Congenital Zika Virus Infection: Beyond Neonatal Microcephaly.

IMPORTANCE: Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. OBJECTIVE: To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. DESIGN, SETTING, AND PARTICIPANTS: We observed 11 infants with congenital ZIKV infection from gestation to 6 months in the state of Paraíba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. MAIN OUTCOMES AND MEASURES: Description of the major lesions caused by ZIKV congenital infection. RESULTS: Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. CONCLUSIONS AND RELEVANCE: Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.

Atualização sobre a síndrome do anticorpo antifosfolípide / Update on antiphospholipid syndrome

A síndrome antifosfolípide é doença auto-imune definida pela ocorrência de tromboses vasculares e/ou morbidade gestacional, em pacientes com testes positivos para os anticorpos antifosfolípides. Anticoagulante lúpico, anticardiolipina e anti beta 2 glicoproteína I são os anticorpos clinicamente importantes para o diagnóstico. Na gestação, pode estar associada a abortamentos recorrentes, restrição do crescimento intra-uterino, oligoidrâmnio, pré-eclâmpsia, parto pré-termo, síndrome HELLP, descolamento prematuro de placenta e óbito fetal. A anticoagulação é a principal estratégia no manejo das complicações trombóticas e obstétricas dessa síndrome, melhorando o prognóstico materno e fetal. O presente artigo tem por objetivo realizar atualização acerca dos principais aspectos relacionados aos critérios diagnósticos, às complicações e ao manejo atual da gestante acometida pela síndrome antifosfolípide.

Complicações e manejo do lúpus eritematoso sistêmico na gestação / Complications and management in systemic lupus erythematosus pregnancy

O lúpus eritematoso sistêmico é doença crônica e auto-imune que afeta principalmente mulheres no período reprodutivo. As gestantes lúpicas estão sob risco mais alto de abortamento espontâneo, crescimento intra-uterino restrito, parto pré-termo, morte fetal e pré-eclâmpsia. Além disso, podem estar associadas à síndrome antifosfolípide e ao lúpus neonatal. Outra importante complicação é a nefrite lúpica, pois, além de influenciar negativamente os resultados gestacionais, seu diagnóstico pode ser dificultado por alterações fisiológicas da gravidez ou por pré-eclâmpsia. Apesar de todos os riscos, bons resultados maternos e fetais podem ser obtidos pelo acompanhamento adequado das pacientes. O presente artigo tem por objetivo realizar atualização sobre os principais aspectos das complicações e do manejo atual da gestante lúpica.