Fetal and placental infection with SARS-CoV-2 in early pregnancy.

To date, mother-to-fetus transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19) pandemic, remains controversial. Although placental COVID-19 infection has been documented in some cases during the second- and third-trimesters, no reports are available for the first trimester of pregnancy, and no SARS-CoV-2 protein has been found in fetal tissues. We studied the placenta and fetal organs from an early pregnancy miscarriage in a COVID-19 maternal infection by immunohistochemical, reverse transcription quantitative real-time polymerase chain reaction, immunofluorescence, and electron microscopy methods. SARS-CoV-2 nucleocapsid protein, viral RNA, and particles consistent with coronavirus were found in the placenta and fetal tissues, accompanied by RNA replication revealed by double-stranded RNA (dsRNA) positive immunostain. Prominent damage of the placenta and fetal organs were associated with a hyperinflammatory process identified by histological examination and immunohistochemistry. The findings provided in this study document that congenital SARS-CoV-2 infection is possible during the first trimester of pregnancy and that fetal organs, such as lung and kidney, are targets for coronavirus. The infection and multi-organic fetal inflammation produced by SARS-CoV-2 during early pregnancy should alert clinicians in the assessment and management of pregnant women for possible fetal consequences and adverse perinatal outcomes.

Reporting detection of Chlamydia trachomatis DNA in tissues of neonatal death cases.

OBJECTIVE: to determine whether C. trachomatis was present in neonates with infection, but without an isolated pathogen, who died during the first week of life. METHODS: early neonatal death cases whose causes of death had been previously adjudicated by the institutional mortality committee were randomly selected. End-point and real-time polymerase chain reaction of the C. trachomatis omp1 gene was used to blindly identify the presence of chlamydial DNA in the paraffinized samples of five organs (from authorized autopsies) of each of the dead neonates. Additionally, differential diagnoses were conducted by amplifying a fragment of the 16S rRNA of Mycoplasma spp. RESULTS: in five cases (35.7%), C. trachomatis DNA was found in one or more organs. Severe neonatal infection was present in three cases; one of them corresponded to genotype D of C. trachomatis. Interestingly, another case fulfilled the same criteria but had a positive polymerase chain reaction for Mycoplasma hominis, a pathogen known to produce sepsis in newborns. CONCLUSION: the use of molecular biology techniques in these cases of early infant mortality demonstrated that C. trachomatis could play a role in the development of severe infection and in early neonatal death, similarly to that observed with Mycoplasma hominis. Further study is required to determine the pathogenesis of this perinatal infection.

Reporting detection of Chlamydia trachomatis DNA in tissues of neonatal death cases / Relato de detecção de DNA de Chlamydia trachomatis em tecidos de casos de óbito neonatal

OBJECTIVE: to determine whether C. trachomatis was present in neonates with infection, but without an isolated pathogen, who died during the first week of life. METHODS: early neonatal death cases whose causes of death had been previously adjudicated by the institutional mortality committee were randomly selected. End-point and real-time polymerase chain reaction of the C. trachomatis omp1 gene was used to blindly identify the presence of chlamydial DNA in the paraffinized samples of five organs (from authorized autopsies) of each of the dead neonates. Additionally, differential diagnoses were conducted by amplifying a fragment of the 16S rRNA of Mycoplasma spp. RESULTS: in five cases (35.7%), C. trachomatis DNA was found in one or more organs. Severe neonatal infection was present in three cases; one of them corresponded to genotype D of C. trachomatis. Interestingly, another case fulfilled the same criteria but had a positive polymerase chain reaction for Mycoplasma hominis, a pathogen known to produce sepsis in newborns. CONCLUSION: the use of molecular biology techniques in these cases of early infant mortality demonstrated that C. trachomatis could play a role in the development of severe infection and in early neonatal death, similarly to that observed with Mycoplasma hominis. Further study is required to determine the pathogenesis of this perinatal infection. .

OBJETIVO: determinar se a C. trachomatis está presente em neonatos com infecção, porém sem patógeno isolado, que morreram durante a primeira semana de vida. MÉTODOS: casos de óbito neonatal precoce cujas causas de óbito haviam sido anteriormente determinadas pelo Comitê de Mortalidade da instituição foram aleatoriamente selecionados. Foram utilizadas as reações em cadeia da polimerase convencional e em tempo real do gene omp1 da C. trachomatis, para identificar, às cegas, a presença de DNA de clamídia nas amostras desparafinizadas de cinco órgãos (de autópsias autorizadas) de cada um dos neonatos mortos. Além disso, foram realizados diagnósticos diferenciais por amplificação de um fragmento do rRNA 16S de Mycoplasma ssp. RESULTADOS: em cinco casos (35,7%) a presença de DNA de C. trachomatis foi detectada em um ou mais órgãos. Havia infecção neonatal grave em três casos; um deles correspondente ao genótipo D de C. trachomatis. Curiosamente, outro caso preencheu os mesmos critérios, porém possuía uma reação em cadeia da polimerase positiva para Mycoplasma hominis, um patógeno conhecido por causar sepse em recém-nascidos. CONCLUSÃO: a utilização de técnicas de biologia molecular nos casos de mortalidade infantil precoce mostrou que a C. trachomatis poderia desempenhar um papel no desenvolvimento de infecção grave e no óbito neonatal precoce semelhante ao observado com a Mycoplasma hominis. São necessários estudos adicionais para determinar a patogênese dessa infecção perinatal. .