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Rollman TB, Berkebile ZW, Okae H, Bardwell VJ, Gearhart MD, Bierle CJ. Human trophoblast stem cells restrict human cytomegalovirus replication. J Virol 2024; 98:e0193523. [PMID: 38451085 PMCID: PMC11019952 DOI: 10.1128/jvi.01935-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024] Open
Abstract
Placental infection plays a central role in the pathogenesis of congenital human cytomegalovirus (HCMV) infections and is a cause of fetal growth restriction and pregnancy loss. HCMV can replicate in some trophoblast cell types, but it remains unclear how the virus evades antiviral immunity in the placenta and how infection compromises placental development and function. Human trophoblast stem cells (TSCs) can be differentiated into extravillous trophoblasts (EVTs), syncytiotrophoblasts (STBs), and organoids, and this study assessed the utility of TSCs as a model of HCMV infection in the first-trimester placenta. HCMV was found to non-productively infect TSCs, EVTs, and STBs. Immunofluorescence assays and flow cytometry experiments further revealed that infected TSCs frequently only express immediate early viral gene products. Similarly, RNA sequencing found that viral gene expression in TSCs does not follow the kinetic patterns observed during lytic infection in fibroblasts. Canonical antiviral responses were largely not observed in HCMV-infected TSCs and TSC-derived trophoblasts. Rather, infection dysregulated factors involved in cell identity, differentiation, and Wingless/Integrated signaling. Thus, while HCMV does not replicate in TSCs, infection may perturb trophoblast differentiation in ways that could interfere with placental function. IMPORTANCE Placental infection plays a central role in human cytomegalovirus (HCMV) pathogenesis during pregnancy, but the species specificity of HCMV and the limited availability and lifespan of primary trophoblasts have been persistent barriers to understanding how infection impacts this vital organ. Human trophoblast stem cells (TSCs) represent a new approach to modeling viral infection early in placental development. This study reveals that TSCs, like other stem cell types, restrict HCMV replication. However, infection perturbs the expression of genes involved in differentiation and cell fate determination, pointing to a mechanism by which HCMV could cause placental injury.
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Affiliation(s)
- Tyler B. Rollman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Zachary W. Berkebile
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hiroaki Okae
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Vivian J. Bardwell
- Developmental Biology Center, Department of Genetics, Cell Biology and Development and the Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Micah D. Gearhart
- Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Craig J. Bierle
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Radoi CL, Zlatian O, Balasoiu M, Dragomir TL, Sorop MI, Bagiu IC, Boeriu E, Susan M, Sorop B, Oprisoni LA, Iliescu DG. Seroprevalence of Anti-Cytomegalovirus Antibodies in Pregnant Women from South-West Romania. Microorganisms 2024; 12:268. [PMID: 38399672 PMCID: PMC10893531 DOI: 10.3390/microorganisms12020268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Cytomegalovirus (CMV), in addition to other agents, is part of the TORCH complex (Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex viruses, and other agents). CMV infection is the most frequent cause of congenital malformations. This study aimed to establish the variation of prevalence of anti-CMV antibodies in pregnant women from the South-West region of Romania, according to demographic factors, such as age and area of residence, in two separate time periods (2013-2016 and 2019-2022). We collected from the hospital records the age, place of residence, and anti-CMV antibody test results using immune electrochemiluminescence and chemiluminescence. This study found that the seroprevalence of anti-CMV IgM antibodies increased slightly from 2013-2016 to 2019-2022, from 1.92% to 2.26%, and for IgG antibodies from 93.68% to 94.96%. In both groups was observed a descending trend of anti-CMV IgM seroprevalence with an increase in age, showing a decrease in seroprevalence from 3.57% to 1.09% in pregnant women from rural areas in the 31-35 years age group, while in urban areas, we observed a decrease in seroprevalence from 11.11% to 3.06% in the <20 years age group. The IgG seroprevalence showed an increase both in rural areas (from 93.97% to 95.52%) and urban areas (from 93.52% to 94.27%). In both groups, seroprevalence was higher in rural areas compared to urban regions. These results show a high rate of immunization against CMV in pregnant women in South-West Romania, which led to a low risk of acquiring the primary infection during pregnancy. However, the increase in the rate of primary CMV infections in pregnancy suggests the need for prioritizing screening programs and improving the existing protocols to enhance maternal and child healthcare.
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Affiliation(s)
- Cristiana Luiza Radoi
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ovidiu Zlatian
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200349 Craiova, Romania; (O.Z.); (M.B.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Maria Balasoiu
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200349 Craiova, Romania; (O.Z.); (M.B.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Tiberiu-Liviu Dragomir
- Department of Internal Medicine I, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Madalina Ioana Sorop
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Iulia Cristina Bagiu
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Estera Boeriu
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Monica Susan
- Department of Internal Medicine I, Centre for Preventive Medicine,”Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timisoara, Romania;
| | - Bogdan Sorop
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Licinia Andrada Oprisoni
- Department of Pediatrics, Discipline of Pediatric Oncology and Hematology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Dominic Gabriel Iliescu
- Obstetrics and Gynecology Department, County Clinical Emergency Hospital of Craiova, 200349 Craiova, Romania;
- Obstetrics and Gynecology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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3
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Losa A, Carvalho I, Sousa B, Ashworth J, Guedes A, Carreira L, Pinho L, Godinho C. Diagnosis of Congenital Toxoplasmosis: Challenges and Management Outcomes. Cureus 2024; 16:e52971. [PMID: 38406029 PMCID: PMC10894009 DOI: 10.7759/cureus.52971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Congenital toxoplasmosis (CT), despite being mostly subclinical at birth, can cause disabling disease in the fetus and lead to long-term sequelae. It is an important cause of chorioretinitis in infants and adolescents. Data on postnatal treatment are controversial, and there is a lack of universal guidelines. Methods A cross-sectional study of newborns with suspected CT was conducted between January 2007 and December 2021. Results Seventy-one patients with suspected CT were included. During pregnancy, 64 (90.1%) of the mothers underwent therapy, of which 59 (83.1%) with spiramycin. Amniocentesis identified one positive polymerase chain reaction assay. Most newborns were asymptomatic with normal laboratory, ophthalmological, and hearing screening. There was one case of hyperproteinorrachia. Fifty-seven patients (80.3%) started treatment: 42 (73.7%) with spiramycin, seven (12.3%) with pyrimethamine, sulfadiazine, and folinic acid (P+S+FA), and eight (14%) with P+S+FA intercalated with spiramycin. Adverse effects were found in 11 (19.3%) cases, mainly neutropenia. After investigation, we found three confirmed CT cases corresponding to 4.2% of suspected cases and an incidence of 0.4 per 10,000 births. All had normal clinical and laboratory exams in the neonatal period and started P+S+FA, fulfilling 12 months of therapy. During the follow-up, all presented normal psychomotor development without any long-term sequelae. Conclusion The lower incidence in our study, compared to the incidence in Europe, may be related to the decline in the prevalence of toxoplasmosis as well as the effectiveness of measures to prevent primary infection and a well-established program of antenatal screening, followed by the early initiation of treatment during pregnancy to prevent vertical transmission.
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Affiliation(s)
- Ana Losa
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Indira Carvalho
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Bebiana Sousa
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Joanna Ashworth
- Pediatrics Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Ana Guedes
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Luísa Carreira
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Liliana Pinho
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Cristina Godinho
- Neonatology Department, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Kotsiri I, Resta P, Spyrantis A, Panotopoulos C, Chaniotis D, Beloukas A, Magiorkinis E. Viral Infections and Schizophrenia: A Comprehensive Review. Viruses 2023; 15:1345. [PMID: 37376644 DOI: 10.3390/v15061345] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Schizophrenia is a complex mental disorder with multiple genetic and environmental factors contributing to its pathogenesis. Viral infections have been suggested to be one of the environmental factors associated with the development of this disorder. We comprehensively review all relevant published literature focusing on the relationship between schizophrenia and various viral infections, such as influenza virus, herpes virus 1 and 2 (HSV-1 and HSV-2), cytomegalovirus (CMV), Epstein-Barr virus (EBV), retrovirus, coronavirus, and Borna virus. These viruses may interfere with the normal maturation of the brain directly or through immune-induced mediators, such as cytokines, leading to the onset of schizophrenia. Changes in the expression of critical genes and elevated levels of inflammatory cytokines have been linked to virally-induced infections and relevant immune activities in schizophrenia. Future research is necessary to understand this relationship better and provide insight into the molecular mechanisms underlying the pathophysiology of schizophrenia.
