Frontiers in Medicine (Jan 2023)

Probable vertical transmission of Alpha variant of concern (B.1.1.7) with evidence of SARS-CoV-2 infection in the syncytiotrophoblast, a case report

  • Hannah A. Bullock,
  • Erika Fuchs,
  • Erika Fuchs,
  • Roosecelis B. Martines,
  • Mamie Lush,
  • Brigid Bollweg,
  • Alyssa Rutan,
  • Amy Nelson,
  • Mark Brisso,
  • Albert Owusu-Ansah,
  • Craig Sitzman,
  • Laurie Ketterl,
  • Tim Timmons,
  • Patricia Lopez,
  • Elizabeth Mitchell,
  • Elizabeth Mitchell,
  • Emily McCutchen,
  • Emily McCutchen,
  • Jonathan Figliomeni,
  • Peter Iwen,
  • Peter Iwen,
  • Timothy M. Uyeki,
  • Sarah Reagan-Steiner,
  • Matthew Donahue

DOI
https://doi.org/10.3389/fmed.2022.1099408
Journal volume & issue
Vol. 9

Abstract

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IntroductionDefinitive vertical transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has been rarely reported. We present a case of a third trimester pregnancy with fetal distress necessitating cesarean section that demonstrated maternal, placental, and infant infection with the SARS-CoV-2 Alpha variant/B.1.1.7.MethodsCDC's Influenza SARS-CoV-2 Multiplex RT-PCR Assay was used to test for SARS-CoV-2 in a maternal NP swab, maternal plasma, infant NP swab, and formalin-fixed paraffin-embedded (FFPE) placental tissue specimens. Whole genome sequencing (WGS) was performed on maternal plasma, infant, and placental specimens to determine the SARS-CoV-2 genotype. Histopathological evaluation, SARS-CoV-2 immunohistochemistry testing (IHC), and electron microscopy (EM) analysis were performed on placenta, umbilical cord, and membrane FFPE blocks.ResultsAll specimens tested positive for SARS-CoV-2 by RT-PCR. WGS further revealed identical SARS-CoV-2 sequences from clade 20I/501Y.V1 (lineage Alpha/B.1.1.7) in maternal plasma, infant, and placental specimens. Histopathologic evaluation of the placenta showed histiocytic and neutrophilic intervillositis with fibrin deposition and trophoblast necrosis with positive SARS-CoV-2 immunostaining in the syncytiotrophoblast and electron microscopy evidence of coronavirus.DiscussionThese findings suggest vertical transmission of SARS-CoV-2, supported by clinical course timing, identical SARS-CoV-2 genotypes from maternal, placental, and infant samples, and IHC and EM evidence of placental infection. However, determination of the timing or distinction between prepartum and peripartum SARS-CoV-2 transmission remains unclear.

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