Clinical findings in congenital infection by Zika virus: a retrospective study in a reference hospital in Central-West Brazil

Background An increased number of congenital Zika virus infections with neurological and musculoskeletal malformations have been diagnosed worldwide, however, there are still several gaps in the knowledge about this infection, its associated mechanism, timing of transmission, and description of throughout findings of signs and symptoms, which is described in this paper. The purpose of this study is to describe aspects of congenital Zika syndrome (CZS) beyond the central nervous system comprising detailed delineation of all the other clinical findings. Methods A retrospective research developed using electronic medical records. We analyzed the files of 69 children with an initial diagnosis of microcephaly by Zika vírus who were born in 2015, 2016 and 2017, treated during the period from 2016 to 2017. Results The newborns presented several neurological and musculoskeletal malformations, eye damage, hearing impairment and other malformations. Conclusions The present study has significant impact for health care teams following lactents with Congenital Zika Syndrome.

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Correlation between Zika virus and microcephaly as a consequence of congenital infection

10.5327/1516-3180.629 ◽

2021 ◽

Author(s):

Ana Flávia Silva Castro ◽

Natália Barros Salgado Vieira ◽

Sarah Joanny da Silva Pereira

Keyword(s):

Nervous System ◽

Virus Infection ◽

Zika Virus ◽

Complex Disease ◽

Congenital Infection ◽

Virus Infections ◽

Zika Virus Infection ◽

The Central Nervous System ◽

Neurological Effects ◽

The Relationship

Introduction: The Zika virus (ZIKV) is an arbovirus of RNA, whose transmission is mainly vector - by mosquitoes of the genus Aedes - but it also occurs through sexual, blood and transplacental transmission, with the last mentioned it was possible to verify serious neurological effects in the epidemic in South America, especially in Brazil, between 2015 and 2016. Objectives: To analyze the relationship between Zika virus infection and microcephaly in recent scientific literature. Methodology: Refers to a bibliographic review in the databases SciELO, LILACS and MEDLINE / Pubmed, with the terms “zika virus”, “infection” and “microcephaly” correlated in Portuguese and in English; 78 articles were found, but only 7 followed for analysis. Articles published more than 5 years ago and out of the proposed theme were disregarded. Results: The Zika virus, although similar to the dengue and chikungunya virus, it has a tendency to cause damage to the central nervous system such as Guillain-Barré Syndrome. However, the association between microcephaly and ZIKV started to be more observed through the increase of the disease among fetuses and newborns of mothers who had been infected during the gestational phase in the epidemic that happened in Brazil. It is known that the development of the nervous system is the product of processes of high proliferation and cellular differentiation, in which even small errors generate dangerous impacts, and it is during this period that ZIKV affects the CNS of the fetus. The disease is characterized by the reduction of the brain perimeter, in this context, is a consequence of abnormalities influenced by the virus. Conclusions: Microcephaly is a complex disease; therefore, it is necessary to emphasize the importance of primary care and other spheres for monitoring Zika virus infections, prenatal care and constant psychosocial monitoring. Furthermore, it is necessary to understand the relevance of studies about ZIKV and microcephaly, and to encourage scientific production in this area.

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Asymptomatic Prenatal Zika Virus Infection and Congenital Zika Syndrome

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy073 ◽

2018 ◽

Vol 5 (4) ◽

Cited By ~ 17

Author(s):

Enny S Paixao ◽

Wei-Yee Leong ◽

Laura C Rodrigues ◽

Annelies Wilder-Smith

Keyword(s):

Virus Infection ◽

Birth Defects ◽

Prospective Studies ◽

Zika Virus ◽

Retrospective Studies ◽

Recall Bias ◽

Virus Infections ◽

Fetal Outcomes ◽

Zika Virus Infection ◽

Congenital Zika Syndrome

Abstract To investigate to what extent asymptomatic vs symptomatic prenatal Zika virus infections contribute to birth defects, we identified 3 prospective and 8 retrospective studies. The ratio varied greatly in the retrospective studies, most likely due to recruitment and recall bias. The prospective studies revealed a ratio of 1:1 for asymptomatic vs symptomatic maternal Zika infections resulting in adverse fetal outcomes.

