Dengue

American Journal of Infectious Diseases 5 (4): 295-300, 2009
ISSN 1553-6203
© 2009 Science Publications

Dengue during Pregnancy: A Study of Thirteen Cases
1

Christiane Fernandes Alvarenga, 2Vânia Glória Silami, 3Patrícia Brasil,
Maria Elizabeth Herdy Boechat, 3Janice Coelho and 4Rita Maria Ribeiro Nogueira
1
Health Surveillance Services of the Azevedo Lima Hospital, ZIP Code:24130-616, Rio de Janeiro, 30,
Teixeira de Freitas Street, Fonseca, Niterói, Rio de Janeiro, Brazil
2
Department of Pathology, Universitary Hospital Antonio Pedro, ZIP Code: 24033-900, Rio de Janeiro,
303, Marquês de Paraná Street, Centro, Niterói, Rio de Janeiro, Brazil
3
Institute of Clinical Research Evandro Chagas/Fiocruz, ZIP Code: 21040-900, 4365, Avenida Brasil,
Manguinhos, Rio de Janeiro,Brazil
4
Flavirus Laboratory of the Oswaldo Cruz Institute /Fiocruz, ZIP Code: 21040-360, Rio de Janeiro,
Brazil, 4365, Avenida Brasil, Manguinhos, Rio de Janeiro, Brazil
1

Abstract: Problem statement: The principal aim was to evaluate the effects of dengue virus infection
by dengue during pregnancy and analyze the histopathology of the placenta. Approach: A
retrospective study wasconducted with 13 pregnant women with dengue confirmed in the period from
January-December 2002, during a widespread dengue type 3 epidemic in Rio de Janeiro. Maternal and
newborn data were collected from patient files and medical records during hospitalization for research
for identification of dengue IgM antibodies (PanBio, Australia). Virus isolation was performed on all
fatal cases andanathomopathological studies and immunohistochemistry of the placenta were carried
out in three cases. Results: Among the 13 women, 11 (84, 6%) were infected in the third quarter of
pregnancy, 6 (54, 5%) of which resulting in premature birth and 4 cases (30, 7%) were classified as
DHF, causing 2 deaths. Intense abdominal pain afflicted 6 patients (46, 2%) and 5 newborns presented
low weight, howeverappropriate for the gestacional age. Conclusion: Dengue virus infection in
pregnancy increases premature birth risk, especially if the infection occurs in the last quarter of
pregnancy.
Key words: Dengue, pregnancy, premature birth, ARDS, placenta
infection, congenital disease or severe dengue events
during the neonatal period and during the first year of
life[7,8]. However, in the last 10years there have been
reports of vertical transmission with severe
consequences to both the fetus and the newborn.
Tan et al.[9] in a study of prospective cohort,
described the vertical transmission incidence rate as
1,6%. Vertical transmission reports describe the
following findings in the newborn: tachypnea, feeding
intolerance and hypoglycemia associated to fever,
petechie, hepatomegaly,thrombocytopenia[10,11], skin
rash[12],
pleural
effusion[13],
prematurity
and
hemorrhagic complications leading to the dengue-shock
syndrome[3-5,14].
During the summer of 2002, Rio de Janeiro had a
large epidemic of dengue fever; 288,245 cases were
reported . This explosive epidemic of DENV-3 was the
most severe dengue epidemic reported in Brazil[15]. In

INTRODUCTION
Within the lastdecade, there has been an increase
or emergence of several human infections and the surge
of others that had previously been under control. The
major factors are related to modern man s impact on the
environment, such as the demographic explosion[1,2].
In the literature, there are controversial reports
addressing the effects of dengue in pregnant women,
the fetus and the newborn. There havebeen
descriptions of thrombocytopenia, liver insufficiency
and hemorrhagic complications after childbirth in
pregnant women, evidencing the importance of
diagnosis distinction from the diseases that are common
to pregnancy, such as the HELLP Syndrome[3-6].
Some authors have illustrated that despite the
occurrence of the dengue viral infection in pregnant
women, there are no indications...