COVID-19: Twin Research in Progress/Twin Research Reviews: Asthmatic and Nonasthmatic Twins; Stanford University Study of Anal Prints; Twin Mammals and COVID-19; Twin Delivery and the Three 'Rs'/Mixed Media: The Rainman Twins - The Film; Twins Irish Pub; Twins 'Covid and Corona'; Death of a Surgeon Who Separated Conjoined Twins; Twinco - Twin-Based Supply Company.

It is likely that genetic factors play a role in the susceptibility to, and recovery from, COVID-19. A survey of ongoing twin research could produce findings likely to help in the prevention and management of this pandemic. This survey is followed by a review of research comparing selected features of asthmatic and nonasthmatic twins, links between twin mammals and COVID-19, and relationships between twin delivery and the three 'Rs'. The final section of this article presents newsworthy twin-related items, some associated with COVID-19. They include a summary of the Rainman Twins film, a study of anal prints, the 'Twins' Irish pub, newborn twins 'Covid and Corona', the death of a surgeon who separated conjoined twins, and Twinco, a twin-based supply company.

Simultaneous intussusception associated with adenovirus infection in monozygotic twins: A case report.

RATIONALE: Intussusception, a common cause of intestinal obstruction in children, typically requires medical reduction. Here, we describe the case of a pair of twins who had simultaneous intussusception and were positive for fecal adenovirus-strongly indicating that adenovirus infection may be a main cause of the intussusception. PATIENT CONCERNS: Two 1-year-old twin girls were brought to Cathay General Hospital one after another on the same day. Both presented with intermittent abdominal pain, abdominal distension, diarrhea, and loss of appetite. DIAGNOSES: Their laboratory data were adenovirus positivity in rectal swab culture. Intussusception was diagnosed through a lower gastrointestinal series. INTERVENTIONS: The twins were treated with reduction for intussusception. OUTCOMES: Both patients recovered well, without recurrence. LESSONS: Most cases of intussusception are idiopathic. However, some potential risk factors-as strongly suggested by the current cases-are genetic factors and adenovirus infection.

Viral Characteristics Associated with Maintenance of Elite Neutralizing Activity in Chronically HIV-1 Clade C-Infected Monozygotic Pediatric Twins.

Broad and potent neutralizing antibodies (bnAbs) with multiple epitope specificities evolve in HIV-1-infected children. Herein, we studied two antiretroviral-naive chronically HIV-1 clade C-infected monozygotic pediatric twins, AIIMS_329 and AIIMS_330, with potent plasma bnAbs. Elite plasma neutralizing activity was observed since the initial sampling at 78 months of age in AIIMS_330 and persisted throughout, while in AIIMS_329 it was seen at 90 months of age, after which the potency decreased over time. We evaluated potential viral characteristics associated with the varied immune profiles by generating single genome-amplified pseudoviruses. The AIIMS_329 viruses generated from the 90-month time point were neutralization sensitive to bnAbs and contemporaneous plasma antibodies, while viruses from the 112-month and 117-month time points were resistant to most bnAbs and contemporaneous plasma. AIIMS_329 viruses developed resistance to plasma neutralizing antibodies (nAbs) plausibly by N160 glycan loss and V1 and V4 loop lengthening. The viruses generated from AIIMS_330 (at 90 and 117 months) showed varied susceptibility to bnAbs and autologous contemporaneous plasma antibodies, while the viruses of the 112-month time point, at which the plasma nAb specificities mapped to the V2 glycan, V3 glycan, and CD4 binding site (CD4bs), were resistant to contemporaneous plasma antibodies as well as to most bnAbs. Chimeric viruses were constructed from 90-month-time-point PG9-sensitive AIIMS_329 and AIIMS_330 viruses with swapped V1V2 regions of their respective evolved viruses (at 112 and 117 months), which led to higher resistance to neutralization by PG9 and autologous plasma antibodies. We observed the evolution of a viral pool in the AIIMS_330 donor comprising plasma antibody neutralization-sensitive or -resistant diverse autologous viruses that may have contributed to the development and maintenance of elite neutralizing activity.IMPORTANCE Herein, we report the longitudinal development of bnAbs in a pair of chronically HIV-1 clade C-infected monozygotic pediatric twins, AIIMS_329 and AIIMS_330, who acquired the infection by vertical transmission. The plasma from both donors, sharing a similar genetic makeup and infecting virus, showed the evolvement of bnAbs targeting common epitopes in the V2 and V3 regions of the envelope, suggesting that bnAb development in these twins may perhaps be determined by specific sequences in the shared virus that can guide the development of immunogens aimed at eliciting V2 and V3 bNAbs. Characterization of the neutralization-sensitive and -resistant viruses coevolving with bNAbs in the contemporaneous AIIMS_330 plasma provides information toward understanding the viral alterations that may have contributed to the development of resistance to bnAbs. Further longitudinal studies in more monozygotic and dizygotic twin pairs will help in delineating the role of host and viral factors that may contribute to the development of bnAbs.

