1
|
Souza JS, Farani PSG, Ferreira BIS, Barbosa HS, Menna-Barreto RFS, Moreira OC, Mariante RM. Establishment of a murine model of congenital toxoplasmosis and validation of a qPCR assay to assess the parasite load in maternal and fetal tissues. Front Microbiol 2023; 14:1124378. [PMID: 36922978 PMCID: PMC10009190 DOI: 10.3389/fmicb.2023.1124378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023] Open
Abstract
Toxoplasma gondii is the causative agent of toxoplasmosis, a disease that affects warm-blooded animals and one third of the human population worldwide. Pregnant women who have never been exposed to the parasite constitute an important risk group, as infection during pregnancy often leads to congenital toxoplasmosis, the most severe form of the disease. Current therapy for toxoplasmosis is the same as it was 50 years ago and has little or no effect when vertical transmission occurs. Therefore, it is urgent to develop new strategies to prevent mother-to-fetus transmission. The implementation of experimental animal models of congenital toxoplasmosis that reproduces the transmission rates and clinical signs in humans opens an avenue of possibilities to interfere in the progression of the disease. In addition, knowing the parasite load in maternal and fetal tissues after infection, which may be related to organ abnormalities and disease outcome, is another important step in designing a promising intervention strategy. Therefore, we implemented here a murine model of congenital toxoplasmosis with outbred Swiss Webster mice infected intravenously with tachyzoites of the ME49 strain of T. gondii that mimics the frequency of transmission of the parasite, as well as important clinical signs of human congenital toxoplasmosis, such as macrocephaly, in addition to providing a highly sensitive quantitative real-time PCR assay to assess parasite load in mouse tissues. As the disease is not restricted to humans, also affecting several domestic animals, including companion animals and livestock, they can also benefit from the model presented in this study.
Collapse
Affiliation(s)
- Jéssica S Souza
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Priscila S G Farani
- Plataforma de PCR em Tempo Real RPT09A, Laboratório de Virologia Molecular, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.,Department of Biological Science, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, United States
| | - Beatriz I S Ferreira
- Plataforma de PCR em Tempo Real RPT09A, Laboratório de Virologia Molecular, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Helene S Barbosa
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | | | - Otacilio C Moreira
- Plataforma de PCR em Tempo Real RPT09A, Laboratório de Virologia Molecular, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Rafael M Mariante
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Sobhani NC, Avvad-Portari E, Nascimento ACM, Machado HN, Lobato DSS, Pereira JP, Esquivel MS, Vasconcelos ZC, Zin AA, Tsui I, Adachi K, Brickley EB, Fisher SJ, Nielsen-Saines K, Brasil P, Moreira ME, Gaw SL. Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort. J Infect Dis 2021; 221:1838-1845. [PMID: 31773163 DOI: 10.1093/infdis/jiz629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. METHODS This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. RESULTS Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16-33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. CONCLUSIONS Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.
Collapse
Affiliation(s)
- Nasim C Sobhani
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | | | - Mikaela S Esquivel
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Andrea A Zin
- Fiocruz, Fernandes Figueira Institute, Rio de Janeiro, Brazil
| | - Irena Tsui
- Jules Stein Eye Institute, Retina Division, University of California, Los Angeles, Los Angeles, California, USA
| | - Kristina Adachi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, USA
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan J Fisher
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, USA
| | - Patricia Brasil
- Fiocruz, Fernandes Figueira Institute, Rio de Janeiro, Brazil
| | - Maria E Moreira
- Fiocruz, Fernandes Figueira Institute, Rio de Janeiro, Brazil
| | - Stephanie L Gaw
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
3
|
Mercado M, Daza M, Moore CA, Valencia D, Rico A, Álvarez-Diaz DA, Brault AC, Fitzpatrick K, Mulkey SB. Discordant Clinical Outcomes in a Monozygotic Dichorionic-Diamniotic Twin Pregnancy with Probable Zika Virus Exposure. Case Report. Trop Med Infect Dis 2020; 5:tropicalmed5040188. [PMID: 33352748 PMCID: PMC7768539 DOI: 10.3390/tropicalmed5040188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/09/2023] Open
Abstract
Prenatal exposure to Zika virus (ZIKV) is associated with congenital anomalies of the brain and the eye and neurodevelopmental sequelae. The spectrum of disease outcomes may relate to timing of infection as well as genetic and environmental factors. Congenital infections occurring in twin pregnancies can inform the clinical spectrum of these conditions and provide unique information regarding timing of infection and in utero environment with disease pathophysiology. Herein, we report a monozygotic dichorionic-diamniotic twin pregnancy with probable prenatal ZIKV exposure identified through the Colombian ZIKV disease surveillance system. Multidisciplinary clinical evaluations were provided to the twins during their first three years of life through a national program for children with in utero ZIKV exposure. Laboratory evidence of congenital infection as well as microcephaly, brain, eye, and neurodevelopmental compromise related to prenatal ZIKV infection were identified in only one infant of the twin pregnancy. This is the first report of monozygotic twins discordant for Zika-associated birth defects. The evaluation of the pathophysiology of discordance in disease outcome for congenital infections in twin pregnancies may lead to a better understanding of potential complex environmental and genetic interactions between the mother, her offspring, and an infectious exposure.
