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Fontes JM, Oliveira EM, Monteiro de Melo Prazeres TC, Nisya de Oliveira Cruz G, Rizzini M, Passos SD, Lisboa LL, Ferreira de Araújo G, Azevedo de Almeida V, Malacarne J, Emília de Domenico Garcia M, Linhares Barreto LC, Calado AA, Fernandes da Nóbrega L, Moura Nascimento Santos MJ, Gonçalves RP, Farache L, Feliciano da Silva M, Rizzo FV, Dias da Silva L, Maria de Jesus Amorim N, Guedes Pinheiro HC, Suely de Oliveira Melo A, de Oliveira Melo F, Moreira RD, Santos da Costa BJ, de Almeida Melo Maciel Mangueira M, Varela MC, Costa Monteiro LM. Prevalence of urologic sequelae and bladder and bowel dysfunctions in patients with congenital Zika syndrome: A multicenter evaluation of the Zika virus bladder and bowel sequelae assistance network. J Pediatr Urol 2024; 20:220.e1-220.e9. [PMID: 38097421 DOI: 10.1016/j.jpurol.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Neurogenic bladder was first confirmed as a urological sequela of Congenital Zika Syndrome (CZS) in 2018. Further clinical-epidemiological evidence also confirmed neurogenic bowel dysfunction and cryptorchidism. To strengthen the care for these children, the Congenital Zika Virus Bladder and Bowel Sequelae Network (RASZ in Brazilian) was created, including six integrated centers in Brazil. This article represents the initial outcome of the efforts by RASZ. OBJECTIVE To evaluate the prevalence of bladder and bowel dysfunction, cryptorchidism and other urological sequelae related to CZS in cohorts attended in six Brazilian states. STUDY DESIGN Observational, prospective, multicenter study including children with CZS assisted in one of six RASZ collaborative centers between June 2016 and February 2023. Data were collected from patient's first assessment using the same protocols for urological and bowel evaluation. Categorical variables were analyzed by frequency of occurrence and numerical variables by mean, median, and standard deviation. The study was approved by the Research Ethics Committees of each center, all parents/caregivers provided written informed consent. RESULTS The study included 414 children aged 2 months to 7 years (mean 2.77 years, SD 1.73), 227 (54.8 %) were male and 140 (33,8 %) referred urological and bowel symptoms on arrival. Prevalence of both urological and bowel sequelae was 66.7 %, 51 % of children aged 4 years and older had urinary incontinence (UI). UTI was confirmed in 23.4 % (two presented toxemia) and among males, 18.1 % had cryptorchidism. Renal ultrasonography, performed in 186 children, was abnormal in 25 (13.4 %), 7 had hydronephrosis. Among the 287 children who performed urodynamics, 283 (98.6 %) were altered: 232 had a lower bladder capacity, 144 a maximum bladder pressure of ≥40 cm H2O, and 127 did not satisfactorily empty their bladder. DISCUSSION A higher prevalence of NLUTD, neurogenic bowel and cryptorchidism was confirmed in children with CZS. Early diagnosis and appropriate treatment, including a multidisciplinary approach, may reduce the risk of UTIs, UI and kidney damage. A limitation of the study was the inability of children to complete the protocol, specifically urodynamic evaluation, and ultrasonography. In both exams, the percentage of abnormal cases was higher than that expected in the normal population. CONCLUSION A 66,7 % prevalence of combined urological sequelae and bladder-bowel dysfunction related to CZS was confirmed in patients evaluated in six Brazilian cohorts. The most frequent changes were related to NLUTD, neurogenic bowel, and cryptorchidism. Prevalence may be underestimated due to access restrictions to diagnostic tests.
