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Epifanova E, Nguyen L. The dangers of rubella virus. eLife 2023; 12:e89265. [PMID: 37327049 DOI: 10.7554/elife.89265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
The rubella virus can interfere with fetal brain development by infecting immune cells called microglia during pregnancy.
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Affiliation(s)
- Ekaterina Epifanova
- Laboratory of Molecular Regulation of Neurogenesis, GIGA-Stem Cells and GIGA-Neurosciences, Interdisciplinary Cluster for Applied Genoproteomics (GIGA-R), University of Liège, Liège, Belgium
| | - Laurent Nguyen
- Laboratory of Molecular Regulation of Neurogenesis, GIGA-Stem Cells and GIGA-Neurosciences, Interdisciplinary Cluster for Applied Genoproteomics (GIGA-R), University of Liège, Liège, Belgium
- WELBIO department, WEL Research Institute, Wavres, Belgium
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2
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Hutton J. Developmental outcomes in children born to women with possible subclinical rubella exposures during pregnancy. J Med Virol 2023; 95:e28517. [PMID: 36680415 DOI: 10.1002/jmv.28517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
This study investigated outcomes of children born to women who seroconverted to rubella immune during pregnancy. In a prior 2012-2013 study of 296 women who were rubella nonimmune, 26 (8.8%) seroconverted to rubella immune during pregnancy. These same women and their now 8-9 years-old children were queried as to the children's developmental health. After removing exclusions and those lost to follow-up, the total response rate was 115/204 (56.4%). Three sets of twins in the nonimmune group increased the total to 118. The seroconversion group had more autism (12.5% vs. 3.9%, p = 0.19), ADHD (37.5% vs. 18.6%, p = 0.10), and any developmental disability (43.8% vs. 31.4%, p = 0.39) but none showed a statistical difference between the two groups. Compared to Autism and Developmental Disabilities Monitoring data, the seroconversion group had a greater prevalence of autism (odds ratio [OR] 6.07, p = 0.051, nonsignificant); and to data derived from the National Health Interview Survey, a nonsignificant higher odds of autism (OR 5.57, p = 0.060), higher odds of ADHD (OR 5.65, p = 0.0027) and of any developmental disability (OR 3.59, p = 0.014). The nonimmune group also demonstrated a statistically significant increase for both ADHD and any developmental disability, but not for autism.
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Affiliation(s)
- Jill Hutton
- Autism Research Texas, Houston, Texas, USA.,Pediatrix Medical Group Inc, Sunrise, Florida, USA
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Guardado K, Varela-Cardoso M, Pérez-Roa VO, Morales-Romero J, Zenteno-Cuevas R, Ramos-Ligonio Á, Guzmán-Martínez O, Sampieri CL, Ortiz-Chacha CS, Pérez-Varela R, Mora-Turrubiate CF, Montero H. Evaluation of Anomalies and Neurodevelopment in Children Exposed to ZIKV during Pregnancy. CHILDREN 2022; 9:children9081216. [PMID: 36010106 PMCID: PMC9406591 DOI: 10.3390/children9081216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/23/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Zika virus (ZIKV) infection in pregnancy is associated with birth and developmental alterations in infants. In this study, clinical records of 47 infants whose mothers had Zika during pregnancy or clinical manifestations compatible with Zika were reviewed. A description of the infants’ anomalies was established, and a neurodevelopmental assessment was performed on 18 infants, using the Evaluation of Infant Development (EDI for its initialism in Spanish) and DDST-II (Denver Developmental Screening Test II) tests. From his sample, 74.5% of the infants evaluated had major anomalies and 51.9% had minor anomalies. The incidence of major anomalies, related to trimester of pregnancy, was 84.2% for the first trimester, 77.8% for the second trimester, and 37.5% in the third trimester. A similar trend was observed in the frequency of infants without anomalies and was less evident in the incidence of minor anomalies (p = 0.016). Through neurodevelopmental assessments, EDI identified 27.8% of infants as having normal development, while 55.5% of affected infants had developmental delay, and 16.7% were at risk for developmental delay. The DDSST-II showed that 77.7% infants had delay in the gross motor and language area, 88.8% in the fine-adaptative motor area, and 72.2% in the personal–social area. In this work, children of mothers with ZIKV infection during pregnancy may have major or minor anomalies regardless of the trimester of pregnancy in which the infection occurred. The neurodevelopmental assessment shows that ZIKV can cause a developmental delay in infants with the fine-adaptative motor area being the most affected.
