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Ginige S, Flower R, Viennet E. Neonatal Outcomes From Arboviruses in the Perinatal Period: A State-of-the-Art Review. Pediatrics 2021; 147:peds.2020-009720. [PMID: 33737375 DOI: 10.1542/peds.2020-009720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Since the 2016 Zika outbreak and the understanding of the teratogenic effect of this infection, there has been a newfound interest in arbovirus infections and their effects on pregnancy, resulting in numerous publications in the last 5 years. However, limited literature focuses on arbovirus infection in different stages of pregnancy and their effect on the neonate. There is currently no consensus management of perinatal acquisition of arboviruses, and current evidence is largely anecdotal observational reports. Teratogens can have different effects on the developing fetus depending on the time of infection, so infections during pregnancy should be analyzed by trimester. A better understanding of arbovirus infection in the perinatal period is required to assist obstetric, neonatal, and pediatric clinicians in making decisions about the management of mother and neonate. Our objective was to assess the evidence of adverse neonatal outcomes for several arboviral infections when contracted during the perinatal period to guide clinicians in managing these patients. There are 8 arboviruses for which neonatal outcomes from maternal acquisition in the perinatal period have been reported, with the most data for dengue and Chikungunya virus infections. The evidence reviewed in this article supports the adoption of preventive strategies to avoid ticks and mosquitoes close to the date of delivery. For the other arbovirus infections, further community-based cohort studies during outbreaks are required to evaluate whether these infections have a similar teratogenic impact.
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Abstract
Background: In the past 5 years, the Zika virus (ZIKV) has gone from being associated with mild infection to one of the most studied viruses worldwide. Between 2015 and 2016, the first reports of pregnant women with confirmed and/or suspected ZIKV infection described fetuses and newborns with severe congenital malformations, in particular microcephaly and central nervous system malformations, leading to a strong suspicion of its association with the virus. Despite all the knowledge rapidly acquired since the beginning of the ZIKV outbreak, many questions are still to be answered and further studies on the infection and its consequences are required.Aim: To present the currently available evidence on the epidemiological and clinical aspects of ZIKV infection.Methods: Non-systematic review carried out in MEDLINE (PubMed), LILACS (VHL), Scopus, Web of Science, Cochrane and CAPES Portal databases for the past five years using the search terms arboviruses, flavivirus, Zika and ZIKV.Results: The acute clinical of ZIKV infection in children seems very similar to that in adults, with fever (usully low), rash maculopapular and pruritus. Neurological complication associated with ZIKV reported in the literature include Guillain-Barré syndrome and meningoencephalitis. More recently, the term congenital Zika syndrome (CZS) has been adopted to describe a set of symptoms and signs in children whose mothers had ZIKV infection confirmed during pregnancy.Conclusions: More detailed knowledge of ZIKV infection in children allows the pediatrician to diagnose earlier, implement the correct treatment, monitor warnings signs for the most severe forms, and especially establish effective preventive measures.Abbreviations:: CDC, Centers for Disease Control; CZS, congenital Zika syndrome; DEET, N, N-diethyl-3-methylbenzamide; GBS, Guillain-Barré syndrome; PRNT, plaque reduction neutralisation test; RNA, ribonucleic acid; RT-PCR, reverse transcriptase polymerase chain reaction; STX, saxitoxin; ZIKV, Zika virus.