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Postnatally Acquired Zika Virus Disease Among Children, United States, 2016–2017

Clinical Infectious Diseases ◽

10.1093/cid/ciz195 ◽

2019 ◽

Vol 70 (2) ◽

pp. 227-231 ◽

Cited By ~ 4

Author(s):

Nicole P Lindsey ◽

Charsey C Porse ◽

Emily Potts ◽

Judie Hyun ◽

Kayleigh Sandhu ◽

...

Keyword(s):

Zika Virus ◽

Virus Disease ◽

Healthcare Providers ◽

Clinical Signs ◽

Virus Transmission ◽

Signs And Symptoms ◽

Clinical Findings ◽

Case Definition ◽

Illness Onset ◽

Clinical Signs And Symptoms

Abstract Background The clinical findings among children with postnatally acquired Zika virus disease are not well characterized. We describe and compare clinical signs and symptoms for children aged <18 years. Methods Zika virus disease cases were included if they met the national surveillance case definition, had illness onset in 2016 or 2017, resided in a participating state, and were reported to the Centers for Disease Control and Prevention. Pediatric cases were aged <18 years; congenital and perinatal infections were excluded. Pediatric cases were matched to adult cases (18‒49 years). Clinical information was compared between younger and older pediatric cases and between children and adults. Results A total of 141 pediatric Zika virus disease cases were identified; none experienced neurologic disease. Overall, 28 (20%) were treated in an emergency department, 1 (<1%) was hospitalized; none died. Of the 4 primary clinical signs and symptoms associated with Zika virus disease, 133 (94%) children had rash, 104 (74%) fever, 67 (48%) arthralgia, and 51 (36%) conjunctivitis. Fever, arthralgia, and myalgia were more common in older children (12‒17 years) than younger children (1‒11 years). Arthralgia, arthritis, edema, and myalgia were more common in adults compared to children. Conclusions This report supports previous findings that Zika virus disease is generally mild in children. The most common symptoms are similar to other childhood infections, and clinical findings and outcomes are similar to those in adults. Healthcare providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia, or conjunctivitis, who reside in or have traveled to an area where Zika virus transmission is occurring.

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Quarantine for Zika Virus? Where is the Science?

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2016.56 ◽

2016 ◽

Vol 10 (5) ◽

pp. 704-706 ◽

Cited By ~ 5

Author(s):

Kristi L. Koenig

Keyword(s):

Public Health ◽

Zika Virus ◽

Ebola Virus ◽

Virus Disease ◽

Rapid Test ◽

Signs And Symptoms ◽

World Health ◽

Virus Infections ◽

Health Organization ◽

Spread Of Infection

AbstractIn January 2016, the World Health Organization warned that Zika virus is “spreading explosively” in the Americas and that up to 4 million infections could be present worldwide within a year. Soon thereafter, some politicians and authors publicly advocated for quarantine of travelers returning from regions where mosquitoes carrying Zika virus are prevalent. The public health tool of quarantine can be used to prevent the spread of infection by restricting the movement of persons who have been exposed to a deadly disease that can be transmitted from person to person before symptom onset. With 80% of Zika virus infections being asymptomatic, no rapid test being available to detect the virus, and primary transmission being via the bites of certain mosquitoes, application of quarantine in this setting is not scientifically sound or practically feasible. Rather, public health interventions should focus on preventing bites from infected mosquitoes, counseling pregnant women on the risks of fetal microcephaly and other birth defects, and identifying patients with signs and symptoms of Guillain-Barré syndrome. As was seen in the Ebola virus disease outbreak of 2014, non-evidence-based factors can influence policy decisions. Public health experts must ensure that policy makers are informed that quarantine is not a scientifically sound approach for the control of Zika virus. (Disaster Med Public Health Preparedness. 2016;0:1–3)

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Time to Evaluate the Clinical Repercussions of Zika Virus Vertical Transmission? A Systematic Review

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.699115 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yasmin Notarbartolo di Villarosa do Amaral ◽

Jocieli Malacarne ◽

Paloma Glauca Brandão ◽

Patrícia Brasil ◽

Karin Nielsen-Saines ◽

...

