E. Antolin

Initial experience with imported Zika virus infection in Spain.

INTRODUCTION A considerable increase of imported Zika virus (ZIKV) infection has been reported in Europe in the last year. This is the result of the large outbreak of the disease in the Americas, along with the increase in the numbers of travellers and immigrants arriving from ZIKV endemic areas. METHODS A descriptive study was conducted in the Tropical Medicine Unit of Hospital La Paz-Carlos III in Madrid on travellers returning from an endemic area for ZIKV from January to April 2016. Demographic, clinical and microbiological data were analyzed. RESULTS A total of 185 patients were screened for ZIKV (59.9% women, median age of 37.7±10.3 years). Main purpose of the travel was tourism to Colombia, Brazil, and México. Just under three-quarters (73%) were symptomatic, mostly with fever and headache. A total of 13 patients (7% of those screened) were diagnosed with ZIKV infections, of which four of them were pregnant. All of them were symptomatic patients, the majority immigrants, and mainly from Colombia. Diagnostic tests were based on positive neutralization antibodies (8 cases, 61.6%) and a positive RT-PCR in different organic fluids (7 cases, 53.8%) The four infected pregnant women underwent a neurosonography every 3 weeks, and no alterations were detected. RT-PCR in amniotic fluid was performed in three of them, with negative results. One of the children has already been born healthy. CONCLUSIONS Our cases series represents the largest cohort of imported ZIKV to Spain described until now. Clinicians must increase awareness about the progression of the ZIKV outbreak and the affected areas so that they can include Zika virus infection in their differential diagnosis for travellers from those areas.

EP26.02: Ultrasound accuracy of transvaginal ultrasound compared with magnetic resonance image in deep infiltrating endometriosis

follow-up. Patient was discharged stable. Ultrasound performed six months later noted a left ovarian cyst with low-level echoes. On follow-up, she was noted to have recovered completely and a scan performed a year later did not demonstrate any abnormalities in the pelvis. Conclusion: Patient was virgo intacta. Transrectal scan was attempted but unsuccessful. Transabdominal ultrasound was restricted by body habitus, hence resulting in suboptimum demonstration of the dermoid.

Successful treatment of a severe early onset case of pemphigoid gestationis with intravenous immunoglobulin in a twin pregnancy conceived with in vitro fertilisation in a primigravida

Pemphigoid gestationis (PG) is a rare autoimmune dermatosis whose incidence during pregnancy is extremely low (1:50.000 pregnancies) (Gan et al. 2012). PG is characterised by an intensely pruritic eruption of erythematous papules and plaques with or without blisters. The lesions frequently appear in the periumbilical area and then spread to the trunk, the arms and the limbs, sparing the mucous membranes and the face (Shornick et al. 1983). The diagnosis of PG can be confirmed by direct immunofluorescence showing linear deposition of complement (C3) and occasionally IgG along the basement membrane zone (Shornick et al. 1983). PG is more common in the third trimester of gestation and in the immediate postpartum period (Ko and Whang 2014). Papular urticarial papules and plaques of pregnancy (PUPPP), dermatitis herpetiformis and erythema multiforme are part of the differential diagnosis, but routine histology can definitively differentiate these entities. PG is associated with an increased foetal risk. Onset of PG in the first or second trimesters may lead to adverse pregnancy outcomes including foetal loss, preterm delivery, low birthweight, congenital malformations and skin lesions in neonates (Shornick and Black 1992).

Patterns of fetal lung growth in fetuses with isolated left-sided congenital diaphragmatic hernia

Abstract Objective: To evaluate right lung growth pattern in fetuses with isolated left-sided congenital diaphragmatic hernia (iL-CDH) and to analyze the pattern according to postnatal outcome. Methods: Lung-to-head ratio (LHR) and observed-to-expected LHR (O/E LHR) were obtained in 58 cases. Correlation and regression analysis for the total number of measurements, general linear models for those cases with a least three serial measurements and linear mixed effect models were used to analyze the influence of gestational age on the right lung size. Cases expectantly managed and those with fetal endoscopic tracheal occlusion were analyzed separately. Results: LHR, but not O/E LHR, increased significantly with gestational age (GA) (r = 0.43, p = 0.003 and r = −0.13, p = 0.30, respectively). According to neonatal mortality, in those fetuses that died, LHR remained unchanged and O/E LHR decreased significantly with GA (r = 0.07, p = 0.65 and r = −0.37, p = 0.02, respectively). In those cases with at least three serial measurements, the same two patterns were found. Similarly, in cases with expectant management, surviving fetuses showed a significantly higher weekly increase in LHR (p = 0.01) and a trend to a lower weekly decrease in O/E LHR (p = 0.17) than in those that died. Conclusions: Patterns of right lung growth in iL-CDH differ according to postnatal survival. Serial measurements, but not a single one, might increase the prediction of neonatal death.