Arthropod-Borne Flaviviruses in Pregnancy

Abstract

Flaviviruses are a diverse group of enveloped RNA viruses that cause significant clinical manifestations in the pregnancy and postpartum periods. This review highlights the epidemiology, pathophysiology, clinical features, diagnosis, and prevention of the key arthropod-borne flaviviruses of concern in pregnancy and the neonatal period—Zika, Dengue, Japanese encephalitis, West Nile, and Yellow fever viruses. Increased disease severity during pregnancy, risk of congenital malformations, and manifestations of postnatal infection vary widely amongst this virus family and may be quite marked. Laboratory confirmation of infection is complex, especially due to the reliance on serology for which flavivirus cross-reactivity challenges diagnostic specificity. As such, a thorough clinical history including relevant geographic exposures and prior vaccinations is paramount for accurate diagnosis. Novel vaccines are eagerly anticipated to ameliorate the impact of these flaviviruses, particularly neuroinvasive disease manifestations and congenital infection, with consideration of vaccine safety in pregnant women and children pivotal. Moving forward, the geographical spread of flaviviruses, as for other zoonoses, will be heavily influenced by climate change due to the potential expansion of vector and reservoir host habitats. Ongoing ‘One Health’ engagement across the human-animal-environment interface is critical to detect and responding to emergent flavivirus epidemics.

Severe dengue in the intensive care unit

“…[ 189 ] Pathological conditions such as hyperemesis, eclampsia or preeclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome are common causes of delayed management. [ 190 ]…”

“…Elective delivery should be postponed, [ 190 ] and the use of tocolytics for uterine inhibition, although not a consensus, should be considered, especially in thrombocytopenic women. [ 196 ] If delivery is inevitable, platelets transfusion should be administered, and intravenous oxytocin analogs are recommended to stimulate uterine contraction and reduce post-partum hemorrhage.…”

“…[ 196 ] If delivery is inevitable, platelets transfusion should be administered, and intravenous oxytocin analogs are recommended to stimulate uterine contraction and reduce post-partum hemorrhage. [ 190 ] Although information about the best mode of delivery is sparse, most guidelines recommend avoiding cesarean section. [ 189 ] Finally, newborns should be closely monitored for signs of dengue due to the risk of vertical transmission.…”

Dengue Fever: Etiology, Diagnosis, Prevention and Treatment

“…Dengue fever is caused Dengue virus, a single positive-stranded RNA virus carried by mosquitoes, belonging to the Flaviviridae family and genus Flavivirus [16]. Yellow fever virus, West Nile virus, Zika virus, Japanese encephalitis virus, tick-borne encephalitis virus, Kyasanur forest disease virus, and Omsk hemorrhagic fever virus are additional relatives of the same genus [17]. According to Howard-Jones et al [17], since the majority are spread by arthropods (such as mosquitoes or ticks), they are also known as arboviruses (arthropod-borne viruses).…”

Análise sistêmica de tecido cerebral em pacientes com morte associada ao vírus febre amarela

“…O gênero Flavivirus compreende um grupo de vírus de RNA, transmitidos por vetores artrópodes, que causam um amplo espectro de doenças potencialmente graves, que incluem as febres hemorrágicas (125), choque (126), encefalites (127), anormalidades congênitas (128), que podem culminar em casos fatais (3,129). Este amplo espectro clínico para apresentação da doença que podem ser causadas por diferentes Flavivirus, refletem principalmente o potencial tropismo celular característico de cada espécie viral, além da capacidade de antagonizar a imunidade do hospedeiro (130).…”