الملخص
ABSTRACT Yellow fever vaccine (YFV) is a live attenuated vaccine that can cause a mild infection in immunocompetent patients. However, it may not be self-limiting in patients with inborn errors of immunity (IEI) and may be the first and most severe presentation in these patients. A 10-month-old female infant sought emergency care presenting fever for three days and diffuse exanthema. She was a previous healthy child of consanguineous parents. The child had received YFV 28 days before the onset of symptoms. Upon hospital admission, petechial rash on the limbs and hepatosplenomegaly were noted on physical exam. Laboratory tests showed thrombocytopenia, increased serum aminotransferases and elevated gamma-glutamyl transferase (GGT) and alkaline phosphatase levels. During hospitalization she developed hypoactivity, drowsiness, and hypotonia. The possibility of viscerotropic and neurotropic vaccine associated disease was suspected and a possible primary immunodeficiency disease considered. The patient was tested for antibodies against the yellow fever virus (MAC ELISA) on serum and cerebrospinal fluid (CSF) samples, showing positive IgM results. Immunophenotyping showed low levels of lymphocytes and absence of T-cell receptor excision circles (TREC), leading to diagnose of severe combined immunodeficiency disease (SCID). Despite treatment, after 35 days of hospitalization, she evolved to cardiorespiratory arrest and death. Serious adverse events after administration of the YFV are rare and associated with neurological or visceral involvement in most cases. The unfavorable outcome highlights the importance of neonatal screening for SCID and the clinical suspicion of primary immunodeficiencies in infants who have serious adverse events to live virus vaccines.
الملخص
As infecções congênitas por herpes-vírus apresentam alta prevalência ou são responsáveis por alta morbimortalidade de recém-nascidos. Nesta revisão estão abordados o herpes-vírus simplex, o vírus Varicela zoster e o citomegalovírus como agentes de infecções em gestantes, feto e recém-nascidos, incluindo medidas para profilaxia da transmissão vertical e recomendações para propedêutica e terapêutica do binômio mãe e filho.
Congenital infections by the herpes virus show high prevalence or are responsible for high morbidity and mortality in newborns. In this review, the herpes virus simplex, Varicella zoster virus, and Cytomegalovirus are addressed as infectious agents in pregnant women, fetus, and newborns, and include measures for the prevention of mother-to-child transmissionand recommendations for the propaedeutics and therapy of both mother and child.
الملخص
A toxoplasmose, parasitose prevalente em todo o mundo, quando adquirida durante a gestação pode ser transmitida ao feto e causar, dentre outros problemas, atraso no desenvolvimento neuropsicomotor, estrabismo, déficit visual e perdas auditivas. A prevenção da transmissão vertical deve ser iniciada antes da con- cepção ou o mais precocemente possível durante o pré-natal. A identificação de gestantes susceptíveis (soronegativas) deve ser acompanhada de orientações escritas e verbais sobre as formas de aquisição da infecção (profilaxia primária) e, se bem realizada, tem se mostrado eficaz. As mulheres com contato prévio com o parasito, antes da gestação, se imunocompetentes, apresentam muito baixo risco de infectar o concepto. Mas, as gestantes agudamente infectadas devem ser identificadas precocemente para instituição de terapêutica adequada (profilaxia secundária) com o objetivo de evitar a infecção ou diminuir as suas conseqüências para o feto. Considerando-se que a infecção adquirida, assim como a congênita, são geralmente assintomáticas, devemos utilizar a triagem sorológica da mãe e, posteriormente da criança suspeita, para diagnosticar e tratar esses casos. Os autores se pro- põem a apresentar uma orientação prática para abordagem do binômio mãe/filho suspeitos de toxoplasmose, com base nos conhecimentos disponíveis no momento e de acordo com o protocolo utilizado no Serviço de Doenças Infecciosas e Parasitárias, setor de Infectologia Pediátrica, do Hospital das Clínicas da Universidade Federal de Minas Gerais.
The toxoplasmosis, a prevalent parasitosis throughout the world, when acquired during pregnancy can be transmítted to the fetus and cause, among other problems, delay in the neuropsychomotor development, strabismus and visual and hearing impairment. The vertical transmission prevention must be initiated before conception or as early as possible in the prenatal assessment. The identification of susceptible pregnant woman (nega tive blood test) must be accompanied by written and verbal orientation about how the disease can be acquired (primary prophylaxis) and, if well per- formed, has showed good efficacy. Women with previous contact with the parasite, before pregnancy, if imunecompetents, show a very low risk of infecting the child. But, the pregnant women acutely infected must be identified early for the implementation of adequa te therapeutics (secondary prophylaxis) aiming to avoid infection ar at least decrease its consequence to the fetus. Considering that the acquired infection as well as the congenital are usually assymptomatic, we should use the mother's serological screening and, afterwards the child's to diagnose and treat these cases. The authors intend to show a public guideline in the assessment of the mother/child suspects of being infected with toxoplasmosis, based in the current available knowledge and according to the protocol used in the Serviço de Doenças Infecciosas e Parasitárias, Setor de Infectologia Pediátrica, Hospital das Clínicas da Universidade Federal de Minas Gerais.