Results of a Zika Virus (ZIKV) Immunoglobulin M-Specific Diagnostic Assay Are Highly Correlated With Detection of Neutralizing Anti-ZIKV Antibodies in Neonates With Congenital Disease.

:  Usually, immunoglobulin M (IgM) serologic analysis is not sufficiently specific to confirm Zika virus (ZIKV) infection. However, since IgM does not cross the placenta, it may be a good marker of infection in neonates. :  We tested blood from 42 mothers and neonates with microcephaly and collected cerebrospinal fluid (CSF) specimens from 30 neonates. Molecular assays were performed for detection of ZIKV, dengue virus, and chikungunya virus; IgM enzyme-linked immunosorbent assays and plaque-reduction neutralization tests (PRNTs) were performed to detect ZIKV and dengue virus. No control neonates without microcephaly were evaluated. :  Among neonates, all 42 tested positive for ZIKV IgM: 38 of 42 serum specimens (90.5%) were positive, whereas 30 of 30 CSF specimens (100%) were positive. ZIKV IgM-specific ELISA ratios, calculated as the mean optical density (OD) of the test sample when reacted on viral antigen divided by the mean OD of the negative control when reacted with viral antigen, were higher in CSF specimens (median, 14.9 [range, 9.3-16.4]) than in serum (median, 8.9 [range, 2.1-20.6]; P = .0003). All ZIKV IgM-positive results among the neonates were confirmed by the detection of neutralizing antibodies. Mother/neonate pairs with primary ZIKV infection had neutralizing antibodies to ZIKV only, and mother/neonate pairs with ZIKV virus infection secondary to infection with another flavivirus had high titers of neutralizing antibodies to ZIKV. Among secondary infections, median titers in serum were 2072 (range, 232-12 980) for mothers and 2730 (range, 398-12 980) for neonates (P &lt; .0001), and the median titer in CSF was 93 (range, 40-578) among neonates (P &lt; .0001). :  Among neonates, detection of ZIKV IgM in serum is confirmatory of congenital ZIKV infection, and detection of ZIKV IgM in CSF is confirmatory of neurologic infection. Therefore, we recommend testing for ZIKV IgM in neonates suspected of having congenital ZIKV infection and performance of PRNTs in equivocal cases.<br/

Promoção em saúde mental: a enfermagem criando e intervindo com histórias infantis Promoción de la salud mental: la enfermería la creación e la intervención con los cuentos infantiles Promotion in mental health: nursing creating and intervening with children's stories

Este trabalho refere-se à importância das histórias infantis enquanto instrumento, para a ação de enfermagem e a promoção da saúde mental na infância. Objetivou-se verificar o (re)conhecimento das emoções de crianças, através de histórias específicas para a saúde. Trata-se de um estudo descritivo-exploratório de natureza qualitativa, realizado em sete encontros de grupo com seis crianças de sete a dez anos, em um ambulatório de saúde mental infantil. Na coleta de dados utilizaram-se como instrumentos: seis histórias infantis, o jogo das emoções, as carinhas emotivas, desenhos, pinturas e esculturas em argila. Utilizou-se a análise temática, na qual emergiu o tema: o (re)conhecimento das emoções. As crianças reconheceram quatro emoções básicas: tristeza, alegria, medo e raiva. Constatou-se no estudo que a criação de histórias contextualizadas e a estratégia do grupo de contação podem ser úteis como ferramenta para a pesquisa e qualificação das ações de enfermagem na promoção de saúde mental infantil.<br>Este artículo se refiere a la importancia de los cuentos infantiles como una herramienta para la acción de enfermería y la promoción de la salud mental en la infancia. Se buscó verificar el reconocimiento de las emociones, a través de historias específicas para la salud. Es un estudio cualitativo y descriptivo-exploratorio, fueron realizados siete encuentros con seis niños, entre siete y diez años, de un servicio de salud mental infantil. En la recogida de datos se utilizaron: seis historias infantiles, el juego de emociones, caras emotivas, diseños, pinturas y esculturas en arcilla. Se utilizó el análisis temático, en el que surgió: el reconocimiento de las emociones. Ellos reconocen cuatro emociones: tristeza, alegría, miedo y rabia. La creación de historias contextualizadas y la estrategia del grupo de narración de cuentos, puede ser útil como herramienta para la investigación y cualificación de las acciones de enfermería en la promoción de salud mental.<br>This paper refers to the importance of the childish stories as an instrument, for the nursing action and the mental health promotion in childhood. The objective was to verify the recognition of the emotions of children, through stories specific to health. This is a descriptive-exploratory study by qualitative nature, conducted in seven groups meetings with six children aged seven to ten years in an outpatient childish mental health. In the data collection were used as instruments: six fairy tales, the play of emotions, emotional faces, drawings, paintings and clay sculptures. It was used thematic analysis, in which emerged: the recognition of emotions. The children recognized four basics emotions: sadness, joy, fear and anger. It was found in the study that the creation of contextualized stories and the strategy of storytelling group may be useful as a tool for research and qualification of nursing actions, to promote children's mental health