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Affiliation(s)
- Ioanna Kotsiri
- Department of Internal Medicine, Asklipeion General Hospital, Voulas, 16673 Athens, Greece
| | - Panagiota Resta
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
- National AIDS Reference Centre of Southern Greece, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece
| | - Alexandros Spyrantis
- Department of Internal Medicine, Asklipeion General Hospital, Voulas, 16673 Athens, Greece
| | | | - Dimitrios Chaniotis
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
- National AIDS Reference Centre of Southern Greece, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece
| | - Emmanouil Magiorkinis
- Department of Laboratory Medicine, Sotiria General Hospital for Chest Diseases, 11527 Athens, Greece
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Damar Çakırca T, Can İN, Deniz M, Torun A, Akçabay Ç, Güzelçiçek A. Toxoplasmosis: A Timeless Challenge for Pregnancy. Trop Med Infect Dis 2023; 8:tropicalmed8010063. [PMID: 36668970 PMCID: PMC9867407 DOI: 10.3390/tropicalmed8010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
This study aimed to evaluate the prevalence of toxoplasmosis in pregnant women, as well as the general characteristics, clinical and laboratory findings, and pregnancy and fetal outcomes of pregnant women diagnosed with acute toxoplasma infection (ATI). The toxoplasma IgM, IgG, and IgG avidity test results of pregnant women who applied to our referral hospital between January 2016 and June 2022, and among them, those diagnosed with ATI, were analyzed. The 119 patients diagnosed with ATI during this time period were included for further analysis. The prevalence of toxoplasmosis in pregnant women was found to be 46.2%, and the rate of ATI was 4%. The total mother-to-child transmission rate was 5% (5/101). Congenital toxoplasmosis (CT) was observed in 1 (1.1%) child of the 87 pregnant women who received spiramycin prophylaxis, though it was found in 4 (30.8%) of the children of the 13 untreated mothers. With respect to prenatal treatment, CT rates were significantly higher in the children born to untreated mothers (p = 0.001). In conclusion, although toxoplasma seroprevalence was found to be high in our region, there was a paucity in diagnosis, follow-up, and treatment. Our findings support that prenatal spiramycin prophylaxis is effective in preventing the transmission of parasites from mother to child.
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Affiliation(s)
- Tuba Damar Çakırca
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
- Correspondence:
| | - İlkay Nur Can
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Melis Deniz
- Department of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Ayşe Torun
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Çiğdem Akçabay
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Ahmet Güzelçiçek
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa 63290, Turkey
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Bogiel T, Ziółkowski S, Domian A, Dobrzyńska Z. An Application of Real-Time PCR and CDC Protocol May Significantly Reduce the Incidence of Streptococcus agalactiae Infections among Neonates. Pathogens 2022; 11:1064. [PMID: 36145496 DOI: 10.3390/pathogens11091064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Streptococcus agalactiae is an important human opportunistic pathogen, especially infectious for pregnant women and neonates. This pathogen belongs to beta hemolytic Streptococcus spp. representatives and accounts for a significant part of early infections in newborns, including serious life-threatening infections. This research investigated the usefulness of Centers for Disease Control and Prevention (CDC) protocol for S. agalactiae DNA detection in 250 samples of recto-vaginal swabs collected from pregnant women (at 35-37 weeks of gestation) and pre-cultured overnight in liquid medium. With an application of the CDC protocol-based real-time PCR, the cfb gene was detected in 68 (27.2%) samples compared to 41 (16.4%) for the standard culture-based methodology. The applied molecular method presented high sensitivity (100.0%) and specificity (87.1%). Therefore, it allowed for more precise detection of S. agalactiae bacteria, compared to the reference diagnostic method, culture on solid media with the following strain identification. The increased sensitivity of GBS detection may result in a reduced number of infections in newborns and leads to more targeted antimicrobial prophylaxis therapy of GBS infections in pregnant women. In addition, the use of the molecular method allows for a significant reduction in the time needed to obtain a result for GBS detection, and interpretation of the results is relatively simple. Therefore, it enables a faster intervention in case of a necessity of an antibiotic therapy introduction in pregnant women whose GBS status is unknown at the time of delivery.
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Bieńkowski C, Aniszewska M, Kowalska JD, Pokorska-Śpiewak M. Testing for HIV Increases the Odds of Correct Fetal Ultrasound Result. Trop Med Infect Dis 2022; 7:tropicalmed7090242. [PMID: 36136653 PMCID: PMC9504467 DOI: 10.3390/tropicalmed7090242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Infectious diseases during pregnancy may pose a threat to both mother and the developing fetus. It also creates an opportunity to screen for diseases being widely underdiagnosed among women in Poland, such as human immunodeficiency virus (HIV) or sexually transmitted infections (STI). Therefore, we aimed to assess the number of pregnant women that had not been tested for HIV despite the recommendations. In addition, a comparison of clinical evaluation between HIV-tested and non-tested pregnant women was also performed. Material and methods: Medical records of all consecutive pregnant women, referred to our Infectious Diseases Hospital between September 2019 and March 2020 were retrospectively analyzed. Implementation of recommended screening testing towards infectious diseases during pregnancy including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), syphilis, and rubella, were also analyzed. Results: Medical records of 273 women were included in the analysis. The median age was 32 years (interquartile range: 26−33 years). In total 243/273 (89.0%) had been tested for HIV as recommended, and the remaining 30/273 (11.0%) had not been tested. HIV infection was not confirmed in any of the participants. Only one woman within the HIV non-tested group had been correctly tested towards other infections during her pregnancy. The recommended full testing was more likely to be correctly implemented in women who had also been tested for HIV (171/243, 70.4% vs. 1/30, 3.3%, OR 68.9; 95% CI 9.2−515.3, p < 0.00001). Moreover, the correct fetal ultrasound result was more likely to be obtained in women who had been tested for HIV as recommended (234/243, 96.3% vs. 11/30, 36.7%, OR 44.9; 95% CI 16.6−121.8, p < 0.00001). Conclusions: Despite the law regulations, 11% of pregnant women referred to consultations to the infectious diseases center had not been tested for HIV. At the same time, correct fetal ultrasound results are more likely to occur in women tested for HIV according to recommendations. This suggests that a holistic approach to screening, both for communicable and non-communicable diseases, among pregnant women may translate to better pregnancy outcomes.
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Affiliation(s)
- Carlo Bieńkowski
- Doctoral School, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-3355-301
| | - Małgorzata Aniszewska
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
| | - Justyna D. Kowalska
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
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Walker S, Coray E, Ginsberg-Peltz J, Smith L. A Five-Week-Old Twin With Profound Anemia: A Case Report of Asymmetric Congenital Babesiosis. Cureus 2022; 14:e22774. [PMID: 35382190 PMCID: PMC8974790 DOI: 10.7759/cureus.22774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 01/10/2023] Open
Abstract
We present a case report and review of the literature of congenital transmission of babesiosis in a five-week-old twin neonate evaluated for lethargy and difficulty with feeding. On presentation to the pediatric emergency department, the patient appeared pale and was found to be profoundly anemic with intraerythrocytic ringed parasites consistent with Babesia microti visible on a thin smear. The patient received a blood transfusion and was treated with a regimen of atovaquone and azithromycin with full recovery. The other twin remained asymptomatic with negative Babesia polymerase chain reaction testing.
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Affiliation(s)
- Sulynn Walker
- Emergency Medicine, Baystate Medical Center, Springfield, USA
| | - Elizabeth Coray
- Pediatric Emergency Medicine, Baystate Medical Center, Springfield, USA
| | | | - Liza Smith
- Emergency Medicine, Baystate Medical Center, Springfield, USA
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Bollani L, Auriti C, Achille C, Garofoli F, De Rose DU, Meroni V, Salvatori G, Tzialla C. Congenital Toxoplasmosis: The State of the Art. Front Pediatr 2022; 10:894573. [PMID: 35874584 PMCID: PMC9301253 DOI: 10.3389/fped.2022.894573] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Infection with the protozoan parasite Toxoplasma gondii occurs worldwide and usually causes no symptoms. However, a primary infection of pregnant women, may infect the fetus by transplacental transmission. The risk of mother-to-child transmission depends on week of pregnancy at the time of maternal infection: it is low in the first trimester, may reach 90% in the last days of pregnancy. Inversely, however, fetal disease is more severe when infection occurs early in pregnancy than later. Systematic serologic testing in pregnant women who have no antibodies at the beginning of pregnancy, can accurately reveal active maternal infection. Therefore, the risk of fetal infection should be assessed and preventive treatment with spiramycin must be introduced as soon as possible to reduce the risk of mother-to-child transmission, and the severity of fetal infection. When maternal infection is confirmed, prenatal diagnosis with Polymerase Chain Reaction (PCR) on amniotic fluid is recommended. If fetal infection is certain, the maternal treatment is changed to a combination of pyrimethamine-sulfonamide and folinic acid. Congenitally infected newborns are usually asymptomatic at birth, but at risk for tardive sequelae, such as blindness. When congenital infection is evident, disease include retinochoroiditis, cerebral calcifications, hydrocephalus, neurocognitive impairment. The diagnosis of congenital infection must be confirmed at birth and management, specific therapy, and follow-up with multidisciplinary counseling, must be guaranteed.
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Affiliation(s)
- Lina Bollani
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Cristian Achille
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Garofoli
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Meroni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Chryssoula Tzialla
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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10
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Yıldız G, Kurt D, Mat E, Yıldız P, Başol G, Gündogdu EC, Kuru B, Topcu B, Kale A. Hearing test results of newborns born from the coronavirus disease 2019 (COVID-19) infected mothers: A tertiary center experience in Turkey. J Obstet Gynaecol Res 2021; 48:113-118. [PMID: 34655257 PMCID: PMC8661853 DOI: 10.1111/jog.15008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/06/2021] [Accepted: 08/26/2021] [Indexed: 01/23/2023]
Abstract
Objective Congenital infections can cause newborn hearing loss. Although vertical transmission of coronavirus disease 2019 (COVID‐19) infection is theoretically possible, this has not been proven yet. To our knowledge, there is no previous report on whether COVID‐19 infection during pregnancy can cause congenital hearing loss. This paper aimed to find an answer to this question. Method This retrospective, single‐center study was performed between April 2020 and May 2021 at a tertiary care referral center in Turkey. A total of 422 pregnant women who had coronavirus infection during pregnancy were followed and 203 of them gave birth in our institution. Results of hearing screening tests of 199 newborns were assessed retrospectively. Results Of patients included in the study, 23 (11.6%) had the disease in the first trimester, 62 (31.2%) in the second trimester, and 114 (57.3%) in the third trimester. In the first hearing test performed on newborns, unilateral hearing loss was observed in 21 babies (10.5%). Hearing tests of these newborns were found to be normal in the second test performed 15 days later. Conclusion Considering the incidence of congenital hearing loss, the absence of hearing loss in our newborn population does not confirm the argument that coronavirus infection does not cause congenital hearing loss. This issue should be evaluated with larger patient series. In addition, it should be kept in mind that hearing loss can occur at later ages as well.