Keyword(s):

Systematic Review ◽

Vertical Transmission ◽

Zika Virus ◽

Newborn Infants ◽

Clinical Findings ◽

Psychomotor Development ◽

Eligibility Criteria ◽

Ophthalmic Manifestations ◽

Bibliographic Search ◽

The Central Nervous System

Background: Vertical transmission of Zika Virus (ZIKV) can be associated with several clinical features in newborn infants. The goal of the present review was to analyze the current state of knowledge regarding clinical repercussions following perinatal exposure to ZIKV in children up to 3 years of age.Methods: A systematic review of published studies was carried out, without the restriction of language or date of publication, identified in the databases PubMed, Virtual Health Library (BVS), Scopus, and Web of Science and the catalog for CAPES theses and dissertations. According to the proposed flowchart, the bibliographic search resulted in 1,563 papers. Of these, according to the eligibility criteria, 70 were selected for systematic review; all were published between 2016 and 2021.Results: Regarding clinical findings, 19 papers evaluated clinical imaging alterations, 21 ophthalmic manifestations, and 39 evaluated the central nervous system; of these, 15 analyzed neuro-psychomotor development. The remainder evaluated audiological (n = 14), nutritional (n = 14), orthopedic (n = 7), cardiorespiratory (n = 5), genitourinary (n = 3) or endocrinological (n = 1) manifestations.Conclusion: It is critical for studies to continue monitoring children with antenatal ZIKV exposure as they grow, given the unknown long-term repercussions of ZIKV and the recognized postnatal complications of this infection during pregnancy. Broader descriptions of observed clinical findings are also important in order to characterize the entire spectrum of disease in children.Systematic Review Registration: PROSPERO REGISTER: CRD42020205947.

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Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170066 ◽

2017 ◽

Vol 75 (6) ◽

pp. 381-386 ◽

Cited By ~ 23

Author(s):

Vanessa van der Linden ◽

Hélio van der Linden Junior ◽

Mariana de Carvalho Leal ◽

Epitacio Leite Rolim Filho ◽

Ana van der Linden ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Zika Virus ◽

Dizygotic Twin ◽

Severe Damage ◽

Congenital Zika Syndrome ◽

The Central Nervous System ◽

Natural Protection ◽

Twin Pregnancies ◽

Infectious Disorder

ABSTRACT Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.

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Zika Virus

10.1093/med/9780190604813.003.0015 ◽

2018 ◽

Cited By ~ 1

Author(s):

Jennifer S. Read

Keyword(s):

Zika Virus ◽

Congenital Infection ◽

Asymptomatic Infection ◽

Cranial Morphology ◽

Full Spectrum ◽

Neurological Sequelae ◽

Infant Outcomes ◽

Congenital Zika Syndrome ◽

Mother To Child ◽

The Brain

Although generally asymptomatic or mildly symptomatic in the general population, infection with the Zika virus (ZIKV) during pregnancy may lead to severely adverse fetal and infant outcomes, including the congenital Zika syndrome (CZS). Characteristics of this syndrome that are unique to it or are not typically observed with other congenital infections comprise anomalies of the brain and cranial morphology, ocular anomalies, congenital contractures, and neurological sequelae. The full spectrum of outcomes of mother-to-child transmission (MTCT) of ZIKV appears to be large, ranging from asymptomatic infection at birth, with possible later manifestation of significant abnormalities, to obvious and severe abnormalities in the fetus and infant. Although our understanding of pathogenesis, rates, and manifestations of CZS has improved rapidly and dramatically, much remains unknown or poorly understood regarding this potentially devastating congenital infection. Because of this, a broad research agenda regarding ZIKV is being implemented.

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Congenital Zika syndrome: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0242367 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242367

Author(s):

Danielle A. Freitas ◽

Reinaldo Souza-Santos ◽

Liege M. A. Carvalho ◽

Wagner B. Barros ◽

Luiza M. Neves ◽

...