Successful treatment of fulminant neonatal enteroviral myocarditis in monochorionic diamniotic twins with cardiopulmonary support, intravenous immunoglobulin and pocapavir.

Neonatal cardiogenic shock most commonly occurs due to critical congenital heart disease, sepsis, metabolic disorder or arrhythmias. In particular, enterovirus infections are common in the neonatal period, and patients can present with fulminant myocarditis. Early recognition is imperative due to its high morbidity and mortality without prompt and aggressive treatment. We present the successful treatment of fulminant neonatal enteroviral myocarditis in a pair of monochorionic diamniotic twins with cardiopulmonary support, intravenous immunoglobulin and pocapavir, an enteroviral capsid inhibitor. The twins took an almost exact parallel hospital course, including day of extracorporeal membrane oxygenation (ECMO) cannulation, day of ECMO decannulation, improvement of cardiac function, discharge and status at follow-up. While it was difficult to assess the relative contribution of each intervention, our case shows promise in the use of pocapavir for treatment of severe enteroviral infections. Remarkably, both twins demonstrated remarkable recovery within 2 weeks, underscoring that early aggressive cardiopulmonary support, and potentially pocapavir, contributed to their recovery.

Case Report: Microcephaly in Twins due to the Zika Virus.

Recent studies have demonstrated an association between congenital Zika virus (ZIKV) infection and microcephaly; however, to date, there have been no reports on the consequences of ZIKV infection on fetuses in twin pregnancies. Herein, we reported on the first case of a monochorionic diamniotic (MCDA) twin pregnancy having ZIKV-related microcephaly. Our findings suggested that, in an MCDA twin pregnancy, the ZIKV may cause infection in both fetuses, resulting in severe abnormalities in the central nervous system due to neural cell destruction and the disruption of the normal development processes of the brain. This case report and other similar twin cases may help to understand the pathogenesis and to confirm the etiology of ZIKV as a teratogenic microorganism.

Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies.

Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.

Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies / Evolução clínica discordante da infecção congénita do vírus Zika em gestação gemelar

ABSTRACT Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.

RESUMO A síndrome congênita do Zika vírus é uma causa de infecção congênita emergente, resultando em graves danos ao sistema nervoso central e microcefalia. Apesar dos avanços na compreensão da fisiopatologia da doença, ainda não conhecemos todo o mecanismo envolvido na transmissão vertical do vírus. Como já foi relatado em outros tipos de infecções congênitas em gestações gemelares dizigóticas, é possível que apenas um dos fetos seja afetado pelo vírus. Este artigo descreve 2 casos de gestações gemelares expostas ao vírus Zika, onde apenas um dos fetos foi afetado, com microcefalia associado a graves danos no sistema nervoso central. Isso indica a necessidade urgente de mais estudos sobre a fisiopatologia da infecção viral e os mecanismo envolvidos na proteção natural contra o vírus.

An atypical course of coxsackievirus A6 associated hand, foot and mouth disease in extremely low birth weight preterm twins.

The incidence of coxsackievirus A6 (CV-A6) associated hand, foot and mouth disease (HFMD) has reportedly increased since 2008 with sometimes severe complications. We here describe an atypical course of CV-A6-associated HFMD in extremely low birth weight twins. The CV-A6-strains are genetically closely related to international strains isolated from HFMD outbreaks.

Premature newborns with fatal intrauterine herpes simplex virus-1 infection: first report of twins and review of the literature.

BACKGROUND: Neonates with blistering skin diseases are dermatologic emergencies. The pathologies involved can pose diagnostic difficulties and there exists a variety of potential life-threatening differential diagnoses. OBJECTIVE: description of the first case of intrauterine acquired herpes simplex virus (HSV) 1 infection in twins. METHODS: We present the case of two premature bicordial biamniotic twins (27th week of gestation) whose intrauterine growth retardation, fetal anaemia and cardiotocography abnormalities led to a caesarean emergency delivery. RESULTS: Accurate medical history revealed a maternal febrile gingivostomatitis at the 23rd week of gestation, which was neglected by the treating gynaecologist. Respiratory distress was present at delivery and intubation was necessary in both children. The whole skin showed extensive erosions and ulcerations and the mucosa of the eyes and genitals was also involved. Intrauterine Herpes simplex virus (HSV) 1 infection was confirmed by immunohistochemistry of skin Tzanck smear (HSV 1 positive, HSV 2 negative), real-time polymerase chain reaction of both serum and skin (HSV 1 positive; HSV 2 negative) and maternal serology positive for HSV 1 IgM and IgG. Siblings were immediately treated with high-dose endovenous acyclovir. Anaemia thrombocytopenia and hepatorenal values markedly deteriorated and both developed consequential hepatorenal failure. The third day live supportive measures were terminated after parental informed consent and both siblings deceased shortly after on their mother's breast. DISCUSSION: Intrauterine HSV infection is rare and accounts only for 5% of neonatal HSV infections. Literature reports only 64 cases and 90% of those are related to HSV-2. Transplacental viral transmission is highest during the first 20 weeks of gestation and has been observed in pregnant women with disseminated HSV infection. Mortality and morbidity of intrauterine herpetic infection are extremely high. CONCLUSION: Despite transplacental HSV transmission remains a rare event, the potential devastating outcome justifies immediate adequate antiviral treatment in a pregnant woman affected by primary HSV infection.

