Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis
Abstract: Hydropsfetalis (HF) occurs in 1/600 pregnancies. With the introduction of Rhesus-immunoprophylaxis, only 50% are caused by Rh-hemolytic disease. Non-immunological causes are heart defects, chromosomal abnormalities, twin-twin transfusion syndrome, or infections by Parvovirus B19/...
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| Formato: | Artículo revista |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/34879 |
| Aporte de: |
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I10-R327-article-34879 |
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| institution |
Universidad Nacional de Córdoba |
| institution_str |
I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| format |
Artículo revista |
| topic |
parvovirus b19 anemia hidropsfetalis non-immune congenital infection Parvovirius B19 hidrops no inmune anemia infección congénita |
| spellingShingle |
parvovirus b19 anemia hidropsfetalis non-immune congenital infection Parvovirius B19 hidrops no inmune anemia infección congénita Dicuatro , N Ortiz , E Boggio , GA Resino , C Melideo , C Miranda , MT Vaca, B Lucchini , H Colazo Salbetti, MB Pedranti , M Adamo , MP Moreno , LB Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis |
| topic_facet |
parvovirus b19 anemia hidropsfetalis non-immune congenital infection Parvovirius B19 hidrops no inmune anemia infección congénita |
| author |
Dicuatro , N Ortiz , E Boggio , GA Resino , C Melideo , C Miranda , MT Vaca, B Lucchini , H Colazo Salbetti, MB Pedranti , M Adamo , MP Moreno , LB |
| author_facet |
Dicuatro , N Ortiz , E Boggio , GA Resino , C Melideo , C Miranda , MT Vaca, B Lucchini , H Colazo Salbetti, MB Pedranti , M Adamo , MP Moreno , LB |
| author_sort |
Dicuatro , N |
| title |
Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis |
| title_short |
Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis |
| title_full |
Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis |
| title_fullStr |
Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis |
| title_full_unstemmed |
Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis |
| title_sort |
report of a case of non-immune hydropsfetalis. importance of parvovirus b19 infection screening in pregnant women for a timely diagnosis |
| description |
Abstract:
Hydropsfetalis (HF) occurs in 1/600 pregnancies. With the introduction of Rhesus-immunoprophylaxis, only 50% are caused by Rh-hemolytic disease. Non-immunological causes are heart defects, chromosomal abnormalities, twin-twin transfusion syndrome, or infections by Parvovirus B19/B19V, among others. B19V can infect susceptible pregnant women causing a wide variety of conditions, including hydrops (with anemia, heart failure and/or fetal-neonatal death).
Objective: to report a case of non-immune HF with B19V as the possible etiology, in order to highlight the importance of its investigation in the pregnant woman.
Clinical case. Para2 gravida3 patient, 32 yr.old, 33.5 weeks gestation/wg, derived from a town in the Province of Córdoba with a probable diagnosis of Rh isoimmunization. She was admitted to the Hospital Universitario de Marternidad y Neonatología/HUMN presenting anemia, threat of preterm labor, and a hydropic fetus on ultrasound. Uterus-inhibition and fetal lung maturation were initiated. The patient did not report fever or other parvoviral symptoms. Laboratory: hemoglobin 7.6 g/dl, hematocrit 22%. Ultrasound control showed fetal right hydrothorax, polyhydramnios and fetal bradycardia, thus a cesarean section was decided and a baby male was born. The patient evolved favorably during the puerperium. Placenta biopsy: chorio-amnionitis. Newborn was premature/34 wg, large for gestational age/3200gr. Apgar score 1/1/3. He presented generalized edema, hydrothorax and ascites. He was admitted to Neonatal Intensive Care Unit in a serious general condition: hemodynamic- hepatic- and renal- compromise, multi-factorial jaundice. Drains and transfusions were performed and mechanical ventilation was required. Supplementaloxygenwaswithdrawn at 40 days. Discharge at 50 days.
Studies: Mother 0(Rh-), newborn 0(Rh+); Coombs test: negative. Only anti-B19V IgG was found in the mother (11.6 IU/ml). Other infections such as syphilis, toxoplasmosis, Chagas (T.cruzi), cytomegalovirus, Hepatitis B/C, and HIV were discarded by serology. Newborn: B19V IgM and DNA were negative.