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Affiliation(s)
- Marlos Melo Martins
- Department of Pediatrics, Institute of Childcare and Pediatrics Martagão Gesteira, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - Roberto De Andrade Medronho
- Department of Epidemiology and Public Health, School of Medicine, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
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Mendes AKT, Ribeiro MRC, Lamy-Filho F, Amaral GA, Borges MCR, Costa LC, Cavalcante TB, Batista RFL, Sousa PDS, Silva AAMD. Congenital Zika syndrome: association between the gestational trimester of maternal infection, severity of brain computed tomography findings and microcephaly at birth. Rev Inst Med Trop Sao Paulo 2020; 62:e56. [PMID: 32844907 PMCID: PMC7447234 DOI: 10.1590/s1678-9946202062056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 12/25/2022] Open
Abstract
This study analyzed possible associations between the trimester of maternal Zika virus infection (ZIKV) in pregnancy, severity of brain computed tomography (CT) findings and the presence of microcephaly at birth in children with Congenital Zika Syndrome (CZS). It was an analytical study in a cohort of children with CZS. Symptoms of maternal infection were dichotomized into the 1st trimester of pregnancy and other trimesters. Head circumference (HC) at birth was used to calculate the z-score. Mild microcephaly was defined as HC between 2 and ≥3 standard deviations (SD) below the mean for each gestational age and sex, and severe microcephaly when HC <3 SD below average. Brain CT images were evaluated by two radiologists and classified, according to the severity, into mild, moderate and severe. Fisher’s exact, Mann-Whitney and Kruskal-Wallis tests were used to verify the associations between variables. In 108 children, maternal infection in the 1st trimester of pregnancy was associated with more severe brain CT abnormalities (p=0.038), greater severity of microcephaly at birth (p=0.013) and lower HC z-scores at birth (p=0.021). The severity of brain CT lesions was also associated with lower HC z-scores at birth (p<0.001). Maternal ZIKV infection during the first trimester of pregnancy proved to be an important risk factor for a more severe spectrum of CZS, as it is associated with more severe brain CT abnormalities and, consequently, with lower HC z-scores at birth.
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Affiliation(s)
| | | | - Fernando Lamy-Filho
- Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | | | | | - Patrícia da Silva Sousa
- Centro de Referência em Neurodesenvolvimento, Assistência e Reabilitação de Crianças, Secretaria de Saúde do Estado do Maranhão, São Luís, Maranhão, Brazil
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Gallo LG, Martinez-Cajas J, Peixoto HM, Pereira ACEDS, Carter JE, McKeown S, Schaub B, Ventura CV, de França GVA, Pomar L, Ventura LO, Nerurkar VR, de Araújo WN, Velez MP. Another piece of the Zika puzzle: assessing the associated factors to microcephaly in a systematic review and meta-analysis. BMC Public Health 2020; 20:827. [PMID: 32487247 PMCID: PMC7266116 DOI: 10.1186/s12889-020-08946-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although it is known that Zika virus (ZIKV) infection during pregnancy may lead to microcephaly in the fetus, the prognostic factors associated with this tragic disorder remain unclear. We conducted a systematic review and meta-analysis to assess the prognostic factors associated with the incidence of microcephaly in congenital ZIKV infection. METHODS We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of print, Embase, Embase Classic, Web of Science, CINAHL, Cochrane CENTRAL, LILACS, and various thesis databases to identify human studies reporting microcephaly associated with congenital ZIKV infection. We requested primary data from the authors of the included studies to calculate summary estimates and conduct the meta-analysis of the most prevalent factors. RESULTS We screened 4106 titles and abstracts, and identified 12 studies for inclusion in the systematic review. The assessment of ZIKV infection and the definition of microcephaly varied among studies. A total of 6154 newborns/fetuses were enrolled; of those, 1120 (18.20%) had a diagnostic of ZIKV infection, of which 509 (45.45%) were diagnosed with microcephaly. Nine studies addressed the link between congenital ZIKV infection and neurological findings in newborns/fetuses. Half of the studies provided primary data. Three out of 11 factors of interest seem to be prognostic factors of microcephaly: infant's sex - males compared to females: Relative Risk (RR) 1.30, 95% Confidence Interval (95% CI) 1.14 to 1.49; the stage of pregnancy when infection occurred - infection in the first trimester of pregnancy compared to infection at other stages of pregnancy: RR 1.41, 95% CI 1.09 to 1.82; and asymptomatic infection compared to symptomatic infection during pregnancy: RR 0.68; 95% CI 0.60 to 0.77. CONCLUSION Our findings support the female-biased resistance hypothesis and reinforce the risk associated with the stage of pregnancy when ZIKV infection occurs. Continued surveillance of ZIKV infection during pregnancy is needed to identify additional factors that could contribute to developing microcephaly in affected fetuses. PROTOCOL REGISTRATION This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD 42018088075.
