Rabelo Kíssila, de Souza Campos Fernandes Regina Célia, de Souza Luiz José, Louvain de Souza Thais, Dos Santos Flávia Barreto, Guerra Nunes Priscila Conrado, de Azeredo Elzinandes Leal, Salomão Natália Gedeão, Trindade Gisela Freitas, Basílio-de-Oliveira Carlos A, de Carvalho Jorge José, Medina-Acosta Enrique, Paes Marciano Viana
Laboratório de Ultraestrutura e Biologia Tecidual, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Faculdade de Medicina de Campos, Campos dos Goytacazes, Brazil.
Front Immunol. 2017 Dec 7;8:1704. doi: 10.3389/fimmu.2017.01704. eCollection 2017.
In the large Zika virus (ZIKV) epidemic that occurred in Brazil in 2015, the intrauterine fetal exposure to ZIKV was associated with a significant risk of developing microcephaly and neurological disorders in the infected infants. ZIKV-associated disease has since been reported in 24 countries in the Americas. At present, definitive evidence is lacking regarding the intrauterine co-exposure to ZIKV and other viral infections and whether the coinfection impacts the risk of acquiring either infection or disease severity. Here, we provide evidence of intrauterine exposure to both ZIKV and human immunodeficiency virus (HIV) infections, causing congenital Zika syndrome in an HIV-exposed uninfected infant. Clinical, imaging and laboratory examinations of the pregnant woman and the newborn were performed. Histopathology, ZIKV/HIV-specific immunoassays, and ultrastructural evaluation of the placenta were performed. The Zika-asymptomatic, HIV-positive pregnant woman underwent ultrasounds revealing fetal cerebral ventriculomegaly, microcephaly, and brain atrophy. Her baby girl was born small for gestational age and with the neurological sequelae of congenital Zika syndrome. The evaluation of the abnormally large term placenta revealed severe damage to the maternal decidua and chorionic villi, cells positive for ZIKV-specific antigens but not for HIV antigens, and intracellular membranous clusters of virus-like particles approximately 25 nm in diameter. The rapid progression and severity of the congenital Zika syndrome may be related to the uncontrolled HIV disease in the mother. The poor inflammatory response observed in the placenta may have reduced the inherent risk of mother-to-child transmission of HIV.
在2015年巴西发生的大规模寨卡病毒（ZIKV）疫情中，子宫内胎儿接触ZIKV与受感染婴儿发生小头畸形和神经紊乱的重大风险相关。自那时起，美洲24个国家报告了寨卡病毒相关疾病。目前，缺乏关于子宫内同时接触ZIKV和其他病毒感染以及这种合并感染是否会影响感染风险或疾病严重程度的确切证据。在此，我们提供了子宫内同时接触ZIKV和人类免疫缺陷病毒（HIV）感染的证据，这种情况导致一名暴露于HIV但未感染的婴儿出现先天性寨卡综合征。对孕妇和新生儿进行了临床、影像学和实验室检查。对胎盘进行了组织病理学、ZIKV/HIV特异性免疫测定和超微结构评估。这位无症状、HIV阳性的孕妇接受超声检查时发现胎儿脑室扩大、小头畸形和脑萎缩。她的女婴出生时小于孕周，并患有先天性寨卡综合征的神经后遗症。对异常大的足月胎盘进行评估发现，母体蜕膜和绒毛膜绒毛严重受损，细胞对ZIKV特异性抗原呈阳性反应，但对HIV抗原呈阴性反应，并且存在直径约25纳米的细胞内病毒样颗粒膜性簇。先天性寨卡综合征的快速进展和严重程度可能与母亲未得到控制的HIV疾病有关。在胎盘中观察到的不良炎症反应可能降低了母婴传播HIV的固有风险。
