Monkeypox infection and pregnancy in lower and middle-income countries: Precautions & recommendations.

Monkeypox (MPX), an orthopoxviral disease endemic in Africa, is now a public health emergency of international concern (PHEIC) as declared by the World Health Organization in July 2023. Although it is generally mild, the overall case fatality rate was reported to be 3%, and the basic reproduction number (R0) is > 1 in men who have sex with men (MSM, i.e., Portugal (1.4), the United Kingdom (1.6), and Spain (1.8)). However, R0 is < 1 in other settings. In concordance with the smallpox virus, it is also expected to increase the risk of adverse outcomes for both the mother and the fetus. The outcomes of the disease in an immunocompromised state of pregnancy are scary, showing high mortality and morbidity of both mother and fetus, with up to a 75% risk of fetal side effects and a 25% risk of severe maternal diseases. Therefore, it warrants timely diagnosis and intervention. The reverse transcription polymerase chain reaction (RT PCR) test is the standard approach to diagnosis. We summarized the recent findings of MPX on pregnancy, and the associated risk factors. We also give recommendations for active fetal surveillance, perinatal care, and good reporting to improve outcomes. The available vaccines have shown promise for primary disease prevention.

Clinical aspects of co-infection by HIV and syphilis in pregnancy and exposure in newborn intended at Pediatric Hospital of Santa Catarina / Aspectos clínicos da coinfecção por HIV e sífilis na gestação e da exposição de recém-nascidos atendidos em Hospital Pediátrico de Santa Catarina

Introduction: Sexually transmitted infections frequently affect pregnant women and, consequently, newborns. HIV and syphilis are vertically transmitted to children and co-infection requires special attention due to its clinical implications. Objective: To describe clinical aspects of HIV/syphilis coinfection during pregnancy and the exposure of newborns to infections treated at a pediatric reference hospital in Santa Catarina between 2015 and 2020. Methods: Observational, descriptive study, secondary to a line of research "Epidemiological description of children exposed to HIV" from January 2015 to December 2020 in a tertiary pediatric hospital in Santa Catarina. Results: 678 medical records were analyzed with ICD Z.206 (contact with and exposure to HIV), in which 71 (10.5%) newborns were exposed to HIV and Syphilis co-infection. Of these, 37 (52.1%) were male, 14 (19.7%) confirmed a diagnosis of HIV and 30 (42.2%) of congenital syphilis. Of the co-infected pregnant women, 38 (53.5%) were diagnosed with HIV prior to pregnancy, 53 (74.6%) used ART and 40 (52.1%) used harmful substances. Furthermore, 34 (46.4%) pregnant women had a minimum number of 6 prenatal consultations, 35 (49.3%) had vaginal births and 29 (40.8%) had undetectable HIV RNA quantification at the time of delivery. HIV prophylaxis for newborns occurred in 66 (92.9%) of cases. Conclusion: It is concluded that the studied population was mostly made up of pregnant women who were diagnosed with HIV infection prior to pregnancy. Of these, the majority were using ART, but the minority carried out the minimum number of consultations recommended by the Ministry of Health. Regarding newborns, the majority received HIV prophylaxis. (AU)

Introdução: As infecções sexualmente transmissíveis afetam frequentemente gestantes e, consequentemente, os recém-nascidos (RN). O vírus da imunodeficiência humana (HIV) e a sífilis são transmitidos verticalmente para as crianças e a coinfecção requer atenção especial por suas implicações clínicas. Objetivo: Descrever aspectos clínicos da coinfecção HIV/sífilis na gestação e da exposição de RN às infecções atendidos em um hospital de referência pediátrica em Santa Catarina entre 2015 e 2020. Métodos: Estudo observacional, descritivo, secundário à linha de pesquisa "Descrição epidemiológica de crianças expostas ao HIV" no período de janeiro de 2015 a dezembro de 2020, em um hospital pediátrico terciário de Santa Catarina. Resultados: Foram analisados 678 prontuários com Classificação Internacional de Doenças ­ CID Z.206 (contato com e exposição ao HIV), nos quais 71 (10,5%) RN foram expostos à coinfecção HIV e sífilis. Destes, 37 (52,1%) eram do sexo masculino, 14 (19,7%) confirmaram diagnóstico de HIV e 30 (42,2%) de sífilis congênita. Das gestantes coinfectadas, 38 (53,5%) possuíam diagnóstico do HIV prévio à gestação, 53 (74,6%) usaram terapia antirretroviral (TARV) e 40 (52,1%) utilizaram substâncias nocivas. Ainda, 34 (46,4%) gestantes obtiveram o número mínimo de seis consultas pré-natais, 35 (49,3%) realizaram partos vaginais e 29 (40,8%) possuíam quantificação RNA-HIV não detectável no momento do parto. A profilaxia para o HIV do RN ocorreu em 66 (92,9%) dos casos. Conclusão: Conclui-se que a população estudada foi formada, na sua maioria, por gestantes que receberam o diagnóstico de infecção pelo vírus do HIV prévio à gestação. Destas, a maioria estava em uso de TARV, porém a minoria realizou o número mínimo de consultas preconizadas pelo Ministério da Saúde. Com relação aos RN, a maioria recebeu profilaxia ao HIV. (AU)

Avaliação normativa do atendimento obstétrico emergencial na prevenção da COVID-19 / Evaluación normativa de la asistencia obstétrica de emergencia en la prevención de COVID-19 / Normative evaluation of emergency obstetric care in the prevention of COVID-19

