to believe that it is a public health problem, especially in our population, in which seroprevalence of T. gondii infections is high. These findings also suggest that special attention is necessary during pregnancy, because the serologic diagnosis may not be indicative of toxoplasmosis reactivation.

Implicações da influenza A/H1N1 no período gestacional / Implications of H1N1 influenza during pregnancy

Objetivos: Revisar os possíveis fatores apresentados na literatura para a grande morbidade e mortalidade entre as gestantes, quando acometidas pelo A/H1N1.Fonte de dados: A pesquisa bibliográfica foi realizada utilizando-se os bancos de dados Medline/PubMed, SciELOe LILACS, utilizando-se os descritores gravidez, sistema imunológico, vírus da influenza A, subtipo H1N1 e fatores de risco, delimitando-se o período de 1996 a 2011.Síntese dos dados: A gripe A/H1N1, causada por um vírus influenza, surgiu em 2009 no México e rapidamente se disseminou pelo Mundo. Essa epidemia resultou em diversos casos de síndrome respiratória aguda grave e em um número significativo de mortes. O vírus influenza A/H1N1 acometeu de forma mais severa os integrantes de grupos de risco, como gestantes, crianças menores de dois anos, idosos acima de 60 anos, imunossuprimidos e portadores de comorbidades crônicas. As particularidades da gestação, como mudanças imunológicas, anatômicas e funcionais, expõem as mulheres grávidas a um maior risco de complicações respiratórias e cardíacas graves, que podem levar a óbito.Conclusões: Os estudos apontam que os possíveis fatores de morbidade e mortalidade entre gestantes acometidas pelo vírus influenza A/H1N1 foram síndrome de desconforto respiratório do adulto, embolia pulmonar, edema pulmonar, pneumonia bacteriana secundária e insuficiência renal. Além disso, as complicações durante a gravidez tendem a acontecer mais no segundo e terceiro trimestre. Medidas preventivas e um adequado tratamento provavelmente diminuirão o número de casos futuros de influenza pandêmica A/H1N1.

Aims: to review the possible factors presented in the literature for the high morbidity and mortality among pregnant women, when affected by the influenza A (H1N1) virus.Source of data: A literature search was performed using the databases Medline/PubMed, SciELO and LILACS, using the key words pregnancy, immune system, influenza A virus subtype H1N1 and risk factors, delimited to the period 1996 to 2011.Summary of findings: the A/H1N1 influenza is caused by an influenza virus emerged in Mexico in 2009 and quicklyspread throughout the world. this epidemic resulted in several cases of severe acute respiratory syndrome and a significant number of deaths. the H1N1 influenza virus more severely struck the members of risk groups such as pregnant women, children under two years, elderly over 60 years, immunocompromised patients and those with chronic comorbidities. the particular conditions of pregnancy such as immunological, anatomical and functional changes, expose pregnant women toan increased risk of serious cardiac and respiratory complications, which can lead to death.Conclusions: Studies indicate that the possible factors of morbidity and mortality among pregnant women affected by the influenza virus A/H1N1 were: respiratory distress syndrome in adults, pulmonary embolism, pulmonary edema,secondary bacterial pneumonia and renal failure. In addition, complications during pregnancy tend to occur more in the second and third trimester. Preventive measures and adequate treatment are likely to decrease the number of future casesof influenza A/H1N1.

Seroprevalencia de IgG contra Rubeola en mujeres entre 10-49 años, en Cartagena, Colombia / The seroprevalence IgG antibodies against rubella (German measles) in 10-49 year-old women from Cartagena, Colombia

