Congenital and perinatal cytomegalovirus infections: clinical aspects, epidemiology, diagnosis and treatment

Citomegalovírus (CMV) é considerado o agente mais comum de infecção congênita e perinatal em todas as regiões do mundo. Esta revisão visa apresentar os principais aspectos clínicos, epidemiológicos, diagnósticos e de tratamento desta infecção em recém-nascidos e lactentes.Cytomegalovirus (CMV) is the most common cause of congenital and perinatal infections throughout the world. This review focuses on aspects of the clinical manifestations, epidemiology, diagnosis and treatment of this infection in newborns and infants

Association of Body Mass Index of HIV-1-Infected Pregnant Women and Infant Weight, Body Mass Index, Length, and Head Circumference: The NISDI Perinatal Study.

This study assessed the relationship between the body mass index (BMI) of HIV-1-infected women and their infants' perinatal outcomes. The study population consisted of women enrolled in the NICHD International Site Development Initiative (NISDI) Perinatal Study with data allowing calculation of the BMI adjusted for length of gestation (adjBMI), who delivered singleton infants. Outcome variables included infant growth parameters at birth (weight, BMI, length and head circumference) and gestational age. Of 697 women from Argentina, the Bahamas, Brazil and Mexico who were included in the analysis, the adjBMI was classified as underweight for 109 (15.6%), normal for 418 (60.0%), overweight for 88 (12.6%) and obese for 82 (11.8%). Median infant birth weight, BMI, birth length and head circumference differed significantly according to maternal adjBMI (P</=0.0002). Underweight mothers gave birth to infants with lower weight, lower BMI, shorter length and smaller head circumference, while infants born to normal, overweight and obese mothers were of similar size

Limits and patterns of cytomegalovirus genomic diversity in humans

Human cytomegalovirus (HCMV) exhibits surprisingly high genomic diversity during natural infection although little is known about the limits or patterns of HCMV diversity among humans. To address this deficiency, we analyzed genomic diversity among congenitally infected infants. We show that there is an upper limit to HCMV genomic diversity in these patient samples, with approximately 25% of the genome being devoid of polymorphisms. These low diversity regions were distributed across 26 loci that were preferentially located in DNA-processing genes. Furthermore, by developing, to our knowledge, the first genome-wide mutation and recombination rate maps for HCMV, we show that genomic diversity is positively correlated with these two rates. In contrast, median levels of viral genomic diversity did not vary between putatively single or mixed strain infections. We also provide evidence that HCMV populations isolated from vascular compartments of hosts from different continents are genetically similar and that polymorphisms in glycoproteins and regulatory proteins are enriched in these viral populations. This analysis provides the most highly detailed map of HCMV genomic diversity in human hosts to date and informs our understanding of the distribution of HCMV genomic diversity within human hosts

Lopinavir/ritonavir dosing during pregnancy in Brazil and maternal/infant laboratory abnormalities

OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r) dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009) enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day) (Group 1)] and 70 increased dosing [(> 800/200 mg/day) (Group 2)]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.Eunice Kennedy Shriver - National Institute of Child Health and Human Development (NIH

Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants

Objectives: To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants.Methods: HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500 g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed.Results: of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence = 0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. the odds of LRTI in infants whose mothers had CD4% = 29 (p = 0.003). the odds of LRTI in infants with a CD4+ count (cells/ mm(3)) = 750 (p = 0.002). Maternal CD4+ decline and infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before 6 months of age.Conclusions: Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed. (C) 2010 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.NICHDUniv São Paulo, Fac Med Ribeirao Preto, BR-14049900 Ribeirao Preto, SP, BrazilWESTAT Corp, Rockville, MD 20850 USAUniv Caxias Sul, Rio Grande Do Sul, BrazilHosp Diego Paroissien, Buenos Aires, DF, ArgentinaUniversidade Federal de São Paulo, São Paulo, BrazilUniv W Indies, Kingston 7, JamaicaHosp Juan Fernandez, Buenos Aires, DF, ArgentinaHosp Agudos Dra Cecilia Grierson, Buenos Aires, DF, ArgentinaNICHD, Pediat Adolescent & Maternal AIDS Branch, CRMC, NIH,DHHS, Bethesda, MD USAUniversidade Federal de São Paulo, São Paulo, BrazilNICHD: N01-HD-3-3345NICHD: HHSN267200800001CNICHD: N01-DK-8-0001Web of Scienc

Opportunistic and Other Infections in HIV-Infected Children in Latin America Compared to a Similar Cohort in the United States

