Zika Virus Infection in Pregnant Women in Rio de Janeiro

被引：1347

作者：

Brasil, P. ^{[1
]}

Pereira, J. P., Jr. ^{[1
]}

Moreira, M. E. ^{[1
]}

Ribeiro Nogueira, R. M. ^{[1
]}

Damasceno, L. ^{[1
]}

Wakimoto, M. ^{[1
]}

Rabello, R. S. ^{[1
]}

Valderramos, S. G. ^{[3
]}

Halai, U. -A. ^{[3
]}

Salles, T. S. ^{[1
]}

Zin, A. A. ^{[1
]}

Horovitz, D. ^{[1
]}

Daltro, P. ^{[2
]}

Boechat, M. ^{[1
]}

Gabaglia, C. Raja ^{[4
]}

Carvalho de Sequeira, P. ^{[1
]}

Pilotto, J. H. ^{[1
]}

Medialdea-Carrera, R. ^{[1
]}

Cotrim da Cunha, D. ^{[1
]}

Abreu de Carvalho, L. M. ^{[1
]}

Pone, M. ^{[1
]}

Machado Siqueira, A. ^{[1
]}

Calvet, G. A. ^{[1
]}

Rodrigues Baiao, A. E. ^{[1
]}

Neves, E. S. ^{[1
]}

Nassar de Carvalho, P. R. ^{[1
]}

Hasue, R. H. ^{[5
]}

Marschik, P. B. ^{[6
,7
]}

Einspieler, C. ^{[6
]}

Janzen, C. ^{[3
]}

Cherry, J. D. ^{[3
]}

Bispo de Filippis, A. M. ^{[1
]}

Nielsen-Saines, K. ^{[3
]}

机构：

[1] Fundacao Oswaldo Cruz, Rio De Janeiro, Brazil

[2] Clin Diagnost Imagem, Rio De Janeiro, Brazil

[3] David Geffen UCLA Sch Med, Los Angeles, CA USA

[4] Biomed Res Inst Southern Calif, Oceanside, CA USA

[5] Univ Sao Paulo, Fac Med, Sao Paulo, Brazil

[6] Med Univ Graz, Graz, Austria

[7] Karolinska Inst, Stockholm, Sweden

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2016年 / 375卷 / 24期

关键词：

TRANSMISSION; BRAZIL;

D O I：

10.1056/NEJMoa1602412

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants. METHODS We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes. RESULTS A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester). CONCLUSIONS Despite mild clinical symptoms in the mother, ZIKV infection during pregnancy is deleterious to the fetus and is associated with fetal death, fetal growth restriction, and a spectrum of central nervous system abnormalities. (Funded by Ministerio da Saude do Brasil and others.)

引用

页码：2321 / 2334

页数：14

共 28 条

[1]

[Anonymous], 2015, EP AL NEUR SYNDR CON

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