Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 137
Filtrar
2.
Int J Infect Dis ; 89: 175-178, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31626981

RESUMO

The majority of parechovirus A type 5 (PeV-A5) infections have been reported in patients with gastrointestinal syndromes. In contrast, a sepsis-like illness associated with PeV-A5 infection has been reported only anecdotally. Herein, we report the first case in Italy of a PeV-A5 neurological infection presenting in a neonate with a sepsis-like syndrome. The patient, a healthy male infant born at 41 weeks of gestation, was highly distressed and inconsolable, and had been crying persistently, with poor breastfeeding, since the previous day. From day 2 to day 4, the newborn was feverish with mild irritability; breastfeeding was preserved and regularly supported. His clinical condition progressively improved, with defervescence on day 4. He was discharged after 7 days, and neurological examination results indicated only mild impairment in visual fixation and vertical eye tracking and mild axial hypotonia. The Italian PeV-A5 strain was phylogenetically related to three strains detected in Denmark in 2012, as well as to one detected in Australia and one in Greece in 2015, with an average nucleotide identity of 97.9% (range 95.9-100.0%). Enterovirus/PeV infection in the newborn should be ruled out in cases of infants with unexplained fever and/or a sepsis-like syndrome and/or meningoencephalitis. An aetiological diagnosis is essential to avoid the unnecessary administration of antibiotics and to plan long-term follow-up until schooling.


Assuntos
Doenças do Recém-Nascido/virologia , Doenças do Sistema Nervoso/virologia , Parechovirus/isolamento & purificação , Infecções por Picornaviridae/virologia , Humanos , Lactente , Recém-Nascido , Itália , Masculino , Doenças do Sistema Nervoso/diagnóstico , Parechovirus/classificação , Parechovirus/genética , Parechovirus/fisiologia , Filogenia
3.
Int J Infect Dis ; 86: 31-39, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31207385

RESUMO

OBJECTIVES: Little is known about the birth prevalence and characteristics of congenital cytomegalovirus (CMV) infection in developing countries. To determine the prevalence and characteristics of congenital CMV infection in Indonesia, we conducted a prospective study in an urban birth cohort of neonates at a national referral hospital in 2016-2017, Jakarta, Indonesia. METHODS: Consecutively born neonates were screened for the presence of CMV by using pan-herpesvirus nested-PCR and Sanger sequencing in saliva and/or urine specimens. Both the neonatal clinical findings as well as maternal characteristics were also evaluated. RESULTS: From a total of 411 newborns screened, congenital CMV infection was confirmed in 5.8% of the neonates. These CMV-positive newborns were more likely to have ventriculomegaly and thrombocytopenia compared to CMV-negative neonates. Notably, 67% CMV-positive neonates in our study had clinical findings that required medical intervention, from which only nine presented with symptoms suggestive of congenital CMV infection. Furthermore, congenital CMV infected babies were almost four times more likely to be born to mothers that had placenta previa and placental abruption. CONCLUSIONS: Our work highlights the high prevalence of congenital CMV infection in neonates born in one of the biggest referral hospitals in metropolitan Jakarta, Indonesia.


Assuntos
Infecções por Citomegalovirus/virologia , Citomegalovirus/fisiologia , Doenças do Recém-Nascido/virologia , Adulto , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/epidemiologia , Feminino , Humanos , Indonésia/epidemiologia , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Masculino , Reação em Cadeia da Polimerase , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Estudos Prospectivos , Saliva/virologia
5.
BMC Pregnancy Childbirth ; 19(1): 32, 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-30651080

