RESUMO
IMPORTANCE: Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. OBJECTIVE: To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. DESIGN, SETTING, AND PARTICIPANTS: We observed 11 infants with congenital ZIKV infection from gestation to 6 months in the state of Paraíba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. MAIN OUTCOMES AND MEASURES: Description of the major lesions caused by ZIKV congenital infection. RESULTS: Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. CONCLUSIONS AND RELEVANCE: Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.
Assuntos
Artrogripose/etiologia , Hidrocefalia/etiologia , Malformações do Sistema Nervoso/etiologia , Complicações Infecciosas na Gravidez , Infecção por Zika virus/complicações , Zika virus , Anormalidades Múltiplas/etiologia , Brasil , Cerebelo/patologia , Cérebro/patologia , Feminino , Seguimentos , Humanos , Lactente , Morte do Lactente , Recém-Nascido , Lisencefalia/etiologia , Masculino , Microcefalia/etiologia , Morte Perinatal , Gravidez , Zika virus/genética , Zika virus/isolamento & purificação , Zika virus/patogenicidade , Infecção por Zika virus/congênitoRESUMO
OBJECTIVE: To evaluate the presence of premature subclinical atherosclerosis, measured by examining carotid intima-media thickness (IMT) and to investigate whether the IMT may be linked to low-grade chronic inflammation, assessed by C-reactive protein (CRP), in young women with polycystic ovary syndrome (PCOS). METHODS: Fifty seven PCOS patients and 37 similarly aged and weight controls underwent B-mode ultrasonography of the carotid arteries for IMT measure. All these women were also screened for CRP and metabolic parameters including fasting insulin, glucose, lipid and androgen levels. Differences between means were analyzed by Student's unpaired t-test and analysis of correlations between parameters was performed by using Pearson's correlation. RESULTS: CRP was significantly higher in PCOS patients than in controls (3.1mg/dL vs. 1.4mg/dL; p=0.004). No difference was noted in IMT mean between PCOS cases and controls (0.52mm vs. 0.53mm; p=0.35). IMT did not correlate with CRP but exhibited a significant positive correlation with total testosterone (r=0.72, p=0.01). CONCLUSION: This study suggests that PCOS itself is not associated with structural arterial injury, carotid IMT is not linked to low-grade chronic inflammation and hyperandrogenism may be associated with subclinical atherosclerosis and cardiovascular risk in young women with PCOS. Additional research is needed to clarify these findings.