Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil.
de Paula Freitas B,de Oliveira Dias,Juliana Prazeres,Gielson Almeida do Sacramento,Albert I. Ko,Mauricio Maia,Rubens Belfort +6 more
TLDR
Congenital infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.Abstract:
IMPORTANCE The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in
northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase
in the prevalence of microcephaly in newborn infants and vision-threatening findings in these
infants is likely associated with the rapid spread of ZIKV.
OBJECTIVE To evaluate the ocular findings in infants with microcephaly associated with
presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil.
DESIGN, SETTING, AND PARTICIPANTS Case series at a tertiary hospital. Twenty-nine infants
with microcephaly (defined by a cephalic circumference of 32 cm) with a presumed
diagnosis of congenital ZIKV were recruited through an active search and referrals from other
hospitals and health unities. The study was conducted between December 1 and December
21, 2015.
INTERVENTIONS All infants and mothers underwent systemic and ophthalmic examinations
from December 1 through December 21, 2015, in the Roberto Santos General Hospital,
Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were
documented using a wide-field digital imaging system. The differential diagnosis included
toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human
immunodeficiency virus, which were ruled out through serologic and clinical examinations.
MAIN OUTCOMES AND MEASURES Ocular abnormalities associated with ZIKV.
RESULTS Twenty-three of 29 mothers (79.3%) reported suspected ZIKV infection signs and
symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the
third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular
abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were
found in 7 of 10 patients presenting with ocular lesions, the most common of which were
focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with
abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris
coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%
CONCLUSIONS AND RELEVANCE Congenital infection due to presumed ZIKV exposure is
associated with vision-threatening findings, which include bilateral macular and perimacular
lesions as well as optic nerve abnormalities in most cases.read more
Citations
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Journal ArticleDOI
The Brazilian Zika virus strain causes birth defects in experimental models
Fernanda R. Cugola,Isabella Rodrigues Fernandes,Isabella Rodrigues Fernandes,Fabiele Baldino Russo,Beatriz C.G. Freitas,João Leonardo Rodrigues Mendonça Dias,Katia de Oliveira Pimenta Guimarães,Cecilia Benazzato,Nathalia Almeida,Graciela Conceição Pignatari,Sarah Romero,Carolina Manganeli Polonio,Isabela Werneck da Cunha,Carla Longo de Freitas,Wesley Nogueira Brandão,Cristiano Rossato,David G. Andrade,Daniele de Paula Faria,Alexandre T. Garcez,Carlos Alberto Buchpigel,Carla Torres Braconi,Erica A. Mendes,Amadou A. Sall,Paolo Marinho de Andrade Zanotto,Jean Pierre Schatzmann Peron,Alysson R. Muotri,Patricia Cristina Baleeiro Beltrão-Braga +26 more
TL;DR: It is demonstrated that the ZIKVBR infects fetuses, causing intra-uterine growth restriction (IUGR), and crosses the placenta and causes microcephaly by targeting cortical progenitor cells, inducing cell death by apoptosis and autophagy, impairing neurodevelopment.
Journal ArticleDOI
A Mouse Model of Zika Virus Pathogenesis
Helen M. Lazear,Jennifer Govero,Amber M. Smith,Derek J. Platt,Estefania Fernandez,Jonathan J. Miner,Michael S. Diamond +6 more
TL;DR: Ifnar1(-/-) mice sustained high viral loads in the brain and spinal cord, consistent with evidence that ZIKV causes neurodevelopmental defects in human fetuses and valuable for evaluating vaccines and therapeutics as well as understanding disease pathogenesis.
Journal ArticleDOI
Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians.
Cynthia A. Moore,J. Erin Staples,William B. Dobyns,André Pessoa,Camila V. Ventura,Eduardo Borges da Fonseca,Erlane Marques Ribeiro,Liana O. Ventura,Norberto Nogueira Neto,J. Fernando P. Arena,Sonja A. Rasmussen +10 more
TL;DR: It is concluded that congenital Zika syndrome is a recognizable pattern of structural anomalies and functional disabilities secondary to central and, perhaps, peripheral nervous system damage that can help determine essential follow-up and ongoing care for affected infants and children.
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Zika virus: History, emergence, biology, and prospects for control.
Scott C. Weaver,Federico Costa,Mariano A. Garcia-Blanco,Albert I. Ko,Guilherme S. Ribeiro,George R. Saade,Pei Yong Shi,Nikos Vasilakis +7 more
TL;DR: Zika virus (ZIKV), a previously obscure flavivirus closely related to dengue, West Nile, Japanese encephalitis and yellow fever viruses, has emerged explosively since 2007 to cause a series of epidemics in Micronesia, the South Pacific, and most recently the Americas as discussed by the authors.
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Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy.
Margaret A. Honein,April L. Dawson,Emily E. Petersen,Abbey M. Jones,Ellen H. Lee,Mahsa M. Yazdy,Nina Ahmad,Jennifer Macdonald,Nicole Evert,Andrea M. Bingham,Sascha R. Ellington,Carrie K. Shapiro-Mendoza,Titilope Oduyebo,Anne D. Fine,Catherine M. Brown,Jamie N. Sommer,Jyoti Gupta,Philip Cavicchia,Sally Slavinski,Jennifer L. White,S. Michele Owen,Lyle R. Petersen,Coleen A. Boyle,Dana Meaney-Delman,Denise J. Jamieson +24 more
TL;DR: The findings support the importance of screening pregnant women for Zika virus exposure, and among pregnant women in the United States with completed pregnancies and laboratory evidence of possible recent Zika infection, 6% of fetuses or infants had evidence of Zika-associated birth defects, primarily brain abnormalities and microcephaly.
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