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Zika Virus Infection in Pregnant Women in Rio de Janeiro - Preliminary Report.

Abstract Background Zika virus (ZIKV) has been linked to neonatal microcephaly. To characterize the spectrum of ZIKV disease in pregnancy, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in fetuses. Methods We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We followed the women prospectively and collected clinical and ultrasonographic data. Results A total of 88 women were enrolled from September 2015 through February 2016; of these 88 women, 72 (82%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 5 to 38 weeks of gestation. Predominant clinical features included pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 28% had fever (short-term and low-grade). Women who were positive for ZIKV were more likely than those who were negative for the virus to have maculopapular rash (44% vs. 12%, P=0.02), conjunctival involvement (58% vs. 13%, P=0.002), and lymphadenopathy (40% vs. 7%, P=0.02). Fetal ultrasonography was performed in 42 ZIKV-positive women (58%) and in all ZIKV-negative women. Fetal abnormalities were detected by Doppler ultrasonography in 12 of the 42 ZIKV-positive women (29%) and in none of the 16 ZIKV-negative women. Adverse findings included fetal deaths at 36 and 38 weeks of gestation (2 fetuses), in utero growth restriction with or without microcephaly (5 fetuses), ventricular calcifications or other central nervous system (CNS) lesions (7 fetuses), and abnormal amniotic fluid volume or cerebral or umbilical artery flow (7 fetuses). To date, 8 of the 42 women in whom fetal ultrasonography was performed have delivered their babies, and the ultrasonographic findings have been confirmed. Conclusions Despite mild clinical symptoms, ZIKV infection during pregnancy appears to be associated with grave outcomes, including fetal death, placental insufficiency, fetal growth restriction, and CNS injury.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the new england journal of medicine
Publication Year Start




PMID- 26943629
OWN - NLM
STAT- Publisher
DA  - 20160704
LR  - 20160704
IS  - 1533-4406 (Electronic)
IS  - 0028-4793 (Linking)
DP  - 2016 Mar 4
TI  - Zika Virus Infection in Pregnant Women in Rio de Janeiro - Preliminary Report.
AB  - Background Zika virus (ZIKV) has been linked to neonatal microcephaly. To
      characterize the spectrum of ZIKV disease in pregnancy, we followed patients in
      Rio de Janeiro to describe clinical manifestations in mothers and repercussions
      of acute ZIKV infection in fetuses. Methods We enrolled pregnant women in whom a 
      rash had developed within the previous 5 days and tested blood and urine
      specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We 
      followed the women prospectively and collected clinical and ultrasonographic
      data. Results A total of 88 women were enrolled from September 2015 through
      February 2016; of these 88 women, 72 (82%) tested positive for ZIKV in blood,
      urine, or both. The timing of acute ZIKV infection ranged from 5 to 38 weeks of
      gestation. Predominant clinical features included pruritic descending macular or 
      maculopapular rash, arthralgias, conjunctival injection, and headache; 28% had
      fever (short-term and low-grade). Women who were positive for ZIKV were more
      likely than those who were negative for the virus to have maculopapular rash (44%
      vs. 12%, P=0.02), conjunctival involvement (58% vs. 13%, P=0.002), and
      lymphadenopathy (40% vs. 7%, P=0.02). Fetal ultrasonography was performed in 42
      ZIKV-positive women (58%) and in all ZIKV-negative women. Fetal abnormalities
      were detected by Doppler ultrasonography in 12 of the 42 ZIKV-positive women
      (29%) and in none of the 16 ZIKV-negative women. Adverse findings included fetal 
      deaths at 36 and 38 weeks of gestation (2 fetuses), in utero growth restriction
      with or without microcephaly (5 fetuses), ventricular calcifications or other
      central nervous system (CNS) lesions (7 fetuses), and abnormal amniotic fluid
      volume or cerebral or umbilical artery flow (7 fetuses). To date, 8 of the 42
      women in whom fetal ultrasonography was performed have delivered their babies,
      and the ultrasonographic findings have been confirmed. Conclusions Despite mild
      clinical symptoms, ZIKV infection during pregnancy appears to be associated with 
      grave outcomes, including fetal death, placental insufficiency, fetal growth
      restriction, and CNS injury.
FAU - Brasil, Patricia
AU  - Brasil P
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Pereira, Jose P Jr
AU  - Pereira JP Jr
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Raja Gabaglia, Claudia
AU  - Raja Gabaglia C
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Damasceno, Luana
AU  - Damasceno L
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Wakimoto, Mayumi
AU  - Wakimoto M
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Ribeiro Nogueira, Rita M
AU  - Ribeiro Nogueira RM
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Carvalho de Sequeira, Patricia
AU  - Carvalho de Sequeira P
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Machado Siqueira, Andre
AU  - Machado Siqueira A
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Abreu de Carvalho, Liege M
AU  - Abreu de Carvalho LM
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Cotrim da Cunha, Denise
AU  - Cotrim da Cunha D
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Calvet, Guilherme A
AU  - Calvet GA
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Neves, Elizabeth S
AU  - Neves ES
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Moreira, Maria E
AU  - Moreira ME
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Rodrigues Baiao, Ana E
AU  - Rodrigues Baiao AE
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Nassar de Carvalho, Paulo R
AU  - Nassar de Carvalho PR
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Janzen, Carla
AU  - Janzen C
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Valderramos, Stephanie G
AU  - Valderramos SG
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Cherry, James D
AU  - Cherry JD
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Bispo de Filippis, Ana M
AU  - Bispo de Filippis AM
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
FAU - Nielsen-Saines, Karin
AU  - Nielsen-Saines K
AD  - From Fundacao Oswaldo Cruz, Rio de Janeiro (P.B., J.P.P.J., L.D., M.W., R.M.R.N.,
      P.C.S., A.M.S., L.M.A.C., D.C.C., G.A.C., E.S.N., M.E.M., A.E.R.B., P.R.N.C.,
      A.M.B.F.); Biomedical Research Institute of Southern California, Oceanside
      (C.R.G.); and David Geffen UCLA School of Medicine, Los Angeles (C.J., S.G.V.,
      J.D.C., K.N.-S.).
LA  - ENG
PT  - JOURNAL ARTICLE
DEP - 20160304
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
EDAT- 2016/03/05 06:00
MHDA- 2016/03/05 06:00
CRDT- 2016/03/05 06:00
AID - 10.1056/NEJMoa1602412 [doi]
PST - aheadofprint
SO  - N Engl J Med. 2016 Mar 4.

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