Opportunistic and other infections have declined since the introduction of highly active antiretroviral therapy (HAART) in developed countries but few studies have addressed the impact of HAART in HIV-infected children from developing countries. This study examines the prevalence and incidence of opportunistic and other infections in Latin America during the HAART era. Vertically HIV-infected children enrolled in a cohort study between 2002 and 2007 were followed for the occurrence of 29 targeted infections. Cross-sectional and longitudinal analyses were performed to calculate the prevalence of infections before enrollment and the incidence rates of opportunistic and other infections after enrollment. Comparisons were made with data from a U. S. cohort (PACTG 219C). Of the 731 vertically HIV-infected children 568 (78%) had at least one opportunistic or other infection prior to enrollment. The most prevalent infections were bacterial pneumonia, oral candidiasis, varicella, tuberculosis, herpes zoster, and Pneumocystis jiroveci pneumonia. After enrollment, the overall incidence was 23.5 per 100 person-years; the most common infections (per 100 person-years) were bacterial pneumonia (7.8), varicella (3.0), dermatophyte infections (2.9), herpes simplex (2.5), and herpes zoster (1.8). All of these incidence rates were higher than those reported in PACTG 219C. The types and relative distribution of infections among HIV-infected children in Latin America in this study are similar to those seen in the United States but the incidence rates are higher. Further research is necessary to determine the reasons for these higher rates.NICHD [N01-HD-3-3345, HHSN267200800001C, N01-HD-8-0001

COLONIZAÇÃO MATERNA POR ESTREPTOCOCOS DO GRUPO B: PREVALÊNCIA ESUSCETIBILIDADE AOS ANTIMICROBIANOS / GROUP B STREPTOCOCCUS COLONIZATION IN PREGNANT WOMEN: PREVALENCE AND ANTIMICROBIAL SUSCEPTIBILITY

Introdução: Estreptococos do Grupo B (EGB) é um importante agente etiológico de infecção neonatal e a colonização das mucosas vaginal/anal materna é fator de risco para transmissão vertical dessa bactéria. Objetivo: Avaliar a prevalência de colonização de mucosas vaginal e anal pelo EGB em gestantes a partir da 35 semana, características sócio-demográficas e clínicas desta o população e o espectro de susceptibilidade aos antimicrobianos. Métodos: Coorte prospectiva incluindo 108 gestantes admitidas no serviço de Ginecologia e Obstetrícia do Hospital das Clínicas de Uberlândia, de fevereiro de 2011 a julho de 2011. A coleta de material clínico foi realizada por meio de dois swabs. As culturas positivas foram identificadas pelas características: morfo-tinturiais, testes de CAMP e de aglutinação em látex. Os dados foram por meio de consultas aos  prontuários e entrevistas. Para o cálculo do valor p utilizou-se o teste exato de Fisher (SAS versão 9.2). Resultados: A taxa de colonização por EGB foi alta, (17,5%). O perfil sócio-demográfico evidenciou mulheres com idade média de 24 anos, casadas/união estável (84,2%), multigestas(61,3%), histórico de aborto em 15,7%. As frequências de amostras resistentes a clindamicina e eritromicina foram de 10,6% e 12,6%, respectivamente. Conclusão: Os resultados evidenciaram uma alta taxa de colonização materna pelo EGB, sobretudo na mucosa vaginal, em  mulheres jovens e multigestas. As amostras de EGB apresentaram frequências baixas de resistência a clindamicina e eritromicina.Palavras-chave: Streptococcus agalactiae. Colonização. Gestantes.AbstractIntroduction: Group B streptococcus is an important etiological agent of newborn infections and the maternal mucosa (vaginal/ anal) colonization is a risk factor to vertical transmission of this bacteria. Objective: To evaluate the occurrence of vaginal and anal colonization by Group B streptococcus in pregnant women from 35 week, clinical and sociodemographic data and to evaluate the susceptibility of the isolates to antimicrobial agents. Methods: Prospective cohort study including 108  pregnant women attended at the Gynecology and Obstetrics settings of the Hospital das Clínicas de Uberlândia between February 2011 to July 2011. The clinical specimens were obtained by two swabs. The positive cultures were indentified through the following characteristics: colony morphology, CAMP and serological test. Maternal risk factors associated to colonization was obtained to medical records and interview. The p-value was calculated through SAS software, 9.2. version. Results: The frequency of colonizationwas high (17.5%). The pregnant women sociodemographical profile evidenced the following characteristics: mean age of 24 years, married/stable union (82.4%), multiparity (61.3%), previous abortion (15.7%). Resistance to clindamycin and erythromycin was detected in 10.6 and 12.6% of the isolates, respectively. Conclusion: The results evidenced a high rate of vaginal GBS colonization, in young and multiparous women. The GBS samples presented low frequencies of clindamycin anderythromycin resistance.Keywords: Streptococcus agalactiae. Colonization. Pregnant women