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Case Reports
. 2023 Jan 6:9:1099408.
doi: 10.3389/fmed.2022.1099408. eCollection 2022.

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  1 , Erika Fuchs  1   2 , Roosecelis B Martines  1 , Mamie Lush  2 , Brigid Bollweg  1 , Alyssa Rutan  3 , Amy Nelson  3 , Mark Brisso  3 , Albert Owusu-Ansah  3 , Craig Sitzman  3 , Laurie Ketterl  3 , Tim Timmons  4 , Patricia Lopez  4 , Elizabeth Mitchell  5   6 , Emily McCutchen  5   6 , Jonathan Figliomeni  2 , Peter Iwen  5   6 , Timothy M Uyeki  1 , Sarah Reagan-Steiner  1 , Matthew Donahue  2
Affiliations
Case Reports

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 et al. Front Med (Lausanne). .

Abstract

Introduction: Definitive 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.

Methods: CDC'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.

Results: All 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.

Discussion: These 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.

Keywords: SARS-CoV-2; case report; electron microscopy; histopathology; immunohistochemistry; vertical transmission.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Correlative histology, immunohistochemistry, and ultrastructural findings in a SARS-CoV-2 positive placenta. (A) Placenta showing histiocytic intervillositis (arrow) with villous trophoblast necrosis and fibrin (H&E, original magnification 20X). (B) Immunostaining of SARS-CoV-2 nucleocapsid protein (arrow) in the syncytiotrophoblast of the placenta (IHC, original magnification 20X). (C) Electron microscopy image displaying a membrane bound accumulation of coronavirus particles in the syncytiotrophoblast. Cross sections through the viral nucleocapsid visible (open arrowhead). Scale bar: 200 nm. (D) Vacuolar, membrane bound accumulations of coronavirus particles (arrows) in the syncytiotrophoblast of the placenta as seen by electron microscopy. A cytotrophoblast (arrowhead) is visible below the syncytiotrophoblast. Scale bar: 1 μm.
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