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Case Report
Febrile Neutropenia following Parvovirus B19 Infection and Cross Anti-Kell Reaction to E. Coli in Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):372-376
06-01-2018
Summary
Case ReportFebrile Neutropenia following Parvovirus B19 Infection and Cross Anti-Kell Reaction to E. Coli in Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):372-376
06-01-2018Views141Abstract
Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient’s lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.
Key-words coombs testescherichia coliInfectionskell-active proteinsparvovirus antenatal infectionPregnancy complicationsSee moreViews141
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Case ReportFebrile Neutropenia following Parvovirus B19 Infection and Cross Anti-Kell Reaction to E. Coli in Pregnancy
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(6):372-376
06-01-2018Views141Abstract
Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient’s lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.
Key-words coombs testescherichia coliInfectionskell-active proteinsparvovirus antenatal infectionPregnancy complicationsSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Artigos Originais
Evaluation of the adverse effects of nevirapine in HIV-infected pregnant women in a South Brazilian University Hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):19-24
04-07-2008
Summary
Artigos OriginaisEvaluation of the adverse effects of nevirapine in HIV-infected pregnant women in a South Brazilian University Hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):19-24
04-07-2008DOI 10.1590/S0100-72032008000100004
Views45See morePURPOSE: The aim of this article is to evaluate the use of nevirapine HIV-infected pregnant women in our service. METHODS: a retrospective study was performed between January 2003 and December 2006 analysing all women prescribed nevirapine in pregnancy. Exclusion criteria included: (1) women who started nevirapine before pregnancy, (2) patients with abnormal baseline liver enzymes, and (3) women with incomplete liver biochemistry data. Evaluated parameters included age, weeks of exposure to nevirapine, gestational age in the begginning of medication, weeks of follow-up, viral load, CD4 cells count and serum aminotransferase levels. The incidence of adverse hepatic and/or cutaneous effects was determined and correlated to the CD4 cells count. Statistical analysis were performed using Fisher’s exact test and t-Student test when appropriate, with a statistical significance level of p<0,05. RESULTS: one hundred fifty-seven women met the inclusion criteria. Thirty-one (19.7%) presented cutaneous and/or hepatic toxicity. Skin rash accounted for 77.4% of toxicities and liver function abnormalities were noted in 22.6% of women exhibiting toxicities. Grade 1, 2 and 3 hepatotoxicities were observed in 0.6, 2.5 and 1.3%, respectively. Baseline CD4 counts, viral loads and transaminases were similar in pregnant women with nevirapine adverse effects and those without reaction. Median absolute CD4 cell counts were 465.4 and 416.6 cells/µL in women with and without side effects, respectively (p=0.3). All patients who experienced hepatotoxicity had pretreatment CD4 counts superior to 250 cells/µL. CONCLUSIONS: The incidence of adverse events with nevirapine in our study was high, but most of them were cutaneous. There was no correlation between high CD4 counts and adverse events when analysing both cutaneous and hepatic reactions; nevertheless, hepatotoxicity occurred only in pregnant women with CD4 counts >250 cells/µL.
Views45This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Artigos OriginaisEvaluation of the adverse effects of nevirapine in HIV-infected pregnant women in a South Brazilian University Hospital
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):19-24
04-07-2008DOI 10.1590/S0100-72032008000100004
Views45See morePURPOSE: The aim of this article is to evaluate the use of nevirapine HIV-infected pregnant women in our service. METHODS: a retrospective study was performed between January 2003 and December 2006 analysing all women prescribed nevirapine in pregnancy. Exclusion criteria included: (1) women who started nevirapine before pregnancy, (2) patients with abnormal baseline liver enzymes, and (3) women with incomplete liver biochemistry data. Evaluated parameters included age, weeks of exposure to nevirapine, gestational age in the begginning of medication, weeks of follow-up, viral load, CD4 cells count and serum aminotransferase levels. The incidence of adverse hepatic and/or cutaneous effects was determined and correlated to the CD4 cells count. Statistical analysis were performed using Fisher’s exact test and t-Student test when appropriate, with a statistical significance level of p<0,05. RESULTS: one hundred fifty-seven women met the inclusion criteria. Thirty-one (19.7%) presented cutaneous and/or hepatic toxicity. Skin rash accounted for 77.4% of toxicities and liver function abnormalities were noted in 22.6% of women exhibiting toxicities. Grade 1, 2 and 3 hepatotoxicities were observed in 0.6, 2.5 and 1.3%, respectively. Baseline CD4 counts, viral loads and transaminases were similar in pregnant women with nevirapine adverse effects and those without reaction. Median absolute CD4 cell counts were 465.4 and 416.6 cells/µL in women with and without side effects, respectively (p=0.3). All patients who experienced hepatotoxicity had pretreatment CD4 counts superior to 250 cells/µL. CONCLUSIONS: The incidence of adverse events with nevirapine in our study was high, but most of them were cutaneous. There was no correlation between high CD4 counts and adverse events when analysing both cutaneous and hepatic reactions; nevertheless, hepatotoxicity occurred only in pregnant women with CD4 counts >250 cells/µL.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Epidemiology of fetal death in a low income population
