CV. Probable transmisión vertical de la infección por coronavirus 2 del síndrome respiratorio agudo grave de madre a neonato

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Santosh Karade et al. https://doi.org/10.1016/j.mjafi.2020.11.026.

Recopilado por Carlos Cabrera Lozada. Director del postgrado de Medicina Materno Fetal. Universidad Central de Venezuela. ORCID: 0000-0002-3133-5183. 25/09/2021

Resumen

La propagación pandémica de la infección por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) ha afectado a 188 países y territorios. El estado fisiológico alterado durante el embarazo hace que una madre sea vulnerable a la infección grave por SARS-CoV-2. El virus puede transmitirse de madre a bebé durante el período prenatal o postnatal. Aunque el modo principal de transmisión del virus es por gotitas respiratorias, hay evidencia emergente de transmisión in utero de madre a feto. En este raro informe de caso, describimos uno de esos episodios de probable transmisión vertical. Hasta donde sabemos, este es el segundo caso indio investigado sistemáticamente, lo que indica la transmisión in utero del SARS-CoV-2 de la madre al feto.

Introduction

First described in December 2019, infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than 24 million cases and 0.8 million deaths globally.1 It is a positive sense, single-stranded RNA virus that enters the human host by binding to angiotensin-converting enzyme 2 receptor (ACE-2).2 The virus primarily infects the lower respiratory tract causing a spectrum of symptoms ranging from mild fever to multiorgan dysfunction.3 The resultant disease is also called coronavirus disease 2019 or COVID-19.

Human to human transmission of SARS-CoV-2 occurs directly by respiratory droplets, whenever an infected individual coughs or sneezes. Indirectly, the disease can be transmitted by contaminated frequently touched surfaces and fomites.4 Although SARS-CoV-2 can infect any age group from neonates to elderly, COVID-19 in pregnancy is not much explored in Indian settings. The hormonal and physiological changes in pregnancy may alter the course of infection. The altered immune responses in pregnancy place the mother at risk of severe inflammation, especially during the first and third trimester.5 Hence, all pregnant mothers are mandatorily tested for SARS-CoV-2 infection during the third trimester as per Indian Council of Medical Research (ICMR), New Delhi, “COVID-19 testing strategy”.6 Transmission of SARS-CoV-2 from mother to child is also a new field of interest. It can occur during antenatal period through the placenta, during delivery or during postnatal period. Reports of COVID-19 in newborn babies of COVID-19–infected mothers raised concern over vertical transmission.7 Here, we describe a case report of SARS-CoV-2 infection in a newborn, possibly acquired by intrauterine route from the mother.

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