scholarly journals 687. Use of Dalbavancin in Gram-positive Infective Endocarditis: Review of Current Literature

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S446-S446
Author(s):  
Tasaduq Fazili ◽  
Ekta Bansal ◽  
Mariana Gomez de la Espriella ◽  
Dorothy C Garner
Keyword(s):  
Infective Endocarditis ◽  
Adverse Events ◽  
English Language ◽  
Case Reports ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Sequential Therapy ◽  
Gram Positive ◽  
Cardiac Device ◽  
Native Valve

Abstract Background Dalbavancin is a long acting, semisynthetic derivative of teicoplanin that is currently approved for treatment of acute bacterial skin and skin structure infections. Its efficacy and role of in the treatment of invasive infections, in particular infective endocarditis, is not well known. Methods We reviewed the English-language literature for the use of Dalbavancin in the treatment of endocarditis due to Gram-positive organisms, using Pubmed. Results 15 publications were reviewed. All the publications were retrospective in nature, with relatively small numbers of patients, including a few case reports. A total of 159 patients received Dalbavancin for endocarditis. The mean age was 47 years. The main reasons for using Dalbavancin were non-feasibility of a standard outpatient regimen (mainly due to drug use) or the need for a simpler regimen. 75 patients had infection of a native valve, 44 of a prosthetic valve and 19 of a cardiac device. The type of infection for the rest of the patients was not specified. The tricuspid valve was the most frequently reported. The etiologic organisms causing endocarditis were Staphylococcus species, followed by Streptococcus species and Enterococcus species, with Staphylococcus aureus being the most common. All, but one, patients received Dalbavancin as sequential therapy, after receiving other intravenous antibiotics initially. The duration of antibiotics received prior to initiation of Dalbavancin was variable, with the median being 3 weeks. The median duration of Dalbavancin use was 2.7 weeks. The dosage regimens varied, with the more common ones using a loading dose of either 1500 mg or 1000 mg, followed by one or more weekly doses of 500 mg. The overall clinical efficacy was around 89%. Adverse events were mild, including nausea, vomiting, rash, headache and reversible acute kidney injury. None of the patients had to discontinue the drug because of adverse events. Two publications evaluated the cost effectiveness of Dalbavancin and found it to save about &9000 per patient, the saving being mainly due to reduced length of hospital stay. Conclusion Dalbavancin appears to be an efficacious, safe and cost-effective option for sequential treatment of endocarditis caused by Staph aureus and other Gram-positive organisms. Disclosures All Authors: No reported disclosures

scholarly journals Ampicillin-Ceftriaxone vs Ampicillin-Gentamicin for Definitive Therapy of Enterococcus faecalis Infective Endocarditis: A Propensity Score–Matched, Retrospective Cohort Analysis

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Niyati H Shah ◽  
Kathleen A Shutt ◽  
Yohei Doi
Keyword(s):  
Infective Endocarditis ◽  
Propensity Score ◽  
Adverse Events ◽  
Cohort Analysis ◽  
Hospital Readmissions ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Aminoglycoside Resistance ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Ampicillin-ceftriaxone (AC) has emerged as an alternative antibiotic regimen for enterococcal infective endocarditis (EIE) with reduced toxicity compared with ampicillin-gentamicin (AG), but evidence regarding its success in reducing EIE-associated death in the United States is limited. Methods We conducted a retrospective, propensity score–matched cohort analysis of EIE patients treated with AC or AG between 2010 and 2017 at 3 hospitals in Pittsburgh, Pennsylvania. We assessed all-cause 90-day mortality as the primary outcome and in-hospital mortality, length of hospital stay, hospital readmissions, adverse events, and relapse of bacteremia as the secondary outcomes. Results A total of 190 patients with EIE (100 treated with AC and 90 with AG) were included. Ninety-day mortality was significantly higher with AC than AG (21% vs 8%; P = .02). After propensity score matching, 56 patients in each group remained for the outcomes analysis. Documented aminoglycoside resistance, presence of annular or aortic abscess, and complete pacemaker removal were the significantly different variables between the 2 matched cohorts. We observed no statistically significant difference in 90-day mortality between the 2 treatment groups (11% vs 7%; P = .55). Adverse events were more common in patients treated with AG (25 vs 39; P = .0091), and more patients in the propensity score–matched AG cohort switched antibiotic regimens than in the AC group (10% vs 49%; P < .0001). Conclusions Patients treated with AC demonstrate no significant differences in mortality, treatment failure, or bacteremia relapse compared with AG in a propensity score–matched EIE cohort.