Keyword(s):

Systematic Review ◽

Virus Infection ◽

Zika Virus ◽

Low Birthweight ◽

Signs And Symptoms ◽

Neurological Complications ◽

Zika Virus Infection ◽

Peripheral Nerve Involvement ◽

Congenital Zika Syndrome ◽

Meta Analyses

Background The signs and symptoms of Zika virus infection are usually mild and self-limited. However, the disease has been linked to neurological complications such as Guillain-Barré syndrome and peripheral nerve involvement, and also to abortion and fetal deaths due to vertical transmission, resulting in various congenital malformations in newborns, including microcephaly. This review aimed to describe the o signs and symptoms that characterize the congenital Zika syndrome. Methods and findings A systematic review was performed with a protocol and described according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search strategy yielded 2,048 studies. After the exclusion of duplicates and application of inclusion criteria, 46 studies were included. The main signs and symptoms associated with the congenital Zika syndrome were microcephaly, parenchymal or cerebellar calcifications, ventriculomegaly, central nervous system hypoplasia or atrophy, arthrogryposis, ocular findings in the posterior and anterior segments, abnormal visual function and low birthweight for gestational age. Conclusions Zika virus infection during pregnancy can cause a series of changes in the growth and development of children, while impacting the healthcare system due to the severity of cases. Our findings outline the disease profile in newborns and infants and may contribute to the development and updating of more specific clinical protocols.

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Zika Virus Infection in Pregnant Women and Microcephaly

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0037-1603450 ◽

2017 ◽

Vol 39 (05) ◽

pp. 235-248 ◽

Cited By ~ 18

Author(s):

Geraldo Duarte ◽

Antonio Moron ◽

Artur Timerman ◽

César Fernandes ◽

Corintio Mariani Neto ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Pregnant Women ◽

Zika Virus ◽

Rna Virus ◽

Signs And Symptoms ◽

Short Period ◽

Reproductive Life ◽

Human Reproductive ◽

The Central Nervous System

AbstractFrom the discovery of the Zika virus (ZIKV) in 1947 in Uganda (Africa), until its arrival in South America, it was not known that it would affect human reproductive life so severely. Today, damage to the central nervous system is known to be multiple, and microcephaly is considered the tip of the iceberg. Microcephaly actually represents the epilogue of this infection's devastating process on the central nervous system of embryos and fetuses. As a result of central nervous system aggression by the ZIKV, this infection brings the possibility of arthrogryposis, dysphagia, deafness and visual impairment. All of these changes of varying severity directly or indirectly compromise the future life of these children, and are already considered a congenital syndrome linked to the ZIKV. Diagnosis is one of the main difficulties in the approach of this infection. Considering the clinical part, it has manifestations common to infections by the dengue virus and the chikungunya fever, varying only in subjective intensities. The most frequent clinical variables are rash, febrile state, non-purulent conjunctivitis and arthralgia, among others. In terms of laboratory resources, there are also limitations to the subsidiary diagnosis. Molecular biology tests are based on polymerase chain reaction (PCR) with reverse transcriptase (RT) action, since the ZIKV is a ribonucleic acid (RNA) virus. The RT-PCR shows serum or plasma positivity for a short period of time, no more than five days after the onset of the signs and symptoms. The ZIKV urine test is positive for a longer period, up to 14 days. There are still no reliable techniques for the serological diagnosis of this infection. If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment. However, evidence is needed to rule out other infections that also cause rashes, such as dengue, chikungunya, syphilis, toxoplasmosis, cytomegalovirus, rubella, and herpes. There is no specific antiviral therapy against ZIKV, and the therapeutic approach to infected pregnant women is limited to the use of antipyretics and analgesics. Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded. There is no need to modify the schedule of prenatal visits for pregnant women infected by ZIKV, but it is necessary to guarantee three ultrasound examinations during pregnancy for low-risk pregnancies, and monthly for pregnant women with confirmed ZIKV infection. Vaginal delivery and natural breastfeeding are advised.

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