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Affiliation(s)
- Luciana Guerra Gallo
- Postgraduate Program in Tropical Medicine, University of Brasilia, Brasilia, Brazil
- Department of Obstetrics and Gynecology and Department of Public Health Sciences, Queen's University, Kingston, Canada
| | | | - Henry Maia Peixoto
- Postgraduate Program in Tropical Medicine, University of Brasilia, Brasilia, Brazil
| | | | - Jillian E Carter
- Department of Obstetrics and Gynecology and Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen's University, Kingston, Canada
| | - Bruno Schaub
- Centre Pluridisciplinaire de Diagnostic Prénatal de le Martinique, Maison de la Femme, de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, Martinique
| | - Camila V Ventura
- Department of Scientific Investigation, Altino Ventura Foundation, Recife, Brazil
| | | | - Léo Pomar
- Materno-fetal and Obstetrics Research Unit, Département "Femme-Mère Enfant", University Hospital, Lausanne, Switzerland
- Department of Obstetrics and Gynaecology, Centre Hospitalier de l'Ouest Guyanais Franck Joly, Saint-Laurent-du-Maroni, French Guiana
| | - Liana O Ventura
- Department of Pediatric Ophthalmology and Strabismus, Altino Ventura Foundation, Recife, Brazil
| | - Vivek R Nerurkar
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | | | - Maria P Velez
- Department of Obstetrics and Gynecology and Department of Public Health Sciences, Queen's University, Kingston, Canada.
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Soriano-Arandes A, Frick MA, García López-Hortelano M, Sulleiro E, Rodó C, Sánchez-Seco MP, Cabrera-Lafuente M, Suy A, De la Calle M, Santos M, Antolin E, Viñuela MDC, Espiau M, Salazar A, Guarch-Ibáñez B, Vázquez A, Navarro-Morón J, Ramos-Amador JT, Martin-Nalda A, Dueñas E, Blázquez-Gamero D, Reques-Cosme R, Olabarrieta I, Prieto L, De Ory F, Thorne C, Byrne T, Ades AE, Ruiz-Burga E, Giaquinto C, Mellado-Peña MJ, García-Alix A, Carreras E, Soler-Palacín P. Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain. Pathogens 2020; 9:pathogens9050352. [PMID: 32392815 PMCID: PMC7281364 DOI: 10.3390/pathogens9050352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. Methods: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. Results: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4–6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4–39.6%). Conclusions: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations.
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Affiliation(s)
- Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
- Correspondence: ; Tel.: +34-93-4893-140
| | - Marie Antoinette Frick
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | | | - Elena Sulleiro
- Departament of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carlota Rodó
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | | | | | - Anna Suy
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | - María De la Calle
- Department of Obstetrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (E.A.)
| | - Mar Santos
- Department of Paediatrics, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (M.S.); (E.D.)
| | - Eugenia Antolin
- Department of Obstetrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.D.l.C.); (E.A.)
| | | | - María Espiau
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Ainara Salazar
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Borja Guarch-Ibáñez
- Department of Paediatrics, Hospital Universitari Josep Trueta, 17007 Girona, Spain;
| | - Ana Vázquez
- Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.P.S.-S.); (A.V.); (F.D.O.)
| | | | | | - Andrea Martin-Nalda
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
| | - Eva Dueñas
- Department of Paediatrics, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (M.S.); (E.D.)
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, 28041 Madrid, Spain; (D.B.-G.); (L.P.)
| | | | | | - Luis Prieto
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, 28041 Madrid, Spain; (D.B.-G.); (L.P.)
| | - Fernando De Ory
- Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.P.S.-S.); (A.V.); (F.D.O.)
