Abstract
BackgroundZika virus (ZIKV) was first isolated in Uganda in 1947. In Brazil, the first reported case of ZIKV infection was in May 2015. Additionally, dengue (DENV) is endemic and there has been a recent outbreak of chikungunya (CHIKV). Since the clinical manifestations of different arboviral infections (AI) can be similar, definitive diagnosis requires laboratory testing.ObjectivesTo determine the prevalence of ZIKV, DENV, and CHIKV infections in a Brazilian cohort of HIV-infected pregnant women, to assess clinical/immunological characteristics and pregnancy outcomes of women with evidence of recent AI.Study designLaboratory diagnosis of ZIKV, DENV and CHIKV infections utilized serological assays, RT-PCR and PRNT. The tests were performed at the first visit, 34–36 weeks of gestation and at any time if a woman had symptoms suggestive of AI. Mann-Whitney tests were used for comparison of medians, Chi-square or Fisher’s to compare proportions; p< 0.05 was considered statistically significant. Poisson regression was used to analyze risk factors for central nervous system (CNS) malformations in the infant according to maternal symptomatology.ResultsOf 219 HIV-infected pregnant women enrolled, 92% were DENV IgG+; 47(22%) had laboratory evidence of recent AI. Of these, 34 (72%) were ZIKV+, nine (19%) CHIKV+, and two (4%) DENV+. Symptoms consistent with AI were observed in 23 (10%) women, of whom 10 (43%) were ZIKV+, eight (35%) CHIKV+. No CNS abnormalities were observed among infants of DENV+ or CHIKV+ women; four infants with CNS abnormalities were born to ZIKV+ women (three symptomatic). Infants born to ZIKV+ women had a higher risk of CNS malformations if the mother was symptomatic (RR = 7.20), albeit not statistically significant (p = 0.066).ConclusionsAmong HIV-infected pregnant women with laboratory evidence of a recent AI, 72% were ZIKV-infected. In this cohort, CNS malformations occurred among infants born to both symptomatic and asymptomatic pregnant women with Zika infection.
Highlights
Zika virus (ZIKV) is an arbovirus of the genus Flavivirus and was first isolated from a Rhesus monkey in the Zika forest of Uganda in 1947 [1]
No central nervous system (CNS) abnormalities were observed among infants of dengue virus (DENV)+ or chikungunya virus (CHIKV)+ women; four infants with CNS abnormalities were born to ZIKV+ women
Infants born to ZIKV+ women had a higher risk of CNS malformations if the mother was symptomatic (RR = 7.20), albeit not statistically significant (p = 0.066)
Summary
Zika virus (ZIKV) is an arbovirus of the genus Flavivirus and was first isolated from a Rhesus monkey in the Zika forest of Uganda in 1947 [1]. In Brazil, the first case of ZIKV infection was reported in May 2015 and since ZIKV infection has affected thousands of individuals, initially in the northeast and eventually spreading throughout the country [3,4]. In the Americas, the most important vectors are Aedes aegypti and Aedes albopictus, which can transmit other arboviruses such as dengue virus (DENV) and chikungunya virus (CHIKV) [5]. In Brazil, DENV is endemic and there has been a recent outbreak of CHIKV [8]. Individuals infected with ZIKV and other arboviruses frequently present with similar clinical features, making laboratory testing an important component of the diagnostic process [9]. In Brazil, the first reported case of ZIKV infection was in May 2015. Dengue (DENV) is endemic and there has been a recent outbreak of chikungunya (CHIKV). Since the clinical manifestations of different arboviral infections (AI) can be similar, definitive diagnosis requires laboratory testing
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