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Affiliation(s)
- Kathia Guardado
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa 91090, Mexico
| | | | | | | | | | - Ángel Ramos-Ligonio
- LADISER Inmunología y Biología Molecular, Facultad de Ciencias Químicas, Universidad Veracruzana, Orizaba 94340, Mexico
| | - Oscar Guzmán-Martínez
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa 91090, Mexico
| | - Clara L. Sampieri
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
| | | | | | | | - Hilda Montero
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa 91090, Mexico
- Correspondence: ; Tel.: +52-22-88-41-89-00 (ext. 13323)
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Auriti C, De Rose DU, Santisi A, Martini L, Piersigilli F, Bersani I, Ronchetti MP, Caforio L. Pregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166198. [PMID: 34118406 PMCID: PMC8883330 DOI: 10.1016/j.bbadis.2021.166198] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/07/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023]
Abstract
Some maternal infections, contracted before or during pregnancy, can be transmitted to the fetus, during gestation (congenital infection), during labor and childbirth (perinatal infection) and through breastfeeding (postnatal infection). The agents responsible for these infections can be viruses, bacteria, protozoa, fungi. Among the viruses most frequently responsible for congenital infections are Cytomegalovirus (CMV), Herpes simplex 1–2, Herpes virus 6, Varicella zoster. Moreover Hepatitis B and C virus, HIV, Parvovirus B19 and non-polio Enteroviruses when contracted during pregnancy may involve the fetus or newborn at birth. Recently, new viruses have emerged, SARS-Cov-2 and Zika virus, of which we do not yet fully know the characteristics and pathogenic power when contracted during pregnancy. Viral infections in pregnancy can damage the fetus (spontaneous abortion, fetal death, intrauterine growth retardation) or the newborn (congenital anomalies, organ diseases with sequelae of different severity). Some risk factors specifically influence the incidence of transmission to the fetus: the timing of the infection in pregnancy, the order of the infection, primary or reinfection or chronic, the duration of membrane rupture, type of delivery, socio-economic conditions and breastfeeding. Frequently infected neonates, symptomatic at birth, have worse outcomes than asymptomatic. Many asymptomatic babies develop long term neurosensory outcomes. The way in which the virus interacts with the maternal immune system, the maternal-fetal interface and the placenta explain these results and also the differences that are observed from time to time in the fetal‑neonatal outcomes of maternal infections. The maternal immune system undergoes functional adaptation during pregnancy, once thought as physiological immunosuppression. This adaptation, crucial for generating a balance between maternal immunity and fetus, is necessary to promote and support the pregnancy itself and the growth of the fetus. When this adaptation is upset by the viral infection, the balance is broken, and the infection can spread and lead to the adverse outcomes previously described. In this review we will describe the main viral harmful infections in pregnancy and the potential mechanisms of the damages on the fetus and newborn.
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Affiliation(s)
- Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Alessandra Santisi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Ludovica Martini
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Fiammetta Piersigilli
- Department of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium.
| | - Iliana Bersani
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
| | - Leonardo Caforio
- Fetal and Perinatal Medicine and Surgery Unit, Medical and Surgical Department of Fetus, Newborn and Infant - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
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Shuid AN, Jayusman PA, Shuid N, Ismail J, Kamal Nor N, Mohamed IN. Association between Viral Infections and Risk of Autistic Disorder: An Overview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2817. [PMID: 33802042 PMCID: PMC7999368 DOI: 10.3390/ijerph18062817] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition of the central nervous system (CNS) that presents with severe communication problems, impairment of social interactions, and stereotypic behaviours. Emerging studies indicate possible associations between viral infections and neurodegenerative and neurobehavioural conditions including autism. Viral infection during critical periods of early in utero neurodevelopment may lead to increased risk of autism in the offspring. This review is aimed at highlighting the association between viral infections, including viruses similar to COVID-19, and the aetiology of autism. A literature search was conducted using Pubmed, Ovid/Medline, and Google Scholar database. Relevant search terms included "rubella and autism", "cytomegalovirus and autism", "influenza virus and autism", "Zika virus and autism", "COVID-19 and autism". Based on the search terms, a total of 141 articles were obtained and studies on infants or children with congenital or perinatal viral infection and autistic behaviour were evaluated. The possible mechanisms by which viral infections could lead to autism include direct teratogenic effects and indirect effects of inflammation or maternal immune activation on the developing brain. Brain imaging studies have shown that the ensuing immune response from these viral infections could lead to disruption of the development of brain regions and structures. Hence, long-term follow up is necessary for infants whose mothers report an inflammatory event due to viral infection at any time during pregnancy to monitor for signs of autism. Research into the role of viral infection in the development of ASD may be one avenue of improving ASD outcomes in the future. Early screening and diagnosis to detect, and maybe even prevent ASD are essential to reduce the burden of this condition.