Resumo Objetivo Avaliar a estrutura e o fluxo assistencial do acolhimento - classificação de risco e emergência obstétrica em uma maternidade pública no contexto da COVID-19. Métodos Estudo do tipo avaliação normativa e observacional nos setores de Acolhimento (Classificação de Risco e Emergência Obstétrica) de uma maternidade pública no Rio de Janeiro. A coleta de dados foi realizada de junho a agosto de 2020 por 480 horas de observação direta não participante, com registros sistematizados em checklist contendo variáveis relacionadas à disponibilidade e conformidade dos recursos estruturais, e à conformidade do fluxo assistencial. Os dados foram organizados em planilhas (Microsoft Excel® 2010) e analisados usando a estatística descritiva. Resultados A avaliação da estrutura obteve 80,3% de disponibilidade, resultando em classificação de alta disponibilidade e 91,1% de conformidade, obtendo conformidade adequada. O fluxo assistencial mostrou 72,7% de conformidade total; 9,1% de conformidade parcial e 18,2% de não cumprimento, configurando-se como alta conformidade. Conclusão A avaliação normativa indicou altas disponibilidade e conformidade em estrutura e fluxo assistencial nos cenários estudados.

Resumen Objetivo Evaluar la estructura y el flujo de asistencia de recepción, clasificación de riesgo y emergencia obstétrica, en una maternidad pública en el contexto del COVID-19. Métodos Estudio tipo evaluación normativa y observacional en los sectores de Recepción (clasificación de riesgo y emergencia obstétrica) de una maternidad pública en Rio de Janeiro. La recopilación de datos se realizó de junio a agosto de 2020 durante 480 de observación directa no participante, con registros sistematizados en una checklist con variables relacionadas con la disponibilidad y conformidad de los recursos estructurales y con la conformidad del flujo de asistencia. Los datos se organizaron en planillas (Microsoft Excel® 2010) y se analizaron usando la estadística descriptiva. Resultados La evaluación de la estructura obtuvo un 80,3 % de disponibilidad, que tuvo como resultado una clasificación de alta disponibilidad, y un 91,1 % de conformidad, con una conformidad adecuada. El flujo de asistencia mostró un 72,7 % de conformidad total, un 9,1 % de conformidad parcial y un 18,2 % de no cumplimiento, lo que se configura como alta conformidad. Conclusión La evaluación normativa indicó alta disponibilidad y alta conformidad en estructura y flujo de asistencia en los escenarios estudiados.

Abstract Objective Evaluate the structure and care flow - risk classification and obstetric emergency in a public maternity hospital in the context of COVID-19. Methods Normative and observational evaluation study in the Care sectors (Risk Classification and Obstetric Emergency) of a public maternity hospital in Rio de Janeiro. Data collection was carried out from June to August 2020 for 480 hours of non-participant direct observation, with records systematized in a checklist containing variables related to the availability and compliance of structural resources, and the compliance of the care flow. Data were organized into spreadsheets (Microsoft Excel® 2010) and analyzed using descriptive statistics. Results The framework assessment scored 80.3% availability, resulting in a high availability rating, and 91.1% compliance, achieving adequate compliance. The care flow showed 72.7% of total compliance; 9.1% of partial compliance and 18.2% of non-compliance, configuring high compliance. Conclusion Normative evaluation indicated high availability and compliance in structure and care flow in the studied scenarios.

Monkeypox infection and pregnancy in lower and middle-income countries: Precautions & recommendations

Abstract Monkeypox (MPX), an orthopoxviral disease endemic in Africa, is now a public health emergency of international concern (PHEIC) as declared by the World Health Organization in July 2023. Although it is generally mild, the overall case fatality rate was reported to be 3%, and the basic reproduction number (R0) is > 1 in men who have sex with men (MSM, i.e., Portugal (1.4), the United Kingdom (1.6), and Spain (1.8)). However, R0 is < 1 in other settings. In concordance with the smallpox virus, it is also expected to increase the risk of adverse outcomes for both the mother and the fetus. The outcomes of the disease in an immunocompromised state of pregnancy are scary, showing high mortality and morbidity of both mother and fetus, with up to a 75% risk of fetal side effects and a 25% risk of severe maternal diseases. Therefore, it warrants timely diagnosis and intervention. The reverse transcription polymerase chain reaction (RT PCR) test is the standard approach to diagnosis. We summarized the recent findings of MPX on pregnancy, and the associated risk factors. We also give recommendations for active fetal surveillance, perinatal care, and good reporting to improve outcomes. The available vaccines have shown promise for primary disease prevention.

[Comment on article: "Risk factors associated with lateonset neonatal sepsis"]. / Comentario al artículo "Factores de riesgo asociados a sepsis neonatal tardía".

We have read with great interest the article published by Arias-Arellano Santiago et al on the risk factors associated with late neonatal sepsis. This study aims to determine the neonatal risk factors for the use of invasive and maternal methods associated with neonatal sepsis (early and late) in a neonatology unit during 2016 in a hospital in Ecuador.

Hemos leído el artículo publicado por Santiago Arias Arellano et al. acerca de los factores de riesgo asociados a sepsis neonatal tardía. El citado trabajo tiene como objetivo determinar los factores de riesgo neonatales y maternos por uso de métodos invasivos asociados a sepsis neonatal (temprana y tardía) en una unidad de neonatología en un hospital de Ecuador.