RESUMO

BACKGROUND: Nigeria suffers from the highest burden of mother-to-child transmission worldwide. To increase retention in care and prevention programmes, we piloted and evaluated a conditional cash transfer (CCT) programme for preventing mother-to-child transmission (PMTCT) in Akwa Ibom, Nigeria. METHODS: In a randomised controlled trial, pregnant women testing positive for HIV during antenatal care registration at three public hospitals were randomised to one of two study arms: (1) offered enrolment into the CCT programme or (2) continue in standard care for (PMTCT). In the CCT programme, women could receive a compensation package totaling 33,300 Naira (~US$114) for enroling, delivering at the facility, and obtaining a newborn early infant diagnosis (EID) test. The intent-to-treat (ITT) and per protocol (PP) effects of the programme on the primary outcomes of facility delivery and EID testing and on the secondary outcome of nevirapine administration were estimated with logistic regressions. RESULTS: From August 1, 2015 to April 19, 2017, 554 pregnant women tested positive for HIV; 273 were randomised to standard care and 281 were offered enrolment into the CCT intervention. Women offered the CCT programme were more likely to give birth at the facility (n = 109/263; 41.4%) compared to women in standard care (n = 80/254; 31.5%), an absolute difference of 9.9% (OR = 1.54, 95% CI: 1.07-2.21, p = 0.019). For EID testing there was an absolute difference of 12.8% between those offered the CCT intervention (n = 69/263; 26.2%) and those in standard care (n = 34/254; 13.4%; OR = 2.30, 95% CI 1.46-3.62, p = 0.000). PP results show larger differences for both facility deliveries (16.7% absolute difference; OR = 2.02, 95% CI 1.38-2.98, p = 0.000) and EID testing (18.9% absolute difference; OR = 3.09, 95% CI 1.93-4.94, p = 0.000) among intervention enrolees. Over 86% of the facility-delivered newborns received nevirapine, and ITT and PP estimates were similar to those for facility deliveries. CONCLUSIONS: Results show that CCTs improved the likelihood of HIV-positive women giving birth at a facility, of nevirapine being administered to their newborn, and of undergoing EID testing in Akwa Ibom, Nigeria. Effects are especially large among those who agreed to participate in the CCT intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT02447159 , May 18, 2015.


Assuntos
Parto Obstétrico/métodos , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos , Adulto , Parto Obstétrico/economia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Hospitais Públicos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/prevenção & controle , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doença Infecciosa/economia , Análise de Intenção de Tratamento , Modelos Logísticos , Nevirapina/uso terapêutico , Nigéria , Gravidez , Cuidado Pré-Natal/economia , Avaliação de Programas e Projetos de Saúde
6.
Curr Opin HIV AIDS ; 14(1): 55-59, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30394949

RESUMO

PURPOSE OF REVIEW: This article aims at examining the key recent advances in the field of EID, as well as at discussing approaches for resolving the major bottlenecks faced by health systems in the identification and linkage to care of HIV-infected infants. RECENT FINDINGS: Programmatic experience in South Africa and research in other high-burden countries showed that birth HIV testing is accurate, feasible and has the potential to decrease infant mortality. Substantial evidence has mounted on the accuracy of point-of-care testing for EID, including for birth testing. Importantly, it has now been demonstrated that point-of-care EID improves the rate of results return to patients and has significant positive effect on ART initiation rates. Finally, there are good examples of how EID fits into more comprehensive and integrated packages of services covering the antenatal, birth and postpartum periods. SUMMARY: Point-of-care testing for EID, including for birth testing, should be widely implemented to complement laboratory-based testing in high-burden countries. Most of the current barriers for timely EID testing and ART initiation in infants are related to weaknesses in the health system, and will require the implementation of comprehensive approaches aiming at scaling-up these interventions within strengthened primary healthcare services.


Assuntos
Infecções por HIV/diagnóstico , HIV/isolamento & purificação , Doenças do Recém-Nascido/diagnóstico , Diagnóstico Precoce , Feminino , HIV/genética , HIV/fisiologia , Infecções por HIV/transmissão , Infecções por HIV/virologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doença Infecciosa , Masculino , Gravidez , África do Sul
7.
Rev. neurol. (Ed. impr.) ; 67(12): 484-490, 16 dic., 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-175178

RESUMO

Introducción. Las meningitis víricas representan una entidad relativamente frecuente en los recién nacidos, aunque en muchos casos infradiagnosticadas, ante la ausencia de pleocitosis en el líquido cefalorraquídeo (LCR). Objetivos. Describir las características clínicas y los hallazgos de laboratorio de neonatos con meningitis víricas y destacar la importancia de la reacción en cadena de la polimerasa (PCR) en el LCR para diagnosticar esta patología. Pacientes y métodos. Revisión retrospectiva de historias clínicas de neonatos ingresados en la sección de neonatología diagnosticados de meningitis vírica entre mayo de 2014 y mayo de 2017. Resultados. Se registraron 17 casos de meningitis vírica (15 causadas por enterovirus y dos por parecho virus), que constituyenel 14,8% de los neonatos ingresados por síndrome febril. Todos manifestaron fiebre (100%), y otros síntomas destacados fueron irritabilidad (76%) y rechazo de la ingesta (65%). El 88% cursó con celularidad normal en el LCR y sin hiperproteinorraquia, y el 100%, sin hipoglucorraquia, por lo que previamente muchos de estos niños quedaban con el diagnóstico de síndrome febril sin foco. Estos datos resaltan la necesidad de realizar la PCR en el LCR a neonatos con fiebre sin foco, debido a la normalidad de las pruebas complementarias en la mayoría de los casos. El 64,7% de los niños recibió seguimiento neurológico posterior en consulta de neurología, sin objetivarse secuelas neurológicas, salvo en uno de ellos. Conclusiones. La PCR múltiple en el LCR se ha convertido en una técnica diagnóstica imprescindible en el recién nacido con sospecha de infección, y sustituye al cultivo viral como prueba de referencia por su mayor rapidez y sensibilidad