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | - Thomas Byrne
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | | | - Elisa Ruiz-Burga
- University College London Great Ormond Street Institute of Child Health, GOSH NIHR BRC, London WC1N 1EH, UK; (C.T.); (T.B.); (E.R.-B.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35122 Padova, Italy;
| | - María José Mellado-Peña
- Department of Paediatrics, Hospital Universitario La Paz, 28046 Madrid, Spain; (M.G.L.-H.); (M.J.M.-P.)
| | | | - Elena Carreras
- Unit of Fetal Medicine, Department of Obstetrics, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (C.R.); (A.S.); (E.C.)
| | - Pere Soler-Palacín
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (M.A.F.); (M.E.); (A.S.); (A.M.-N.); (P.S.-P.)
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Xanthenedione (and intermediates involved in their synthesis) inhibit Zika virus migration to the central nervous system in murine neonatal models. Microbes Infect 2020; 22:489-499. [PMID: 32353601 DOI: 10.1016/j.micinf.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/25/2022]
Abstract
Zika Virus (ZIKV), an arbovirus that belongs to the Flaviviridae family, has become a global concern since its outbreak in the Americas in 2015. With symptoms similar to other Flavivirus as Dengue and Yellow Fever viruses, infections by ZIKV have also been related to several neurological complications such as microcephaly in newborns and Guillain-Barre syndrome. Considering the high prevalence of ZIKV infection in certain areas, the risks that the virus poses to fetal brain development, and the fact that there is no vaccine or specific prophylaxis available, an effective treatment capable of preventing the infection is of potential interest. Therefore, in the present investigation, the antiviral activity on ZIKV of a group of xanthenodiones and intermediate ketones involved in their synthesis was evaluated for the first time. It was found that the compound 2-(2,6-dichlorobenzylidene)cyclohexane-1,3-dione 27 was able to completely inhibit the viral infection of Vero cells as well as to significantly reduce viral load in the brains of newborn Swiss mice. These effects are related to a direct interaction of the compound with the viral particle, blocking the viral adsorption.
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Peçanha PM, Gomes Junior SC, Pone SM, Pone MVDS, Vasconcelos Z, Zin A, Vilibor RHH, Costa RP, Meio MDBB, Nielsen-Saines K, Brasil P, Brickley E, Lopes Moreira ME. Neurodevelopment of children exposed intra-uterus by Zika virus: A case series. PLoS One 2020; 15:e0229434. [PMID: 32109947 PMCID: PMC7048286 DOI: 10.1371/journal.pone.0229434] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
The main goal of this manuscript was to investigate the neurodevelopment of children exposed by Zika virus in the intrauterine period who are asymptomatic at birth. Newborns with documented Zika virus exposure during the intrauterine period who were asymptomatic at birth were followed in the first two years of life for neurodevelopment using Bayley III test. Children were classified as having normal or delayed neurodevelopment for age based on most recent Bayley III evaluation results. Eighty-four infants were included in the study. The first Bayley III evaluation was performed at a mean chronological age of 9.7±3.1 month; 13 children (15%) had a delay in one of the three domains, distributed as follow: 10 (12%) in the language domain and 3 (3.5%) in the motor domain. The most recent Bayley III evaluation was performed at a mean age 15.3±3.1 months; 42 children (50%) had a delay in one of the three domains: 4 (5%) in cognition, 31 (37%) in language, and 20 (24%) in motor performance. There were no statistical differences in Gender, Gestational Age, Birth Weight and Head Circurference at birth between children with normal and delayed neurodevelopment for age. A very high proportion of children exposed ZIKV during pregnancy who were asymptomatic at birth demonstrated a delay in neurodevelopment, mainly in the language domain, the first two years of life.
