Ernesto Antonio Figueiró-Filho

Freqüência das infecções pelo HIV-1, rubéola, sífilis, toxoplasmose, citomegalovírus, herpes simples, hepatite B, hepatite C, doença de Chagas e HTLV I/II em gestantes, do Estado de Mato Grosso do Sul

It was aimed to estimate the frequency of syphilis, rubella, hepatitis B, hepatitis C, toxoplasmosis, Chagas disease, HTLV I/II, simple herpes virus, HIV-1 and cytomegalovirus in pregnant women and to evaluate the relationship between age and the frequency of the infections studied. A transversal study of 32,512 pregnant women submitted to pre-natal screening in the period of November 2002 to October 2003. The frequency of the tried infections among the pregnant women were 0.2% of HIV-1, 0.03% of rubella, 0.8% of syphilis, 0.4% of toxoplasmosis, 0.05% of cytomegalovirus, 0.02% of simple herpes virus, 0.3% of HBsAg, 0.1% of hepatitis C, 0.1% of HTLV and 0.1% of Chagas disease. There was significative statistical association between age and prenatal infection of rubella, cytomegalovirus, Chagas disease and herpes virus. The rates of frequency of rubella, syphilis, toxoplasmosis, Chagas disease and cytomegalovirus in pregnant women studied were lower than the compared rates.

Toxoplasmose aguda: estudo da freqüência, taxa de transmissão vertical e relação entre os testes diagnósticos materno - fetais em gestantes em estado da Região Centro - Oeste do Brasil

PURPOSE: to establish the frequency of acute toxoplasmosis in pregnant women, vertical transmission rate and the perinatal results of the infected fetuses and also to evaluate the relationship between the most used maternal-fetal diagnostic tests for toxoplasmosis during pregnancy and the relationship between age and acute toxoplasmosis infection during pregnancy. METHODS: longitudinal prospective study of 32,512 pregnant women attended by The Pregnancy Protection Program of the State of Mato Grosso do Sul - Brazil, from November 2002 to October 2003. ELISA (IgG and IgM) and IgG avidity test were performed for maternal diagnosis and amniotic fluid PCR for fetal investigation of the infection. The relationship between data was analyzed statistically by the c2 or two-sided Fishers exact test in contingency tables. RESULTS: a 0.42% frequency of acute Toxoplasma gondii infection among pregnant population was found, where 92% were previously exposed and 8% were susceptible. Among IgM-positive pregnant women, the age ranged from 14 to 39 years, with a mean of 23±5.9 years. There was no statistically significant relationship between age and maternal acute T. gondii infection (p=0.73). The vertical transmission rate was 3.9%. A statistically significant relationship was shown (p=0.001) between a lower avidity IgG test ( 60%) and the absence of fetal infection. There was a statistically significant association (p=0.001) between fetal infection (amniotic fluid PCR) and neonatal infection. CONCLUSIONS: maternal acute toxoplasmosis frequency was lower than the Brazilian national parameters, whereas vertical transmission rate did not differ from the rates found in other studies. The IgG avidity test, when associated with gestational age and the examination date, was useful to evaluate the therapeutical options and to consider the risk of vertical transmission when performed before 12 weeks. Positive PCR in amniotic fluid showed a positive relationship with the worst neonatal prognosis, being a specific method in diagnosing intrauterine fetal infection.

Visceral leishmaniasis (kala-azar) and pregnancy

OBJECTIVE: The aim of the present review was to close the gap in the approach to pregnant women with visceral leishmaniasis (kala-azar) by providing up-to-date information to obstetricians about physiopathology, epidemiology, vertical transmission, drugs and treatment during pregnancy. BACKGROUND: Infection with Leishmania chagasi during pregnancy is rare and deserves special attention since little information is available regarding the occurrence of visceral leishmaniasis during gestational period and the real possibility of vertical transmission of this disease. Because specific areas in the world are endemic for the disease and considering the continuous growth of the population, cases of pregnant women with visceral leishmaniasis are becoming more frequent. Unfortunately, textbooks on infectious diseases do not include this specific group of patients, and studies in the literature on aspects related to pregnancy and visceral leishmaniasis are scarce. CONCLUSIONS: Vertical transmission of leishmaniasis is possible and the institution of treatment is imperative in cases of pregnant women with kala-azar. Amphotericin B is strongly recommended as the first choice drug due to its fewer maternal-fetal adverse effects.

Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis.