Introduction. The different types of viral meningitis constitute a condition that is relatively frequent in newborn infants, although in many cases they are underdiagnosed due to the absence of pleocytosis in the cerebrospinal fluid (CSF). Aims. To describe the clinical features and laboratory findings of newborn infants with viral meningitis and to highlight the importance of the polymerase chain reaction (PCR) in the CSF to diagnose this condition. Patients and methods. A retrospective review of the medical records of newborn infants hospitalised in the neonatology section who had been diagnosed with viral meningitis between May 2014 and May 2017. Results. Altogether 17 cases of viral meningitis were registered (15 caused by enterovirus and two due to parechovirus), which accounts for 14.8% of all newborns hospitalised owing to febrile symptoms. All of them had fever (100%), and other notable symptoms were irritability (76%) and rejection of feeding (65%). Normal cellularity was found in the CSF without high protein levels in 88% of them, and without hypoglycorrhachia in all of them (100%), which meant that many of these children had previously been left with a diagnosis of a febrile syndrome with no focus. These data stress the need to perform the PCR in the CSF of newborn infants who have a fever without a focus, due to the normal status of the results of the complementary tests in most cases. Subsequent neurological follow-up was performed in 64.7% of the children in the neurology service, without any neurological sequelae being found, except in one case. Conclusions. Multiple PCR in the CSF has become an essential diagnostic technique in cases of newborn infants with a suspected infection, and replaces viral culture as the reference test due its being quicker and more sensitive


Assuntos
Humanos , Masculino , Gravidez , Recém-Nascido , Doenças do Recém-Nascido/virologia , Doenças do Recém-Nascido/diagnóstico , Líquido Cefalorraquidiano/virologia , Meningite Viral/diagnóstico , Reação em Cadeia da Polimerase , Estudos Retrospectivos
8.
Public Health Rep ; 133(6): 637-643, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30265616

RESUMO

OBJECTIVES: The annual number of women with HIV infection who delivered infants in the United States was estimated to be 8700 in 2006. An accurate, current estimate is important for guiding perinatal HIV prevention efforts. Our objective was to analyze whether the 2006 estimate was consistent with the number of infants with HIV infection observed in the United States and with other data on perinatal HIV transmission. METHODS: We compared the number of infants born with HIV in 2015 (n = 53) with data on interventions to prevent perinatal HIV transmission (eg, maternal HIV diagnosis before and during pregnancy and prenatal antiretroviral use). We also estimated the annual number of deliveries to women living with HIV by using the number of women of childbearing age living with HIV during 2008-2014 and the estimated birth rate among these women. Finally, we determined any changes in the annual number of infants born to women with HIV from 2007-2015, among 19 states that reported these data. RESULTS: The low number of infants born in the United States with HIV infection and the uptake of interventions to prevent perinatal HIV transmission were not consistent with the 2006 estimate (n = 8700), even with the best uptake of interventions to prevent perinatal HIV transmission. Given the birth rate among women with HIV (estimated at 7%) and the number of women aged 13-44 living with HIV during 2008-2014 (n = 111 273 in 2008, n = 96 363 in 2014), no more than about 5000 women with HIV would be giving birth. Among states consistently reporting the annual number of births to women with HIV, the number declined about 14% from 2008 to 2014. CONCLUSION: The current annual number of women with HIV infection delivering infants in the United States is about 5000, which is substantially lower than the 2006 estimate. More accurate estimates would require comprehensive reporting of perinatal HIV exposure.


