Aparecida Gomes Pinto Garcia

Placental morphology in cytomegalovirus infection

Abstract Three groups of placentae from 27 cases of cytomegalovirus infection were examined morphologically and by specific immuno-fluorescence. Placentae in Group 1 (four cases) had a mean gestational age of 24.5 ± 2.5 weeks; those in Group 2 (11 cases) had a mean gestational age of 36.4 ± 2.7 weeks; those in Group 3 (12 cases) had a mean gestational age of 40 ± 1.8 weeks. A tendency towards increased placental weight was observed. In 23 cases, a haematogenous placentitis was suspected on gross examination. Some specific features were detected on light microscopy. In Group I the lesions were represented by pronounced dysmaturity of villous structures, diffuse reparative villitis and intervillitis allied to an abundance of cytomegalic cells and areas of necrosis and calcification. In Group 2 a chronic active process was indicated by the presence of vascular involvement, proliferative-necrotic and reparative villitis and fresh villous necrosis; cytomegalic cells were scarce. In Group 3 placentae there was a predominance of villous plate lesions similar to those found in the septicaemic phase of maternal infections; necrotizing, proliferative and, rarely, reparative villitis was present; cytomegalic cells were rare. We may conclude that placental morphology needs to be substantiated by special laboratory techniques for the detection of cytomegalovirus infection.

Estudo prospectivo de gestantes e seus bebês com risco de transmissão de toxoplasmose congênita em município do Rio Grande do Sul

This study followed up 2,126 pregnant women cared for at SUS day-care clinics (Public Health Insurance System) of the northwest of the State of Rio Grande do Sul, Brazil. After serological screening we performed a follow up of all pregnant women and their babies. Serologic tests included: IgG, IgM, IgA and IgG avidity levels, mice inoculation and polymerase chain reaction (PCR) also placentas and umbilical materials were tested using immunoperoxidase as well as clinical evaluation. Of all the pregnant women screened, 74.5% were reactive to toxoplasmosis, and 3.6% presented IgM seropositivity. At ophthalmic evaluation ten women had ocular lesions and one infant presented eye lesions and brain calcification. The presence of anti-T.gondii specific IgM throughout the entire pregnancy did not characterize acute phase infection, for this, complementary tests were necessary. The importance is underscored for attendance of the newborn of mothers presenting serology compatible with this infection even in the absence of signs and symptoms of congenital toxoplasmosis.

Enterovirus associated placental morphology: A light, virological, electron microscopic and immunohistologic study

The purpose of this study was to identify the possible effect of enteroviruses on placental tissue. Seventy-eight pregnant women were studied throughout their pregnancy: enteroviral infection was detected by faecal viral isolation and seric neutralization of previously identified virus in cell culture. In 19 cases of confirmed maternal infection, placentae were examined grossly, by optical microscopy, immunohistochemical and electron microscopic methods. Ten term placentae from women included in the study, with no clinical, serological or virological evidence of enteroviral infection, were used as control, and examined by gross and optical microscopy. In 17 specimens (echovirus-coxsackievirus) an haematogenous placentitis was suspected on the basis of gross observation. Microscopic lesions were similar to those found in other viral infections, with specific features. The nature of the inflammatory reaction pointed to the presence of an acute type of haematogenous placentitis, not present in placentae of the control group. The authors (AA) comment on the results and present the hypotheses about the available data: (1) maternal enteroviremia and faecal virus shedding without placental invasion, placentary damage being an unspecific consequence of infection; (2) direct virus-induced injury is not the only possible cause for the lesions: (3) placental enteroviral infection occurred with placental pathology but the virus did not cross the organ as the newborn had no signs of infection.

FETO-PLACENTARY PATHOLOGY IN HUMAN PARVOVIRUS B19 INFECTION

In view of the scarce references concerning the histological data in congenital parvovirus human B19 infection, we intend to provide a description of the pathological features observed in six autopsies. The virus was detected by DNA hybridization (ISH-DBH), PCR and electronmicroscopy (EM) in paraffin-embedded feto-placentary tissues. These cases constitute a subset from 86 Non Immunologic Hydrops Fetalis (NIHF) cases, in which a systemic complex of inflammatory/degenerative lesions of unknown etiology was visualized by optical microscopy. In one case a syphilitic process was detected, typefying a double infection. All fetuses showed a similar pathology--hydrops, hepato-splenomegaly, lung hypoplasia and erythroblastemia, the specific histological feature being the presence of intranuclear inclusions in the erythroid progenitors, in the erythropoietic visceral tissue and in blood marrow. Complex cardiopathy allied to abnormal lung lobulation and polisplenia were observed once; in 2 cases endocardial fibroelastosis was diagnosed. The pulmonary lesions were represented by dysmaturity allied to interstitial mononuclear infiltration. The hepatic consisted of cholestasis, portal fibrosis, canalicular proliferation, hemossiderosis, focal necroses and giant cell transformation. The central nervous system lesions were predominantly anoxic although the autolysis impaired a correct diagnosis.