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Affiliation(s)
- Gazi Yıldız
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Didar Kurt
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Emre Mat
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Pınar Yıldız
- Obstetrics and Gynecology Department, Adatıp Kurtköy Hospital, Istanbul, Turkey
| | - Gülfem Başol
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Elif Cansu Gündogdu
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Betül Kuru
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Bahtisen Topcu
- Neonatology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Kale
- Obstetrics and Gynecology Department, University of Health Sciences Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
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11
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Abstract
PURPOSE OF REVIEW This review provides an update of nonviral, curable sexually transmitted infections (STIs) in pregnancy and summarizes our understanding of the current issues and controversies surrounding risk factors, screening, and treatment of STIs in pregnancy primarily in high-income countries (using the United States and the United Kingdom as examples). The infections covered in this review are syphilis, gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium infections. RECENT FINDINGS Overall, limited modern data is available to update researchers and clinicians on the epidemiology and care of STIs in pregnancy. Though common risk factors can be identified among these STIs, like socioeconomic status and inadequate antenatal care, specific screening and treatment challenges vary by geography and pathogen. Wherever available, surveillance data and research evidence are often limited to nonpregnant patients, leading to imperfect pregnancy-specific risk estimates and obstetric lags in the development and adoption of new guidelines. We have identified three areas of opportunity that may enhance the effectiveness of current approaches and inform new ones: improved data collection and evidence-based screening practices; prompt and comprehensive therapy, including partner services, and evaluations of new treatment modalities; and equitable antenatal and sexual healthcare for all pregnant persons and their partners. SUMMARY These findings highlight the need to revisit standards of screening and management of STIs in pregnancy in high-income countries.
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Affiliation(s)
- Andreea Waltmann
- Institute for Global Health and Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tyler R McKinnish
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St Louis, Missouri
| | - Joseph A Duncan
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Benavides-Lara A, la Paz Barboza-Arguello MD, González-Elizondo M, Hernández-deMezerville M, Brenes-Chacón H, Ramírez-Rojas M, Ramírez-Hernández C, Arjona-Ortegón N, Godfred-Cato S, Valencia D, Moore CA, Soriano-Fallas A. Zika Virus-Associated Birth Defects, Costa Rica, 2016-2018. Emerg Infect Dis 2021; 27. [PMID: 33496653 PMCID: PMC7853552 DOI: 10.3201/eid2702.202047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Enhanced birth defect surveillance increased identification of virus-associated abnormalities, including microcephaly. After Zika virus (ZIKV) infection in Costa Rica was confirmed in January 2016, the national surveillance system was enhanced to monitor associated birth defects. To characterize the ZIKV outbreak among live-born infants during March 2016–March 2018, we conducted a descriptive analysis. Prevalence of ZIKV-associated birth defects was 15.3 cases/100,000 live births. Among 22 infants with ZIKV-associated birth defects, 11 were designated as confirmed (positive for ZIKV) and 11 were designated as probable cases (negative for ZIKV or not tested, but mother was expsed to ZIKV during pregnancy). A total of 91% had microcephaly (head circumference >2 SDs below mean for age and sex), 64% severe microcephaly (head circumference > 3 SDs below mean for age and sex), 95% neurodevelopmental abnormalities, 82% brain anomalies, 41% eye abnormalities, and 9% hearing loss. Monitoring children for > 1 year can increase identification of ZIKV-associated abnormalities in addition to microcephaly.
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13
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Kuan MI, Jaeger HK, Balemba OB, O'Dowd JM, Duricka D, Hannemann H, Marx E, Teissier N, Gabrielli L, Bonasoni MP, Keithley EM, Fortunato EA. Human Cytomegalovirus Interactions with the Basement Membrane Protein Nidogen 1. J Virol 2021; 95:e01506-20. [PMID: 33177203 DOI: 10.1128/JVI.01506-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/06/2020] [Indexed: 12/27/2022] Open
Abstract
In 2000, we reported that human cytomegalovirus (HCMV) induced specific damage on chromosome 1. The capacity of the virus to induce DNA breaks indicated potent interaction between viral proteins and these loci. We have fine mapped the 1q42 breaksite. Transcriptional analysis of genes encoded in close proximity revealed virus-induced downregulation of a single gene, nidogen 1 (NID1). Beginning between 12 and 24 hours postinfection (hpi) and continuing throughout infection, steady-state (ss) NID1 protein levels were decreased in whole-cell lysates and secreted supernatants of human foreskin fibroblasts. Addition of the proteasomal inhibitor MG132 to culture medium stabilized NID1 in virus-infected cells, implicating infection-activated proteasomal degradation of NID1. Targeting of NID1 via two separate pathways highlighted the virus' emphasis on NID1 elimination. NID1 is an important basement membrane protein secreted by many cell types, including the endothelial cells (ECs) lining the vasculature. We found that ss NID1 was also reduced in infected ECs and hypothesized that virus-induced removal of NID1 might offer HCMV a means of increased distribution throughout the host. Supporting this idea, transmigration assays of THP-1 cells seeded onto NID1-knockout (KO) EC monolayers demonstrated increased transmigration. NID1 is expressed widely in the developing fetal central and peripheral nervous systems (CNS and PNS) and is important for neuronal migration and neural network excitability and plasticity and regulates Schwann cell proliferation, migration, and myelin production. We found that NID1 expression was dramatically decreased in clinical samples of infected temporal bones. While potentially beneficial for virus dissemination, HCMV-induced elimination of NID1 may underlie negative ramifications to the infected fetus.IMPORTANCE We have found that HCMV infection promotes the elimination of the developmentally important basement membrane protein nidogen 1 (NID1) from its host. The virus both decreased transcription and induced degradation of expressed protein. Endothelial cell (EC) secretion of basement membrane proteins is critical for vascular wall integrity, and infection equivalently affected NID1 protein levels in these cells. We found that the absence of NID1 in an EC monolayer allowed increased transmigration of monocytes equivalent to that observed after infection of ECs. The importance of NID1 in development has been well documented. We found that NID1 protein was dramatically reduced in infected inner ear clinical samples. We believe that HCMV's attack on host NID1 favors viral dissemination at the cost of negative developmental ramifications in the infected fetus.
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14
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Affiliation(s)
- Andrea A Z Kovacs
- Maternal, Child, and Adolescent Center for Infectious Diseases and Virology, Division of Pediatric Infectious Diseases, Keck Medicine of the University of Southern California, Los Angeles
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15
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Singh T, Otero CE, Li K, Valencia SM, Nelson AN, Permar SR. Vaccines for Perinatal and Congenital Infections-How Close Are We? Front Pediatr 2020; 8:569. [PMID: 33384972 PMCID: PMC7769834 DOI: 10.3389/fped.2020.00569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022] Open
Abstract
Congenital and perinatal infections are transmitted from mother to infant during pregnancy across the placenta or during delivery. These infections not only cause pregnancy complications and still birth, but also result in an array of pediatric morbidities caused by physical deformities, neurodevelopmental delays, and impaired vision, mobility and hearing. Due to the burden of these conditions, congenital and perinatal infections may result in lifelong disability and profoundly impact an individual's ability to live to their fullest capacity. While there are vaccines to prevent congenital and perinatal rubella, varicella, and hepatitis B infections, many more are currently in development at various stages of progress. The spectrum of our efforts to understand and address these infections includes observational studies of natural history of disease, epidemiological evaluation of risk factors, immunogen design, preclinical research of protective immunity in animal models, and evaluation of promising candidates in vaccine trials. In this review we summarize this progress in vaccine development research for Cytomegalovirus, Group B Streptococcus, Herpes simplex virus, Human Immunodeficiency Virus, Toxoplasma, Syphilis, and Zika virus congenital and perinatal infections. We then synthesize this evidence to examine how close we are to developing a vaccine for these infections, and highlight areas where research is still needed.