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Affiliation(s)
| | | | | | | | | | - Andrea Zin
- Instituto Fernandes Figueira–Fiocruz, Rio de Janeiro, Brazil
| | | | | | | | - Karin Nielsen-Saines
- Universidade da California- UCLA, Los Angeles, California, United States of America
| | - Patricia Brasil
- Instituto Nacional de Infectologia-Fiocruz, Rio de Janeiro, Brazil
| | - Elizabeth Brickley
- London School of Hygiene & Tropical Medicine, London, England, United Kingdom
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8
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Mei C, Yang W, Wei X, Wu K, Huang D. The Unique Microbiome and Innate Immunity During Pregnancy. Front Immunol 2019; 10:2886. [PMID: 31921149 PMCID: PMC6929482 DOI: 10.3389/fimmu.2019.02886] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/25/2019] [Indexed: 12/26/2022] Open
Abstract
A successful pregnancy depends on not only the tolerance of the fetal immune system by the mother but also resistance against the threat of hazardous microorganisms. Infection with pathogenic microorganisms during pregnancy may lead to premature delivery, miscarriage, growth restriction, neonatal morbidity, and other adverse outcomes. Moreover, the host also has an intact immune system to avoid these adverse outcomes. It is important to note the presence of normal bacteria in the maternal reproductive tract and the principal role of the maternal-placental-fetal interaction in antimicrobial immunity. Previous studies mainly focused on maternal infection during pregnancy. However, this review summarizes the new views on the study of the maternal microbiome and expounds the innate immune defense mechanism of the maternal vagina and decidua as well as how cytotrophoblasts and syncytiotrophoblasts recognize and kill bacteria in the placenta. Fetal immune systems, thought to be weak, also exhibit an immune defense function that is indispensable for maintaining the safety of the fetus. The skin, lungs, and intestines of the fetus during pregnancy constitute the main immune barriers. These findings will provide a new understanding of the effects of normal microbial flora and how the host resists harmful microbes during pregnancy. We believe that it may also contribute to the reference on the clinical prevention and treatment of gestational infection to avoid adverse pregnancy outcomes.
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Affiliation(s)
- Chunlei Mei
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weina Yang
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Wei
- Second Affiliated Hospital of Jinlin University, Changchun, China
| | - Kejia Wu
- Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Donghui Huang
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ximenes R, Ramsay LC, Miranda RN, Morris SK, Murphy K, Sander B. Health outcomes associated with Zika virus infection in humans: a systematic review of systematic reviews. BMJ Open 2019; 9:e032275. [PMID: 31685512 PMCID: PMC6858219 DOI: 10.1136/bmjopen-2019-032275] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE With the emergence of Zika virus (ZIKV) disease in Central and South America in the mid-2010s and recognition of the teratogenic effects of congenital exposure to ZIKV, there has been a substantial increase in new research published on ZIKV. Our objective is to synthesise the literature on health outcomes associated with ZIKV infection in humans. METHODS We conducted a systematic review (SR) of SRs following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE, Embase, Cochrane and LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) databases from inception to 22 July 2019, and included SRs that reported ZIKV-associated health outcomes. Three independent reviewers selected eligible studies, extracted data and assessed the quality of included SRs using the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews 2) tool. Conflicts were resolved by consensus or consultation with a third reviewer. RESULTS The search yielded 1382 unique articles, of which 21 SRs met our inclusion criteria. The 21 SRs ranged from descriptive to quantitative data synthesis, including four meta-analyses. The most commonly reported ZIKV-associated manifestations and health outcomes were microcephaly, congenital abnormalities, brain abnormalities, neonatal death and Guillain-Barré syndrome. The included reviews were highly heterogeneous. The overall quality of the SRs was critically low with all studies having more than one critical weakness. CONCLUSION The evolving nature of the literature on ZIKV-associated health outcomes, together with the critically low quality of existing SRs, demonstrates the need for high-quality SRs to guide patient care and inform policy decision making. PROSPERO REGISTRATION NUMBER CRD42018091087.