scholarly journals 18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

2021 ◽  
Vol 23 (9) ◽  
Author(s):  
D. ten Hove ◽  
R.H.J.A. Slart ◽  
B. Sinha ◽  
A.W.J.M. Glaudemans ◽  
R.P.J. Budde
Keyword(s):  
Infective Endocarditis ◽  
Fdg Pet ◽  
Prosthetic Valve Endocarditis ◽  
Cardiac Device ◽  
Native Valve ◽  
Prosthetic Valves ◽  
Cardiac Devices ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Disseminated Disease

Abstract Purpose of Review Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. Recent Findings There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Summary Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.

scholarly journals Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Núria Fernández Hidalgo ◽  
Amal A Gharamti ◽  
María Luisa Aznar ◽  
Benito Almirante ◽  
Mohamad Yasmin ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Case Report Form ◽  
Predisposing Factor ◽  
Cardiac Device ◽  
Native Valve ◽  
Data Set ◽  
Standard Case ◽  
Cardiac Devices

Abstract Background Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.

scholarly journals 472 Epidemiology and temporal trends of cardiac device related infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Denes ◽  
A Bence ◽  
T Ferenci ◽  
S Borbas ◽  
Z Som ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Coagulase Negative Staphylococcus ◽  
Cardiac Device ◽  
Native Valve ◽  
Tertiary Referral Center ◽  
Device Implantation ◽  
Epidemiological Characteristics ◽  
Over Time

Abstract Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends. Results 465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p < 0.001), had worse renal function (GFR: 46.3 ± 15.3 vs 60.2 ± 23.5 ml/min/1.73m2, p = 0.04), shorter time since first device implantation (2.1 yrs [IQR: 1.1-4.8 yrs] vs 6.7 yrs [4.1-12.9 yrs], p = 0.006), and CRT device implantation were more prevalent (32% vs 10%, p < 0.05). Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05) Conclusions During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.

scholarly journals Adverse Events of Acupuncture: A Systematic Review of Case Reports

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Shifen Xu ◽  
Lizhen Wang ◽  
Emily Cooper ◽  
Ming Zhang ◽  
Eric Manheimer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Safety Assessment ◽  
English Language ◽  
Case Reports ◽  
Major Complication ◽  
The West ◽  
Source Of Infection ◽  
Skin Contact ◽  
Needle Technique ◽  
Main Complication

Acupuncture, moxibustion, and cupping, important in traditional Eastern medicine, are increasingly used in the West. Their widening acceptance demands continual safety assessment. This review, a sequel to one our team published 10 years ago, is an evaluation of the frequency and severity of adverse events (AEs) reported for acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in six databases were identified and assessed by two reviewers. During this 12-year period, 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Country of occurrence, patient’s sex and age, and outcome were extracted. Infections, mycobacterial, staphylococcal, and others, were the main complication of acupuncture. In the previous review, we found the main source of infection to be hepatitis, caused by reusable needles. In this review, we found the majority of infections to be bacterial, caused by skin contact at acupoint sites; we found no cases of hepatitis. Although the route of infection had changed, infections were still the major complication of acupuncture. Clearly, guidelines such as Clean Needle Technique must be followed in order to minimize acupuncture AEs.

scholarly journals Prevalence of infective endocarditis in streptococcal bloodstream infections is dependent on streptococcal species

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Chamat ◽  
A Dahl ◽  
L Oestergaard ◽  
M Arpi ◽  
E Fosboel ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Public Hospital ◽  
Bloodstream Infections ◽  
Population Based ◽  
University Hospital ◽  
Multivariable Logistic Regression Analysis ◽  
Funding Source ◽  
Cardiac Device ◽  
Native Valve ◽  
Streptococcal Species