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Affiliation(s)
- Ahmad Naqib Shuid
- Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas 13200, Malaysia;
| | - Putri Ayu Jayusman
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Nazrun Shuid
- Department of Pharmacology, Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh 47000, Malaysia
| | - Juriza Ismail
- Autism Research Group, Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.I.); (N.K.N.)
| | - Norazlin Kamal Nor
- Autism Research Group, Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (J.I.); (N.K.N.)
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
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Rosalina E, Purnami N. Congenital Rubella Syndrome profile of audiology outpatient clinic in Surabaya, Indonesia. Infect Dis Rep 2020; 12:8762. [PMID: 32874477 PMCID: PMC7447925 DOI: 10.4081/idr.2020.8762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
Congenital Rubella Syndrome (CRS) consists of hearing impairment, ophthalmology abnormalities, and congenital heart disease in children, resulting from rubella infection during pregnancy. Rubella vaccine has been implemented as national immunization program in Indonesia since 2017, and needed to be evaluated. This study aimed to report the CRS patients' profile of Audiology Outpatient Clinic in Surabaya. A descriptive study from patient's medical record was conducted in Dr. Soetomo Hospital Surabaya from January 2016 to December 2017. CRS was categorized using World Health Organization classification. Suspected infants with CRS burden were assessed by Otoacoustic Emission and rubella antibody test. Ninety five infants suspected with CRS classified as laboratory- confirmed CRS (58.95%), clinically confirmed CRS (15.79%), and discarded CRS (25.26%). Clinical manifestations included combination of congenital heart disease and hearing impairment (17.89%), congenital heart disease, ophthalmology abnormalities, and hearing impairment (16.84%), and hearing impairment and ophthalmology abnormalities (13.68%). The data show a high burden of CRS in Surabaya. These implies the urgent need for national rubella immunization program.
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Affiliation(s)
- Elsa Rosalina
- Faculty of Medicine, Universitas Airlangga, Surabaya
| | - Nyilo Purnami
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia
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Toizumi M, Do CGT, Motomura H, Do TN, Fukunaga H, Iijima M, Le NN, Nguyen HT, Moriuchi H, Yoshida LM. Characteristics of Patent Ductus Arteriosus in Congenital Rubella Syndrome. Sci Rep 2019; 9:17105. [PMID: 31745134 PMCID: PMC6863812 DOI: 10.1038/s41598-019-52936-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
This study investigated the characteristics of congenital rubella syndrome (CRS)-associated cardiac complications, particularly patent ductus arteriosus (PDA). We reviewed the medical records of patients with CRS who were admitted to the Children's Hospital 1 in Vietnam between December 2010 and December 2012, and patients with CRS who underwent PDA transcatheter occlusion therapy at the cardiology department between December 2009 and December 2015. We compared the characteristics of PDA treated with transcatheter closure between children with CRS (CRS-PDA) and those without CRS (non-CRS-PDA) who underwent PDA transcatheter closure between July 2014 and December 2015. One-hundred-and-eight children with CRS were enrolled. Cardiac defects (99%), cataracts (72%), and hearing impairment (7%) were detected. Fifty CRS-PDA and 290 non-CRS-PDA patients were examined. CRS-PDA patients had smaller median birthweight (p < 0.001), more frequent pulmonary (p < 0.001) and aortic stenosis (p < 0.001), higher main pulmonary artery pressure, and higher aortic pressure in systole/diastole (p < 0.001 for each) than did non-CRS-PDA patients. The proportion of tubular-type PDA was higher in CRS-PDA patients (16%) than in non-CRS-PDA patients (3%) (p = 0.020). Tubular-type PDA was frequently seen in patients with CRS and accompanied by pulmonary/systemic hypertension and pulmonary/aortic stenosis; in these patients, more cautious device selection is needed for transcatheter PDA closure.