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Affiliation(s)
- Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Lauren C Ramsay
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rafael Neves Miranda
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases and Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kellie Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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10
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Sulleiro E, Frick MA, Rodó C, Espasa M, Thorne C, Espiau M, Martín-Nalda A, Suy A, Giaquinto C, Melendo S, Rando A, Alarcón A, Martinón-Torres F, Pumarola T, Soler-Palacín P, Soriano-Arandes A. The challenge of the laboratory diagnosis in a confirmed congenital Zika virus syndrome in utero: A case report. Medicine (Baltimore) 2019; 98:e15532. [PMID: 31096455 PMCID: PMC6531038 DOI: 10.1097/md.0000000000015532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Zika virus (ZIKV) has caused one of the most challenging global infectious epidemics in recent years because of its causal association with severe microcephaly and other congenital malformations. The diagnosis of viral infections usually relies on the detection of virus proteins or genetic material in clinical samples as well as on the infected host immune responses. Serial serologic testing is required for the diagnosis of congenital infection when diagnostic molecular biology is not possible. PATIENT CONCERNS A 2-year-old girl, born to a mother with confirmed ZIKV infection during pregnancy, with a confirmed ZIKV infection in utero, showed at birth a severe microcephaly and clinical characteristics of fetal brain disruption sequence compatible with a congenital ZIKV syndrome (CZS). DIAGNOSIS ZIKV-RNA and ZIKV-IgM serological response performed at birth and during the follow-up time tested always negative. Serial serologic ZIKV-IgG tests were performed to assess the laboratory ZIKV diagnosis, ZIKV-IgG seroreversion was observed at 21 months of age. ZIKV diagnosis of this baby had to be relied on her clinical and radiological characteristics that were compatible with a CZS. INTERVENTIONS The patient was followed-up as per protocol at approximately 1, 4, 9, 12, 18-21, and 24 months of age. Neurological, radiological, audiological, and ophthalmological assessment were performed during this period of time. Prompt rehabilitation was initiated to prevent potential adverse long-term neurological outcomes. OUTCOMES The growth of this girl showed a great restriction at 24 months of age with a weight of 8.5 kg (-2.5 z-score) and a head circumference of 40.5 cm (-4.8 z-score). She also had a great neurodevelopmental delay at the time of this report. CONCLUSION We presume that as a consequence of prenatal ZIKV infection, the fetal brain and other organs are damaged before birth through direct injury. Following this, active infection ends during intrauterine life, and as a consequence the immune system of the infant is unable to build up a consistent immune response thereafter. Further understanding of the mechanisms taking part in the pathogenesis of ZIKV congenital infection is needed. This finding might change our paradigm regarding serological response in the ZIKV congenital infection.
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Affiliation(s)
- Elena Sulleiro
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Marie Antoinette Frick
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Carlota Rodó
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Mateu Espasa
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Claire Thorne
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- University College London, London, United Kingdom
| | - María Espiau
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Andrea Martín-Nalda
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Anna Suy
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
| | - Carlo Giaquinto
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- University of Padova, PENTA Foundation, Padova, Italy
| | | | - Ariadna Rando
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ana Alarcón
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Federico Martinón-Torres
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
- Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | | | - Antoni Soriano-Arandes
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
- ZIKAction Consortium, European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857
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Runge-Ranzinger S, Morrison AC, Manrique-Saide P, Horstick O. Zika transmission patterns: a meta-review. Trop Med Int Health 2019; 24:523-529. [PMID: 30771269 DOI: 10.1111/tmi.13216] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assesses what is known and identify knowledge gaps for Zika virus (ZIKV) transmission patterns. METHODS Meta-review searching the databases BioSys; Cochrane Infectious Diseases Group Specialised Register and Cochrane Central Register of Controlled Trials; EMBASE; Google Scholar; LILACS; MEDLINE (PubMed); Web of Science; and WHOLIS with the term 'ZIKA'. Systematic reviews and reviews specifying the search methods and describing potential modes of transmission were eligible for analysis. RESULTS Of 5,401 hits for 'Zika', 44 studies were assessed and 11 included after applying in- and exclusion criteria: six systematic reviews and five reviews with specified methods, covering all ways of possible transmission. Results can be grouped into transmission routes with good evidence and agreement between the studies (evidence on vector, mother-to-child and sexual transmission) and transmission routes with limited evidence. Transmission by breastfeeding, intrapartum, by animal bites or laboratory-based remains inconclusive, as these routes are suggested by single studies only. The risk of transfusion transmission is described and public health measures for safe transfusion should be taken as available. CONCLUSION Our results imply the need for public health measures to limit transmission via vectors, mother-to-child, sexual transmission and blood transfusion. Also needed are long-term prospective cohort studies covering periods of active Zika virus transmission and measuring epidemiological parameters to establish evidence on other routes of transmission; seroprevalence studies; transmission dynamics modelling and modelling health impacts by different modes of transmission.