Abstract Background Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. Purpose To investigate the prevalence of IE in BSIs with different streptococcal species. Methods We included all patients with streptococcal BSIs, from 2008 to 2017, in a population-based setup. Based on microbiological identification of phylogenetic relationship, streptococcal species were classified into eight main groups: Anginosus, Bovis, Mitis, Mutans, Salivarius, Pyogenic, S. pneumoniae, and “other streptococci”. Using nationwide registries, we determined the prevalence of IE at streptococcal group level and at species level. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species with S. pneumoniae as reference and adjusted for age, sex, ≥3 positive blood culture (BC) bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. Results In 6,506 cases with streptococcal BSIs (mean age 68.1 years (SD 16.2), 52.8% men), the IE prevalence was 7.1% (95% CI: 6.5–7.8%). For the most common streptococcal species (>5% of BSIs), the IE prevalence was: S. pneumoniae 1.2% (95% CI: 0.8–1.6%), S. dysgalactiae 6.4% (95% CI: 4.9–8.2%), S. pyogenes 1.9% (95% CI: 0.9–3.3%), S. agalactiae 9.1% (95% CI: 6.6–12.1%), S. anginosus 4.8% (95% CI: 3.0–7.3%), and S. mitis/oralis 19.4% (95% CI: 15.6–23.5%) (Figure 1). For moderately common streptococcal species (1–5% of BSIs), the IE prevalence was: S. gallolyticus 30.2% (95% CI: 24.3–36.7%), S. salivarius 5.8% (95% CI: 2.9–10.1%), S. sanguinis 34.6% (95% CI: 26.6–43.3%), S. parasanguinis 10.3% (95% CI: 5.2–17.7), and S. gordonii 44.2% (95% CI: 34.0–54.8%). For uncommon streptococcal species (0.1–1% of BSIs), the highest IE prevalence was in S. mutans with 47.9% (95% CI: 33.3–62.8%). In a multivariable adjusted analysis using S. pneumoniae as a reference, we identified that all species except S. pyogenes were associated with a significantly higher IE risk (Figure 1). The highest associated IE risk was found in S. mutans (OR 81.3, 95% CI: 37.6–176), S. gordonii (OR 80.8, 95% CI: 43.9–149), S. sanguinis (OR 59.1, 95% CI: 32.6–107), S. gallolyticus (OR 31.0, 95% CI: 18.8–51.1), and S. mitis/oralis (OR 31.6, 95% CI: 19.8–50.5) (Figure 1). Conclusion The prevalence of IE in streptococcal BSIs is highly species dependent with the lowest IE prevalence observed in S. pneumoniae and S. pyogenes BSIs, whereas S. mutans, S. gordonii, S. sanguinis, S. gallolyticus and S. mitis/oralis had the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors. Figure 1. Risk of IE in streptococcal BSIs Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Herlev-Gentofte University Hospital

scholarly journals Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species

Circulation ◽  
2020 ◽  
Vol 142 (8) ◽  
pp. 720-730 ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Anders Dahl ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Odds Ratio ◽  
Prosthetic Valve ◽  
Multivariable Analysis ◽  
Bloodstream Infections ◽  
Species Level ◽  
Multivariable Logistic Regression Analysis ◽  
Cardiac Device ◽  
Native Valve ◽  
Streptococcal Species

Background: Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. We aimed to investigate the prevalence of IE at species level in patients with streptococcal BSIs. Methods: We investigated all patients with streptococcal BSIs, from 2008 to 2017, in the Capital Region of Denmark. Data were crosslinked with Danish nationwide registries for identification of concomitant hospitalization with IE. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species adjusted for age, sex, ≥3 positive blood culture bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. Results: Among 6506 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men) the IE prevalence was 7.1% (95% CI, 6.5–7.8). The lowest IE prevalence was found with Streptococcus pneumoniae ( S pneumoniae ) 1.2% (0.8–1.6) and Spyogenes 1.9% (0.9–3.3). An intermediary IE prevalence was found with Sanginosus 4.8% (3.0–7.3), Ssalivarius 5.8% (2.9–10.1), and Sagalactiae 9.1% (6.6–12.1). The highest IE prevalence was found with Smitis/oralis 19.4% (15.6–23.5), Sgallolyticus (formerly Sbovis ) 30.2% (24.3–36.7), Ssanguinis 34.6% (26.6–43.3), Sgordonii 44.2% (34.0–54.8), and Smutans 47.9% (33.3–62.8). In multivariable analysis using S pneumoniae as reference, all species except S pyogenes were associated with significantly higher IE risk, with the highest risk found with S gallolyticus odds ratio (OR) 31.0 (18.8–51.1), S mitis/oralis OR 31.6 (19.8–50.5), S sanguinis OR 59.1 (32.6–107), S gordonii OR 80.8 (43.9–149), and S mutans OR 81.3 (37.6–176). Conclusions: The prevalence of IE in streptococcal BSIs is species dependent with S mutans, S gordonii, S sanguinis, S gallolyticus , and S mitis/oralis having the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors.