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Affiliation(s)
- Juliana Marin Fontes
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil.
| | | | | | - Glaura Nisya de Oliveira Cruz
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Marta Rizzini
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | - Saulo Duarte Passos
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Lilian Lira Lisboa
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Grace Ferreira de Araújo
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Valéria Azevedo de Almeida
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Jociele Malacarne
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | - Lilian Cagliari Linhares Barreto
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Rafael Pauletti Gonçalves
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Luana Farache
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | | | - Fábio Valente Rizzo
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Luiz Dias da Silva
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | | | - Hannah Cavalcante Guedes Pinheiro
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Adriana Suely de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Fabiana de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Rômulo Dias Moreira
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | | | | | - Margareth Catoia Varela
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional Infectologia (INI), Laboratório de Pesquisa em Imunização e Vigilância em Saúde - Oswaldo Cruz Foundation (Fiocruz), Health Surveillance and Immunization Research Unit - Rio de Janeiro, RJ, Brazil
| | - Lucia Maria Costa Monteiro
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
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Calado AM, Seixas F, Dos Anjos Pires M. Virus as Teratogenic Agents. Methods Mol Biol 2024; 2753:105-142. [PMID: 38285335 DOI: 10.1007/978-1-0716-3625-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Viral infectious diseases are important causes of reproductive disorders, as abortion, fetal mummification, embryonic mortality, stillbirth, and congenital abnormalities in animals and in humans. In this chapter, we provide an overview of some virus, as important agents in teratology.We begin by describing the Zika virus, whose infection in humans had a very significant impact in recent years and has been associated with major health problems worldwide. This virus is a teratogenic agent in humans and has been classified as a public health emergency of international concern (PHEIC).Then, some viruses associated with reproductive abnormalities on animals, which have a significant economic impact on livestock, are described, as bovine herpesvirus, bovine viral diarrhea virus, Schmallenberg virus, Akabane virus, and Aino virus.For all viruses mentioned in this chapter, the teratogenic effects and the congenital malformations associated with fetus and newborn are described, according to the most recent scientific publications.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Mukhopadhyay K, Sengupta M, Misra SC, Majee K. Trends in emerging vector-borne viral infections and their outcome in children over two decades. Pediatr Res 2024; 95:464-479. [PMID: 37880334 DOI: 10.1038/s41390-023-02866-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
This review utilizes quatitative methods and bibliometric data to analyse the trends of emerging and re-emerging vector-borne diseases, with a focus on their impact on pediatric population. To conduct this analysis, a systematic search of PubMed articles from the past two decades was performed, specifically looking at 26 different vector-borne viruses listed in WHO and CDC list of vector-borne viruses. The review found that diseases like Dengue, Zika, West Nile, and Chikungunya were frequently discussed in the literature. On the other hand, diseases such as Tick-borne encephalitis, Rift Valley fever, Venezuelan equine encephalitis, Sindbis fever, Venezuelan equine encephalitis, Ross River virus, and Eastern equine encephalitis showed an upward trend in publications, indicating potential resurgence. In addition to discussing trends and patterns, the review delves into the clinical manifestations and long-term effects of the top 10 viruses in children. It highlights various factors including deforestation, urbanization, global travel, and immunosuppression that contribute to disease emergence and resurgence. To effectively combat these vector-borne diseases, continuous surveillance is crucial. The review also emphasizes the importance of increased vaccination efforts and targeted research to address the health challenges they pose. IMPACT: This review employs quantitative analysis of publications to elucidate trends in emerging pediatric vector-borne viral diseases over two decades. Dengue, the most prevalent of these diseases, has spread to new regions. New strains of Japanese Encephalitis have caused outbreaks. Resurgence of Tick-borne Encephalitis, West Nile, and Yellow Fever due to vaccine hesitancy has also transpired. Continuous global surveillance, increased vaccination, and research into novel therapeutics are imperative to combat the substantial morbidity and mortality burden these diseases pose for children worldwide.