Objetivo Determinar la seroprevalencia de Inmunoglobulina G (IgG) contra Virus de la Rubéola (VR) en Cartagena y si las metas de cobertura en inmunización contra VR han sido alcanzadas. Métodos Se desarrolló un estudio transversal, durante 2009. Se incluyeron mujeres entre 10-49 años de edad. Los individuos fueron seleccionados aleatoriamente. Las variables socio-demográficas fueron registradas por entrevista directa. La IgG contra VR fue detectada mediante ELISA. Para analizar diferencias entre grupos se emplearon la prueba exacta de Fisher y X2. Se aplicó un modelo de regresión logística para correlacionar variables. Resultados Se analizaron 1 528 muestras. El 93 por ciento (n=1 422) de la población fue seropositiva. Las mujeres entre 10-14 años reportaron un menor nivel de seropositividad en relación con el resto de la población. Las diferencias entre proporciones de seroprevalencia fueron estadísticamente significativas en los rangos de edad (p<0,001) y la ocupación (p=0,042). Las mujeres entre 10-14 años reportaron riesgo elevado para seronegatividad (OR=0,27, p<0,001). Conclusiones Las metas de seroprevalencia contra VR no han sido alcanzadas en Cartagena y nuevos casos de Rubéola o Síndrome de Rubéola Congénita podrían presentarse en el Distrito. Estos hallazgos revelan que no hubo progreso significativo desde 2006, cuando el porcentaje de cobertura en vacunación contra VR oscilaba entre 90-95 por ciento. El alto riesgo en el grupo de 10-14 años sugiere falencias en la administración de las dosis iniciales en el esquema de vacunación.

Objective Determining immunoglobulin G (IgG) against the rubella virus (RV) causing German measles in Cartagena and whether vaccination goals against German measles have been achieved. Methods A cross-sectional study was carried out during 2009; females aged 10-49 years were included. Selection was randomised. Socio-demographic variables were recorded in face-to-face interviews. IgG against RV was detected by ELISA. X2 and Fisher's exact tests were used for comparing variables. A logistic regression model was used for correlating data. Results A total of 1,528 serum samples were analysed; 93 percent (n=1,422) were seropositive. The lowest seropositivity was reported in girls aged 10-14. Differences regarding seroprevalence percentages were statistically significant between age ranges (p<0.001) and employment (p=0.042). A high risk of seronegativity was reported for girls aged 10-14 (OR=0.27; p<0.001). Conclusions Seroprevalence goals against RV had not been reached in Cartagena and new cases of rubella (German measles) or congenital rubella (German measles)syndrome are still possible in the area. These findings revealed that no significant progress had been made since 2006 when German measles vaccine coverage was 90 percent-95 percent. High risk in girls aged 10-14 suggests that the local immunisation programme fails in MMR vaccine administration.

Parvovirus B19 antibodies and correlates of infection in pregnant women attending an antenatal clinic in central Nigeria

Human parvovirus B19 infection is associated with spontaneous abortion, hydrops foetalis, intrauterine foetal death, erythema infectiosum (5th disease), aplastic crisis and acute symmetric polyarthropathy. However, data concerning Nigerian patients with B19 infection have not been published yet. The purpose of this study was to establish the prevalence of B19 IgG and IgM antibodies, including correlates of infection, among pregnant women attending an antenatal clinic in Nigeria. Subsequent to clearance from an ethical committee, blood samples were collected between August-November 2008 from 273 pregnant women between the ages of 15-40 years who have given their informed consent and completed self-administered questionnaires. Recombinant IgG and IgM enzyme linked immunosorbent assay kits (Demeditec Diagnostics, Germany) were used for the assays. Out of the 273 participants, 111 (40.7 percent) had either IgG or IgM antibodies. Out of these, 75 (27.5 percent) had IgG antibodies whereas 36 (13.2 percent) had IgM antibodies, and those aged 36-40 years had the highest prevalence of IgG antibodies. Significant determinants of infection (p < 0.05) included the receipt of a blood transfusion, occupation and the presence of a large number of children in the household. Our findings have important implications for transfusion and foeto-maternal health policy in Nigeria. Routine screening for B19 IgM antibodies and accompanying clinical management of positive cases should be made mandatory for all Nigerian blood donors and women of childbearing age.

Hepatites virais e gestação

As seis formas de hepatites virais constituem uma relativamente comum e bastante séria infecção que poderá atingir as gestantes,condicionando danos a elas e seriamente comprometendo todo o evoluir da gravidez.Os quadros de hepatite aguda na gestação necessitam internação hospitalar se existir algum sinal de encefalopatia aguda, coagulopatia ou grave debilidade devido a má-nutrição.Nessas eventualidades pode haver necessidade de reposição de sangue e fatores da coagulação sanguínea,tais como plasma fresco criocipitados.Aproximadamente 10% a 20% das mulheres que são soropositivas para o HBsAg podem transmitir aos seus fetos o HBV e,entre as pacientes que são positivas para o HBsAg e HBeAg,a possibilidade de transmissão atinge os 90%.A vacinação de recém-nascidos de mães soropositivas é indicada.Há risco de transmição de hepatite intraparto.