OBJECTIVE We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. STUDY DESIGN We performed an electronic literature search for cohort studies that reported on women experiencing HDP and who had a subsequent pregnancy. The principal investigators were contacted and informed of our study; we requested their original study data. The data were merged to form one combined database. The results will be presented as percentages with 95% confidence interval (CI) and odds ratios with 95% CI. RESULTS Of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of 99,415 women. Pooled data of 64 studies that used published data (IPD where available) showed a recurrence rate of 18.1% (n=152,213; 95% CI, 17.9-18.3%). In the 22 studies that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4-20.9%). Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6-14.1%), gestational hypertension in 8.6% of the studies (95% CI, 8.4-8.8%) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome in 0.2% of the studies (95% CI, 0.16-0.25%). The delivery of a small-for-gestational-age child accompanied the recurrent HDP in 3.4% of the studies (95% CI, 3.2-3.6%). Concomitant HELLP syndrome or delivery of a small-for-gestational-age child increased the risk of recurrence of HDP. Recurrence increased with decreasing gestational age at delivery in the index pregnancy. If the HDP recurred, in general it was milder, regarding maximum diastolic blood pressure, proteinuria, the use of oral antihypertensive and anticonvulsive medication, the delivery of a small-for-gestational-age child, premature delivery, and perinatal death. Normotensive women experienced chronic hypertension after pregnancy more often after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3-6.1). CONCLUSION Among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low, and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision-making in women who consider a new pregnancy after a pregnancy that was complicated by hypertension.

Visceral leishmaniasis and pregnancy: analysis of cases reported in a central-western region of Brazil.

ObjectivesBecause of the large number of cases of visceral leishmaniasis (VL) recorded in Brazil over the last few years, this disease has been showing characteristics different from previously known ones. We report cases of pregnant women treated for VL, describing their course and outcome and the chemotherapeutic medication used according to the clinical signs and symptoms of each patient.Study designWe report five cases of pregnant women treated for VL in a central-western region of Brazil.ResultsNo case of vertical transmission was observed, even in patients who were treated after delivery. One of the patients with a late diagnosis made after the onset of symptoms died. Thus, the treatment of VL during pregnancy reduces maternal mortality and the rate of vertical transmission of the disease, being safe and effective as long as the disease is diagnosed early.ConclusionAt present, amphotericin B and its derivatives appear to be the best therapeutic option for the mother–child binomial.

Obstetric, clinical, and perinatal implications of H1N1 viral infection during pregnancy

To determine perinatal outcome and epidemiologic, clinical, and obstetric characteristics among pregnant women infected with the H1N1 virus admitted to a Brazilian university hospital.

Hepatite C e gestação: análise de fatores associados à transmissão vertical

INTRODUCTION Data concerning hepatitis C virus infection during pregnancy in Brazilian medical services are scarce. This study aimed to verify factors associated with vertical transmission (VT) of HCV in pregnant women. METHODS Observational transversal study of pregnant women from Campo Grande, MS, central Brazil, with confirmed reagent serology for HCV infection from 2002 to 2005. Vertical transmission was considered to be positive HCV serology by ELISA, confirmed by PCR, after 18 months of life of the newborn. The factors studied associated with VT were: delivery mode, time of premature rupture of membranes, breastfeeding, blood transfusion history, drug addiction, number of sexual partners and the presence of body tattoos. RESULTS Fifty-eight pregnant women with HCV infection were identified, indicating a prevalence rate of 0.2% (58/31,187). Of these 58 pregnant women,23 (39.6%) fulfilled the inclusion criteria. The VT rate was 13% (3/23), and the most frequent HCV viral subtypes were 1a (53%), 1b (30%), 2b (4%) e 3a (13.0%). Two (8.7%) patients were coinfected with HIV. A significant association (p < 0.05) was observed between VT and high maternal serum viremia (> 2.5 x 10(6)) and VT and the use of illicit drugs by the mother. CONCLUSIONS The present study demonstrates that high serum maternal viremia for HCV and the use of illicit drugs by the mother are associated with vertical transmission of HCV.

Variaveis perinatais e associacao de recem-nascidos de muito baixo peso ao nascer em hospital publico universitario do Brasil

PURPOSE To investigate the association of perinatal variables with the birth of very low birth weight (VLBW) preterm newborns. METHODS It was a retrospective study of the medical records of infants born after spontaneous preterm labor with admission to a neonatal intensive care unit. Preterm infants were divided into two groups: very low birth weight (VLBW) group (weight <1,500 g) and low birth weight (LBW) group (weight ≥1,500 g and <2,500 g). Prenatal variables such as maternal complications during pregnancy and childbirth/postpartum, and fetal/neonatal complications were investigated. Statistical analysis was performed using the Fisher exact test or χ2 test, with calculation of relative risk (RR), and the Student t test for comparison of group means, with the level of significance set at p≤0.05. RESULTS Hemorrhagic comorbidities (p=0.006; RR=1.2) and hypertension (p=0.04; RR=1.5), surgical delivery (p=0.001; RR=0.5), gestational age <33 weeks (p< 0.001; RR=16.7) and Apgar score at 1st and 5th minute (p=0.006; RR=1.6; p=0.01; RR=1.9) were associated with the occurrence of VLBW. Infants with VLBW had a significant association with the occurrence of metabolic comorbidities (p=0.01; RR=1.8), neurological (p=0.01; RR=1.7) and infectious diseases (p=0.001; RR=1.9), hospitalization >4 weeks (p=0.02; RR=1.8) and early neonatal death (p=0.0001; RR=2.9). CONCLUSIONS Factors such as hypertension and bleeding comorbidities during delivery and management of gestational age of less than 33 weeks were associated with the birth of VLBW newborns. This group of infants also showed higher RR for the occurrence of early neonatal death.