Assuntos
Infecções por HIV/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Taxa de Gravidez , Estados Unidos/epidemiologia , Adulto Jovem
9.
Paediatr Perinat Epidemiol ; 32(4): 358-368, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29882971

RESUMO

BACKGROUND: Since the Zika virus epidemic in the Americas began in 2015, Zika virus transmission has occurred throughout the Americas. However, limited information exists regarding possible risks of transmission of Zika virus and other flaviviruses through breast feeding and human milk. We conducted a systematic review of the evidence regarding flaviviruses detection in and transmission through milk, specifically regarding Zika virus, Japanese encephalitis virus, tick-borne encephalitis virus, Powassan virus, West Nile virus, dengue virus, and yellow fever virus. METHODS: Medline, Embase, Global Health, CINAHL, Cochrane Library, Scopus, Popline, Virtual Health Library, and WorldCat were searched through June 2017. Two authors independently screened potential studies for inclusion and extracted data. Human and nonhuman (animal) studies describing: 1) confirmed or suspected cases of mother-to-child transmission through milk; or 2) the presence of flavivirus genomic material in milk. RESULTS: Seventeen studies were included, four animal models and thirteen observational studies. Dengue virus, West Nile virus, and Zika virus viral ribonucleic acid was detected in human milk, including infectious Zika virus and dengue virus viral particles. Human breast-feeding transmission was confirmed for only yellow fever virus. There was evidence of milk-related transmission of dengue virus, Powassan virus, and West Nile virus in animal studies. CONCLUSIONS: Because the health advantages of breast feeding are considered greater than the potential risk of transmission, the World Health Organization recommends that mothers with possible or confirmed Zika virus infection or exposure continue to breast feed. This review did not identify any data that might alter this recommendation.


Assuntos
Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Leite Humano/virologia , Infecção por Zika virus/transmissão , Zika virus/isolamento & purificação , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto , Fatores de Risco , Infecção por Zika virus/virologia
10.
PLoS Negl Trop Dis ; 12(6): e0006510, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29897898

RESUMO

BACKGROUND: Chikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and may cause fetal and neonatal infections after maternal CHIKV-infections during gestation. METHODOLOGY: We performed a systematic review to evaluate the risk for: a) mother-to-child transmission (MTCT), b) antepartum fetal deaths (APFD), c) symptomatic neonatal disease, and d) neonatal deaths from maternal CHIKV-infections during gestation. We also recorded the neonatal clinical manifestations after such maternal infections (qualitative data synthesis). We searched PubMed (last search 3/2017) for articles, of any study design, with any of the above outcomes. We calculated the overall risk of MTCT, APFDs and risk of symptomatic neonatal disease by simple pooling. For endpoints with ≥5 events in more than one study, we also synthesized the data by random-effect-model (REM) meta-analysis. PRINCIPAL FINDINGS: Among 563 identified articles, 13 articles from 8 cohorts were included in the quantitative data synthesis and 33 articles in the qualitative data synthesis. Most cohorts reported data only on symptomatic rather than on all neonatal infections. By extrapolation also of these data, the overall pooled-MTCT-risk across cohorts was at least 15.5% (206/1331), (12.6% by REMs). The pooled APFD-risk was 1.7% (20/1203); while the risk of CHIKV-confirmed-APFDs was 0.3% (3/1203). Overall, the pooled-risk of symptomatic neonatal disease was 15.3% (203/1331), (11.9% by REMs). The pooled risk of symptomatic disease was 50.0% (23/46) among intrapartum vs 0% (0/712) among antepartum/peripartum maternal infections. Infected newborns, from maternal infections during gestation were either asymptomatic or presented within their first week of life, but not at birth, with fever, irritability, hyperalgesia, diffuse limb edema, rashes and occasionally sepsis-like illness and meningoencephalitis. The pooled-risk of neonatal death was 0.6% (5/832) among maternal infections and 2.8% (5/182) among neonatal infections; long-term neurodevelopmental delays occurred in 50% of symptomatic neonatal infections. CONCLUSIONS/SIGNIFICANCE: Published cohorts with data on the risk to the fetus and/or newborn from maternal CHIKV-infections during gestation were sparse compared to the number of recently reported CHIKV-infection outbreaks worldwide; however perinatal infections do occur, at high rates during intrapartum period, and can be related to neonatal death and long-term disabilities.