Conclusions: a case of non-immune hydropsfetalis with a probable diagnosis of B19V infection is reported. The interpretation of laboratory results (serology/DNA) for the diagnosis of vertical infection is complex, depending on which/when clinical samples are obtained. It is important to consider screening of B19V infection in pregnant women in order to optimize the diagnosis of non-immune hydropsfetalis. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2021 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/34879 |
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2024-09-03T21:02:43Z |
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I10-R327-article-348792024-04-15T16:19:09Z Report of a case of non-immune hydropsfetalis. Importance of Parvovirus B19 infection screening in pregnant women for a timely diagnosis Reporte de un caso de Hidropesía fetal no inmune. Importancia de la pesquisa de Infección por Parvovirus B19 en embarazadas para un diagnóstico oportuno Dicuatro , N Ortiz , E Boggio , GA Resino , C Melideo , C Miranda , MT Vaca, B Lucchini , H Colazo Salbetti, MB Pedranti , M Adamo , MP Moreno , LB parvovirus b19 anemia hidropsfetalis non-immune congenital infection Parvovirius B19 hidrops no inmune anemia infección congénita Abstract: Hydropsfetalis (HF) occurs in 1/600 pregnancies. With the introduction of Rhesus-immunoprophylaxis, only 50% are caused by Rh-hemolytic disease. Non-immunological causes are heart defects, chromosomal abnormalities, twin-twin transfusion syndrome, or infections by Parvovirus B19/B19V, among others. B19V can infect susceptible pregnant women causing a wide variety of conditions, including hydrops (with anemia, heart failure and/or fetal-neonatal death). Objective: to report a case of non-immune HF with B19V as the possible etiology, in order to highlight the importance of its investigation in the pregnant woman. Clinical case. Para2 gravida3 patient, 32 yr.old, 33.5 weeks gestation/wg, derived from a town in the Province of Córdoba with a probable diagnosis of Rh isoimmunization. She was admitted to the Hospital Universitario de Marternidad y Neonatología/HUMN presenting anemia, threat of preterm labor, and a hydropic fetus on ultrasound. Uterus-inhibition and fetal lung maturation were initiated. The patient did not report fever or other parvoviral symptoms. Laboratory: hemoglobin 7.6 g/dl, hematocrit 22%. Ultrasound control showed fetal right hydrothorax, polyhydramnios and fetal bradycardia, thus a cesarean section was decided and a baby male was born. The patient evolved favorably during the puerperium. Placenta biopsy: chorio-amnionitis. Newborn was premature/34 wg, large for gestational age/3200gr. Apgar score 1/1/3. He presented generalized edema, hydrothorax and ascites. He was admitted to Neonatal Intensive Care Unit in a serious general condition: hemodynamic- hepatic- and renal- compromise, multi-factorial jaundice. Drains and transfusions were performed and mechanical ventilation was required. Supplementaloxygenwaswithdrawn at 40 days. Discharge at 50 days. Studies: Mother 0(Rh-), newborn 0(Rh+); Coombs test: negative. Only anti-B19V IgG was found in the mother (11.6 IU/ml). Other infections such as syphilis, toxoplasmosis, Chagas (T.cruzi), cytomegalovirus, Hepatitis B/C, and HIV were discarded by serology. Newborn: B19V IgM and DNA were negative. Conclusions: a case of non-immune hydropsfetalis with a probable diagnosis of B19V infection is reported. The interpretation of laboratory results (serology/DNA) for the diagnosis of vertical infection is complex, depending on which/when clinical samples are obtained. It is important to consider screening of B19V infection in pregnant women in order to optimize the diagnosis of non-immune hydropsfetalis. Resumen: La hidropesía fetal (HF) ocurre en 1c/600 embarazos. Con la introducción de la Inmunoprofilaxis con Rhesus, solo el 50% son causados por enfermedad hemolítica-Rh. Existen causas no inmunológicas como: defectos cardiacos, anomalías cromosómicas, síndrome de transfusión gemelo-gemelo, o infecciones como Parvovirus B19 (B19V), entre otras. Parvovirus B19 (B19V) puede infectar embarazadas susceptibles ocasionando cuadros muy variados, entre ellos Hidropesía (con anemia, insuficiencia cardíaca y/o muerte feto-neonatal). Objetivo: reportar un caso de HF no inmune de posible etiología por B19V a fin de resaltar la importancia de su pesquisa oportuna en embarazadas. Caso clínico. Paciente tercigesta secundípara, de 32 años, embarazo de 33.5 semanas. Derivada del interior de Córdoba con diagnóstico probable de isoinmunización Rh. Presenta anemia, amenaza de parto prematuro, y feto hidrópico por ecografía. Ingresa al Hospital Universitario Materno Neonatal/HUMN; se inicia útero-inhibición y maduración pulmonar fetal. No refiere fiebre o síntomas parvovirales. Laboratorio: Hb:7,6 g/dl. Hto:22%. Control ecográfico: Hidrotórax fetal derecho, polihidramnios. Se constata bradicardia fetal (signos de falta de bienestar fetal) por lo que se decide finalización por operación cesárea de un recién nacido masculino. La paciente evoluciona su puerperio favorablemente. Biopsia de placenta: corio-amnionitis. Recién Nacido Prematuro/34 semanas, Grande para Edad Gestacional/3200gr. Apgar: 1/1/3. Presenta edema generalizado, hidrotórax y ascitis. Ingresa a Terapia Intensiva Neonatal en grave estado general: compromiso hemodinámico, hepático, renal e ictericia multifactorial. Se realizan drenajes y transfusiones. Requirió de ventilación mecánica; a los 40 días se retira oxigeno suplementario, alta a los 50 días. Estudios: Madre O (Rh-), RN O (Rh+); prueba de Coombs Negativa (no sensibilizada). Sólo se encuentra IgG positiva para B19V (madre y RN); IgM y ADN negativos. Serología para Hepatitis B-C, HIV, VDRL, Toxoplasmosis, Chagas, CMV, negativos. Conclusiones: se reporta un caso de hidropesía fetal no inmune con diagnóstico probable de infección por B19V. La interpretación de los resultados de laboratorio (serología y ADN) para el diagnóstico de infección vertical es compleja dependiendo, además, del momento de toma de las muestras. Sería importante considerar a la pesquisa de infección por B19V en las embarazadas a fin de optimizar el diagnóstico de hidropesía fetal no inmune. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-10-12 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion texto texto texto https://revistas.unc.edu.ar/index.php/med/article/view/34879 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. Suplemento (2021): Suplemento JIC XXII Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. Suplemento (2021): Suplemento JIC XXII Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. Suplemento (2021): Suplemento JIC XXII 1853-0605 0014-6722 http://creativecommons.org/licenses/by-nc/4.0 |