Collapse
Affiliation(s)
- Marcela Mercado
- Division of Research in Public Health, National Institute of Health of Colombia, Bogota 110311, Colombia; (M.M.); (A.R.); (D.A.Á.-D.)
| | - Marcela Daza
- Vysnova Partners, Bethesda, MD 20785, USA
- Correspondence: ; Tel.: +57(1)-321-201-4409
| | - Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Division of Birth Defects and Infant Disorders, Atlanta, GA 30333, USA; (C.A.M.); (D.V.)
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Division of Birth Defects and Infant Disorders, Atlanta, GA 30333, USA; (C.A.M.); (D.V.)
| | - Angelica Rico
- Division of Research in Public Health, National Institute of Health of Colombia, Bogota 110311, Colombia; (M.M.); (A.R.); (D.A.Á.-D.)
| | - Diego A. Álvarez-Diaz
- Division of Research in Public Health, National Institute of Health of Colombia, Bogota 110311, Colombia; (M.M.); (A.R.); (D.A.Á.-D.)
| | - Aaron C. Brault
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Ft Collins, CO 80521, USA; (A.C.B.); (K.F.)
| | - Kelly Fitzpatrick
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Ft Collins, CO 80521, USA; (A.C.B.); (K.F.)
| | - Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20310, USA;
- Departments of Pediatrics and Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
| |
Collapse
|
4
|
Louchet M, Peytavin G, Didelot H, Lê M, Bourgeois-Moine A, Carbillon L, Luton D, Matheron I, Rigonnot L, Mandelbrot L. Frequency of differential placental transfer to twins of maternal antiretroviral medications. Eur J Obstet Gynecol Reprod Biol 2020; 256:405-411. [PMID: 33285497 DOI: 10.1016/j.ejogrb.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Placental passage of drugs in twins is poorly understood, and is unknown regarding antiretrovirals (ARVs). In the event of large differences in the exposure of 2 twins to the same maternal therapy, this could have a clinical impact in terms of prevention of perinatal HIV transmission or adverse effects. OBJECTIVE To describe the frequency of differential transplacental passage of antiretrovirals between twins. STUDY DESIGN The study was performed retrospectively, on data from women included in a multicenter perinatal HIV cohort study. All twin pairs for which the mother received antiretroviral therapy and for which drug concentrations in both of the umbilical cords after cord clamping at delivery were studied. We considered that a difference in concentrations of more than 50 % between twins was a substantial difference (ratios below 0.67 or above 1.50). RESULTS We analyzed 29 twin pairs, 27 dichorionic and 2 monochorionic diamniotic. Cord blood concentrations differed between the 2 twins by more than 50 % for at least one ARV in 9 twin pairs, 8 dichorionic and 1 monochorionic. Discordant concentrations were observed in one or more cases for several nucleoside reverse transcriptase inhibitors (tenofovir, emtricitabine, lamivudine, zidovudine) and protease inhibitors (atazanavir, lopinavir, saquinavir et ritonavir); within individual twin pairs placental transfer was discordant for one or more ARVs, but identical for others. CONCLUSION Concentrations differed in nearly one third of twin pairs. This may be due to interindividual genetic variability of placental transporters between dizygotic twins as well as physiological differences between twins.
Collapse
Affiliation(s)
- Margaux Louchet
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris, France
| | - Gilles Peytavin
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pharmacologie-Toxicologie, HUPNVS, Paris, France; Inserm IAME U1137, F-75018, Paris, France
| | - Hélène Didelot
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, Paris, France
| | - Minh Lê
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pharmacologie-Toxicologie, HUPNVS, Paris, France
| | - Agnès Bourgeois-Moine
- FHU PREMA, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Gynécologie-Obstétrique, HUPNVS, Paris, France
| | - Lionel Carbillon
- Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Service de Gynécologie-Obstétrique, Bondy, France
| | - Dominique Luton
- Université de Paris, Paris, France; FHU PREMA, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Gynécologie-Obstétrique, HUPNVS, Paris, France
| | - Isabelle Matheron
- Centre Hospitalier Intercommunal Villeneuve-St-George, Service de Gynécologie-Obstétrique, Villeneuve St George, France
| | - Luc Rigonnot
- Centre Hospitalier Sud Francilien, Service de Gynécologie-Obstétrique, Corbeil-Essonnes, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris, France; Inserm IAME U1137, F-75018, Paris, France.