Assuntos
Febre de Chikungunya/transmissão , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doença Infecciosa , Complicações Infecciosas na Gravidez/virologia , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Vírus Chikungunya/fisiologia , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Masculino , Gravidez
11.
Pediatr Infect Dis J ; 37(9): 954-957, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29389824

RESUMO

Infectious agents including viruses are thought to play a role in the pathogenesis of necrotizing enterocolitis, a well-known gastrointestinal emergency in newborns. Enteroviruses are common pathogens in neonates and have been associated with outbreaks in neonatal units. Enterovirus-associated necrotizing enterocolitis has been described in 3 preterms. Spatiotemporal and molecular analyses have provided evidence of nosocomial transmission.


Assuntos
Infecção Hospitalar/complicações , Enterocolite Necrosante/etiologia , Infecções por Enterovirus/complicações , Enterovirus/isolamento & purificação , Infecção Hospitalar/virologia , Surtos de Doenças , Enterocolite Necrosante/diagnóstico , França , Humanos , Recém-Nascido , Doenças do Recém-Nascido/virologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Análise Espaço-Temporal
12.
J Infect Dis ; 216(suppl_10): S912-S918, 2017 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-29267912

RESUMO

A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 from South and Central America and the Caribbean. Although the full spectrum of ZIKV infection of the newborn has yet to be determined, other maternal viral infections resulting in transmission to the fetus provide instructive lessons that can be applied to the prospective evaluation of individuals with ZIKV infection. This review focuses on those other congenital infections, including rubella, congenital cytomegalovirus, human immunodeficiency virus, hepatitis B virus, and neonatal herpes simplex virus, from which lessons for the evaluation of ZIKV in the newborn can be applied.


Assuntos
Doenças do Recém-Nascido/virologia , Viroses/virologia , Infecção por Zika virus/virologia , Zika virus/patogenicidade , Américas , Região do Caribe , Feminino , Hepatite B/transmissão , Hepatite B/virologia , Herpes Simples/transmissão , Herpes Simples/virologia , Humanos , Recém-Nascido , Complicações Infecciosas na Gravidez/virologia , Rubéola (Sarampo Alemão)/transmissão , Rubéola (Sarampo Alemão)/virologia , Viroses/transmissão , Infecção por Zika virus/transmissão
13.
J Int AIDS Soc ; 20(4)2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29282882

RESUMO

Globally, 150,000 new paediatric human immunodeficiency virus type 1 (HIV-1) infections occurred in 2015. There remain complex challenges to the global elimination of paediatric HIV-1 infection. Thus, for the global community to achieve elimination of new paediatric HIV-1 infections, innovative approaches need to be explored. Immune-based approaches to prevention of mother-to-child transmission (MTCT) may help fill some of the remaining gaps and provide new opportunities to achieve an AIDS-free generation. Immune-based interventions to prevent MTCT of HIV-1 may include paediatric HIV vaccines and passive immunization approaches. Recent discoveries providing evidence of robust immune responses to HIV in infants open new and exciting prospects for paediatric HIV vaccines. Moreover, successful vaccination of infants has a different set of requirements than vaccination of adults and may be easier to achieve. Proof-of-concept has been established over the last two decades that passively administered HIV-1 Env-specific monoclonal antibody (mAbs) can prevent chimeric simian human immunodeficiency virus (SHIV) transmission to newborn nonhuman primates. There has been tremendous progress in isolating and characterizing broadly neutralizing antibodies to HIV, and clinical testing of these antibodies for treatment and prevention in both infants and adults is a major effort in the field. Immune-based interventions need to be actively explored as they can provide critically important tools to address persistent challenges in MTCT prevention. It is a pivotal time for the field with active discussions on the best strategy to further reduce HIV infection of infants and accomplish the World Health Organization Fast-Track 2030 goals to eliminate new paediatric HIV infections.