Toxoplasmose e gestação: resultados perinatais e associação do teste de avidez de IgG com infecção congênita em gestantes com IgM anti-Toxoplasma gondii reagente

OBJETIVOS: verificar os desfechos perinatais em gestantes com toxoplasmose aguda e se houve associacao entre os resultados dos testes de avidez para anticorpos IgG anti- Toxoplasma gondii e a presenca ou ausencia de infeccao fetal/neonatal. METODOS: um estudo transversal incluiu gestantes com diagnostico sorologico de toxoplasmose apresentando IgM especifica reagente, atendidas no Ambulatorio de Gestacao de Alto Risco da Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, no periodo de novembro de 2002 a novembro de 2007. Resultados do teste de avidez de IgG demonstrando indices superiores a 30% foram considerados alta avidez, enquanto valores inferiores a 30% foram considerados baixa avidez. Definiram-se como sendo de infeccao fetal e/ou neonatal os casos com resultado positivo para a reacao em cadeia da polimerase no liquido amniotico ou com IgM especifica para toxoplasmose reagente no sangue do recem-nascido. RESULTADOS: considerando-se todas as gestantes referidas para o ambulatorio de gestacao de alto risco no periodo estudado, a frequencia de gestantes com IgM anti- Toxoplasma gondii reagente foi de 10,8% (176/1.634). A taxa de infeccao congenita nessas pacientes foi de 4% (7/176). O teste de avidez de IgG foi realizado em 162 gestantes (92%), encontrando-se avidez alta em 144 (88,9%). Houve associacao (p=0,003) entre avidez alta e ausencia de toxoplasmose fetal/neonatal na amostra estudada, com razao de prevalencia de 13,4 (intervalo de confianca [IC] 95% 2,2-86,6). O Valor preditivo positivo do teste de avidez (probabilidade de infeccao congenita com avidez baixa) foi de 22% (IC 95% 6%-47%), enquanto o valor preditivo negativo (probabilidade de ausencia da infeccao congenita com avidez alta) foi de 98% (IC 95% 94%-99%). CONCLUSOES: neste estudo a taxa de infeccao congenita em gestantes com diagnostico de toxoplasmose aguda foi de 4%. Nas gestantes com IgM anti- Toxoplasma gondii positiva, o resultado do teste de avidez de IgG anti- Toxoplasma gondii associou-se a presenca ou ausencia de infeccao congenita, com elevado valor preditivo negativo (ausencia de infeccao fetal/neonatal quando a avidez era alta).

Fenilcetonúria materna: relato de caso

A fenilcetonuria materna e uma aminoacidopatia caracterizada por niveis elevados de fenilalanina plasmatica na gestante, o que pode provocar anormalidades no desenvolvimento do feto, condicao que se denomina sindrome de fenilcetonuria materna. Deve ser diagnosticada laboratorialmente, uma vez que as manifestacoes clinicas sao inespecificas. Relatamos um caso de paciente secundigesta, com antecedente pessoal de retardo do desenvolvimento cognitivo, sem antecedentes patologicos obstetricos, com diagnostico laboratorial de hiperfenilalaninemia na atual gestacao, sendo tratada com dieta especifica. O recem-nato, nascido a termo, nao apresentou alteracoes fisicas ou defeitos congenitos confirmados. A gestacao anterior, na qual nao houve diagnostico e controle da fenilcetonuria, resultou em crianca com seria deficiencia psicomotora confirmada, alem de microcefalia e disturbios auditivos e da fala. Com o conhecimento dos efeitos da hiperfenilalaninemia materna sobre o feto, tornam-se essenciais o diagnostico e a instituicao precoce do tratamento durante a gravidez em pacientes com suspeita clinica de fenilcetonuria. No caso aqui descrito, houve beneficios materno-fetais do tratamento dietoterapico oferecido, reforcando a importância da identificacao de mulheres fenilcetonuricas em idade reprodutiva.