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):71-75
04-16-1998
Summary
Trabalhos OriginaisEpidemiology of fetal death in a low income population
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):71-75
04-16-1998DOI 10.1590/S0100-72031998000200003
Views44See moreFetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
Views44This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisEpidemiology of fetal death in a low income population
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):71-75
04-16-1998DOI 10.1590/S0100-72031998000200003
Views44See moreFetal death may not be considered an unusual event and, in developing countries, the most prevalent causes could be possibly controlled and/or treated. The purpose of the present study was to investigate causes of fetal death in a Brazilian population. This is a descriptive study performed at the Hospital Maternidade Leonor Mendes de Barros in São Paulo. The study subjects were 122 pregnant women with diagnosis of fetal death and gestation age of 20 or more weeks. The statistical procedures used were means and standard deviation. The main causes of the fetal death were hypertensive disorders and infections and, for a quarter of the cases, they were not identified at all. It is concluded that an important percentage of fetal deaths would have been prevented and that there was a significant number of unidentified causes. Results of the present study might be useful to orientate a primary prevention health program, specially concerning antenatal care.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Trabalhos Originais
Chronic effects of primaquine diphosphate on pregnant rats
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):505-508
04-09-1998
Summary
Trabalhos OriginaisChronic effects of primaquine diphosphate on pregnant rats
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):505-508
04-09-1998DOI 10.1590/S0100-72031998000900003
Views87See morePurpose: to evaluate the chronic action of primaquine diphosphate on the pregnancy of female albino rats. Methods: sixty pregnant female rats, separated into six groups, were used. Group I received daily, by gavage, 1 ml of distilled water from day zero to the 20th day of pregnancy (control group). The female rats of the other groups also received daily, by gavage, during the same period of time the volume of 1 ml containing gradually concentrated primaquine diphosphate solution: 0.25 mg/kg, group II; 0.50 mg/kg, group III; 0.75 mg/kg, group IV; 1.5 mg/kg, group V and 3.0 mg/kg, group VI. The maternal weights were considered on day zero and on the 7th, 14th and 20th days of pregnancy, when the matrices were sacrificed. Results: the results showed that primaquine diphosphate, in the used doses, did not interfere with none of the following variables: maternal weight, newborn weight, medium individual weight of fetuses, weight of the group of placentas and medium individual weight of the placentas, implantation number, number of placentas and number of fetuses, when compared with the control group. Also there was no case of reabsorption, malformation, maternal mortality or intrauterine death, in any of the studied groups. Conclusion: in the conditions of the study there were no contraindications for the continuous use of primaquine diphosphate during the pregnancy of the female rat.
Views87This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Trabalhos OriginaisChronic effects of primaquine diphosphate on pregnant rats
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):505-508
04-09-1998DOI 10.1590/S0100-72031998000900003
Views87See morePurpose: to evaluate the chronic action of primaquine diphosphate on the pregnancy of female albino rats. Methods: sixty pregnant female rats, separated into six groups, were used. Group I received daily, by gavage, 1 ml of distilled water from day zero to the 20th day of pregnancy (control group). The female rats of the other groups also received daily, by gavage, during the same period of time the volume of 1 ml containing gradually concentrated primaquine diphosphate solution: 0.25 mg/kg, group II; 0.50 mg/kg, group III; 0.75 mg/kg, group IV; 1.5 mg/kg, group V and 3.0 mg/kg, group VI. The maternal weights were considered on day zero and on the 7th, 14th and 20th days of pregnancy, when the matrices were sacrificed. Results: the results showed that primaquine diphosphate, in the used doses, did not interfere with none of the following variables: maternal weight, newborn weight, medium individual weight of fetuses, weight of the group of placentas and medium individual weight of the placentas, implantation number, number of placentas and number of fetuses, when compared with the control group. Also there was no case of reabsorption, malformation, maternal mortality or intrauterine death, in any of the studied groups. Conclusion: in the conditions of the study there were no contraindications for the continuous use of primaquine diphosphate during the pregnancy of the female rat.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Infections Archives - Revista Brasileira de Ginecologia e Obstetrícia
