Susceptibility to endemic Aedes-borne viruses among pregnant women in Risaralda, Colombia.

OBJECTIVES: Aedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses (ZIKV) highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. METHODS: A cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood samples were obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. RESULTS: Most women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016. However, only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. CONCLUSION: Hence, a high proportion of pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating a risk for future epidemics in this region.

Fatal Zika virus infection in the Americas: A systematic review.

INTRODUCTION: While death due to Zika virus (ZIKV) infection has been described, reports of fatal cases have been infrequent and no systematic reviews on the subject have been published. METHODS: A systematic review of the literature in four databases was performed to assess fatal outcomes of postnatal ZIKV infection and the available evidence that links ZIKV infection to death. RESULTS: Three hundred and eleven articles were retrieved; 20 of them were epidemiological reports from surveillance agencies and ministries of health. After screening by abstract and title, 59 articles were selected for full-text assessment. Of these, 35 were excluded (with reasons) and 24 were finally included for qualitative analysis. A total of 51 reported deaths associated with ZIKV infection in nine countries were identified. The majority of cases (56.9%) were not related to Guillain-Barré syndrome. Cases from three countries accounted for 67.6% of the deaths. ZIKV infection was laboratory-confirmed in the majority of cases (64.7%). DISCUSSION: ZIKV was not considered to be a dangerous, and much less a lethal pathogen, until very recently. However, an increasing number of fatalities have been published in the literature since the first death was reported in 2016. Additional research is needed to elucidate factors that may mediate the pathogenesis of severe, atypical, and fatal disease.

Successful treatment of gonococcal osteomyelitis with one week of intravenous antibiotic therapy.

Gonorrhea is one of the most common sexually transmitted infections (STIs). In a minority of cases, a disseminated infection can occur including gonococcal osteoarticular disease. With the steep and sustained increase in STIs in the US, we could see invasive gonococcal disease more often. Most cases of gonococcal osteomyelitis receive prolonged courses of antibiotic therapy. We report here the successful treatment of gonococcal osteomyelitis with one week of antibiotic therapy. Given the emergence of bacterial resistance worldwide and associated side effects, it is crucial to limit antibiotic exposures to the smallest effective dose possible.

Diagnosis and outcomes of pregnant women with Zika virus infection in two municipalities of Risaralda, Colombia: Second report of the ZIKERNCOL study.

BACKGROUND: Zika virus (ZIKV) infection has emerged as a significant threat for pregnant women and newborns in populations living in or visiting Latin America. We previously reported a preliminary analysis in Sucre, Colombia, as the first group of pregnant women with RT-PCR-confirmed ZIKV (ZIKa enEmbarazadas yReciénNacidos enCOLombia, ZIKERNCOL). METHODS: In this second report, findings of the first 86 pregnant women from La Virginia and Dosquebradas (municipalities), Risaralda, Colombia, with RT-PCR-confirmed ZIKV infection are reported. Clinical, demographical and obstetrical findings are described. RESULTS: All women reported ZIKV symptoms during pregnancy: 79.1% rash, 55.8% fever, among others. In addition to ZIKV, RT-PCR was positive for dengue in 18.6%; 45.3% Dengue IgM+; 5.8% RT-PCR positive for chikungunya; 3.6% Chikungunya IgM+. STORCH screening in mother: 11.6% IgG + anti-Toxoplasma gondii, 6% IgG + anti-rubella, 4.7% IgG + CMV. The rest of STORCH tests were negative. Microcephaly was observed in 2.4% of the newborns. No calcifications or other CNS alterations were detected. One newborn had cleft palate and one had bilateral renal ectopy. CONCLUSIONS: The rate of microcephaly in our cohort was consistent with other studies. Pregnant women in endemic areas should be followed and tested according to standard protocols, and asymptomatic ZIKV infection should be considered. Long-term follow-up of children is required in the congenital Zika syndrome (CZS) assessment.