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Affiliation(s)
| | - Mallika Sengupta
- Microbiology, AIIMS Kalyani, Basantapur, Saguna, West Bengal, India
| | | | - Kiranmay Majee
- Student, AIIMS Kalyani, Basantapur, Saguna, West Bengal, India
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Bhattacharjee S, Ghosh D, Saha R, Sarkar R, Kumar S, Khokhar M, Pandey RK. Mechanism of Immune Evasion in Mosquito-Borne Diseases. Pathogens 2023; 12:635. [PMID: 37242305 PMCID: PMC10222277 DOI: 10.3390/pathogens12050635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
In recent decades, mosquito-borne illnesses have emerged as a major health burden in many tropical regions. These diseases, such as malaria, dengue fever, chikungunya, yellow fever, Zika virus infection, Rift Valley fever, Japanese encephalitis, and West Nile virus infection, are transmitted through the bite of infected mosquitoes. These pathogens have been shown to interfere with the host's immune system through adaptive and innate immune mechanisms, as well as the human circulatory system. Crucial immune checkpoints such as antigen presentation, T cell activation, differentiation, and proinflammatory response play a vital role in the host cell's response to pathogenic infection. Furthermore, these immune evasions have the potential to stimulate the human immune system, resulting in other associated non-communicable diseases. This review aims to advance our understanding of mosquito-borne diseases and the immune evasion mechanisms by associated pathogens. Moreover, it highlights the adverse outcomes of mosquito-borne disease.
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Affiliation(s)
| | - Debanjan Ghosh
- Department of Biotechnology, Pondicherry University, Puducherry 605014, India
| | - Rounak Saha
- Department of Biochemistry and Molecular Biology, Pondicherry University, Puducherry 605014, India
| | - Rima Sarkar
- DBT Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, India
| | - Saurav Kumar
- DBT Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, India
| | - Manoj Khokhar
- Department of Biochemistry, AIIMS, Jodhpur 342005, India
| | - Rajan Kumar Pandey
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, 171 77 Solna, Sweden
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Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model. Viruses 2022; 14:v14102108. [PMID: 36298663 PMCID: PMC9611262 DOI: 10.3390/v14102108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023] Open
Abstract
Understanding functioning and disabilities in children with Congenital Zika Syndrome (CZS) is essential for health planning. We describe disabilities present in children with CZS followed in a reference hospital in Rio de Janeiro, Brazil, based on the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). This was a cohort study of children >3 years of age with CZS. Disability was characterized through outcomes related to ICF components assessed via clinical and motor development evaluations. Among 50 children, with a median age of 40 months, 47 (94%) presented with severe impairment and 46 (92%) had microcephaly. Damage to the head and neck was found in most children, with abnormal central nervous system imaging universally present. Most children had cognitive impairment (92%), muscle tone problems (90%), and speech deficits (94%). We found movement limitations in all categories but more pervasively (80−94%), in postural transfers and displacements. The main environmental factors identified in the ICF model were the use of products or substances for personal consumption and access to health services. Children with CZS have extremely high rates of disability beyond aged 3 years, particularly regarding motor activity. ICF-based models can contribute to the assessment of health domains.
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de Vasconcelos RAL, Ximenes RADA, Calado AA, Martelli CMT, Veras Gonçalves A, Brickley EB, de Araújo TVB, Wanderley Rocha MA, Miranda-Filho DDB. Zika-Related Microcephaly and Its Repercussions for the Urinary Tract: Clinical, Urodynamic, Scintigraphic and Radiological Aspects. Viruses 2022; 14:v14071512. [PMID: 35891492 PMCID: PMC9320115 DOI: 10.3390/v14071512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Aims: Describing the urodynamic parameters of children aged 3 to 5 years with microcephaly related to congenital Zika syndrome and verifying the association with clinical, imaging and neurological characteristics. Methods: From October 2018 to March 2020, children with Zika-related microcephaly underwent urological, ultrasonographic and urodynamic evaluation. In selected cases, complementary exams such as urethrocystography and scintigraphy were performed. The children also underwent a complete neurological evaluation. To compare frequency between groups, we used Pearson’s chi-squared test or Fisher’s exact test. Results: This study evaluated 40 children, of whom 85% were 4 years old, and all had abnormalities on the urodynamic study, with low bladder capacity (92.5%) and detrusor overactivity (77.5%) as the most frequent findings. Only three children had ultrasound abnormalities, but no child had cystographic or scintigraphic abnormalities, and the postvoid residual volume was normal in 80% of cases. In spite of a frequency of 67.5% of intestinal constipation, there was no record of febrile urinary tract infection after the first year of life. All children presented severe microcephaly and at least one neurological abnormality in addition to microcephaly. The homogeneity of the children in relation to microcephaly severity and neurological abnormalities limited the study of the association with the urodynamic parameters. Conclusions: Urodynamic abnormalities in children aged 3 to 5 years with Zika-related microcephaly do not seem to characterize a neurogenic bladder with immediate risks for the upper urinary tract. The satisfactory bladder emptying suggests that the voiding pattern is reflex.