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Affiliation(s)
- Tulika Singh
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
| | - Claire E. Otero
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Katherine Li
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Sarah M. Valencia
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Ashley N. Nelson
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Sallie R. Permar
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
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16
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Schultz EM, Jones TJ, Hopkins HK, Zeng J, Barr KL. Post-Vaccination Yellow Fever Antiserum Reduces Zika Virus in Embryoid Bodies When Placental Cells are Present. Vaccines (Basel) 2020; 8:E752. [PMID: 33322247 DOI: 10.3390/vaccines8040752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
Zika virus (ZIKV) is a flavivirus that originated in Africa but emerged in Latin America in 2015. In this region, other flaviviruses such as Dengue (DENV), West Nile, and Yellow Fever virus (YFV) also circulate, allowing for possible antigenic cross-reactivity to impact viral infections and immune responses. Studies have found antibody-mediated enhancement between DENV and ZIKV, but the impact of YFV antibodies on ZIKV infection has not been fully explored. ZIKV infections cause congenital syndromes, such as microcephaly, necessitating further research into ZIKV vertical transmission through the placental barrier. Recent advancements in biomedical engineering have generated co-culture methods that allow for the in vitro recapitulation of the maternal–fetal interface. This study utilized a transwell assay, which was a co-culture model utilizing human placental syncytiotrophoblasts, fetal umbilical cells, and a differentiating embryoid body, to replicate the maternal–fetal axis. To determine if cross-reactive YFV vaccine antibodies impacted the pathogenesis of ZIKV across the maternal–fetal axis, syncytiotrophoblasts were inoculated with ZIKV or ZIKV incubated with YFV vaccine antisera, and the viral load was measured 72 h post-inoculation. Here, we report that BeWo and HUVEC cells were permissive to ZIKV and that the impact of YFV post-vaccination antibodies on ZIKV replication was cell line-dependent. Embryoid bodies were also permissive to ZIKV, and the presence of YFV antibodies collected 4–14 months post-vaccination reduced ZIKV infection when placental cells were present. However, when directly infected with ZIKV, the embryoid bodies displayed significantly increased viral loads in the presence of YFV antiserum taken 30 days post-vaccination. The data show that each of the cell lines and EBs have a unique response to ZIKV complexed with post-vaccination serum, suggesting there may be cell-specific mechanisms that impact congenital ZIKV infections. Since ZIKV infections can cause severe congenital syndromes, it is crucial to understand any potential enhancement or protection offered from cross-reactive, post-vaccination antibodies.
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17
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Sanchez Clemente N, Brickley EB, Furquim de Almeida M, Witkin SS, Duarte Passos S. Can Zika Virus Infection in High Risk Pregnant Women Be Differentiated on the Basis of Symptoms? Viruses 2020; 12:v12111263. [PMID: 33167566 PMCID: PMC7694531 DOI: 10.3390/v12111263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Zika virus (ZIKV) infection in pregnancy is associated with congenital neurological abnormalities. Our understanding of the full clinical spectrum of ZIKV infection is incomplete. Using data from this prospective cohort study consisting of 650 women attending a high-risk pregnancy clinic during the Zika virus outbreak in Brazil, we investigated the extent to which specific symptoms can be utilized to differentiate ZIKV-infected pregnant women from those with other pregnancy-related problems. All were tested for ZIKV in urine by RT-qPCR. Demographic and clinical data including physical symptoms during follow-up were recorded and analyzed with respect to Zika virus exposure status. Forty-eight (7.4%) women were positive for ZIKV by RT-qPCR. The majority (70.8%) were asymptomatic, and only four ZIKV-positive women (8.3%) reported symptoms during pregnancy that met the WHO case definition. Zika-positive and -negative women reported similar frequencies of ZIKV-like symptoms (as per the WHO definition): fever (16.7% vs. 13.6%), arthralgia/arthritis (10.4% vs. 11.3%), rash (4.2% vs. 5.3%), and conjunctivitis (2.1% vs. 3.2%). Most pregnant women positive for ZIKV in urine are asymptomatic and do not deliver a baby with microcephaly. Physical symptoms alone did not differentiate between high-risk pregnant women positive or negative for ZIKV.
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Affiliation(s)
- Nuria Sanchez Clemente
- Department of Epidemiology, University of São Paulo School of Public Health, São Paulo 01246-904, Brazil;
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
- Correspondence:
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Marcia Furquim de Almeida
- Department of Epidemiology, University of São Paulo School of Public Health, São Paulo 01246-904, Brazil;
| | - Steven S. Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Saulo Duarte Passos
- Jundiaí Medical School, Jundiaí University, Jundiaí, São Paulo 13202-550, Brazil;
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18
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Warnecke JM, Pollmann M, Borchardt-Lohölter V, Moreira-Soto A, Kaya S, Sener AG, Gómez-Guzmán E, Figueroa-Hernández L, Li W, Li F, Buska K, Zakaszewska K, Ziolkowska K, Janz J, Ott A, Scheper T, Meyer W. Seroprevalences of antibodies against ToRCH infectious pathogens in women of childbearing age residing in Brazil, Mexico, Germany, Poland, Turkey and China. Epidemiol Infect 2020; 148:e271. [PMID: 33124529 PMCID: PMC7689786 DOI: 10.1017/s0950268820002629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/17/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Determination of antibodies against ToRCH antigens at the beginning of pregnancy allows assessment of both the maternal immune status and the risks to an adverse pregnancy outcome. Age-standardised seroprevalences were determined in sera from 1009 women of childbearing age residing in Mexico, Brazil, Germany, Poland, Turkey or China using a multiparametric immunoblot containing antigen substrates for antibodies against Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex viruses (HSV-1, HSV-2), Bordetella pertussis, Chlamydia trachomatis, parvovirus B19, Treponema pallidum and varicella zoster virus (VZV). Seroprevalences for antibodies against HSV-1 were >90% in samples from Brazil and Turkey, whereas the other four countries showed lower mean age-adjusted seroprevalences (range: 62.5-87.9%). Samples from Brazilian women showed elevated seroprevalences of antibodies against HSV-2 (40.1%), C. trachomatis (46.8%) and B. pertussis (56.6%) compared to the other five countries. Seroprevalences of anti-T. gondii antibodies (0.5%) and anti-parvovirus B19 antibodies (7.5%) were low in samples from Chinese women, compared to the other five countries. Samples from German women revealed a low age-standardised seroprevalence of anti-CMV antibodies (28.8%) compared to the other five countries. These global differences in immune status of women in childbearing age advocate country-specific prophylaxis strategies to avoid infection with ToRCH pathogens.
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Affiliation(s)
- J. M. Warnecke
- Institute for Experimental Immunology, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - M. Pollmann
- Institute for Experimental Immunology, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - V. Borchardt-Lohölter
- Institute for Experimental Immunology, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - A. Moreira-Soto
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Kaya
- Department of Medical Microbiology, İzmir Katip Çelebi University, Ataturk Training and Research Hospital, İzmir, Turkey
| | - A. G. Sener
- Department of Medical Microbiology, İzmir Katip Çelebi University, Ataturk Training and Research Hospital, İzmir, Turkey
| | - E. Gómez-Guzmán
- Department of Science and Biotechnology, INOCHEM S.A. DE C.V., Col. San Miguel Ajusco, Mexico City, Mexico
| | - L. Figueroa-Hernández
- National Institute of Respiratory Diseases, Immunology and Autoimmunity Laboratory, Mexico City, Mexico
| | - W. Li
- EUROIMMUN Medical Diagnostics China Co., Ltd., Beijing, China
| | - F. Li
- EUROIMMUN Medical Diagnostics China Co., Ltd., Beijing, China
| | - K. Buska
- EUROIMMUN Polska Sp. z.o.o., Wroclaw, Poland
| | | | - K. Ziolkowska
- Department of Laboratory Diagnostics, K. Marcinkowski Poznań University of Medical Sciences, Poznan, Poland
- Central Laboratory, Gynaecology and Obstetrics Clinical Hospital Poznan University of Medical Sciences, Poznan, Poland
| | - J. Janz
- Institute for Experimental Immunology, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - A. Ott
- Institute for Experimental Immunology, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - T. Scheper
- Institute for Experimental Immunology, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - W. Meyer
- Institute for Experimental Immunology, EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
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19
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de Campos VS, Calaza KC, Adesse D. Implications of TORCH Diseases in Retinal Development-Special Focus on Congenital Toxoplasmosis. Front Cell Infect Microbiol 2020; 10:585727. [PMID: 33194824 PMCID: PMC7649341 DOI: 10.3389/fcimb.2020.585727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
There are certain critical periods during pregnancy when the fetus is at high risk for exposure to teratogens. Some microorganisms, including Toxoplasma gondii, are known to exhibit teratogenic effects, interfering with fetal development and causing irreversible disturbances. T. gondii is an obligate intracellular parasite and the etiological agent of Toxoplasmosis, a zoonosis that affects one third of the world's population. Although congenital infection can cause severe fetal damage, the injury extension depends on the gestational period of infection, among other factors, like parasite genotype and host immunity. This parasite invades the Central Nervous System (CNS), forming tissue cysts, and can interfere with neurodevelopment, leading to frequent neurological abnormalities associated with T. gondii infection. Therefore, T. gondii is included in the TORCH complex of infectious diseases that may lead to neurological malformations (Toxoplasmosis, Others, Rubella, Cytomegalovirus, and Herpes). The retina is part of CNS, as it is derived from the diencephalon. Except for astrocytes and microglia, retinal cells originate from multipotent neural progenitors. After cell cycle exit, cells migrate to specific layers, undergo morphological and neurochemical differentiation, form synapses and establish their circuits. The retina is organized in nuclear layers intercalated by plexus, responsible for translating and preprocessing light stimuli and for sending this information to the brain visual nuclei for image perception. Ocular toxoplasmosis (OT) is a very debilitating condition and may present high severity in areas in which virulent strains are found. However, little is known about the effect of congenital infection on the biology of retinal progenitors/ immature cells and how this infection may affect the development of this tissue. In this context, this study reviews the effects that congenital infections may cause to the developing retina and the cellular and molecular aspects of these diseases, with special focus on congenital OT.