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Affiliation(s)
- Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Cam Giang T Do
- Department of Cardiology, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Hideki Motomura
- Department of Pediatrics, Nagasaki Medical Center, Omura, Japan
| | - Tin N Do
- Department of Cardiology, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Hirofumi Fukunaga
- Department of Pediatrics, Nagasaki University Hospital, Nagasaki, Japan
| | - Makiko Iijima
- Expanded Programme on Immunization, WHO representative office in Viet Nam, Hanoi, Vietnam
| | - Nhan Nt Le
- Outreach and International Department, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Hung Thanh Nguyen
- Outreach and International Department, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Hiroyuki Moriuchi
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan. .,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
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Toizumi M, Vo HM, Dang DA, Moriuchi H, Yoshida LM. Clinical manifestations of congenital rubella syndrome: A review of our experience in Vietnam. Vaccine 2018; 37:202-209. [PMID: 30503658 DOI: 10.1016/j.vaccine.2018.11.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/09/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Abstract
Rubella vaccination programs have dramatically reduced the incidence of rubella and congenital rubella syndrome (CRS) in developed countries. However, CRS prevalence is still rising in developing countries where rubella-containing vaccines (RCV) are not included in the immunization program and even in some countries where a part of the population lacks immunity to rubella despite the presence of RCV in the regular immunization program. This review aimed to summarize the clinical features of CRS using data from our studies conducted between 2011 and 2015 in Vietnam, wherein we examined clinical manifestations in Vietnamese children with CRS who were born after the large rubella outbreak of 2011; a series of studies dealing with CRS in North America and Europe after the 1960s epidemic; and those from countries before introduction of RCVs. This review shows that children with CRS have a variety of disabilities such as hearing, visual, developmental, behavioral, cardiac, and endocrine impairments, which have variable severity and may appear in different combinations. Some of these impairments can appear or worsen later in the lives of these children. Physicians should thus complete pediatric, cardiac, auditory, ophthalmologic, and neurologic examinations along with laboratory diagnostic testing soon after birth. These assessments should be repeated during follow-up if congenital rubella infection is suspected in a neonate. Timely intervention for cardiac defects can be lifesaving. Early introduction and continuation of speech, occupational, physical, and behavior therapies and training with appropriate medical interventions by a multidisciplinary team approach are required to maximize quality of life.
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Affiliation(s)
- Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Hien Minh Vo
- Department of Pediatrics, Khanh Hoa General Hospital, Nha Trang, Viet Nam
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
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Abstract
Why certain viruses cross the physical barrier of the human placenta but others do not is incompletely understood. Over the past 20 years, we have gained deeper knowledge of intrauterine infection and routes of viral transmission. This review focuses on human viruses that replicate in the placenta, infect the fetus, and cause birth defects, including rubella virus, varicella-zoster virus, parvovirus B19, human cytomegalovirus (CMV), Zika virus (ZIKV), and hepatitis E virus type 1. Detailed discussions include ( a) the architecture of the uterine-placental interface, ( b) studies of placental explants ex vivo that provide insights into the infection and spread of CMV and ZIKV to the fetal compartment and how these viruses undermine early development, and ( c) novel treatments and vaccines that limit viral replication and have the potential to reduce dissemination, vertical transmission and the occurrence of congenital disease.
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Affiliation(s)
- Lenore Pereira
- Department of Cell and Tissue Biology, School of Dentistry, University of California, San Francisco, California 94143, USA;
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Alves LV, Paredes CE, Silva GC, Mello JG, Alves JG. Neurodevelopment of 24 children born in Brazil with congenital Zika syndrome in 2015: a case series study. BMJ Open 2018; 8:e021304. [PMID: 30012787 PMCID: PMC6082469 DOI: 10.1136/bmjopen-2017-021304] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the neurodevelopment of children with congenital Zika syndrome during the second year of life. DESIGN Case series study. SETTING Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Pernambuco, Brazil. PARTICIPANTS 24 children with congenital Zika syndrome born with microcephaly during the Zika outbreak in Brazil in 2015 and followed up at the IMIP during their second year of life. MAIN OUTCOME MEASURE Denver Developmental Screening Test II, head circumference and clinical neurological examination. RESULTS All children presented neurodevelopmental delay: for an average chronological age of 19.9 months, language was equivalent to that of age 2.1 months, gross motor 2.7 months, fine motor/adaptive 3.1 months and personal/social 3.4 months. Head circumference remained below the third percentile for age and gender, and growth rate up to the second year of life was 10.3 cm (expected growth 13 cm). Muscle tone was increased in 23 (95.5%) of 24 children, musculotendinous reflexes were increased in the whole sample and clonus was present in 18 (77.3%) of 24 children. All children except one had epilepsy. CONCLUSION Children born with microcephaly associated with congenital Zika virus have a significant neurodevelopmental delay.
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Affiliation(s)
- Lucas V Alves
- Department of Paediatrics Neurology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Camila E Paredes
- Teaching Department, Faculdade Pernambucana de Saude, Recife, Pernambuco, Brazil
| | - Germanna C Silva
- Teaching Department, Faculdade Pernambucana de Saude, Recife, Pernambuco, Brazil
| | - Júlia G Mello
- Department of Paediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - João G Alves
- Department of Paediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
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