Assuntos
Infecções por HIV/prevenção & controle , HIV-1/fisiologia , Doenças do Recém-Nascido/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Vacinas contra a AIDS/administração & dosagem , Vacinas contra a AIDS/imunologia , Adolescente , Adulto , Animais , Anticorpos Neutralizantes/imunologia , Criança , Feminino , Anticorpos Anti-HIV/imunologia , Infecções por HIV/imunologia , Infecções por HIV/transmissão , HIV-1/imunologia , Humanos , Imunização Passiva , Lactente , Recém-Nascido , Doenças do Recém-Nascido/imunologia , Doenças do Recém-Nascido/virologia , Masculino , Vacinação , Adulto Jovem
14.
J Int AIDS Soc ; 20(Suppl 6): 21761, 2017 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-28872276

RESUMO

INTRODUCTION: HIV-1 polymerase chain reaction (PCR) testing at birth aims to facilitate earlier initiation of antiretroviral therapy (ART) for HIV-infected neonates. Data from two years of universal birth testing implementation in a high-burden South African urban setting are presented to demonstrate the prevalence and outcomes of diagnostic challenges in this context. METHODS: HIV-exposed neonates born at Rahima Moosa Mother and Child Hospital between 5 June 2014 and 31 August 2016 were routinely screened at birth for HIV-1 on whole blood samples using the COBAS® AmpliPrep/COBAS® TaqMan (CAP/CTM) HIV-1 Qualitative Test, version 2.0 (Roche Molecular Systems, Inc., Branchburg, NJ, USA). Virological results were interpreted according to standard operating procedures with the South African National Health Laboratory Service. All neonates with non-negative results were actively followed-up and categorized according to HIV infection status as positive, negative, uncertain and lost to follow-up (LTFU). RESULTS: 104 (1.8%) of 5743 HIV-exposed neonates received a non-negative birth PCR result, for which laboratory data were available for 102 (98%) cases - 78 (76%) tested positive and 24 (24%) indeterminate. HIV infection status was confirmed positive in 83 (81%) infants, negative in 8 (8%), uncertain in 5 (5%) and LTFU in 6 (6%) cases. The positive predictive value (excluding cases of uncertain diagnosis and inadequate testing) following a non-negative HIV-1 PCR screening test at birth was 0.91 (83/91; 95% confidence interval: 0.85-0.96). Neonates testing positive at birth had significantly higher viral load (VL) results than those testing indeterminate at birth of 4.5 and 3.0 log copies/ml (p = 0.0007), respectively. Similarly, mothers of neonates with positive as compared to indeterminate birth test results had higher VLs of 4.5 and 2.7 log copies/ml (p = 0.0013), respectively. Half of neonates with an indeterminate birth test were shown to be HIV-infected on subsequent confirmatory testing, with time to final diagnosis 30 days longer for these neonates (p < 0.0001). CONCLUSION: Indeterminate HIV-1 PCR results accounted for a quarter of non-negative results at birth and were associated with a high risk of infection in comparison to the risk of in utero transmission. Indeterminate birth results with positive HIV PCR results on repeat testing were associated with later final diagnosis. The HIV-1 status remains uncertain in a minority of cases because of repeatedly indeterminate results, highlighting the need for more sensitive and specific virological tests.


Assuntos
Infecções por HIV/diagnóstico , HIV-1/isolamento & purificação , Doenças do Recém-Nascido/diagnóstico , Estudos de Coortes , Feminino , Infecções por HIV/sangue , Infecções por HIV/transmissão , Infecções por HIV/virologia , HIV-1/genética , HIV-1/fisiologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doença Infecciosa , Perda de Seguimento , Masculino , Triagem Neonatal , Reação em Cadeia da Polimerase , Prevalência , Carga Viral
15.
PLoS One ; 12(8): e0181005, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28796791

RESUMO

Long turnaround times (TAT) for the processing and posting of results of infant HIV DNA PCR samples can hinder the success of early infant diagnosis (EID) programs. The HITSystem is an eHealth intervention that alerts staff when services are overdue or results are delayed. We conducted a retrospective analysis of 3669 HIV-exposed infants enrolled in 15 Kenya hospital EID programs and three laboratories using the HITSystem from 2011-2014. We assessed mean and median TAT from when a sample was: 1) obtained to when it was shipped to the laboratory, 2) shipped to when it was received at the laboratory, 3) received to when a result was posted, and 4) the total time from obtaining the sample (step 1) to posting the result (step 3). TAT were compared by laboratory, clinic, year, and month of sample collection. 3625 infant samples had results posted by end of 2014. Mean TAT from sample collection to shipping was 5.2 days, from shipping to laboratory receipt was 2.0 days, and from laboratory receipt to result posting was 17.4 days. Altogether, it took an average of 24.7 days from sample collection until result posting. There was significant variation between laboratories, particularly in laboratory processing times (step 3). TAT showed a decreasing trend from 2011-2014, although TAT in December remained higher. Compared with other Kenyan studies, TAT in these HITSystem enrolled settings were shorter. Significant variation between laboratories, however, indicates the need to strengthen protocols and infrastructure to ensure that all laboratories can provide rapid, high-quality services.