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Affiliation(s)
- Viviane Souza de Campos
- Laboratório de Neurobiologia da Retina, Instituto de Biologia, Universidade Federal Fluminense, Niteroi, Brazil
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Karin C. Calaza
- Laboratório de Neurobiologia da Retina, Instituto de Biologia, Universidade Federal Fluminense, Niteroi, Brazil
| | - Daniel Adesse
- Laboratório de Biologia Estrutural, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
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Turriziani Colonna A, Buonsenso D, Pata D, Salerno G, Chieffo DPR, Romeo DM, Faccia V, Conti G, Molle F, Baldascino A, De Waure C, Acampora A, Luciano R, Santangelo R, Valentini P. Long-Term Clinical, Audiological, Visual, Neurocognitive and Behavioral Outcome in Children With Symptomatic and Asymptomatic Congenital Cytomegalovirus Infection Treated With Valganciclovir. Front Med (Lausanne) 2020; 7:268. [PMID: 32793607 PMCID: PMC7393008 DOI: 10.3389/fmed.2020.00268] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
Cytomegalovirus (CMV) is the most common cause of congenital infection in humans. There are no enough data on long-term outcome of newborns with congenital CMV (cCMV) infection, particularly for those asymptomatic at birth. For this reason, we performed this study to evaluate long-term audiological, visual, neurocognitive, and behavioral outcome in patients with symptomatic and asymptomatic cCMV infection treated with oral Valganciclovir (VGC). Thirty-six newborns with confirmed cCMV infection were evaluated: 12 (33.3%) symptomatic at birth and 24 asymptomatic (66.7%). No one had cognitive impairment. Cognitive assessment scales resulted abnormal in 4/35 patients (11.4%). 11/21 patients (52.4%) achieved abnormal scores in neuropsychological tests. The language evaluation gave pathological results in 6/21 (28.5%) patients. 6/35 patients (17.1%) developed SNHL, all symptomatic at birth except one. None of the 34 patients evaluated developed CMV retinopathy. Our study shows that both symptomatic and asymptomatic newborns with cCMV infection develop long-term sequelae, particularly in the behavioral and communicative areas, independently from the trimester of maternal infection.
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Affiliation(s)
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Pata
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gilda Salerno
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela P R Chieffo
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.,Istituto di Neuropsichiatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico M Romeo
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.,Istituto di Neuropsichiatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Faccia
- Unit of Pediatrics, Department of Gynecologic, Pediatric and Neonatologic Sciences, "Sant'Andrea" University Hospital, University "Sapienza" of Rome, Rome, Italy
| | - Guido Conti
- Department of Aging, Neurologic, Orthopedic and Head and Neck Science, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Otorinolaringoiatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fernando Molle
- Department of Aging, Neurologic, Orthopedic and Head and Neck Science, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Oculistica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Baldascino
- Department of Aging, Neurologic, Orthopedic and Head and Neck Science, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Oculistica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara De Waure
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Anna Acampora
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.,Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rita Luciano
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosaria Santangelo
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Microbiology and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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21
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Uprety P, Graf EH. Closing the Brief Case: Nystagmus in a 3-Month-Old Leading to a Diagnosis of Congenital Cytomegalovirus Infection. J Clin Microbiol 2020; 58:e01471-19. [PMID: 32580968 DOI: 10.1128/JCM.01471-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Uprety P, Graf EH. The Brief Case: Nystagmus in a 3-Month-Old Leading to a Diagnosis of Congenital Cytomegalovirus Infection. J Clin Microbiol 2020; 58:e01470-19. [PMID: 32580967 DOI: 10.1128/JCM.01470-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gantt S, Goldfarb DM, Park A, Rawlinson W, Boppana SB, Lazzarotto T, Mertz LM. Performance of the Alethia CMV Assay for Detection of Cytomegalovirus by Use of Neonatal Saliva Swabs. J Clin Microbiol 2020; 58:e01951-19. [PMID: 31969426 DOI: 10.1128/JCM.01951-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/17/2020] [Indexed: 11/20/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is a major cause of childhood hearing loss and neurodevelopmental delay. Identification of newborns with cCMV infection allows provision of beneficial interventions. However, most infants with cCMV infection have subclinical infection and go undiagnosed. Thus, expanded neonatal CMV testing is increasingly recommended. Saliva is an attractive sample type for CMV testing of newborns, because it is easier to collect than urine and more sensitive for CMV detection than dried blood spots. We evaluated the Alethia CMV assay, a rapid, easy-to-use loop-mediated isothermal amplification method for qualitative detection of CMV DNA in neonatal saliva samples. Saliva swabs were collected prospectively from newborns <21 days old and tested by the Alethia assay according to the manufacturer's instructions. Archived saliva swabs from newborns with cCMV infection were also tested retrospectively. A composite reference method (CRM; two validated PCR assays followed by bidirectional sequencing of amplicons) was performed on all samples as the reference standard comparator. Of 1,480 prospectively collected saliva swabs, 1,472 (99.5%) were negative by both the Alethia assay and CRM, 5 (0.34%) were positive by both the Alethia assay and CRM, and 3 (0.20%) were positive only by the Alethia assay. All 34 (100%) archived swabs from newborns with cCMV infection were positive by both the CRM and the Alethia assay. Overall, the Alethia assay showed 100% and 99.8% positive and negative agreement with the CRM, respectively. The Alethia CMV assay is an accurate method for identifying neonates with cCMV infection and, given its simplicity, appears suitable for CMV testing using neonatal saliva outside a reference laboratory, including remote and resource-limited settings.
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Teixeira FME, Pietrobon AJ, Oliveira LDM, Oliveira LMDS, Sato MN. Maternal-Fetal Interplay in Zika Virus Infection and Adverse Perinatal Outcomes. Front Immunol 2020; 11:175. [PMID: 32117303 PMCID: PMC7033814 DOI: 10.3389/fimmu.2020.00175] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/22/2020] [Indexed: 12/26/2022] Open
Abstract
During pregnancy, the organization of complex tolerance mechanisms occurs to assure non-rejection of the semiallogeneic fetus. Pregnancy is a period of vulnerability to some viral infections, mainly during the first and second trimesters, that may cause congenital damage to the fetus. Recently, Zika virus (ZIKV) infection has gained great notoriety due to the occurrence of congenital ZIKV syndrome, characterized by fetal microcephaly, which results from the ability of ZIKV to infect placental cells and neural precursors in the fetus. Importantly, in addition to the congenital effects, studies have shown that perinatal ZIKV infection causes a number of disorders, including maculopapular rash, conjunctivitis, and arthralgia. In this paper, we contextualize the immunological aspects involved in the maternal-fetal interface and vulnerability to ZIKV infection, especially the alterations resulting in perinatal outcomes. This highlights the need to develop protective maternal vaccine strategies or interventions that are capable of preventing fetal or even neonatal infection.
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Affiliation(s)
- Franciane Mouradian Emidio Teixeira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna Julia Pietrobon
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luanda Mara da Silva Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Maria Notomi Sato
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Voordouw B, Rockx B, Jaenisch T, Fraaij P, Mayaud P, Vossen A, Koopmans M. Performance of Zika Assays in the Context of Toxoplasma gondii, Parvovirus B19, Rubella Virus, and Cytomegalovirus (TORCH) Diagnostic Assays. Clin Microbiol Rev 2019; 33:e00130-18. [PMID: 31826871 DOI: 10.1128/CMR.00130-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Infections during pregnancy that may cause congenital abnormalities have been recognized for decades, but their diagnosis is challenging. This was again illustrated with the emergence of Zika virus (ZIKV), highlighting the inherent difficulties in estimating the extent of pre- and postnatal ZIKV complications because of the difficulties in establishing definitive diagnoses. We reviewed the epidemiology, infection kinetics, and diagnostic methods used for Toxoplasma gondii, parvovirus B19, rubella virus, and cytomegalovirus (TORCH) infections and compared the results with current knowledge of ZIKV diagnostic assays to provide a basis for the inclusion of ZIKV in the TORCH complex evaluations. Similarities between TORCH pathogens and ZIKV support inclusion of ZIKV as an emerging TORCH infection. Our review evaluates the diagnostic performance of various TORCH diagnostic assays for maternal screening, fetal screening, and neonatal screening. We show that the sensitivity, specificity, and positive and negative predictive value of TORCH complex pathogens are widely variable, stressing the importance of confirmatory testing and the need for novel techniques for earlier and accurate diagnosis of maternal and congenital infections. In this context it is also important to acknowledge different needs and access to care for different geographic and resource settings.
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26
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Boppana SB, Britt WJ, Fowler K, Hutto SC, James SH, Kimberlin DW, Poole C, Ross SA, Whitley RJ. Pathogenesis of Non-Zika Congenital Viral Infections. J Infect Dis 2019; 216:S912-S918. [PMID: 29267912 DOI: 10.1093/infdis/jix431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 from South and Central America and the Caribbean. Although the full spectrum of ZIKV infection of the newborn has yet to be determined, other maternal viral infections resulting in transmission to the fetus provide instructive lessons that can be applied to the prospective evaluation of individuals with ZIKV infection. This review focuses on those other congenital infections, including rubella, congenital cytomegalovirus, human immunodeficiency virus, hepatitis B virus, and neonatal herpes simplex virus, from which lessons for the evaluation of ZIKV in the newborn can be applied.