Seroprevalence of subclinical HEV infection in pregnant women from north India: A hospital based study.

Background & objectives: Hepatitis E virus (HEV) is a major public health problem in the developing countries. HEV infection in pregnant women is more common and fatal in the third trimester. The mortality rate due to HEV-induced hepatitis is as high as 15-20 per cent. The present study was designed to determine the seroprevalence of subclinical HEV infection in pregnant primigravidae women. Methods: A total of 300 asymptomatic healthy primigravidae (gestational age 16-24 wk) with no history of jaundice were included in the study. Prevalence of anti-HEV antibodies was determined by an enzyme linked immunosorbent assay (ELISA) kit. Results: The overall prevalence of seropositive HEV IgG was 33.67 per cent among the pregnant women. The seropositivity of HEV IgG was significantly high in urban population (P<0.05), and related with the period of settlement (P<0.05) and source of water (P=0.05). Low socio-economic status of the pregnant women appeared to be the only risk factor (OR=1.96, CI=1.17-3.28) associated with HEV IgG antibody. Interpretation & conclusions: In the present study, exposure to HEV during pregnancy was higher in urban (slum areas) than rural population. Socio-economic status was a risk factor for anti-HEV IgG in pregnant women. Early preventive measures if taken, may decrease the maternal and perinatal mortality and morbidity of HEV infection.

Congenital rubella syndrome after rubella vaccination in 1-4 weeks periconceptional period.

OBJECTIVE: To examine weather exposure to rubella vaccine during 1-4 wk periconceptional period can cause congenital rubella syndrome (CRS). METHODS: This prospective study was performed in 60 pregnant women who received rubella vaccine inadvertently 1-4 wk pre or post conception. Time of conception was determined by last menstrual period (LMP) and first trimester sonography. In addition to gathering mother's obstetric and demographic information, all neonates were evaluated for CRS signs by systemic physical examination and anti rubella IgG and IgM antibody titers in cord blood samples. RESULTS: A total of 60 pregnant women with the median gestational age of 38 weeks were studied. The mean maternal age was 22 years and 58.3% of pregnancies were unintended. In 90% of mothers there were no post vaccination side effects (fever, lymphadenopathy, arthritis, arthralgia). None of the mothers had a history of drug abuse, smoking or teratogenic exposures. Mean neonatal weight was 3100grs and 6.7% of them were premature. No signs of CRS were found in the neonates based on systemic physical exam at birth and one month later. Mean value of cord blood anti rubella IgG titere was 148/28+/-67/26 lu/ml. cord blood anti rubella IgM was negative in all of the neonates. CONCLUSION: In this study inadvertent rubella vaccination 1-4 wk before and after conception did not cause CRS in neonates and according to all reasearches pregnancy termination is not indicated in these cases.

Immunological response in cases of complicated and uncomplicated bartonellosis during pregnancy

Bartonellosis (Carrion's Disease) during pregnancy is associated with high rates of maternal and perinatal mortality. We report the immunological patterns in two cases of human bartonellosis during pregnancy. One patient had an uncomplicated course while the second patient developed life threatening anasarca and cardiac tamponade. The patient with a complicated course had a Th1 response with a higher elevation of IL-10. This elevation has been associated with poor outcome pregnancies during bacterial infections.

Bartonelosis (Enfermedad de Carrión) durante el embarazo esta asociado a una alta tasa de mortalidad maternal y perinatal. Reportamos el perfil inmunológico de dos casos de Bartonelosis humana en el embarazo. Una paciente tuvo un curso sin complicaciones, mientras la segunda presento complicaciones severas de anasarca y tamponamiento cardiaco. La paciente con curso complicado tuvo un patrón de repuesta Th1, con una elevación de IL-10, que se ha asociado a mal pronóstico en infecciones durante embarazo.