Congenital Zika Virus Infection Paradigm: What is in the Wardrobe? A Narrative Review

2019 ◽  
Vol 1 (1) ◽  
pp. 49-56
Author(s):  
Mariam M. Mirambo ◽  
Lucas Matemba ◽  
Mtebe Majigo ◽  
Stephen E. Mshana
Keyword(s):  
Virus Infection ◽  
Neural Tube ◽  
Zika Virus ◽  
English Language ◽  
Case Reports ◽  
Case Series ◽  
Epidemiological Studies ◽  
Ocular Manifestations ◽  
Zika Virus Infection ◽  
N 93

Background: Zika virus infection during pregnancy has been recently associated with congenital microcephaly and other severe neural tube defects. However, the magnitude of confirmed cases and the scope of these anomalies have not been extensively documented. This review focuses on the magnitude of laboratory-confirmed congenital Zika virus cases among probable cases and describing the patterns of congenital anomalies allegedly caused by the Zika virus, information which will inform further research in this area. Methods: We conducted a literature search for English-language articles about congenital Zika virus infection using online electronic databases (PubMed/MEDLINE, POPLINE, Embase, Google Scholar, and Web of Knowledge). The search terms used were, “zika”, “pregnancy”, [year], “microcephaly”, “infants”, “children”, “neonates”, “foetuses”, “neural tube defect”, and “CNS manifestations” in different combinations. All articles reporting cases or case series between January 2015 and December 2016 were included. Data were entered into a Microsoft Excel database and analysed to obtain proportions of the confirmed cases and patterns of anomalies. Results: A total of 24 articles (11 case series, 9 case reports, and 4 others) were found to be eligible and included in this review. These articles reported 919 cases, with or without microcephaly, presumed to have congenital Zika virus infection. Of these cases, 884 (96.2%) had microcephaly. Of the 884 cases of microcephaly, 783 (88.6%) were tested for Zika virus infection, and 216 (27.6%; 95% confidence interval, 24.5% to 30.8%) were confirmed to be Zika virus-positive. In addition to microcephaly, other common abnormalities reported – out of 442 cases investigated – were calcifications of brain tissue (n=240, 54.3%), ventriculomegaly (n=93, 20.8%), cerebellar hypoplasia (n=52, 11.7%), and ocular manifestations (n=46, 10.4%). Conclusion: Based on the available literature, Zika virus infection during pregnancy might lead to a wide array of outcomes other than microcephaly. There is a need for more epidemiological studies in Zika-endemic areas, particularly in Africa, to ascertain the role of Zika virus in causing congenital neurological defects.

Congenital Zika Virus Infection Paradigm: What is in the Wardrobe? A Narrative Review

2019 ◽  
Vol 1 (1) ◽  
pp. 49-56
Author(s):  
Mariam M. Mirambo ◽  
Lucas Matemba ◽  
Mtebe Majigo ◽  
Stephen E. Mshana
Keyword(s):  
Virus Infection ◽  
Neural Tube ◽  
Zika Virus ◽  
English Language ◽  
Case Reports ◽  
Case Series ◽  
Epidemiological Studies ◽  
Ocular Manifestations ◽  
Zika Virus Infection ◽  
N 93

Background: Zika virus infection during pregnancy has been recently associated with congenital microcephaly and other severe neural tube defects. However, the magnitude of confirmed cases and the scope of these anomalies have not been extensively documented. This review focuses on the magnitude of laboratory-confirmed congenital Zika virus cases among probable cases and describing the patterns of congenital anomalies allegedly caused by the Zika virus, information which will inform further research in this area. Methods: We conducted a literature search for English-language articles about congenital Zika virus infection using online electronic databases (PubMed/MEDLINE, POPLINE, Embase, Google Scholar, and Web of Knowledge). The search terms used were, “zika”, “pregnancy”, [year], “microcephaly”, “infants”, “children”, “neonates”, “foetuses”, “neural tube defect”, and “CNS manifestations” in different combinations. All articles reporting cases or case series between January 2015 and December 2016 were included. Data were entered into a Microsoft Excel database and analysed to obtain proportions of the confirmed cases and patterns of anomalies. Results: A total of 24 articles (11 case series, 9 case reports, and 4 others) were found to be eligible and included in this review. These articles reported 919 cases, with or without microcephaly, presumed to have congenital Zika virus infection. Of these cases, 884 (96.2%) had microcephaly. Of the 884 cases of microcephaly, 783 (88.6%) were tested for Zika virus infection, and 216 (27.6%; 95% confidence interval, 24.5% to 30.8%) were confirmed to be Zika virus-positive. In addition to microcephaly, other common abnormalities reported – out of 442 cases investigated – were calcifications of brain tissue (n=240, 54.3%), ventriculomegaly (n=93, 20.8%), cerebellar hypoplasia (n=52, 11.7%), and ocular manifestations (n=46, 10.4%). Conclusion: Based on the available literature, Zika virus infection during pregnancy might lead to a wide array of outcomes other than microcephaly. There is a need for more epidemiological studies in Zika-endemic areas, particularly in Africa, to ascertain the role of Zika virus in causing congenital neurological defects.

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