Percorrer por autor "Lopo, Silvia"
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- Challenges of Congenital HHV6 Infection Diagnosis and Treatment: Two Case Reports and Literature ReviewPublication . Fernandes, Andreia; Pereira, Mafalda; Oliveira, Íris; Novo, Marta; Soares, Marta; Ramalho, Ana Raquel; Santos, Vera; Vinagre, Elsa; Lopo, Silvia; Gaspar, LuísaIntroduction: Congenital human herpesvirus 6 (HHV6) infection occurs in 1% of the general population and may result from the transmission of an inherited chromosomally integrated HHV6 (iciHHV6) or transplacental infection. It is mostly asymptomatic. Case reports: Case 1: a 29th-week-old female preterm newborn, admitted to the neonatal intensive care unit, became clinically unstable and irritable on the 20th day of hospitalization. Cranial ultrasound, revealed a significant posthemorrhagic tetraventricular dilation, with signs of ventriculitis. Investigations revealed HHV6 positivity on cerebrospinal fluid polymerase chain reaction multiplex panel testing and HHV6-DNA high viral loads in plasma samples. Case 2: a female late preterm newborn was admitted to the neonatal intensive care unit due to early-onset sepsis. Investigations revealed group B streptococcus positive blood cultures and cerebrospinal fluid HHV6 positivity on polymerase chain reaction multiplex panel testing, with negative bacterial culture. After 3 days of adequate antibiotic treatment, she maintained persistent moaning, which motivated a cranial ultrasound, revealing mild brain edema. Clinical improvement was observed only after beginning antiviral treatment in both newborns. Due to the persistency of high viral loads in both cases, despite antiviral treatment and clinical improvement, an iciHHV6 was suspected and posteriorly confirmed. Discussion/conclusion: Congenital iciHHV6 infection diagnosis is challenging because the presence of an iciHHV6 results in persistently high viral loads, even in the absence of active infection. Only a few diagnostic techniques can confirm active replication; unfortunately, these are not available in most countries. The decision to initiate antiviral treatment should be based on clinical judgment. Better ways for the diagnosis of active infection are needed.
- Suspected Cases of Parvovirus B19 Infection During Pregnancy: A Retrospective Analysis (2009-2012)Publication . Lopo, Silvia; Reis, Tânia; Palminha, PaulaINTRODUCTION Parvovirus B19 (B19V) infection in pregnancy may cause serious damage to the foetus, where infection of placental endothelial cells can lead to hydrops fetalis and/or intrauterine fetal death. In Portugal, B19V female prevalence rates increases with age, reaching about 54.60% between age 20 and 24, 63.8% between age 25 and 29, 64.6% between age 30 an 34 and increasing up to 82.7% in the elder people. After maternal infection, transplacental transmission can occur at different rates depending on gestational ages. The virus is not teratogenic, but congenital infection may be associated to serious birth defects. OBJECTIVES To study suspected cases of B19V infection during pregnancy between May 2009 – May 2012, according to epidemiological, laboratory and clinical data, based on a retrospective study at the National Institute of Health (NIH) in Lisbon. METHODS Thirty-one amniotic fluid samples of 31 pregnant women (median age 29.7 years old) obtained between weeks 13 and 36 of gestation, were analysed at the NIH, according to the clinic indication of maternal cutaneous rash (2 cases), fetal dead (3 cases at 13, 21 and 33 weeks of pregnancy) or fetal ultrasonographic abnormalities (26 cases). B19V-DNA was determined by a ready-to-use commercial real-time PCR system, with a specific amplification of a 76 bp region of the B19V genome. RESULTS B19V DNA were detected in 3/31 amniotic fluid samples (9.7%), all of them with previous clinical diagnosis of hydrops fetalis at 21, 23 e 25 weeks of gestation. From the 26 cases with fetal ultrasonographic abnormalities, 10 cases were not specified, 8 cases had clinical diagnosis of hydrops fetalis and the remaining 8 were other specific abnormalities. One positive case result in fetal death and other positive case result in fetal death after intrauterine blood transfusion. One case resolved after intrauterine blood transfusion, without sequelae. CONCLUSIONS B19V infection is an important health issue since is the most common cause of nonimmune hydrops fetalis and can result in fetal death in 2-6% of cases A total of 3 patients (9.7%) were tested positive for B19V infection in amniotic fluid. According to our results and previous literature, the risk of developing fetal hydrops is high and the risk of fetal dead when maternal infection occurs in the first 20 weeks of pregnancy. Fetal ultrasonography was useful in detecting hydrops and real-time PCR technique in amniotic fluid has been shown to be a good methodology in cases of clinical suspicion of active B19V infection. These results are not representative of all suspected cases of B19V infection during pregnancy in Portugal. Preconceptional screening or prophylactic interventions are not presently recommended. Considering that as many as 36% of women may not be immune to B19V and are susceptible to infection, PCR technologies for DNA detection of B19V in amniotic fluid with increased sensitivity level, are an important diagnostic tool and an aid to confirm clinic B19V diagnostic.