Vacinação em situações especiais / Vaccination in special situations

OBJETIVOS: Revisar a indicação, contra-indicação e eficácia da vacinação em algumas situações especiais: imunossupressão, prematuridade, gestação e pós-exposição. FONTES DOS DADOS: Revisão sistemática dos artigos sobre o tema publicado nas 2 últimas décadas pesquisados nas bases de dados MEDLINE, SciELO e Lilacs. Consulta às normas do Programa Nacional de Imunização, Brasil, 2001 a 2004, e normas do Programa Nacional de DST/AIDS, Brasil, 2004. Consulta aos temas livres publicados em anais de congressos internacionais e nacionais de pediatria e doenças infecciosas, nos últimos 5 anos. SíNTESE DOS DADOS: Algumas situações especiais, como imunossupressão, prematuridade, gestação e exposição às doenças infecciosas, colocam os indivíduos em maior risco de adoecer ou apresentar eventos adversos pós-vacinais. Essas situações requerem esquemas vacinais diferenciados, podem indicar adiamento da vacinação e mesmo contra-indicá-la. De modo geral, as vacinas inativadas, ou de toxóides, podem ser aplicadas, levando-se sempre em consideração a possibilidade de resposta imunogênica insuficiente. Para indivíduos imunossuprimidos, as vacinas de vírus e bactérias vivos devem ser evitadas devido ao risco de disseminação do agente vacinal. O cuidado na imunização deve incluir não só o paciente, mas seus contatos no domicílio, creche, etc. CONCLUSÕES: Esquemas adequados para cada uma dessas situações aumentam a possibilidade de obter melhor proteção vacinal e diminuem o risco de eventos adversos indesejáveis. Após exposição às doenças infecciosas, indivíduos imunodeficientes ou imunossuprimidos que não tiveram os títulos de anticorpos pós-vacinais avaliados devem ser considerados não protegidos, e medidas profiláticas disponíveis, incluindo imunização passiva, devem ser aplicadas, mesmo para aqueles previamente vacinados.

Estatus inmunológico de las madres infectadas por T. cruzi / Immunological status of mothers infected with Trypanosoma cruzi

The mechanisms of congenital transmission of Chagas disease remain largely unknown. To better understand the role of maternal immunology during pregnancy in congenital Chagas transmission, we studied the cytokine production and the parasitic load in three groups of mothers: infected mothers who transmitted the disease to their babies (M+B+-), infected mothers who did not transmit the disease to their babies (M+B-) and not infected mothers as a control group (M-B-). M+B+ mothers produced less IFNgamma and more IL-10 than the M+B- mothers, and they are not able to produce IL-2. M+B+ mothers showed a higher parasitic load. These results, indicated that the congenital Chagas transmission is associated with an immunological imbalance and a high parasitic load in the M+B+ mothers.

HIV-1: maternal prognosis

Atualmente, dentro do contexto epidêmico da AIDS observam-se profundas modificações no perfil dos pacientes acometidos, especialmente traduzida pela pauperização e feminilização. A população mais afetada encontra-se em idade reprodutiva e entre adultos de 18 a 24 anos, a relação é de 1 homem para 1 mulher, o que ocorre indiscriminadamente como fenômeno global. Um dos maiores desafios para as gestantes portadoras do HIV-1 e seus médicos assistentes é a repercussão advinda da interação entre a infecção pelo HIV e a gestação. Esse artigo é uma revisão de literatura e tem por objetivos avaliar a influência da infecção pelo HIV-1 sob a perspectiva materna tecendo considerações sobre a função imunológica, o prognóstico materno e a interface HIV e abortamento. Até o presente, não se pode concluir que a gestação tenha, a curto prazo, um efeito norteador da evolução da infecção pelo HIV, porém a concomitância HIV e gestação pode adversamente afetar o prognóstico gestacional, especialmente face à freqüente associação com acréscimo nos índices de aborto e morbidade puerperal.

Who is at high risk? A comparison of the seroprevalence of human immunodeficiency virus in pregnant women and a high risk group

To compare the seroprevalence of HIV in Jamaican pregnant women with that in substance abusers, two groups of antenatal patients were studied, one (A) attending a public hospital clinic and the other (B) attending private clinics. The HIV seroprevalence in the antenatal patients was compared with that in the substance abusers, group C, in 1996 and five years later in 2001. HIV antibody was determined by enzyme immunoassay. The HIV seroprevalence in group A more than doubled (1.6-3.8) in five-years, 1996-2001. There were no seropositives in group B. In group C, the seroprevalence rose from 2.08 in 1996 to 5.76 in 2001. There was indication that group A might no longer be considered [quot ]low risk[quot ], as there was no significant difference from group C in HIV seroprevalence in 1996 and 2001. The trend seen in this study is worthy of further investigation