Limb hypoplasia resulting from intrauterine infection with herpes simplex virus: a case report.

Intrauterine infection with herpes simplex virus, although very rare, has devastating effects on multiple organ systems in the fetus and can lead to in utero fetal demise. Neonates born following intrauterine herpes simplex virus infection commonly manifest with cutaneous lesions, ocular damage and/or brain abnormalities. We describe the case of a dichorionic, diamniotic twin gestation complicated by intrauterine herpes simplex virus infection. This infection led to the fetal demise of twin A and a very uncommon presentation of limb hypoplasia in twin B.

Persistent pure red cell aplasia in dicygotic twins with persistent congenital parvovirus B19 infection-remission following high dose intravenous immunoglobulin.

UNLABELLED: We report the course of dicygotic twins born preterm after 29 (4)/7 weeks of gestation due to congenital Parvovirus B19 infection causing fetal hydrops with severe anemia in one infant in whom intrauterine transfusion was impossible to perform and high levels of viremia in both infants. After being discharged, they were readmitted at 3 months of age with critical aplastic crisis. Therapy with intravenous immunoglobulin infusion resulted in decreasing viremia followed by stable hemoglobin levels in both infants. CONCLUSION: Intravenous immunoglobulin treatment of congenital pure red cell aplasia due to Parvovirus B19 infection in preterm infants seems to be effective to introduce viral remission and to normalize erythropoiesis.

Apnea with RSV infection in three infants receiving palivizumab.

The present report describes three infants receiving palivizumab prophylaxis who presented with apnea associated with respiratory syncytial virus (RSV) infection. All three were found to be RSV positive but had mild bronchiolitis courses. Even though palivizumab has been shown to be an effective prophylaxis in preventing RSV bronchiolitis hospitalizations, its effect on apnea is unknown. The cases presented raise the concern that apnea associated with RSV must still be considered in infants who receive proper prophylaxis with palivizumab. Also, if palivizumab is found to be ineffective in preventing apnea, clinical management of these patients could be altered.

[Congenital cytomegaly in one twin - a case report]. / Wrodzona cytomegalia w ciazy blizniaczej-opis przypadka.

A report on dichorionic/diamniotic pregnancy in which only one, female, fetus was infected with cytomegalovirus and presented with severe congenital diseases at birth. Infection of the fetus occurred after recurrent maternal infection. The second, male, fetus did not have CMV infection. The cesarean section was performed at the 38th week of gestation. The birth weight of the infected girl was 1680g, the main symptoms, beside dystrophy, concerned the central nervous system: microcephaly, brain atrophy, hydrocephalus, corpus callosum agenesis. She also had Turner syndrome symptoms. The viral load was highest in the urine 81.2 x10^6/ml, in the cerebro-spinal fluid 15.4x10^6/ml and lower in blood 0.38 x10^5/ml. The concentration of specific IgG was 308 U/ml. Specific IgM was not detected. Throughout hospitalization, the infection maintained only one viral genotype gB2. Despite treatment with ganciclovir (10 weeks) and foscarnet (2 weeks), the girl died at the age of 8 months. Novel molecular diagnostic techniques (nested and real time PCR) confirmed the congenital infection and were helpful in the monitoring of the infection and treatment efficacy.

[Neonatal herpes simplex encephalitis: two twins, two cases]. / Encefalitis herpética neonatal: dos gemelas, dos casos.

Herpes simplex encephalitis is an infrequent infection with high mortality and morbidity. Antiviral therapies decrease mortality but long term sequelae are still high, so early diagnosis is important for opportune treatment. We present a pair of twins with central nervous system herpes simplex infection during the first month of life. Both twins presented non-specific symptoms and consulted with 48 hours apart needing intensive care admission, the first one for noninvasive mechanical ventilation and the second for hemodynamic support. Diagnosis was made by cerebrospinal fluid PCR, in the first twin at day 9 of disease and in the second at admission. Both twins were treated with acyclovir, but only the second one at the beginning of her illness. Initial study with electroencephalogram and magnetic resonance was normal and cerebrospinal fluid on day 18 of treatment was negative for herpes simplex virus DNA detection in both patients.