Assuntos
Infecções por HIV/diagnóstico , HIV/isolamento & purificação , Doenças do Recém-Nascido/diagnóstico , Diagnóstico Precoce , Produtos do Gene tat/análise , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/virologia , Quênia/epidemiologia , Laboratórios/economia , Estudos Retrospectivos , Manejo de Espécimes/economia , Fatores de Tempo
16.
J Pediatric Infect Dis Soc ; 6(4): e177-e179, 2017 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-28379476

RESUMO

A 10-day-old child was treated for neonatal herpes simplex virus (HSV) central nervous system (CNS) disease with 21 days of intravenous acyclovir and 6 months of oral acyclovir. She presented 7 years later with HSV CNS disease and new lesions in her brain, illustrating the non-benign nature of delayed recurrent HSV CNS disease.


Assuntos
Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Encefalite por Herpes Simples/etiologia , Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Encéfalo/patologia , Encéfalo/virologia , Criança , Encefalite por Herpes Simples/diagnóstico por imagem , Encefalite por Herpes Simples/prevenção & controle , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/virologia , Imagem por Ressonância Magnética , Neuroimagem , Recidiva , Simplexvirus
17.
Gynecol Obstet Fertil Senol ; 45(4): 231-237, 2017 Apr.
Artigo em Francês | MEDLINE | ID: mdl-28373042

RESUMO

Enteroviruses are responsible for about one billion infections every year in the world. The clinical expression is in the vast majority asymptomatic cases (90%). Its consequences during pregnancy are rarely described. From the Medline database, we selected and analyzed 34 articles ranging from 1965 to 2015, to analyse the current knowledge of enterovirus infection consequences during pregnancy. We found that enterovirus infections may be the cause of fetal loss. The enterovirus infections during the 2nd and 3rd trimester may also lead to in utero fetal anomalies and death, but also to severe neonatal infections. PCR enterovirus detection should be performed during pregnancy and the peripartum in case of unexplained fever, specific fetal anomalies or unexplained fetal demise.


Assuntos
Infecções por Enterovirus/complicações , Doenças Fetais/virologia , Doenças do Recém-Nascido/virologia , Complicações Infecciosas na Gravidez/virologia , Enterovirus/isolamento & purificação , Infecções por Enterovirus/diagnóstico , Feminino , Morte Fetal/etiologia , Doenças Fetais/diagnóstico , Doenças Fetais/prevenção & controle , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/prevenção & controle , Gravidez , Cuidado Pré-Natal/métodos
18.
J Int AIDS Soc ; 20(1): 21436, 2017 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-28406596

RESUMO

INTRODUCTION: Timely diagnosis is necessary to avert early death in HIV-infected neonates. Birth PCR testing may improve early identification and facilitate access to care. We implemented a birth HIV diagnosis programme in Johannesburg, South Africa and present successes and challenges of the first two and a half years of operation. METHODS: Between June 2014 and December 2016, we sought to identify all HIV-exposed births and offer newborn HIV PCR testing before discharge after delivery. The programme identified newly delivered women who had tested positive during pregnancy and provided post-partum HIV antibody testing for women without recent negative results. HIV-positive women were required to consent for neonatal birth testing and asked to return a week later to obtain their results. Neonatal venous blood was sampled and tested at the national laboratory using Roche COBAS® TaqMan® HIV-1 Qualitative Test (Version 2.0). Non-negative results triggered active follow-up for confirmatory testing and appropriate treatment. RESULTS: Of 30,591 women with live births, 6864 (22.4%) were known to be HIV positive and an additional 221 women (1.4% of those tested) were identified during maternal postnatal testing. Of 7085 HIV-positive women, 6372 (89.9%) were interviewed and agreed to data collection, 6358 (99.8%) consented to birth testing for 6467 neonates and a blood sample was collected for 6377 (98.6%). If tested, 6210 (97.4%) tested negative, 91 (1.4%) positive, 57 (0.9%) revealed errors and 19 (0.3%) were indeterminate . Seven of the 19 neonates with indeterminate results and one with initial error result were found to be infected on subsequent testing yielding an intrauterine transmission rate of 1.6% (95% CI: 1.3-1.9). Sixteen (16%) of 99 infected infants were born to women (n = 221) identified during postnatal testing. With active outreach, 95/99 (96%) infected infants were initiated on antiretroviral therapy. Of 6261 neonates with negative results, 3251 (52%) returned to receive their test results. CONCLUSION: Our programme successfully achieved high coverage and uptake of birth PCR testing and was able, with active tracking, to start almost all identified HIV-infected neonates on antiretroviral therapy. Implementation required additional staff for counselling, quality control and outreach. Return for negative results was low and neonates with indeterminate results required multiple repeat tests.