Competitive suppression of dengue virus replication occurs in chikungunya and dengue co-infected Mexican infants

Abstract Background Co-circulation of dengue virus (DENV) and chikungunya virus (CHIKV) is increasing worldwide but information on the viral dynamics and immune response to DENV-CHIKV co-infection, particularly in young infants, is scant. Methods Blood samples were collected from 24 patients, aged 2 months to 82 years, during a CHIKV outbreak in Mexico. DENV and CHIKV were identified by RT-PCR; ELISA was used to detect IgM and IgG antibodies. CHIKV PCR products were cloned, sequenced and subjected to BLAST analysis. To address serological findings, HMEC-1 and Vero cells were inoculated with DENV-1, DENV-2 and CHIKV alone and in combination (DENV-2-CHIKV and DENV-1-CHIKV); viral titers were measured at 24, 48 and 72 h. Results Nine patients (38%) presented co-infection, of who eight were children. None of the patients presented severe illness. Sequence analysis showed that the circulating CHIKV virus belonged to the Asian lineage. Seroconversion to both viruses was only observed in the four patients five years or older, while the five infants under two years of age only seroconverted to CHIKV. Viral titers in the CHIKV mono-infected cells were greater than in the DENV-1 and DENV-2 mono-infected cells. Furthermore, we observed significantly increased CHIKV progeny and reduction of DENV progeny in the co-infected cells. Conclusions In our population, DENV-CHIKV co-infection was not associated with increased clinical severity. Our in vitro assay findings strongly suggest that the lack of DENV IgG conversion in the co-infected infants is due to suppression of DENV replication by the Asian lineage CHIKV. The presence of maternal antibody and immature immune responses in the young infants may also play a role

Dengue virus sero-cross-reactivity drives antibody-dependent enhancement of infection with zika virus

Zika virus (ZIKV) was discovered in 1947 and was thought to lead to relatively mild disease. The recent explosive outbreak of ZIKV in South America has led to widespread concern, with reports of neurological sequelae ranging from Guillain Barré syndrome to microcephaly. ZIKV infection has occurred in areas previously exposed to dengue virus (DENV), a flavivirus closely related to ZIKV. Here we investigated the serological cross-reaction between the two viruses. Plasma immune to DENV showed substantial cross-reaction to ZIKV and was able to drive antibody-dependent enhancement (ADE) of ZIKV infection. Using a panel of human monoclonal antibodies (mAbs) to DENV, we showed that most antibodies that reacted to DENV envelope protein also reacted to ZIKV. Antibodies to linear epitopes, including the immunodominant fusion-loop epitope, were able to bind ZIKV but were unable to neutralize the virus and instead promoted ADE. Our data indicate that immunity to DENV might drive greater ZIKV replication and have clear implications for disease pathogenesis and future vaccine programs for ZIKV and DENV