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Affiliation(s)
- Suresh B Boppana
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - William J Britt
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Karen Fowler
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - S Cecelia Hutto
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Scott H James
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Claudette Poole
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Shannon A Ross
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
| | - Richard J Whitley
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham
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Rosenstierne MW, Schaltz-Buchholzer F, Bruzadelli F, Có A, Cardoso P, Jørgensen CS, Michiels J, Heyndrickx L, Ariën KK, Fischer TK, Fomsgaard A. Zika Virus IgG in Infants with Microcephaly, Guinea-Bissau, 2016. Emerg Infect Dis 2019; 24:948-950. [PMID: 29664391 PMCID: PMC5938792 DOI: 10.3201/eid2405.180153] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We analyzed blood samples from infants born with microcephaly and their mothers in Guinea-Bissau in 2016 for pathogens associated with birth defects. No Zika virus RNA was detected, but Zika virus IgG was highly prevalent. We recommend implementing pathogen screening of infants with congenital defects in Guinea-Bissau.
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28
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Schwartz DA. Clinical Trials and Administration of Zika Virus Vaccine in Pregnant Women: Lessons (that Should Have Been) Learned from Excluding Immunization with the Ebola Vaccine during Pregnancy and Lactation. Vaccines (Basel) 2018; 6:E81. [PMID: 30518082 PMCID: PMC6313913 DOI: 10.3390/vaccines6040081] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/01/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023] Open
Abstract
As evidenced from recent epidemics, both Ebola and Zika virus infection are potentially catastrophic when occurring in pregnant women. Ebola virus causes extremely high rates of mortality in both mothers and infants; Zika virus is a TORCH infection that produces a congenital malformation syndrome and pediatric neurodevelopmental abnormalities. Production of efficacious vaccines has been a public health priority for both infections. Unfortunately, during the clinical trials and subsequent deployment of a vaccine for the Ebola virus, pregnant and lactating women were, and continue to be, excluded from receiving the life-saving vaccine. The most serious consequence of Zika virus infection, congenital Zika syndrome, results from fetal infection during pregnancy. Thus, pregnant women have a major stake in the ongoing development of a vaccine for Zika virus. The exclusion of pregnant women from the development, clinical trials and administration of a potential Zika vaccine unfairly deprives them and their infants of the protection they need against this potentially catastrophic intrauterine infection. When creating policy about these issues, it is important to critically evaluate vaccine safety in pregnancy in the context of the substantial risk of infection for the pregnant woman and her fetus in the absence of immunization.
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Affiliation(s)
- David A Schwartz
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
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29
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Tellechea AL, Luppo V, Morales MA, Groisman B, Baricalla A, Fabbri C, Sinchi A, Alonso A, Gonzalez C, Ledesma B, Masi P, Silva M, Israilev A, Rocha M, Quaglia M, Bidondo MP, Liascovich R, Barbero P. Surveillance of microcephaly and selected brain anomalies in Argentina: Relationship with Zika virus and other congenital infections. Birth Defects Res 2018; 110:1016-1026. [PMID: 29921033 DOI: 10.1002/bdr2.1347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Zika virus (ZIKV) vertical transmission may lead to microcephaly and other congenital anomalies. In March and April 2016, the first outbreak of ZIKV occurred in Argentina. The objective was to describe the surveillance of newborns with microcephaly and other selected brain anomalies in Argentina, and evaluation different etiologies. METHODS Participants were enrolled between April 2016 and March 2017. CASES newborns from the National Network of Congenital Abnormalities of Argentina (RENAC) with head circumference lower than the 3rd percentile according to gestational age and sex, or selected brain anomalies. Blood and urine samples from cases and their mothers were tested for ZIKV by real-time polymerase chain reaction (RT-PCR), antigen-specific Immunoglobulin M (MAC-ELISA) and plaque-reduction neutralization test (PRNT90 ). Toxoplasmosis, rubella, herpes simplex, syphilis, and cytomegalovirus (CMV) infection were also tested. RESULTS A total of 104 cases were reported, with a prevalence of 6.9 per 10,000 [95% confidence interval (CI): 5.7-8.4], a significant increase when compared with the data prior to 2016, Prevalence Rate Ratio 1.7 (95% CI 1.2-2.3). In five cases positive serology for ZIKV (IgM and IgG by PRNT) was detected. The five cases presented microcephaly with craniofacial disproportion. We detected four cases of CMV infection, three cases of congenital toxoplasmosis, two cases of herpes simplex infection, and one case of congenital syphilis. CONCLUSION The prevalence of microcephaly was significantly higher when compared with the previous period. The system had the capacity to detect five cases with congenital ZIKV syndrome in a country with limited viral circulation.
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Affiliation(s)
- Ana Laura Tellechea
- National Network of Congenital Abnormalities Argentina (RENAC) under the National Center of Medical Genetics (CENAGEM), Buenos Aires City, Argentina
| | - Victoria Luppo
- National Institute of Human Viral Diseases "Dr. Julio I. Maiztegui" (INEVH), Pergamino, Buenos Aires, Argentina
| | - María Alejandra Morales
- National Institute of Human Viral Diseases "Dr. Julio I. Maiztegui" (INEVH), Pergamino, Buenos Aires, Argentina
| | - Boris Groisman
- National Network of Congenital Abnormalities Argentina (RENAC) under the National Center of Medical Genetics (CENAGEM), Buenos Aires City, Argentina
| | - Agustin Baricalla
- National Institute of Human Viral Diseases "Dr. Julio I. Maiztegui" (INEVH), Pergamino, Buenos Aires, Argentina
| | - Cintia Fabbri
- National Institute of Human Viral Diseases "Dr. Julio I. Maiztegui" (INEVH), Pergamino, Buenos Aires, Argentina
| | - Anabel Sinchi
- National Institute of Human Viral Diseases "Dr. Julio I. Maiztegui" (INEVH), Pergamino, Buenos Aires, Argentina
| | - Alicia Alonso
- National Institute of Infectious Diseases "Dr. Carlos Malbrán" (INEI), Buenos Aires City, Argentina
| | - Cecilia Gonzalez
- National Institute of Infectious Diseases "Dr. Carlos Malbrán" (INEI), Buenos Aires City, Argentina
| | - Bibiana Ledesma
- National Institute of Infectious Diseases "Dr. Carlos Malbrán" (INEI), Buenos Aires City, Argentina
| | - Patricia Masi
- Neonatology Service, Dalmacio Velez Sarsfield Hospital, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Silva
- Neonatology Service, Dalmacio Velez Sarsfield Hospital, Ciudad Autónoma de Buenos Aires, Argentina
| | - Adriana Israilev
- Neonatology Service, Teodoro Alvarez Hospital, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marcela Rocha
- Department of Neonatology, Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Argentina
| | - Marcela Quaglia
- Neonatology Service, Materno Neonatal Hospital, Córdoba Capital, Córdoba, Argentina
| | - María Paz Bidondo
- National Network of Congenital Abnormalities Argentina (RENAC) under the National Center of Medical Genetics (CENAGEM), Buenos Aires City, Argentina
| | - Rosa Liascovich
- National Network of Congenital Abnormalities Argentina (RENAC) under the National Center of Medical Genetics (CENAGEM), Buenos Aires City, Argentina
| | - Pablo Barbero
- National Network of Congenital Abnormalities Argentina (RENAC) under the National Center of Medical Genetics (CENAGEM), Buenos Aires City, Argentina
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- National Network of Congenital Abnormalities Argentina (RENAC) under the National Center of Medical Genetics (CENAGEM), Buenos Aires City, Argentina
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30
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Smit GSA, Padalko E, Van Acker J, Hens N, Dorny P, Speybroeck N, Devleesschauwer B. Public Health Impact of Congenital Toxoplasmosis and Cytomegalovirus Infection in Belgium, 2013: A Systematic Review and Data Synthesis. Clin Infect Dis 2018; 65:661-668. [PMID: 28605518 DOI: 10.1093/cid/cix344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/21/2017] [Indexed: 11/13/2022] Open
Abstract
Congenital toxoplasmosis (CT) and cytomegalovirus infection (cCMV) may cause significant morbidity and even fetal or neonatal mortality. We aimed to quantify the disease burden of CT and cCMV in Belgium in terms of disability-adjusted life years (DALYs) and identify data gaps. The public health impact of CT and cCMV in Belgium in 2013 was 188 (95% uncertainty interval [UI], 43-419) and 1976 (95% UI, 757-4067) DALYs, respectively. The major data gaps identified were representative Belgian studies; information on important sequelae, intrauterine mortality, and termination of pregnancy; and late onset sequelae. A scenario analysis showed important increases in years of life lost when the burden due to fetal losses was included and decreases in DALYs when comprehensive CT prevention measures were conducted. Addressing the key data gaps identified may allow generation of the data needed to break the vicious circle of underrecognition.
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Affiliation(s)
- G Suzanne A Smit
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke.,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp.,Institute of Health and Society, Université catholique de Louvain, Brussels
| | - Elizaveta Padalko
- Department of Clinical Biology, Microbiology and Immunology, Ghent University Hospital.,School of Life Sciences, Hasselt University, Diepenbeek
| | - Jos Van Acker
- Laboratory of Clinical Microbiology, AZ Sint-Lucas, Ghent
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Diepenbeek.,Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute.,Epidemiology and Social Medicine, University of Antwerp
| | - Pierre Dorny
- Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Merelbeke.,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp
| | - Niko Speybroeck
- Institute of Health and Society, Université catholique de Louvain, Brussels
| | - Brecht Devleesschauwer
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
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Mehta R, Gerardin P, de Brito CAA, Soares CN, Ferreira MLB, Solomon T. The neurological complications of chikungunya virus: A systematic review. Rev Med Virol 2018; 28:e1978. [PMID: 29671914 PMCID: PMC5969245 DOI: 10.1002/rmv.1978] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/06/2023]
Abstract
We performed a systematic review on the neurological complications of chikungunya virus. Such complications are being reported increasingly, owing primarily to the scale of recent epidemics but also to a growing understanding of the virus' neurovirulence. We performed a thorough literature search using PubMed and Scopus databases, summating the data on all published reports of neurological disease associated with chikungunya virus. We appraised the data for each major condition in adults, children, and neonates, as well as evaluating the latest evidence on disease pathogenesis and management strategies. The review provides a comprehensive summary for clinicians, public health officials, and researchers tackling the challenges associated with this important emerging pathogen.
