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      Stillbirth During Infection With Middle East Respiratory Syndrome Coronavirus

      brief-report
      Author(s): 1 , 6 , 7 , 9 , 1 , 2 , 3 , 1 , 4 , 8 , 8 , 7 , 1 , 5 , 1 , 1 , 1 , 7 , for the Jordan MERS-CoV Investigation Team , , , , , , , , , , , , , , , , , , , , , , , ,
      Publication date (Electronic):
      Journal: The Journal of Infectious Diseases
      Publisher: Oxford University Press
      Keywords: MERS-CoV, Middle East respiratory syndrome, novel coronavirus, EMC-CoV, Jordan, stillbirth, pregnancy, pneumonia, severe acute respiratory illness, birth outcomes

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          Abstract

          We conducted an epidemiologic investigation among survivors of an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Jordan. A second-trimester stillbirth occurred during the course of an acute respiratory illness that was attributed to MERS-CoV on the basis of exposure history and positive results of MERS-CoV serologic testing. This is the first occurrence of stillbirth during an infection with MERS-CoV and may have bearing upon the surveillance and management of pregnant women in settings of unexplained respiratory illness potentially due to MERS-CoV. Future prospective investigations of MERS-CoV should ascertain pregnancy status and obtain further pregnancy-related data, including biological specimens for confirmatory testing.

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          Most cited references10

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          Novel coronavirus infections in Jordan, April 2012: epidemiological findings from a retrospective investigation.

          N Jaarour, S Alqasrawi, S Alsheikh … (2012)
          In April 2012, an outbreak of acute respiratory illness occurred in a public hospital in Zarqa city, in Jordan; 8 health care workers were among the 11 people affected, 1 of who later died. The cause of the outbreak was unknown at the time and an epidemiological investigation including laboratory testing carried out immediately afterthe outbreak was inconclusive. Following the discovery of novel coronavirus infection (nCoV) in the Arabian peninsula in September 2012, stored respiratory and serum samples of patients from this outbreak were retested and the diagnosis of nCoV was confirmed in 2 deceased patients. This paper describes the epidemiological findings of retrospective investigation carried out in November 2012 and highlights the likelihood of nosocomial transmission of nCoV infection in a health-care setting. A total of 2 laboratory-confirmed and 11 probable cases were identified from this outbreak of whom 10 were HCWs and 2 were family members of cases.
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            PNEUMONIA IN PREGNANCY

            Patrick Ramsey, Kirk D. Ramin (2001)
            Although the advent of broad-spectrum antibiotics has markedly improved the maternal outcomes of pneumonia complicating pregnancy, pneumonia remains a significant condition that may complicate pregnancy. This article has reviewed the inherent physiologic respiratory changes that accompany pregnancy and the common causes of pneumonia in the pregnant woman. The clinical course of bacterial pneumonia seems to be minimally altered by pregnancy, whereas viral pneumonia carries a significantly worse prognosis when encountered during gestation. Prompt diagnosis, the initiation of respiratory support, and appropriate antimicrobial/antiviral therapy are key components of therapy for women in whom pregnancy is complicated by pneumonia. Because preterm labor frequently accompanies pneumonia, women should be monitored closely for the occult onset of preterm labor and appropriate interventions initiated if indicated. Perhaps even more important than interventions to treat acute pneumonia are efforts directed at active immunization or prophylactic therapy to prevent the development of pneumonia in select patient populations. The combination of these efforts is essential to optimize medical care for pregnant women.
            Article 0 comments Cited 35 times – based on 0 reviews     Review now
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              Pregnancy-associated depression of cell-mediated immunity.

              E D Weinberg (2015)
              Pregnancy has been known for some time to be associated with depressed aspects of cell-mediated immunity (CMI) that permit fetal retention but that also may interfere with resistance to specific infectious and neoplastic agents. Clinical and laboratory findings of loss of resistance have been extensively documented. Gestation appears to be associated with depression of selective aspects of CMI. Levels of hormones and other serum factors that may modulate lymphocyte or macrophage synthesis, activation, and/or function shift considerably during pregnancy. The induction and maintenance of pregnancy-associated immune deficiency probably rely on a multifactorial mechanism. Further research is needed to identify agents that would prevent fetal rejection while permitting adequate defense against infection and malignancy; to identify strains particularly dangerous during gestation; and to develop vaccines against the nonshared antigens of such strains.
              Article 0 comments Cited 25 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                :
                Comment :
                a

                Members of the study group are listed at the end of the text.

                Journal
                Journal ID (nlm-ta): J Infect Dis
                Journal ID (iso-abbrev): J. Infect. Dis
                Journal ID (publisher-id): jid
                Journal ID (hwp): jinfdis
                Title: The Journal of Infectious Diseases
                Publisher: Oxford University Press
                ISSN (Print): 0022-1899
                ISSN (Electronic): 1537-6613
                Publication date (Print): 15 June 2014
                Publication date (Electronic): 28 January 2014
                Publication date PMC-release: 28 January 2014
                Volume: 209
                Issue: 12
                Pages: 1870-1872
                Affiliations
                [1 ] Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
                [2 ] Epidemic Intelligence Service
                [3 ] Global Immunization Division, Center for Global Health
                [4 ] Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases
                [5 ] Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia
                [6 ] Jordan Field Epidemiology Training Program
                [7 ] Communicable Diseases Directorate
                [8 ] Directorate of Laboratories, Jordan Ministry of Health
                [9 ] Eastern Mediterranean Public Health Network , Amman, Jordan
                Author notes
                [a]

                Members of the study group are listed at the end of the text.

                Correspondence: Daniel C. Payne, PhD, MSPH, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A-34, Atlanta, GA 30333 ( dvp6@ 123456cdc.gov ).
                Article
                Publisher ID: jiu068
                DOI: 10.1093/infdis/jiu068
                PMC ID: 4618552
                PubMed ID: 24474813
                SO-VID: a32790d6-578c-49ca-bd5a-bf2c76da2698
                Copyright © Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 04 December 2013
                Date accepted : 23 January 2014
                Categories
                Subject: Major Articles and Brief Reports
                Subject: Viruses
                Subject: Editor's Choice

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: mers-cov,middle east respiratory syndrome,novel coronavirus,emc-cov,jordan,stillbirth,pregnancy,pneumonia,severe acute respiratory illness,birth outcomes
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: mers-cov, middle east respiratory syndrome, novel coronavirus, emc-cov, jordan, stillbirth, pregnancy, pneumonia, severe acute respiratory illness, birth outcomes

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