Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden.

The Public Health Agency of Sweden has analyzed how many pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been treated in intensive care units (ICU) in Sweden between 19 March and 20 April 2020 compared with non-pregnant women of similar age. Cases were identified in a special reporting module within the Swedish Intensive Care Registry (SIR). Fifty-three women aged 20-45 years with SARS-CoV-2 were reported in SIR, and 13 of these women were either pregnant or postpartum (<1 week). The results indicate that the risk of being admitted to ICU may be higher in pregnant and postpartum women with laboratory-confirmed SARS-CoV-2 in Sweden, compared with non-pregnant women of similar age.

Course and severity of postpartum metritis cases following antibiotic and PGF2α administration in postpartum metritis cows infected with BoHV-4.

Forty cows between day 1 and day 21 post-calving were examined for the presence of postpartum metritis in a dairy herd that had recently experienced an increase in metritis and that had previously tested positive against bovine herpes virus 4 (BoHV-4) by various methods. Antibodies against BoHV-4 were detected in sera from 15 of 22 cows. For the virological study, uterine swab samples of 22 cows with metritis were used and tested for BoHV-4 using polymerase chain reaction (PCR), virus isolation (VI), and immunofluorescence techniques. Twenty-two point seven per cent (5/22) of the vaginal discharge samples obtained from cows with metritis were found positive for BoHV-4 DNA by PCR. All of these samples were also positive in VI and/or immune fluorescence assay (IF). Swab samples were also tested for bacteria. Empirical therapy with a broad spectrum antibiotic (oxytetracycline) was administrated, pending culture and antibiotic sensitivity result. All cows with puerperal metritis or clinical metritis (CM) were treated with intra-uterine (i.u.) administration of oxytetracycline and with intramuscular (i.m.) injections of dinoprost tromethamine (PGF(2)α) for three consecutive days. Concurrently, with the administration of oxytetracycline and PGF(2)α, cows with a rectal temperature >39.5°C received an additional treatment with oxytetracycline (i.m) for three consecutive days. According to the antibiotic test result, on day 3 after the last oxytetracycline and PGF(2)α administrations, all cows were treated with a combination of amoxicillin and clavulanic acid (i.u.) for three consecutive days. All cows with metritis and that were positive for BoHV-4 recovered clinically after the administration of antibiotic and PGF(2)α. In conclusion, postpartum metritis cases in cows infected BoHV-4 recovered clinically following early diagnosis and prolonged treatments with a combination of antibiotics and PGF(2)α.

Uterine diseases in cattle after parturition.

Bacterial contamination of the uterine lumen is common in cattle after parturition, often leading to infection and uterine disease. Clinical disease can be diagnosed and scored by examination of the vaginal mucus, which reflects the presence of pathogenic bacteria such as Escherichia coli and Arcanobacterium pyogenes. Viruses may also cause uterine disease and bovine herpesvirus 4 (BoHV-4) is tropic for endometrial cells, causing a rapid cytopathic effect. The elimination of pathogens by the innate immune system is dependent on pattern recognition receptors binding pathogen-associated molecules. Uterine epithelial and stromal cells express receptors such as Toll-like Receptor 4 that binds E. coli lipopolysaccharide. The infertility associated with uterine disease is caused by damage to the endometrium and disruption of ovarian cyclic activity. Bacteria modulate endometrial prostaglandin secretion, and perturb ovarian follicle growth and function. Understanding the molecular basis of uterine disease will lead to novel approaches to treating infertility.

Evidence of parvovirus B19 infection in patients of pre-eclampsia and eclampsia with dyserythropoietic anaemia.

Parvovirus B19 (PVB19) infection can induce transient anaemia in patients with increased erythropoiesis. However, the dynamic change within the bone marrow after PVB19 infection is not well understood. Increased erythropoiesis is a physiological phenomenon in puerperital women. Nevertheless, anaemia as a result of PVB19 infection in puerperital women has never been reported. We report one patient with eclampsia and two patients with pre-eclampsia who had transient, severe anaemia during the puerperital period because of PVB19 infection. Viral genomes were detected in the peripheral blood during the anaemic period by polymerase chain reaction and became undetectable after the anaemia was resolved. Viral genomes and protein could also be detected in bone marrow by in situ hybridization and immunohistochemical staining, respectively. Serial aspiration cytology of bone marrow showed severe dysplastic change involving erythroid precursors with a few apoptotic cells at the initial onset of anaemia, markedly increased apoptotic cells that was confirmed by the increased expression of activated caspase 3, around the nadir of anaemia, and a normal marrow picture without features of apoptosis after recovery from anaemia. Our data indicates that PVB19 infection can induce transient, severe dyserythropoietic anaemia in puerperital women with pre-eclampsia/eclampsia and the pathogenetic mechanism may probably involve the induction of apoptosis following PVB19 infection.

Persistent HIV-1-specific CTL clonal expansion despite high viral burden post in utero HIV-1 infection.

To address the issue of clonal exhaustion in humans, we monitored HLA class I-restricted, epitope-specific CTL responses in an in utero HIV-1-infected infant from 3 mo through 5 years of age. Serial functional CTL precursor assays demonstrated persistent, vigorous, and broadly directed HIV-1 specific CTL activity with a dominant response against an epitope in HIV-1 Gag-p17 (SLYNTVATL, aa 77-85). A clonal CTL response directed against the immunodominant, HLA-A*0201-restricted epitope was found to persist over the entire observation period, as shown by TCR analysis of cDNA libraries generated from PBMC. The analysis of autologous viral sequences did not reveal any escape mutations within the targeted epitope, and viral load measurement indicated ongoing viral replication. Furthermore, inhibition of viral replication assays indicated that the epitope was properly processed from autologous viral protein. These data demonstrate that persistent exposure to high levels of viral Ag does not necessarily lead to clonal exhaustion and that epitope-specific clonal CTL responses induced within the first weeks of life can persist for years without inducing detectable viral escape variants.

Postpartum endometritis caused by herpes simplex virus.

BACKGROUND: Herpes simplex virus (HSV) is rarely the causative agent of endometritis and is usually found in association with pelvic inflammatory disease. Only one case of postpartum HSV endometritis has been reported. CASES: We describe two cases of herpes simplex postpartum endometritis. Neither patient had genital HSV lesions noted at the time of delivery. The first case developed after a preterm cesarean delivery in an 18-year-old primipara. She had persistent puerperal fever despite broad-spectrum anti-microbial treatment. The second case was a 16-year-old primipara whose vaginal delivery was complicated by severe postpartum endometritis. Vulvar and endometrial cultures were positive for HSV alone in both patients. Both infants died from disseminated HSV infection. CONCLUSION: Herpes simplex virus can cause clinical postpartum endometritis.