Diseases during pregnancy in a large unselected South American sample / Prevalência de doenças durante a gravidez em uma grande amostra sul-americana não selecionada

ABSTRACT Objective: Our aim was to describe the prevalence of diseases during pregnancy and the association between fetal exposure to the most frequent maternal diseases and the risk of preterm (PTB) and/or small for gestational age (SGA) newborns in an unselected sample of women who gave birth in South American countries. Methods: We conducted a descriptive, cross-sectional study including 56,232 mothers of non-malformed infants born between 2002 and 2016, using data from the Latin American Collaborative Study of Congenital Malformations (ECLAMC). Diseases with higher- than-expected PTB/SGA frequencies were identified. Odds ratios of confounding variables for diseases and birth outcomes were calculated with a multivariable logistic regression. Results: Of the 14 most reported diseases, hypertension, genitourinary infection, epilepsy, hypothyroidism, diabetes, and HIV/AIDS showed higher PTB and/or SGA frequencies. Advanced and low maternal age, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with PTB, while advanced maternal age, primigravidity, previous fetal loss, low socioeconomic level, and African-American ancestry were associated with SGA. After adjusting for the associated variables, the identified illnesses maintained their association with PTB and all, except epilepsy, with SGA. Conclusion: The description of an unselected population of mothers allowed identifying the most frequent diseases occurring during gestation and their impact on pregnancy outcomes. Six diseases were associated with PTB and two with SGA newborns. To the best of our knowledge, there are no similar reports about women not intentionally selected by specific diseases during pregnancy in South American populations.

RESUMO Objetivo: Descrever a prevalência de doenças durante a gravidez e a associação entre a exposição fetal às doenças maternas mais prevalentes e o risco de recém-nascidos prematuros (PP) e/ou pequenos para a idade gestacional (PIG) em uma amostra não selecionada de mulheres que deram à luz em países da América do Sul. Métodos: Estudo descritivo transversal que incluiu 56.232 mães de crianças não malformadas nascidas entre 2002 e 2016, utilizando dados do Estudo Colaborativo Latino-americano de Malformações Congênitas (ECLAMC). Foram identificadas as doenças com maior número de casos observado/esperado de PP/PIG. O esperado foi obtido dos controles sem doenças. Odds ratios para variáveis de confusão de doença e eventos ao nascimento foram calculadas usando regressão logística multivariada. Resultados: Das 14 doenças mais referidas, hipertensão, infecção geniturinária, epilepsia, hipotireoidismo, diabetes e HIV/AIDS apresentaram maiores frequências de PP e/ou PIG. Idade materna nos dois extremos, perda fetal prévia, baixo nível socioeconômico e ascendência afro-americana foram associados a PP, enquanto idade materna avançada, primigravidez, perda fetal prévia, baixo nível socioeconômico e ascendência afro-americana foram associados a PIG. Após ajuste para as variáveis associadas, as doenças identificadas mantiveram associação com PP e todas, exceto epilepsia, com PIG. Conclusão: A descrição de uma população não selecionada de gestantes possibilitou identificar as doenças mais frequentes e seu impacto nos resultados adversos na gravidez. Seis doenças foram associadas a PP e duas a recém-nascidos PIG. Até onde sabemos, não há relatos semelhantes sobre mulheres não selecionadas intencionalmente por doenças específicas durante a gravidez em populações sul-americanas.

The use of convalescent plasma therapy in the management of a pregnant woman with COVID-19: a case report

ABSTRACT The coronavirus disease 19 (COVID-19) is responsible for the current worldwide pandemic. Treatment and prophylaxis are still under investigation. Convalescent plasma therapy could be an alternative. We report a case of a 41-year-old patient, at 28 weeks of gestation, was hospitalized with COVID-19. On the 10th day after onset of symptoms, the clinical picture worsened, and she required high-flow oxygen therapy (30L/minute), with 92% oxygen saturation, and chest X-ray showing mild bilateral opacities at lung bases. Blood tests showed D-dimer 1,004ng/mL, C-reactive protein 81mg/L, pro-calcitonin 0.05ng/mL and interleukine-6 42.9pg/mL. The therapy chosen was Tazocin® 12g/day, vancomycin 2g/day, and methylprednisolone 40mg/day. In addition, convalescent plasma therapy was administered (275mL) uneventfully, including SARS-CoV-2 antibodies and neutralizing antibodies >1:160. The patient had a fast recovery. The early administration of convalescent plasma, with high titers of neutralizing antibodies, may be an alternative option for severe COVID-19 during pregnancy, until further studies demonstrate an efficient and safe treatment or prophylaxis.

Trend analysis of clinical aspects of congenital syphilis in Brazil, 2009-2018

SUMMARY INTRODUCTION: Congenital syphilis is caused by the vertical transmission of bacteria, Treponema pallidum, from nontreated or inappropriately treated pregnant to the fetus. OBJECTIVE: To evaluate the clinical aspects of Congenital syphilis in Brazil, between 2009-2018. METHOD: It is an analytical cross-sectional study whose data were collected from the Department of Chronical Conditions and Sexually Transmitted Infections of Brazilian Health Ministry. Clinical variables were analyzed using the software Joinpoint Regression, which makes a segmented linear regression. RESULTS: In the study period, 156,969 cases of Congenital syphilis and 1642 deaths by this disease were reported. The trend analysis indicates growing in diagnosis of maternal syphilis during prenatal care, appropriate treatment of pregnant, realization of prenatal care, maternal partner treatment, diagnosis of syphilis in children under seven days, and diagnosis of recent syphilis. CONCLUSIONS: Although the trend analysis presents relative improvement in Congenital syphilis panorama in Brazil, the disease still related to high numbers of evitable perinatal morbidity and mortality. Therefore, the prenatal assistance with quality is fundamental to have a possible change in this field in the country.

COVID-19 and pregnancy: A scoping review on pregnancy characteristics and outcomes.