Assuntos
Infecções por HIV/transmissão , HIV-1/isolamento & purificação , Doenças do Recém-Nascido/diagnóstico , Transmissão Vertical de Doença Infecciosa , Adulto , Fármacos Anti-HIV/administração & dosagem , Aconselhamento , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV-1/genética , Hospitais Urbanos , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Triagem Neonatal , Reação em Cadeia da Polimerase , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , África do Sul , Adulto Jovem
19.
Am J Obstet Gynecol ; 216(3): 292.e1-292.e8, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28153665

RESUMO

BACKGROUND: Zika virus infection during pregnancy is a known cause of congenital microcephaly and other neurologic morbidities. OBJECTIVE: We present the results of a large-scale prenatal screening program in place at a single-center health care system since March 14, 2016. Our aims were to report the baseline prevalence of travel-associated Zika infection in our pregnant population, determine travel characteristics of women with evidence of Zika infection, and evaluate maternal and neonatal outcomes compared to women without evidence of Zika infection. STUDY DESIGN: This is a prospective, observational study of prenatal Zika virus screening in our health care system. We screened all pregnant women for recent travel to a Zika-affected area, and the serum was tested for those considered at risk for infection. We compared maternal demographic and travel characteristics and perinatal outcomes among women with positive and negative Zika virus tests during pregnancy. Comprehensive neurologic evaluation was performed on all infants delivered of women with evidence of possible Zika virus infection during pregnancy. Head circumference percentiles by gestational age were compared for infants delivered of women with positive and negative Zika virus test results. RESULTS: From March 14 through Oct. 1, 2016, a total of 14,161 pregnant women were screened for travel to a Zika-affected country. A total of 610 (4.3%) women reported travel, and test results were available in 547. Of these, evidence of possible Zika virus infection was found in 29 (5.3%). In our population, the prevalence of asymptomatic or symptomatic Zika virus infection among pregnant women was 2/1000. Women with evidence of Zika virus infection were more likely to have traveled from Central or South America (97% vs 12%, P < .001). There were 391 deliveries available for analysis. There was no significant difference in obstetric or neonatal morbidities among women with or without evidence of possible Zika virus infection. Additionally, there was no difference in mean head circumference of infants born to women with positive vs negative Zika virus testing. No microcephalic infants born to women with Zika infection were identified, although 1 infant with hydranencephaly was born to a woman with unconfirmed possible Zika disease. Long-term outcomes for infants exposed to maternal Zika infection during pregnancy are yet unknown. CONCLUSION: Based on a large-scale prenatal Zika screening program in an area with a predominantly Hispanic population, we identified that 4% were at risk from reported travel with only 2/1000 infected. Women traveling from heavily affected areas were most at risk for infection. Neonatal head circumference percentiles among infants born to women with evidence of possible Zika virus infection during pregnancy were not reduced when compared to infants born to women without infection.


Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Diagnóstico Pré-Natal , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/virologia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores de Risco , Viagem
20.
Ocul Immunol Inflamm ; 25(4): 563-568, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27191471

RESUMO

We report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients' inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Encefalite por Herpes Simples/diagnóstico , Infecções Oculares Virais/diagnóstico , Doenças do Recém-Nascido/diagnóstico , Síndrome de Necrose Retiniana Aguda/diagnóstico , Aciclovir/uso terapêutico , Adulto , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Criança , DNA Viral/genética , Deficiências do Desenvolvimento/tratamento farmacológico , Deficiências do Desenvolvimento/virologia , Combinação de Medicamentos , Encefalite por Herpes Simples/tratamento farmacológico , Encefalite por Herpes Simples/virologia , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Doenças do Recém-Nascido/virologia , Masculino , Reação em Cadeia da Polimerase , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/virologia , Simplexvirus/fisiologia , Ativação Viral , Corpo Vítreo/virologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA