Miscarriage following dengue virus 3 infection in the first six weeks of pregnancy of a dengue virus-naive traveller returning from Bali to Italy, April 2016

We report miscarriage following dengue virus (DENV)-3 infection in a pregnant woman returning from Bali to Italy in April 2016. On her arrival, the woman had fever, rash, asthenia and headache. DENV RNA was detected in plasma and urine samples collected the following day. Six days after symptom onset, she had a miscarriage. DENV RNA was detected in fetal material, but in utero fetal infection cannot be demonstrated due to possible contamination by maternal blood

Identifying high-confidence variants in human cytomegalovirus genomes sequenced from clinical samples

Understanding the intrahost evolution of viral populations has implications in pathogenesis, diagnosis and treatment, and has recently made impressive advances from developments in high-throughput sequencing. However, the underlying analyses are very sensitive to sources of bias, error and artefact in the data, and it is important that these are addressed adequately if robust conclusions are to be drawn. The key factors include: (i) determining the number of viral strains present in the sample analysed; (ii) monitoring the extent to which the data represent these strains and assessing the quality of these data; (iii) dealing with the effects of cross-contamination; and (iv) ensuring that the results are reproducible. We investigated these factors by generating sequence datasets, including biological and technical replicates, directly from clinical samples obtained from a small cohort of patients who had been infected congenitally with the herpesvirus human cytomegalovirus, with the aim of developing a strategy for identifying high-confidence intrahost variants. We found that such variants were few in number and typically present in low proportions, and concluded that human cytomegalovirus exhibits a very low level of intrahost variability. In addition to clarifying the situation regarding human cytomegalovirus, our strategy has wider applicability to understanding the intrahost variability of other viruses

Thermal design, optimization and additive manufacturing of ceramic regular structures to maximize the radiative heat transfer

The present study is focused on the application of a ceramic tubular high temperature heat exchanger with engineered cellular architectures. Thermal design and optimization to maximise the radiative heat transfer has been investigated both experimentally and computationally. Numerical models were designed involving various arrangements of cells and their different sizes (while the total heat transfer area remains constant). They were 3D-printed by Stereolithography (SLA) and subsequently sintered. Heat transfer tests were performed both with a high temperature pressure drop test and by CFD simulations on 2D and 3D models. The computational results agree with the experimental data. We found that radial heat transfer in a tube increases by 160% to 280%, if a ceramic lattice is inserted, in respect of an empty tube. Moreover, the arrangement of cells and their size significantly influences the radiative heat transfer showing (for a given array) its top performances above 773 K. Geometries with large cells outside and small cells inside in the radial direction allow radiation to penetrate better through the core of the porous body. With this engineered ceramic lattices it is possible to reduce the tube length by one third to obtain more compact heat exchangers than an empty tubular solution

Onset of valganciclovir resistance in two infants with congenital cytomegalovirus infection

Ganciclovir and its prodrug valganciclovir are elective treatments for cCMV. Neonates with important symptoms undergo 6 months of therapy to ameliorate/prevent symptoms and late sequelae, but evidence of resistance is emerging. Over the last 5 years, we took care of 59 cCMV infants and experienced two cases of resistance among nine cCMV infants receiving long-term valganciclovir therapy. In the first case, valganciclovir therapy was prolonged beyond 6 months due to severity of symptoms, control of viral load, and absence of adverse events. Resistance was detected in the 8th month of therapy. In the second case, after a significant reduction following valganciclovir administration and no adverse events, CMV viral load suddenly increased in the 6th month of therapy due to resistance. Both events were associated with UL97 gene mutation. The cCMV infants, affected by severe symptoms, remained in a steady state during treatment, and their later neurological development was coherent with initial seriousness of diagnosis. Prolonged therapeutic exposure may therefore be a risk for resistance, suggesting that constant dosage/weight adjustments, monthly surveillance of viral load, and therapeutic drug monitoring could be proposed to monitor resistance onset and optimize the therapy regime. The risk–benefit ratio for long-term therapy, including the possibility of resistance onset, alongside SNHL and neurodevelopmental improvement, should also be evaluated

Rising Levels of Human Cytomegalovirus (HCMV) Antigenemia during Initial Antiviral Treatment of Solid-Organ Transplant Recipients with Primary HCMV Infection

In 7 of 18 solid-organ transplant recipients with primary human cytomegalovirus (HCMV) infection, HCMV antigenemia levels were unexpectedly found to rise significantly (P = 0.018) during a mean time of 7.3 ± 3.2 days after initiation of specific antiviral treatment, whereas corresponding levels of viremia dropped significantly (P = 0.043). Thus, shifting to an alternative antiviral drug based solely on increasing antigenemia levels is not justified in this group of patients