| |
Collapse
|
5
|
Romani L, Pane S, Severini C, Menegon M, Foglietta G, Bernardi S, Tchidjou HK, Onetti Muda A, Palma P, Putignani L. Challenging diagnosis of congenital malaria in non-endemic areas. Malar J 2018; 17:470. [PMID: 30551740 PMCID: PMC6295090 DOI: 10.1186/s12936-018-2614-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/05/2018] [Indexed: 01/19/2023] Open
Abstract
Background Congenital malaria is usually defined as the detection of asexual forms of Plasmodium spp. in a blood sample of a neonate during perinatal age if there is no possibility of postpartum infection by a mosquito bite. The incidence of congenital malaria is highly variable and seems related to several factors, such as different diagnostic methods for Plasmodium spp. detection, and area in which the epidemiologic analyses are performed. In non-endemic countries, cases of congenital malaria are rare. Hereby, a case of a congenital malaria in an HIV exposed child is reported. Case presentation A 2-month-old male child was admitted to Bambino Gesù Children’s Hospital due to anaemia and exposure to HIV. He was born prematurely in Italy by cesarean section at 34 weeks’ gestation after a bicorial, biamniotic pregnancy by a migrant woman from Nigeria. He was the first of non-identical twins. Combined with anaemia, spleen and liver enlargement was noted, malaria was hypothesized. Malaria laboratory panel was performed on the newborn, mother and other twin blood samples, as follows: (i) malaria rapid diagnostic test (RDT); (ii) Giemsa-stained thick and thin blood smears for Plasmodium spp. identification and parasitaemia titration; (iii) molecular screening and typing of Plasmodium spp. by multiplex qualitative PCR assay based on 18S rRNA gene. Genotyping of Plasmodium falciparum isolates from mother and child was performed by neutral microsatellite and highly polymorphic marker amplification. Conclusions The maternal RDT sample was negative, while the infant RDT was positive; in both cases microscopy of blood smears and PCR showed infection with P. falciparum. Two of the genotypic molecular markers displayed different allelic variants between the two samples. This difference could imply infection multiplicity of the mother during the pregnancy, possibly harbouring more than one isolate, only one of them being transmitted to the newborn while the other persisting in the mother’s blood. Because of the increasing number of pregnant women coming from endemic areas for malaria, an accurate anamnesis of infant’s mother, and the inclusion of Plasmodium spp. research into TORCH screenings for mother-infant pair at birth, aiming at reducing morbidity and mortality associated to the disease might be suitable.
Collapse
Affiliation(s)
- Lorenza Romani
- Division of Immunology and Infectious Diseases, Research Unit in Congenital and Perinatal Infections, University-Hospital, Pediatric Department (DPUO), Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Stefania Pane
- Unit of Parasitology, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Carlo Severini
- Istituto Superiore di Sanità (ISS), Viale Regina Elena 299, 00161, Rome, Italy
| | - Michela Menegon
- Istituto Superiore di Sanità (ISS), Viale Regina Elena 299, 00161, Rome, Italy
| | - Gianluca Foglietta
- Unit of Parasitology, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Stefania Bernardi
- Division of Immunology and Infectious Diseases, Research Unit in Congenital and Perinatal Infections, University-Hospital, Pediatric Department (DPUO), Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Hyppolite K Tchidjou
- Division of Immunology and Infectious Diseases, Research Unit in Congenital and Perinatal Infections, University-Hospital, Pediatric Department (DPUO), Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Andrea Onetti Muda
- Department of Laboratories, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Paolo Palma
- Division of Immunology and Infectious Diseases, Research Unit in Congenital and Perinatal Infections, University-Hospital, Pediatric Department (DPUO), Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Lorenza Putignani
- Unit of Parasitology, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy. .,Unit of Human Microbiome, Bambino Gesù Children's Hospital, Viale San Paolo 15, 00146, Rome, Italy.
| |
Collapse
|
6
|
Linden VVD, Linden HVD, Leal MDC, Rolim EL, Linden AVD, Aragão MDFVV, Brainer-Lima AM, Cruz DDCS, Ventura LO, Florêncio TLT, Cordeiro MT, Caudas SDS, Ramos RC. Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:381-386. [PMID: 28658408 DOI: 10.1590/0004-282x20170066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/06/2017] [Indexed: 11/22/2022]
Abstract
Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.
Collapse
Affiliation(s)
- Vanessa van der Linden
- Hospital Barão de Lucena, Recife PE, Brasil.,Associação de Assistência à Criança Deficiente (AACD), Recife PE, Brasil
| | | | - Mariana de Carvalho Leal
- Universidade Federal de Pernambuco, Recife PE, Brasil.,Hospital Agamenon Magalhães, Recife PE, Brasil
| | - Epitacio Leite Rolim
- Associação de Assistência à Criança Deficiente (AACD), Recife PE, Brasil.,Universidade Federal de Pernambuco, Recife PE, Brasil
| | - Ana van der Linden
- Instituto de Medicina Integral Professor Fernando Figueira, Recife PE, Brasil
| | | | | | | | - Liana O Ventura
- Fundação Altino Ventura, Recife PE, Brasil.,Hospital de Olhos de Pernambuco (HOPE), Recife PE, Brasil
| | | | | | | | | |
Collapse
|