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Affiliation(s)
- Ravi Mehta
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic InfectionsUniversity of LiverpoolLiverpoolUK
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
| | - Patrick Gerardin
- INSERM CIC1410Centre Hospitalier Universitaire de la RéunionSaint PierreRéunionFrance
- UM 134 PIMIT CNRS 9192, INSERM U1187, IRD 249Université de la Réunion, CHU, CYROISaint PierreRéunionFrance
| | | | | | | | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic InfectionsUniversity of LiverpoolLiverpoolUK
- Department of NeurologyWalton Centre NHS Foundation TrustLiverpoolUK
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
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32
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Permar SR, Schleiss MR, Plotkin SA. Advancing Our Understanding of Protective Maternal Immunity as a Guide for Development of Vaccines To Reduce Congenital Cytomegalovirus Infections. J Virol 2018; 92:e00030-18. [PMID: 29343580 DOI: 10.1128/JVI.00030-18] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Human cytomegalovirus (HCMV) is the most common congenitally transmitted pathogen worldwide, impacting an estimated 1 million newborns annually. Congenital HCMV (cCMV) infection is a major global contributor to long-term neurologic deficits, including deafness, microcephaly, and neurodevelopmental delay, as well as to fetal loss and occasional infant mortality. Accordingly, design of a maternal vaccine to prevent cCMV continues to be a top public health priority. Nevertheless, we remain without a licensed vaccine. Maternal immunity provides partial protection, as the risk of vertical HCMV transmission from chronically infected mothers is reduced compared to settings in which the mother is newly infected during pregnancy. Therefore, an understanding of the maternal immune correlates of protection against cCMV is critical to informing design of an efficacious maternal vaccine. Although vaccine development is being assiduously pursued by a large number of pharmaceutical manufacturers, biotechnology organizations, and academic researchers, some pessimism has been expressed regarding the issue of whether a vaccine to protect against cCMV is possible. This pessimism is based on observations that natural immunity is not completely protective against maternal reinfection and congenital transmission. However, we assert that optimism regarding vaccine development is indeed justified, on the basis of accruing evidence of immune correlates of protection-readily achievable by vaccination-that are associated with reduced transmission of HCMV to the fetus in seronegative women. In light of the substantial burden on society conferred by cCMV infection, even a modest reduction in the occurrence of this fetal disease is an important public health goal and justifies aggressive clinical evaluation of vaccines currently in the pipeline.
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Abstract
A vaccine against congenital human cytomegalovirus (CMV) infection is a major public health priority. Congenital CMV causes substantial long-term morbidity, particularly sensorineural hearing loss (SNHL), in newborns, and the public health impact of this infection on maternal and child health is underrecognized. Although progress toward development of a vaccine has been limited by an incomplete understanding of the correlates of protective immunity for the fetus, knowledge about some of the key components of the maternal immune response necessary for preventing transplacental transmission is accumulating. Moreover, although there have been concerns raised about observations indicating that maternal seropositivity does not fully prevent recurrent maternal CMV infections during pregnancy, it is becoming increasing clear that preconception immunity does confer some measure of protection against both CMV transmission and CMV disease (if transmission occurs) in the newborn infant. Although the immunity to CMV conferred by both infection and vaccination is imperfect, there are encouraging data emerging from clinical trials demonstrating the immunogenicity and potential efficacy of candidate CMV vaccines. In the face of the knowledge that between 20,000 and 30,000 infants are born with congenital CMV in the United States every year, there is an urgent and compelling need to accelerate the pace of vaccine trials. In this minireview, we summarize the status of CMV vaccines in clinical trials and provide a perspective on what would be required for a CMV immunization program to become incorporated into clinical practice.
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Affiliation(s)
- Mark R Schleiss
- Center for Infectious Diseases and Microbiology Translational Research, University of Minnesota Medical School, Department of Pediatrics, Minneapolis, Minnesota, USA
| | - Sallie R Permar
- Duke University Medical School, Human Vaccine Institute, Department of Pediatrics, Durham, North Carolina, USA
| | - Stanley A Plotkin
- University of Pennsylvania, Vaxconsult, Philadelphia, Pennsylvania, USA
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Kęsik-Maliszewska J, Krzysiak MK, Grochowska M, Lechowski L, Chase C, Larska M. EPIDEMIOLOGY OF SCHMALLENBERG VIRUS IN EUROPEAN BISON ( BISON BONASUS) IN POLAND. J Wildl Dis 2018; 54:272-82. [PMID: 29148884 DOI: 10.7589/2017-07-159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Schmallenberg virus (SBV), an emerging arbovirus in Europe, is an important pathogen in domestic ruminants; however, its impact on free-ranging wild ruminants is not well studied. Three hundred and forty-seven serum samples collected between 2011 and 2016 from 302 European bison ( Bison bonasus) from 12 different sites in Poland were tested for the presence of SBV antibodies. In addition, 86 sera were collected between 2013 and 2016 from three species of cervids for testing for SBV antibodies. After the first detection of the virus in Poland in October 2012, the proportion of SBV-seropositive European bison reached 81% (95% confidence interval [CI]: 77.1-85.8%), whereas in cervids seroprevalence was 34% (95% CI: 23.5-43.9%). There was an increase in seroprevalence in European bison from 2012 to 2014. Biting midges ( Culicoides spp.), the primary vectors of SBV, were monitored entomologically for the identification of the biting midge populations and virologically for SBV infections in the Białowieża Forest region, which contains the world's largest European bison population. We detected SBV by PCR in 3% of Culicoides pools from 2015. In addition, seven fetal brain samples from European bison or cervids were tested and were negative for SBV RNA. Our results indicate a high seroprevalence with reduced transmission of SBV in subsequent years in the European bison populations and lower seroprevalence in cervids.
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35
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Seleme MC, Kosmac K, Jonjic S, Britt WJ. Tumor Necrosis Factor Alpha-Induced Recruitment of Inflammatory Mononuclear Cells Leads to Inflammation and Altered Brain Development in Murine Cytomegalovirus-Infected Newborn Mice. J Virol 2017; 91:e01983-16. [PMID: 28122986 DOI: 10.1128/JVI.01983-16] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/06/2017] [Indexed: 12/24/2022] Open
Abstract
Congenital human cytomegalovirus (HCMV) infection is a significant cause of abnormal neurodevelopment and long-term neurological sequelae in infants and children. Resident cell populations of the developing brain have been suggested to be more susceptible to virus-induced cytopathology, a pathway thought to contribute to the clinical outcomes following intrauterine HCMV infection. However, recent findings in a newborn mouse model of the infection in the developing brain have indicated that elevated levels of proinflammatory mediators leading to mononuclear cell activation and recruitment could underlie the abnormal neurodevelopment. In this study, we demonstrate that treatment with tumor necrosis factor alpha (TNF-α)-neutralizing antibodies decreased the frequency of CD45+ Ly6Chi CD11b+ CCR2+ activated myeloid mononuclear cells (MMCs) and the levels of proinflammatory cytokines in the blood and the brains of murine CMV-infected mice. This treatment also normalized neurodevelopment in infected mice without significantly impacting the level of virus replication. These results indicate that TNF-α is a major component of the inflammatory response associated with altered neurodevelopment that follows murine CMV infection of the developing brain and that a subset of peripheral blood myeloid mononuclear cells represent a key effector cell population in this model of virus-induced inflammatory disease of the developing brain.IMPORTANCE Congenital human cytomegalovirus (HCMV) infection is the most common viral infection of the developing human fetus and can result in neurodevelopmental sequelae. Mechanisms of disease leading to neurodevelopmental deficits in infected infants remain undefined, but postulated pathways include loss of neuronal progenitor cells, damage to the developing vascular system of the brain, and altered cellular positioning. Direct virus-mediated cytopathic effects cannot explain the phenotypes of brain damage in most infected infants. Using a mouse model that recapitulates characteristics of the brain infection described in human infants, we have shown that TNF-α plays a key role in brain inflammation, including recruitment of inflammatory mononuclear cells. Neutralization of TNF-α normalized neurodevelopmental abnormalities in infected mice, providing evidence that virus-induced inflammation is a major component of disease in the developing brain. These results suggest that interventions limiting inflammation associated with the infection could potentially improve the neurologic outcome of infants infected in utero with HCMV.
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Abstract
Despite the clear need, progress toward a vaccine for congenital cytomegalovirus (CMV) has been slow. However, recent events have provided new interest, and several vaccine candidates are either in clinical trials or the trials are close to starting. In this issue of Clinical and Vaccine Immunology, Schleiss and colleagues show that a nonreplicating lymphocytic choriomeningitis virus (rLCMV)-vectored vaccine expressing CMV glycoprotein B (gB) and/or pp65 induces B and T cells and improves pup survival in a guinea pig model of congenital CMV infection (Clin Vaccine Immunol 24:e00300-16, 2017, https://doi.org/10.1128/CVI.00300-16). The combination vaccine appeared to be the most effective.