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Affiliation(s)
- S Runge-Ranzinger
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | - A C Morrison
- Department of Entomology and Nematology, University of California, Davis, USA
| | | | - O Horstick
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
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12
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Bovbjerg ML. Current Resources for Evidence-Based Practice, March 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:230-248. [PMID: 30735623 DOI: 10.1016/j.jogn.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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13
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Diteepeng T, Khongwichit S, Paemanee A, Roytrakul S, Smith DR. Proteomic analysis of monkey kidney LLC-MK2 cells infected with a Thai strain Zika virus. Arch Virol 2019; 164:725-737. [PMID: 30612200 DOI: 10.1007/s00705-018-04137-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022]
Abstract
Zika virus (ZIKV) has been endemic in Southeast Asian countries for several years, but the presence of the virus has not been associated with significant outbreaks of infection unlike other countries around the world where the Asian lineage ZIKV was introduced recently. However, few studies have been undertaken using the endemic virus. The Thai isolate was shown to have a similar tissue tropism to an African isolate of ZIKV, albeit that the Thai isolate infected cells at a lower level as compared to the African isolate. To further understand the pathogenesis of the Thai isolate, a 2D-gel proteomic analysis was undertaken of ZIKV infected LLC-MK2 cells. Seven proteins (superoxide dismutase [Mn], peroxiredoxin 2, ATP synthase subunit alpha, annexin A5 and annexin A1, carnitine o-palmitoyltransferase 2 and cytoskeleton-associated protein 2) were identified as differentially regulated. Of four proteins selected for validation, three (superoxide dismutase [Mn], peroxiredoxin 2, ATP synthase subunit alpha, and annexin A1) were shown to be differentially regulated at both the transcriptional and translational levels. The proteins identified were primarily involved in energy production both directly, and indirectly through mediation of autophagy, as well as in the response to oxidative stress, possibly occurring as a consequence of increased energy production. This study provides further new information on the pathogenesis of ZIKV.
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Affiliation(s)
- Thamonwan Diteepeng
- Molecular Pathology Laboratory, Institute of Molecular Biosciences, Mahidol University, Salaya Campus, 25/25 Phuttamonton Sai 4, Salaya, Nakorn Pathom, 73170, Thailand
| | - Sarawut Khongwichit
- Molecular Pathology Laboratory, Institute of Molecular Biosciences, Mahidol University, Salaya Campus, 25/25 Phuttamonton Sai 4, Salaya, Nakorn Pathom, 73170, Thailand
| | - Atchara Paemanee
- Molecular Pathology Laboratory, Institute of Molecular Biosciences, Mahidol University, Salaya Campus, 25/25 Phuttamonton Sai 4, Salaya, Nakorn Pathom, 73170, Thailand
| | - Sittiruk Roytrakul
- National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Thailand Science Park, Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani, 12120, Thailand
| | - Duncan R Smith
- Molecular Pathology Laboratory, Institute of Molecular Biosciences, Mahidol University, Salaya Campus, 25/25 Phuttamonton Sai 4, Salaya, Nakorn Pathom, 73170, Thailand.
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