Pathogenesis and pathology of hematogenous infections of the fetus and newborn

The earlier infections occur in intrauterine life the more severe are they. When the infection develops during embryogenesis, the lesions are much more serious, sometimes causing disruptions (malformations). At this time the organs are not completely formed and microorganisms may interfere with organogenesis to such an extent that the development of the functions necessary for viability become impaired. Infection acquired in utero may result in resorption of the embryo, abortion, stillbirth, neonatal death, intrauterine growth retardation (IUGR), or prematurity. The infected newborns commonly are apparently normal at birth but they may develop a late onset disease. Otherwise, neonates presenting symptomatology may derelop untoward sequelae.

Human parvovirus B19 infection and hydrops fetalis in Rio de Janeiro, Brazil

Formalin-fixed paraffin embedded lung and liver tissue from 23 cases of non immune hydrops fetalis and five control cases, in which hydrops were due to syphilis (3) and genetic causes (2), were examined for the presence of human parvovirus B19 by DNA hybridisation. Using in situ hybridisation with a biotynilated probe one positive case was detected. Using 32P-labelled probes in a dot blot assay format, five further positives were obtained. These were all confirmed as positive by a nested polymerase chain reaction assay. Electron microscopy revealed virus in all these five positive cases. The six B19 DNA positive cases of hydrops fetalis were from 1974, 1980, 1982, 1987 and 1988, four of which occurred during the second half of the year, confirming the seasonality of the disease.

The placenta in hematogenous infections.

Although congenital infections have been known since ancient times, at present they constitute an evolution due to the broadening of diagnostic methods. Also, the histopathological examination of selected placentas has increased in perinatal pathology. All placentas should be examined grossly by the obstetrician or the neonatologist who must select the specimens to be sent for pathologic examination. The indications for selection at delivery to detect hematogenous infection are listed in Table 1. The placentas that do not meet guidelines for pathologic examination must be kept stored at 40 degrees C for at least 72 h. This routine ensures that the placentas of asymptomatic newborns who might present early manifestations suggestive of infection would be submittedfor pathologic examination.

Placental Morphology of Newborns at Risk for Congenital Toxoplasmosis

Gross and histologic examination of 13 placentas related to newborns serologically suspected of congenital toxoplasmosis exhibited lesions compatible with hematogenous infection. In four cases microorganisms having the morphologic features of trophozoites and cysts of Toxoplasma gondii were observed. We would like to emphasize the importance of gross examination of the placenta, which permitted the diagnosis of prolonged fetal distress and or probable hematogenous infection in ten cases.

Congenital toxoplasmic myocarditis: case report of an unusual presentation

Extensive calcification of the heart, involving predominantly the right ventricle and interventricular septum, was observed in a 3-h-old baby. The aetiology of the condition was attributed to infection by Toxoplasma gondii, based on the presence of several visceral lesions allied to the identification of the microorganism. The case is reported in view of the rarity of the type of the heart lesion. It is considered that calcification of the myocardium is secondary to vascular, inflammatory or toxic condition. The factors implicated in the pathogenesis of this unusual myocardial lesion are discussed.

Non-immunologic hydrops fetalis : study of 86 autopsies

INTRODUCTION As a result of prophylaxis for Rh isoimmunization, non-immune causes are assuming an increasingly prominent role in the aetiology of hydrops fetalis (HF). We report our experience of non-immunologic hydrops fetalis (NIHF) based on 86 autopsies done in the Instituto Fernandes Figueira (KO de Janeiro, Brazil). Of 3 11 1 paediatric autopsies performed during 19541992, 86 cases of nonimmunologic hydrops fetalis (NIHF) were reviewed. Cases were identified as H F when generalized oedema and cavity effusions were present. Family history, complications of pregnancy and delivery, blood typing of both mother and infant, Coombs test, serological examination for syphilis, toxoplasmosis and other laboratory tests were recorded. Postmortem roentgenograms and chromosomal analysis were also occasionally made. Placentas were available for pathological examination in all cases. During the same period 12 cases of immunologic hydrops (Rh immunization) also were autopsied.