AIM: The study aim was to map clinical characteristics and the evolution of pregnancies in pregnant women with confirmed diagnosis of SARS-CoV-2 infection. METHODS: Searching four databases, studies were investigated that described the evolution of pregnancies in women diagnosed with SARS-CoV-2 infection through laboratory tests. A scoping review was undertaken, including 35 articles published in English. Two pairs of independent researchers synthesized the data. RESULTS: Most studies were case studies or case series and had a low risk of bias. A predominance of cases was found in women over the age of 30 years who got infected in the third term of pregnancy and who had comorbidities. The prematurity index varied with the heterogeneity of the samples, and the cases of abortion occurred in combination with severe forms of infection. Caesarean section deliveries predominated, indicated mainly by respiratory decompensation caused by infection. Most women were discharged. CONCLUSION: Based on the reviewed studies, the profile and evolution of pregnant women infected with COVID-19 could be evaluated.

Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization / Prevalência de colonização retovaginal por estreptococo do grupo B em gestantes de programa de atendimento pré-natal de instituição de saúde

ABSTRACT Objective To evaluate the prevalence of group B Streptococci in pregnant women of a corporate health program, as well as the epidemiological correlations. Methods This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. Results A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients' age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B Streptococcus (prevalence of 23.3%; 95%CI: 18.7-28.5). Conclusion Considering the high prevalence of group B Streptococcus in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.

RESUMO Objetivo Identificar a prevalência de estreptococo do grupo B entre gestantes que frequentaram um programa de saúde corporativa, bem como as correlações com a colonização positiva. Métodos Estudo retrospectivo dos prontuários do pré-natal de um hospital privado em São Paulo, no período de 2015 a 2016. Foram excluídas as mulheres que abandonaram o programa ou apresentavam dados incompletos nos prontuários. As variáveis quantitativas foram descritas por média, desvios padrão, mediana, valores mínimos e máximos. A paridade e a condição socioeconômica foram descritos por frequência absoluta e percentagens. Utilizamos modelos de regressão logística no programa (SPSS) para analisar as correlações de variáveis de acordo com a cultura retovaginal, considerando IC95% e valores de p. As variáveis foram idade, número de gestações, peso ganho na gestação e idade gestacional no parto. Resultados Foram incluídos 347 prontuários e, após a aplicação dos critérios de exclusão, 287 prontuários compuseram a amostra final. A idade dos pacientes variou entre 17 e 44 anos. A média de idade foi de 30,6 anos, e 67 pacientes tiveram resultado positivo para o estreptococo do grupo B (prevalência de 23,3%; IC95%: 18,7-28,5). Conclusão Considerando a alta prevalência de estreptococos do grupo B em nosso serviço, existem evidências de que a estratégia de antibiótico profilaxia baseada na cultura retovaginal é custo-efetiva.

Risk factors associated with late-onset neonatal sepsis / Factores de riesgo asociados a sepsis neonatal tardía

Background: Sepsis is one of the main causes of morbidity and mortality in neonates. Objective: To identify the risk factors for neonatal sepsis in a neonatal unit from March to October, 2016. Methods: Case-control study. The factors analyzed were: a) neonatal factors such as: type of delivery, sex, birth weight, gestational age, criteria for systemic inflammatory response syndrome, type of sepsis (early or late) and blood culture result; B) invasive methods such as: central catheterization, total parenteral nutrition, umbilical catheterization and mechanical ventilation; C) maternal factors such as: number of prenatal controls, infection during pregnancy, premature rupture of membranes, maternal age and maternal fever. Odds Ratio was used to determine association. Results: For the development of early-onset sepsis, significant risk factors were: thermodynamic imbalance, tachycardia and maternal fever. With regard to late-onset sepsis, significant associations were found for thermodynamic imbalance, umbilical catheterization, mechanical ventilation and insufficient prenatal care. Conclusions: Thermodynamic imbalance, tachycardia, mechanical ventilation, umbilical catheterization, maternal fever, and insufficient prenatal care were the probable risk factors associated with neonatal sepsis.

Introducción: la sepsis es una de las principales causas de morbimortalidad en neonatos. Objetivo: identificar los factores de riesgo para sepsis neonatal en una unidad de neonatología durante los meses de marzo a octubre del año 2016. Métodos: estudio de casos y controles. Los factores analizados fueron: a) factores neonatales como: tipo de parto, sexo, peso al nacimiento, edad gestacional, criterios de síndrome de respuesta inflamatoria sistémica, tipo de sepsis (temprana o tardía) y resultado de hemocultivo; b) métodos invasivos como: cateterismo central, nutrición parenteral total, cateterismo umbilical y ventilación mecánica y; c) factores maternos como: número de controles prenatales, infección durante el embarazo, ruptura prematura de membranas, edad materna y fiebre materna. Se utilizó razón de momios (RM) para determinar asociación. Resultados: para el desarrollo de sepsis temprana, los factores de riesgo significativos fueron: el desequilibrio termodinámico, la taquicardia y la fiebre materna. Respecto a la sepsis tardía se encontraron asociaciones significativas para el desequilibrio termodinámico, el uso de cateterismo umbilical, la ventilación mecánica y los controles prenatales insuficientes. Conclusión: el desequilibrio termodinámico, la taquicardia, la ventilación mecánica, el cateterismo umbilical, la fiebre materna y los controles prenatales insuficientes fueron los probables factores de riesgo significativos asociados a sepsis neonatal.

Fatal Disseminated Herpes Simplex in a very premature neonate

Herpes Simplex Virus infections (HSV) are ubiquitous. The neonatal HSV infection (NHSV) is rare. The incidence is estimated globally at only 10.3 per 100,000 births, but it can cause devastating disease in premature infants. Both HSV-1 and HSV-2 can be the etiologic agents in this type of vertically transmittted NHSV infection. Here we describe the pathological findings from a complete autopsy of a very low birth weight infant who succumbed to the infection despite early institution of antiviral treatment. We urge more awareness of this disease with continued surveillance; every effort should be taken to make an early diagnosis and thus prevent this devastating disease.

Sepse em gestantes atendidas em um hospital público de Curitiba - PR / Sepsis in pregnant women attended at a public hospital in Curitiba - PR

OBJETIVO: Avaliar a frequência de sepse em gestantes e puérperas atendidas em um hospital, identificar os principais focos originários de sepse na gestação e puerpério, e verificar os principais agentes etiológicos envolvidos em sua etiopatogenia. MÉTODOS: Estudo do tipo transversal descritivo realizado no Hospital do Trabalhador, em Curitiba (PR), de agosto de 2014 a agosto de 2016. Revisão e análise de 71 prontuários de pacientes diagnosticadas com sepse, sepse grave ou choque séptico. Os aspectos estudados foram idades gestacional, agente etiológico, foco infeccioso, principal trimestre gestacional acometido e prevalência de cada tipo de sepse. RESULTADOS: A frequência de sepse durante a gestação e o puerpério no período estudado foi de nove casos para cada mil gestantes. A ocorrência de sepse foi relacionada principalmente ao segundo semestre gestacional (39,4%). Os casos de sepse somaram 73,2% do total, enquanto os demais evoluíram com quadros de sepse grave e choque séptico . Escherichia coli representou 33,8%, sendo o urinário o foco infeccioso mais prevalente (70,4%). Ceftriaxona foi o antibiótico mais utilizado, tanto isoladamente quanto em associação (84,4%). Entre os desfechos para o feto, 85,9% não tiveram complicações. CONCLUSÕES: Os novos conceitos de sepse publicados pela Society of Critical Care Medicine (SCCM) e pela European Society of Critical Care Medicine (ESICM) contrariam os interesses dos países conhecidos como de baixos e médios recursos. Foi encontrado aumento da incidência de sepse gestacional, ocorrendo prevalência do foco urinário; consequentemente, o agente principal foi E. coli. Ademais, ocorreram importantes consequências perinatais como mortalidade e prematuridade. (AU)

OBJECTIVE: To evaluate the frequency of sepsis in pregnant and puerperal patients attended in a hospital, and to identify the main focus of sepsis during gestation and puerperium, and check the main etiological agents involved in its pathogenesis. METHODS: This is a cross-sectional and descriptive study carried out at Hospital do Trabalhador (city of Curitiba, state of Paraná), from August 2014 to August 2016. It is a review and analysis of the charts of 71 patient diagnosed with sepsis, severe sepsis, or septic shock. Aspects studied: gestational age, etiologic agent, infectious focus, main affected gestational trimester, and prevalence of each type of sepsis. RESULTS: The frequency of sepsis during pregnancy and puerperium was 9 cases for 1000 pregnant women. The occurrence of sepsis was mainly related to the second gestational semester (39.4%). Severe sepsis and septic shock comprised 73.2% of the cases. Escherichia coli accounted for 33.8%, and the most prevalent infectious focus was urinary (70.4%). Ceftriaxone was the most commonly used antibiotic, both alone and in combination (84.4%). Among the outcomes for the fetus, 85.9% had no complications. CONCLUSIONS: The new concepts of sepsis, published by the Society of Critical Care Medicine (SCCM), and by the European Society of Critical Care Medicine (ESICM) contradict the interests of the countries with low and medium resources. An increase in the incidence of gestational sepsis occurred, with a prevalence of urinary focus; consequently the main agent was Escherichia coli. In addition, there were important perinatal consequences such as mortality and prematurity. (AU)

Fatal Disseminated Herpes Simplex in a very premature neonate.

Herpes Simplex Virus infections (HSV) are ubiquitous. The neonatal HSV infection (NHSV) is rare. The incidence is estimated globally at only 10.3 per 100,000 births, but it can cause devastating disease in premature infants. Both HSV-1 and HSV-2 can be the etiologic agents in this type of vertically transmittted NHSV infection. Here we describe the pathological findings from a complete autopsy of a very low birth weight infant who succumbed to the infection despite early institution of antiviral treatment. We urge more awareness of this disease with continued surveillance; every effort should be taken to make an early diagnosis and thus prevent this devastating disease.

Pyelonephritis in pregnancy: clinical and laboratorial aspects and perinatal results / Pielonefrite na gestação: aspectos clínicos e laboratoriais e resultados perinatais

Abstract Objective To identify the prevalence of pyelonephritis during pregnancy and to analyze the clinical and laboratorial aspects, perinatal results and complications. Methods A transversal study of 203 pregnant women who had pyelonephritis during pregnancy and whose labor took place between 2010 and 2016 at a hospital in the state of Santa Catarina, Brazil. The analysis was based on medical records as well as on the hospital's database. Clinical and laboratory conditions, antibiotics, bacterial resistance, perinatal outcomes and complications were all taken into account. The data was compared using the Mann-Whitney test and the Chi-square test. Results A prevalence of 1.97% with pyelonephritis was evidenced, with most patients having it during the second trimester of gestation. The bacteriamost commonly found in the urine cultures was Escherichia coli, in 76.6% of cases, followed by Klebsiella pneumoniae (8.7%). Ceftriaxone had the lowest bacterial resistance (only 3.5% of the cases). On the other hand, ampicillin and cephalothin presented higher bacterial resistance, 52% and 36.2%, respectively. The risk of very premature delivery was more than 50% higher in patients with pyelonephritis. Conclusion Ampicillin and first-generation cephalosporins are associated with a higher bacterial resistance while ceftriaxone proved to have a high efficacy for the treatment of pyelonephritis due to low bacterial resistance. Patients with pyelonephritis showed a higher risk for very premature delivery (< 32 weeks). In this casuistry, there were no others significant differences in the overall perinatal outcomes when compared with the routine service series.

Resumo Objetivo Identificar a prevalência da pielonefrite durante a gestação, analisar seus aspectos clínicos e laboratoriais, resultados perinatais e complicações. Métodos Estudo transversal que incluiu 203 gestantes com pielonefrite durante a gestação e cujos partos aconteceram entre 2010 e 2016 em um hospital no estado de Santa Catarina, no Brasil. A análise foi feita através de informações coletadas de prontuários e da base de dados do hospital. Foram levados em consideração aspectos received Resultados Foi evidenciada uma prevalência de 1,97%, sendo que a maioria das pacientes se encontrava no segundo trimestre de gestação. A bactériamais encontrada nas uroculturas foi a Escherichia coli, em 76,6% dos casos, seguido pela Klebsiella pneumoniae (8,7%). A ceftriaxona, usada como primeira escolha, demonstrou ser o antibiótico commenor resistência bacteriana (apenas 3,5% dos casos). A ampicilina e a cefalotina apresentaram maiores resistências bacterianas, 52% e 36,2%, respectivamente. O risco de parto prematuro extremo (<32 semanas) foimais que 50% maior em pacientes com pielonefrite. Conclusão A ampicilina e cefalosporinas de primeira geração estão associadas à maior resistência bacteriana enquanto a ceftriaxona provou ter uma alta eficácia para o tratamento da pielonefrite devido à baixa resistência bacteriana. Pacientes com pielonefrite têm maior risco para parto prematuro extremo (< 32 semanas). Nesta casuística, não houveram outras diferenças significativas nos resultados perinatais gerais quando comparados com a série de serviços de rotina.

Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo / Obesity, a risk factor for ascending bacterial infection during pregnancy

Background: Obesity in pregnancy is associated with significantly higher rates of infection. Aim: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). Material and Methods: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. Results: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). Conclusions: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious.

Prevalência de infecções congênitas e perinatais em gestantes HIV positivas da região metropolitana de Belo Horizonte / Prevalence of congenital and perinatal infection in HIV positive pregnant in Belo Horizonte metropolitan region

OBJETIVOS: Avaliar a prevalência de toxoplasmose, rubéola, citomegalovirose, hepatites B e C e sífilis (Torchs) em uma coorte de gestantes, bem como identificar os fatores sociodemográficos, clínicos e laboratoriais.MÉTODOS: Entre 1998 e 2013, foram atendidas 1.573 gestantes com sorologia positiva para o HIV em área metropolitana do Brasil, das quais 704 (44,8%) foram submetidas a algum dos testes sorológicos. Gestantes Torchs positivas (Gtp) foram consideradas aquelas com resultado positivo para uma dessas infecções, e gestantes Torchs negativas (Gtn) aquelas com resultados negativos para todas elas. As variáveis maternas investigadas foram: idade, estado civil, escolaridade, momento e forma de contágio da infeccção pelo HIV, contagem de linfócitos TCD4+, carga viral plasmática do HIV próxima ao parto e uso de terapia antirretroviral durante a gestação. As variáveis neonatais investigadas foram ocorrência de: transmissão vertical, prematuridade, baixo peso ao nascimento, complicações fetais, aborto e óbito fetal. Foram utilizadas razões de chance com intervalo de confiança de 95% para quantificar a associação entre as variáveis maternas e neonatais e a presença de Torchs.RESULTADOS: Entre as 704 gestantes, 70 (9,9%; IC95% 7,8-12,4) tinham alguma sorologia positiva para Torchs. Foram encontradas taxas: 1,5% (10/685) para a toxoplasmose; 1,3% (8/618) para rubéola; 1,3% (8/597) para citomegalovirose; 0,9% (6/653) para hepatite B e 3,7% (20/545) para hepatite C; e 3,8% (25/664) para sífilis. A transmissão vertical do HIV entre as gestantes Gtp foi 4,6% e de 1,2% entre as Gtn. As variáveis associadas à presença de Torchs na análise univariada foram: uso de terapia antirretroviral, transmissão vertical do HIV, baixo peso ao nascimento e complicações fetais.CONCLUSÃO: A prevalência das Torchs mostrou-se elevada para algumas infecções. Conclui-se que é importante manter o rastreamento de Torchs na gravidez, especialmente nas gestantes HIV positivas, para que se possa estabelecer diagnóstico e tratamento, e/ou medidas preventivas para evitar a transmissão materno-fetal.

PURPOSE: To evaluate the prevalence of toxoplasmosis, rubella, cytomegalovirus, hepatitis B&C and syphilis (Torchs) in a cohort pregnant women and to identify the sociodemographic, clinical and laboratory factors.METHODS: A total of 1,573 HIV-infected pregnant women from a Brazilian metropolitan region were studied between 1998 and 2013. The results of serological tests were available for 704 (44.8%) pregnant women. Pregnant women were considered to be Torchs positive (Gtp) when they had positive results for at least one of these infections, and to be Torchs negative (Gtn) when they had negative results for all of them. Maternal covariables were: age, marital status, educational level, time and mode of infection, CD4 lymphocyte count, viral load at delivery, and use of antiretroviral therapy (ARV). Neonatal covariables were: HIV infection, prematurity, low birth weight, neonatal complications, abortion and neonatal death. Odds ratios with 95% confidence interval were used to quantify the association between maternal and neonatal variables and the presence of Torchs.RESULTS: Among 704 pregnant women, 70 (9.9%; 95%CI 7.8-12.4) had positive serological tests for any Torchs factor. The individual prevalence rates were: 1.5% (10/685) for toxoplasmosis; 1.3% (8/618) for rubella; 1.3% (8/597) for cytomegalovirus; 0.9% (6/653) for hepatitis B and 3.7% (20/545) for hepatitis C; and 3.8% (25/664) for syphilis. The HIV Vertical HIV transmission was 4.6% among Gtp pregnant women and 1.2% among Gtn women. Antiretroviral therapy (ARV), vertical transmission, low birth weight and neonatal complications were significantly associated with Torchs positivity in univariate analysis.CONCLUSIONS: The Torchs prevalence found in the study was high for some infections. These findings emphasize the need to promote serological Torchs screening for all pregnant women, especially HIV-infected women, so that an early diagnosis can be made and treatment interventions can be implemented to prevent vertical HIV transmission.

Uso de drogas ilícitas por gestantes infectadas pelo HIV / Illicit drug use by pregnant women infected with HIV

OBJETIVO: Determinar se o uso de drogas ilícitas aumenta a transmissão vertical do HIV, identificar os fatores de risco envolvidos na saúde materno-infantil e a prevalência do uso de drogas entre essas gestantes. MÉTODOS: Entre 845 gestantes da região metropolitana de Belo Horizonte, Minas Gerais, atendidas no serviço entre outubro de 1997 e fevereiro de 2012, 64 (7,6%) afirmaram usar drogas ilícitas. Os casos são as gestantes HIV positivas usuárias de drogas ilícitas (n=64) e os controles as não usuárias (n=192). Para cada caso foram selecionados três controles. Consideraram-se as diferentes exposições/condições no grupo controle como: tabagismo; etilismo; uso de tabaco e álcool; idade materna; escolaridade; etnia; e estado civil. Foram investigadas também intercorrências no pré-natal, parto e puerpério, taxa de transmissão vertical e resultados neonatais. RESULTADOS: As variáveis com significância estatística na análise univariada foram: idade materna; uso de tabaco; número de consultas de pré-natal; tipo de terapia antirretroviral; forma de contágio e carga viral na época do parto. A regressão logística mostrou como significantes: idade materna (menores de 25 anos), uso de tabaco e o número de consultas de pré-natal (menos de 6). A transmissão vertical entre usuárias foi de 4,8% (IC95% 1,7–13,3) e, no grupo controle, 2,1% (IC95% 0,8–5,2), sem diferença significante. As complicações neonatais foram mais frequentes entre os recém-nascidos das gestantes usuárias, também sem diferença significante. CONCLUSÃO: O uso de drogas ilícitas na gravidez entre mulheres infectadas pelo HIV é frequente. Assim, a abordagem sobre o uso dessas drogas deve fazer parte da rotina pré-natal. Essas ...

PURPOSE: To determine if illicit drug use increases the vertical transmission of HIV, to identify the risk factors involved in mother and child health and the prevalence of illicit drug use among these pregnant women. METHODS: Sixty-four (7.6%) of 845 pregnant women from the metropolitan region of Belo Horizonte, Minas Gerais, Brazil, attended in the service between October 1997 and February 2012 reported the use of illicit drugs. Cases were HIV-positive drug users (n=64) and controls were women who did not use drugs (n=192). Three controls were selected for each case. Several conditions of exposure were considered in the control group such as tobacco use, alcohol use, alcohol and tobacco use, maternal age, educational level, ethnicity, and marital status. Problems during the prenatal period, delivery and postpartum, vertical HIV transmission and neonatal outcomes were also investigated. RESULTS: Univariate analysis showed as significant variables: maternal age, tobacco use, number of prenatal care visits, antiretroviral therapy, mode of infection, and viral load at delivery. Logistic regression revealed as significant variables: maternal age (less than 25 years); tobacco use, and number of prenatal care visits (less than 6). The vertical transmission of HIV was 4,8% (95%CI 1.7–13.3) among drug users and 2,1% (95%CI 0.8–5.2) in the control group, with no statistically significant difference between groups. Neonatal complications were more frequent among drug users, but also with no statistically significant difference between groups. CONCLUSION: The use of illicit drug is frequent during pregnancy among HIV-infected women. The approach to illicit drug use should be routine during prenatal care visits. These women are more discriminated against and tend to deny their habits or do not seek prenatal care. There was no difference in vertical virus transmission between groups, probably indicating adherence to antiretroviral ...

Análise espacial da prevalência de toxoplasmose em gestantes de Aracaju, Sergipe, Brasil / Spatial distribution of anti-toxoplasma antibodies in pregnant women from Aracaju, Sergipe, Brazil

OBJETIVO: Analisar a distribuição espacial da prevalência de anticorpos antitoxoplasma em gestantes residentes em uma cidade do Nordeste do Brasil, e correlacionar a prevalência de anticorpos antitoxoplasma com a faixa etária materna e o local de residência. MÉTODOS: Estudo ecológico, descritivo e analítico, desenvolvido no período de 01 janeiro a 31 de dezembro de 2012. As informações foram obtidas retrospectivamente de um banco de dados, e processadas com o pacote estatístico Epi info (Epi 7, Centers for Disease Control and Prevention, Atlanta, EUA) e também em planilha do pacote Microsoft Office Excel, versão 2010. Para avaliar a associação entre a prevalência de anticorpos para a toxoplasmose e a faixa etária, foi aplicado o teste do X2. A análise espacial da prevalência dessa infecção foi realizada com o programa TerraView, versão 4.2.2, utilizando o estimador de intensidade Kernel, que permite estimar a quantidade de eventos em mapa para identificar áreas de maior concentração de casos no município. RESULTADOS: A soroprevalência encontrada para IgG foi de 68,5% (IC95% 67,2-69,8) e IgM de 0,36% (IC95% 0,23-0,6). Foi encontrado incremento da prevalência de IgG associado ao aumento da idade nos bairros mais antigos da capital. Entre as mulheres mais jovens, a maior prevalência foi nos bairros de periferia. Quanto ao anticorpo IgM, a concentração espacial foi mais elevada em bairros da periferia e não ocorreu associação significativa entre a soroprevalência e a idade. CONCLUSÃO: O geoprocessamento permitiu identificar as áreas de maior prevalência, assim como a faixa etária com maior suscetibilidade, servindo como instrumento de avaliação e implementação de medidas preventivas apropriadas para esse município ...

PURPOSE: To analyze the spatial distribution of the prevalence of anti-toxoplasma gondii antibodies in pregnant women from a Brazilian Northeast city, and to correlate such prevalence with average maternal age and place of residence. METHODS: A descriptive, analytical and ecological study was conducted from January 1st to December 31st 2012. Data were obtained retrospectively from the Medical Specialties Center database and processed with the Epi info statistical package (Epi 7, Centers for Disease Control and Prevention, Atlanta, USA) and with Microsoft Excel 2010. The X2 test was applied to assess the association between the prevalence of antibodies to toxoplasma gondii and the average age. Spatial analysis of infection prevalence was performed using the TerraView software, version 4.2.2, with Kernel density estimation, which estimates the quantity of events through maps in order to identify areas with the highest concentration of cases in the city. RESULTS: The seroprevalence of IgG was 68.5% (95%CI 67.2-69.8) and the prevalence of IgM was 0.36% (95%CI 0.23-0.6). A higher IgG prevalence was associated with increased age in the oldest neighborhoods of the state capital, whereas a higher IgG prevalence among younger women was detected in suburban neighborhoods. The spatial concentration of IgM antibodies was higher in suburban neighborhoods, with no significant correlation between seroprevalence and age. CONCLUSION: Geoprocessing allowed the identification of areas with the highest prevalence, as well as the most susceptible average age and it was also useful as an instrument for the evaluation and implementation of appropriate preventive measures for this municipality and for other regions of Brazil. .

Sepse e gravidez: sabemos tratar? / Sepsis and pregnancy: do we know how to treat this situation?

Sepse é definida por síndrome da resposta inflamatória aguda secundária a um foco infeccioso. Associa-se a elevadas taxas de incidência, morbidade e mortalidade, gerando importante gastos financeiros, especialmente por causas de suas complicações, como choque séptico e disfunção de múltiplos órgãos. As toxinas dos patógenos, associadas à suscetibilidade individual, culminam com a liberação de citocinas capazes de promover resposta inflamatória aguda sistêmica, sendo esta uma das responsáveis pela disfunção de múltiplos órgãos e eventual óbito do paciente. Especificamente em relação a gestantes, as taxas de incidência e morbimortalidade são menores, dado que as mesmas representam um grupo mais jovem e com menos comorbidades. A etiologia mais comum nesse grupo é de origem polimicrobiana. A gestante apresenta particularidades fisiológicas que conferem características específicas na apresentação clínica e laboratorial da sepse nesse grupo. Assim, o melhor conhecimento dessas alterações é fundamental para melhor identificação e condução dessas pacientes. A presença do feto também confere singularidade na abordagem das mesmas. O tratamento da sepse baseia-se em algumas diretrizes que foram construídas após importantes ensaios clínicos, os quais, infelizmente, sempre tiveram as grávidas como fator de exclusão. Assim, extrapola-se o tratamento da sepse para a população em geral também para a população de gestantes, sendo as principais metas: manutenção da perfusão tecidual com reposição volêmica e drogas vasoativas (ressuscitação inicial); oxigenação adequada; controle do foco infeccioso e antibioticoterapia precoce; controle glicêmico; infusão de corticoide e transfusão sanguínea quando bem indicadas; profilaxias e, especificamente, vigilância e manutenção da vitalidade fetal.

Sepsis is defined as an acute inflammatory response syndrome secondary to an infectious focus. It has a high incidence, morbidity and mortality, causing substantial financial costs, especially due to complications such as septic shock and multiple organ dysfunction. The pathogen toxins associated with individual susceptibility culminate with cytokine release, which promotes a systemic inflammatory response that can progress to multiple organ dysfunction and eventual patient death. Specifically, sepsis incidence, morbidity and mortality are lower in pregnant women, as this group is typically younger with fewer comorbidities having a polymicrobial etiology resulting in sepsis. Pregnant women exhibit physiological characteristics that may confer specific clinical presentation and laboratory patterns during the sepsis course. Thus, a better understanding of these changes is critical for better identification and management of these patients. The presence of a fetus also requires unique approaches in a pregnant woman with sepsis. Sepsis treatment is based on certain guidelines that were established after major clinical trials, which, unfortunately, all classified pregnancy as a exclusion criteria. Thus, the treatment of sepsis in the general population has been extrapolated to the pregnant population, with the following main goals: maintenance of tissue perfusion with fluid replacement and vasoactive drugs (initial resuscitation), adequate oxygenation, control of the infection source and an early start of antibiotic therapy, corticosteroid infusion and blood transfusion when properly indicated, prophylaxis, and specifically monitoring and maintenance of fetal heath.