Xenotropic murine leukemia virus-related virus in monozygotic twins discordant for chronic fatigue syndrome.

A recent report suggested an association between xenotropic murine leukemia virus-related virus (XMRV) and chronic fatigue syndrome (CFS). If confirmed, this would suggest that antiretroviral therapy might benefit patients suffering from CFS. We validated a set of assays for XMRV and evaluated the prevalence of XMRV in a cohort of monozygotic twins discordant for CFS. Stored peripheral blood mononuclear cell (PBMC) samples were tested with 3 separate polymerase chain reaction (PCR) assays (one of which was nested) for XMRV DNA, and serum/plasma was tested for XMRV RNA by reverse transcription (RT)-PCR. None of the PBMC samples from the twins with CFS or their unaffected co-twins was positive for XMRV, by any of the assays. One plasma sample, from an unaffected co-twin, was reproducibly positive by RT-PCR. However, serum from the same day was negative, as was a follow-up plasma sample obtained 2 days after the positive specimen. These data do not support an association of XMRV with CFS.

Encefalitis herpética neonatal: dos gemelas, dos casos / Neonatal herpes simplex encephalitis: two twins, two cases

Herpes simplex encephalitis is an infrequent infection with high mortality and morbidity. Antiviral therapies decrease mortality but long term sequelae are still high, so early diagnosis is important for opportune treatment. We present a pair of twins with central nervous system herpes simplex infection during the first month of life. Both twins presented non-specific symptoms and consulted with 48 hours apart needing intensive care admission, the first one for noninvasive mechanical ventilation and the second for hemodynamic support. Diagnosis was made by cerebrospinal fluid PCR, in the first twin at day 9 of disease and in the second at admission. Both twins were treated with acyclovir, but only the second one at the beginning of her illness. Initial study with electroencephalogram and magnetic resonance was normal and cerebrospinal fluid on day 18 of treatment was negative for herpes simplex virus DNA detection in both patients.

La encefalitis herpética en una infección poco frecuente, pero que condiciona alta morbilidad y mortalidad. Las terapias antivirales han logrado disminuir la mortalidad pero no las secuelas a largo plazo que siguen siendo altas, por lo que el énfasis está puesto en la precocidad del diagnóstico, en aras de implementar un tratamiento oportuno. Se presenta el caso de dos gemelas con encefalitis causada por virus herpes simplex durante el primer mes de vida. Ambas gemelas presentaron síntomas inespecíficos al mes de vida y consultaron con 48 horas de diferencia, necesitando cuidados intensivos, la primera por requerimientos de ventilación mecánica no invasora y la segunda por inestabilidad hemodinámica. El diagnostico fue realizado por RPC cualitativa en LCR positivo para VHS, en la primera gemela el día 9 de síntomas y en la segunda al momento de su consulta. Ambas gemelas recibieron aciclovir, pero sólo la segunda precozmente, desde el inicio de los síntomas. El estudio inicial en ambas, incluyendo EEG y RM, resultó normal y el LCR del día 18 de tratamiento no presentaba ADN de VHS en ambas pacientes.

HIV-1 infected monozygotic twins: a tale of two outcomes.

BACKGROUND: Replicate experiments are often difficult to find in evolutionary biology, as this field is inherently an historical science. However, viruses, bacteria and phages provide opportunities to study evolution in both natural and experimental contexts, due to their accelerated rates of evolution and short generation times. Here we investigate HIV-1 evolution by using a natural model represented by monozygotic twins infected synchronically at birth with an HIV-1 population from a shared blood transfusion source. We explore the evolutionary processes and population dynamics that shape viral diversity of HIV in these monozygotic twins. RESULTS: Despite the identical host genetic backdrop of monozygotic twins and the identical source and timing of the HIV-1 inoculation, the resulting HIV populations differed in genetic diversity, growth rate, recombination rate, and selection pressure between the two infected twins. CONCLUSIONS: Our study shows that the outcome of evolution is strikingly different between these two "replicates" of viral evolution. Given the identical starting points at infection, our results support the impact of random epigenetic selection in early infection dynamics. Our data also emphasize the need for a better understanding of the impact of host-virus interactions in viral evolution.

Enterovirus--a double act.

This case report describes twins presenting approximately 24 h apart both with enterovirus meningoencephalitis. The presenting symptoms are described along with laboratory results. Both had extremely high white cell counts in cerebrospinal fluid, which were predominantly lymphocytes. Clinical course and outcomes are described. There was a potential delay in diagnosis of the second twin given the pathology of the twin sibling and the symptoms presented.