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Abstract
Congenital cytomegalovirus (CMV) infection represents a relevant cause of deafness and neurological damage in newborns. Intrauterine CMV transmission might result after primary or nonprimary infections, though at different rates (30% versus 0.2%, respectively). At present, a prenatal diagnosis of CMV infection is based mainly on maternal serology, the detection of CMV-DNA in amniotic fluid and fetal blood, and ultrasound (US) and magnetic resonance imaging (MRI). Recent evidences suggest that congenital CMV infection may be an immune-mediated disease and that evaluation of humoral and especially T-cell immunities may improve the overall prenatal diagnosis. This review summarizes the most recent advancements in the diagnosis of maternal and prenatal CMV infections.
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Abstract
INTRODUCTION Congenital and perinatal infections are a leading cause of neonatal and infant morbidity and mortality. Maternal screening, vaccines or treatment where available, constitute effective prevention strategies to reduce the burden of these diseases. Data on the burden of congenital and perinatal infections are very limited for low and middle-income regions. AREAS COVERED This review aims to summarize the burden of congenital and perinatal infections and the main challenges for their control in resource-limited settings. Articles were identified through the main electronic databases and cover the period 1971-2016. Expert commentary: Estimates from low and middle-income countries indicate that the burden of congenital infections may be higher in these regions than in industrialized countries. As preventive and curative strategies are available to tackle some of these infections, efforts at the international and national levels must be made to implement those and thus reduce their burden in resource-limited countries.
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Affiliation(s)
- Lola Madrid
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - Rosauro Varo
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - Antonio Sitoe
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique
| | - Quique Bassat
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
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Contopoulos-Ioannidis D, Wheeler KM, Ramirez R, Press C, Mui E, Zhou Y, Van Tubbergen C, Prasad S, Maldonado Y, Withers S, Boyer KM, Noble AG, Rabiah P, Swisher CN, Heydemann P, Wroblewski K, Karrison T, Grigg ME, Montoya JG, McLeod R. Clustering of Toxoplasma gondii Infections Within Families of Congenitally Infected Infants. Clin Infect Dis 2015; 61:1815-24. [PMID: 26405150 DOI: 10.1093/cid/civ721] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/07/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family clusters and epidemics of toxoplasmosis in North, Central, and South America led us to determine whether fathers of congenitally infected infants in the National Collaborative Chicago-Based Congenital Toxoplasmosis Study (NCCCTS) have a high incidence of Toxoplasma gondii infection. METHODS We analyzed serum samples collected from NCCCTS families between 1981 and 2013. Paternal serum samples were tested for T. gondii antibodies with immunoglobulin (Ig) G dye test and IgM enzyme-linked immunosorbent assay. Additional testing of paternal serum samples was performed with differential-agglutination and IgG avidity tests when T. gondii IgG and IgM results were positive and serum samples were collected by the 1-year visit of the congenitally infected child. Prevalence of paternal seropositivity and incidence of recent infection were calculated. We analyzed whether certain demographics, maternal parasite serotype, risk factors, or maternal/infant clinical manifestations were associated with paternal T. gondii infection status. RESULTS Serologic testing revealed a high prevalence (29 of 81; 36%) of T. gondii infection in fathers, relative to the average seropositivity rate of 9.8% for boys and men aged 12-49 years in the United States between 1994 and 2004 (P < .001). Moreover, there was a higher-than-expected incidence of recent infections among fathers with serum samples collected by the 1-year visit of their child (6 of 45; 13%; P < .001). No demographic patterns or clinical manifestations in mothers or infants were associated with paternal infections, except for sandbox exposure. CONCLUSIONS The high prevalence of chronic and incidence of recent T. gondii infections in fathers of congenitally infected children indicates that T. gondii infections cluster within families in North America. When a recently infected person is identified, family clustering and community risk factors should be investigated for appropriate clinical management.
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Affiliation(s)
- Despina Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious Diseases Palo Alto Medical Foundation Toxoplasma Serology Laboratory, California
| | - Kelsey M Wheeler
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | - Raymund Ramirez
- Palo Alto Medical Foundation Toxoplasma Serology Laboratory, California
| | - Cindy Press
- Palo Alto Medical Foundation Toxoplasma Serology Laboratory, California
| | - Ernest Mui
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | - Ying Zhou
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | - Christine Van Tubbergen
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | - Sheela Prasad
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | | | - Shawn Withers
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | - Kenneth M Boyer
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago Department of Pediatrics, Rush University Medical Center
| | - A Gwendolyn Noble
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago Lurie Children's Hospital, Northwestern Memorial Hospital, Northwestern University, Chicago
| | - Peter Rabiah
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago North Shore University Hospital, Evanston, Illinois
| | - Charles N Swisher
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago Lurie Children's Hospital, Northwestern Memorial Hospital, Northwestern University, Chicago
| | - Peter Heydemann
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago Department of Pediatrics, Rush University Medical Center
| | - Kristen Wroblewski
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | - Theodore Karrison
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
| | - Michael E Grigg
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jose G Montoya
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine Palo Alto Medical Foundation Toxoplasma Serology Laboratory, California
| | - Rima McLeod
- Departments of Ophthalmology and Visual Sciences and Pediatric Infectious Diseases, Toxoplasmosis Center, Department of Public Health Sciences, University of Chicago
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Abdoli A, Pirestani M. Are pregnant women with chronic helminth infections more susceptible to congenital infections? Front Immunol 2014; 5:53. [PMID: 24575099 PMCID: PMC3921675 DOI: 10.3389/fimmu.2014.00053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/29/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amir Abdoli
- Department of Parasitology, Faculty of Medical Sciences, Kashan University of Medical Science , Kashan , Iran ; Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University , Tehran , Iran
| | - Majid Pirestani
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University , Tehran , Iran
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Simeone RM, Rasmussen SA, Mei JV, Dollard SC, Frias JL, Shaw GM, Canfield MA, Meyer RE, Jones JL, Lorey F, Honein MA. A pilot study using residual newborn dried blood spots to assess the potential role of cytomegalovirus and Toxoplasma gondii in the etiology of congenital hydrocephalus. ACTA ACUST UNITED AC 2013; 97:431-6. [PMID: 23716471 DOI: 10.1002/bdra.23138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/14/2013] [Accepted: 03/18/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Congenital hydrocephalus is a condition characterized by accumulation of cerebrospinal fluid in the ventricles of the brain. Prenatal infections are risk factors for some birth defects. This pilot study investigated whether residual dried blood spots (DBS) could be used to assess infections as risk factors for birth defects by examining the associations between prenatal infection with Toxoplasma gondii (T. gondii) or cytomegalovirus (CMV) with congenital hydrocephalus. METHODS Case-infants with hydrocephalus (N=410) were identified among live-born infants using birth defects surveillance systems in California, North Carolina, and Texas. Control-infants without birth defects were randomly selected from the same geographic areas and time periods as case-infants (N=448). We tested residual DBS from case- and control-infants for T. gondii immunoglobulin M and CMV DNA. When possible, we calculated crude odds ratios (cORs) and confidence intervals (CIs). RESULTS Evidence for prenatal T. gondii infection was more common among case-infants (1.2%) than control-infants (0%; p=0.11), and evidence for prenatal CMV infection was higher among case-infants (1.5%) than control-infants (0.7%; cOR: 2.3; 95% CI: 0.48, 13.99). CONCLUSIONS Prenatal infections with T. gondii and CMV occurred more often among infants with congenital hydrocephalus than control-infants, although differences were not statistically significant. This pilot study highlighted some challenges in using DBS to examine associations between certain infections and birth defects, particularly related to reduced sensitivity and specimen storage conditions. Further study with increased numbers of specimens and higher quality specimens should be considered to understand better the contribution of these infections to the occurrence of congenital hydrocephalus.
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Affiliation(s)
- Regina M Simeone
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Abstract
PURPOSE To observe changes in audiology, intellectual development, behavior development, and physical growth during systematic follow-up of infants with asymptomatic congenital human cytomegalovirus (HCMV) infection. MATERIALS AND METHODS Fifty-two infants diagnosed with asymptomatic congenital HCMV infection from July 2003 to July 2007 served as the infection group, and 21 healthy infants served as the control group. All infants were confirmed to have HCMV infection by Fluorescent Quantative polymerase chain reaction (FQ-PCR). In both the infection and control groups, the neonates and infants at 3 months, 6 months, and 1 year of age underwent examinations. RESULTS 1) 20 items of National Black Nurses Association (NBNA) scores of neonates 12-14 days after birth in 2 groups were 38.3 +/- 1.95 and 38.5 +/- 2.29, without significant differences. 2) Auditory test: 50 ears of 25 cases in the infection group showed abnormal auditory thresholds in V waves with an abnormal rate of 14%, while no abnormalities were found in 21 cases in the control group. 3) Mental and psychomotor development index scores in the control group (107.49 +/- 11.31 and 107.19 +/- 10.98) were compared with those in 41 asymptomatically infected infants at 1 year of age (107.21 +/- 9.96 and 108.31 +/- 11.25), and no statistically significant difference was noted. CONCLUSION 1) An elevated threshold in the V wave was present in asymptomatically infected infants, but could not be detected through otoacoustic emission (OAE) screening. 2) Either in the neonatal or infant periods, asymptomatic congenital HCMV infection did not have a significant influence on nervous behavior or on physical and intellectual development.
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Affiliation(s)
- Ruobing Shan
- Department of Neonatology, Women and Children's Hospital, Qingdao, China.
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