Carvalho Fabiana Rabe, Medeiros Thalia, Vianna Renata Artimos de Oliveira, Douglass-Jaimes Guillermo, Nunes Priscila Conrado Guerra, Quintans Maria Dolores Salgado, Souza Cintia Fernandes, Cavalcanti Silvia Maria Baêta, Dos Santos Flávia Barreto, Oliveira Solange Artimos de, Cardoso Claudete Aparecida Araújo, Silva Andrea Alice
Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil.
Environmental Analysis Program, Pomona College, Claremont, CA, USA.
Acta Trop. 2019 Apr;192:49-54. doi: 10.1016/j.actatropica.2019.01.020. Epub 2019 Jan 24.
Arboviruses (Zika, dengue and chikungunya) represent a major risk for pregnant women, especially because their vertical transmission can lead to neurological damage in newborns. Early diagnosis can be difficult due to similar clinical presentation with other congenital infections that are associated with congenital abnormalities.
To investigate the circulation of arboviruses and other pathogens responsible for congenital infections, reporting clinical aspects and geographic distribution of maternal rash in a metropolitan region of Rio de Janeiro (Brazil).
Cross-sectional study with pregnant women presenting rash attended at the Exanthematic Diseases Unit (Niterói, Rio de Janeiro) from 2015 to 2018. Diagnosis of arboviruses was performed by real-time PCR (RT-qPCR) and laboratorial screening for syphilis, toxoplasmosis, rubella, cytomegalovirus and HIV was assessed. Demographic data was used for georeferencing analysis.
We included 121 pregnant women, of whom Zika virus was detected in 45 cases (37.2%), chikungunya in 33 (27.3%) and dengue in one (0.8%). Five patients presented syphilis, and we observed one case each of listeria, cytomegalovirus, and a syphilis-toxoplasmosis case. Similarity of clinical symptoms was observed in all groups; however, 84.8% of patients with chikungunya presented arthralgia. Following the decline of Zika cases, chikungunya infection was mostly observed during 2017-2018. Considering pregnant women infected with arboviruses and other infections, 41% resided in urban slums, mostly in Niterói.
Simultaneous circulation of arboviruses and other agents responsible for congenital infections were observed; however, we did not identify co-infections between arboviruses. In this scenario, we emphasize the importance of adequate prenatal care to provide an accurate diagnosis of maternal rash.
虫媒病毒（寨卡病毒、登革热病毒和基孔肯雅病毒）对孕妇构成重大风险，尤其是因为它们的垂直传播可导致新生儿神经损伤。由于其临床表现与其他与先天性异常相关的先天性感染相似，早期诊断可能会很困难。
调查虫媒病毒和其他导致先天性感染的病原体的传播情况，报告巴西里约热内卢一个大都市地区孕妇皮疹的临床特征和地理分布。
对2015年至2018年在发疹性疾病科（里约热内卢尼泰罗伊）就诊的出疹孕妇进行横断面研究。通过实时荧光定量聚合酶链反应（RT-qPCR）诊断虫媒病毒，并评估梅毒、弓形虫病、风疹、巨细胞病毒和艾滋病毒的实验室筛查情况。人口统计学数据用于地理定位分析。
我们纳入了121名孕妇，其中45例（37.2%）检测到寨卡病毒，33例（27.3%）检测到基孔肯雅病毒，1例（0.8%）检测到登革热病毒。5名患者患有梅毒，我们还观察到1例李斯特菌感染、1例巨细胞病毒感染以及1例梅毒合并弓形虫感染病例。所有组均观察到临床症状相似；然而，84.8%的基孔肯雅病毒感染患者出现关节痛。随着寨卡病毒病例数的下降，2017 - 2018年期间主要观察到基孔肯雅病毒感染。在感染虫媒病毒和其他感染的孕妇中，41%居住在城市贫民窟，主要在尼泰罗伊。
观察到虫媒病毒和其他导致先天性感染的病原体同时传播；然而，我们未发现虫媒病毒之间的合并感染。在这种情况下，我们强调充分产前护理对于准确诊断孕妇皮疹的重要性。