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Affiliation(s)
- Rômulo Augusto Lucena de Vasconcelos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Correspondence: (R.A.L.d.V.); (D.d.B.M.-F.); Tel./Fax: +558131833510 (R.A.L.d.V. & D.d.B.M.-F.)
| | - Ricardo Arraes de Alencar Ximenes
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Adriano Almeida Calado
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
| | | | - Andreia Veras Gonçalves
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Elizabeth Bailey Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | | | - Maria Angela Wanderley Rocha
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
| | - Demócrito de Barros Miranda-Filho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Correspondence: (R.A.L.d.V.); (D.d.B.M.-F.); Tel./Fax: +558131833510 (R.A.L.d.V. & D.d.B.M.-F.)
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Ferreira RVB, Pinheiro HCG, de Oliveira Melo F, Gama GL, Monteiro LMC, Fontes JM, de Oliveira Cruz GN, de Araújo GF, Amorim MMR, Melo A. Urological outcomes in children with congenital Zika syndrome: The experience of a cohort in Campina Grande, Brazil. Trop Med Int Health 2022; 27:583-591. [PMID: 35441418 DOI: 10.1111/tmi.13754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe the urological outcomes in children with congenital Zika syndrome (CZS) and investigate the relationship between clinical and urological findings in this population. METHODS This cross-sectional study involved children with CZS followed up by a referral centre for children with microcephaly in the state of Paraiba in northeast Brazil. The urological evaluation included clinical history, urine culture results, ultrasonography of the urinary tract, and urodynamic evaluation, following the protocol proposed by Costa Monteiro et al. (2017). Descriptive statistical analysis was performed in addition to association and correlation tests, considering clinical and urodynamic variables. RESULTS Among the 88 children with CZS (35.5 ± 5.5 months), 97.7% had microcephaly, and 51% presented urinary tract infection (UTI) confirmed with clinical history and lab tests. The number of confirmed UTI episodes varied from one to 14 per child. The urodynamic evaluation confirmed the presence of an overactive bladder in 78 children and incomplete voiding in 50. Urodynamic findings were associated with the number of confirmed UTI episodes, child's sex, and actual weight, in addition to the use of anticonvulsant and myorelaxant drugs. CONCLUSIONS UTIs were confirmed in most children. Other urological outcomes observed were overactive bladder and low bladder capacity, which were associated with the number of confirmed UTI episodes, use of anticonvulsants and myorelaxants, and the child's sex and weight. These are treatable conditions, and it is paramount that paediatricians, neonatologists, and infectious disease specialists are aware of them to make clinical decisions and help reduce the risk of renal damage and other morbidities.
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Affiliation(s)
| | | | | | - Gabriela Lopes Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA, Campina Grande, Paraíba, Brazil
| | | | | | | | | | | | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande, Paraíba, Brazil.,UNIFACISA, Campina Grande, Paraíba, Brazil
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de Aguiar EB, Pone SM, Gomes Junior SCDS, Soares FVM, Zin AA, Vasconcelos ZFM, Ribeiro CTM, Pereira Junior JP, Moreira MEL, Nielsen-Saines K, Pone MVDS. Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life. Viruses 2022; 14:v14050876. [PMID: 35632618 PMCID: PMC9147871 DOI: 10.3390/v14050876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/20/2022] Open
Abstract
Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from −0.45 ± 0.1 to 0.27 ± 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus −1.84 ± 0.2 to −2.15 ± 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from −0.3 ± 0.1 at 1 month to 0.17 ± 0.2 SD between 31 and 36 months in the NCZS group, versus −2.3 ± 0.3 to −2.0 ± 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 ± 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 ± 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.
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Affiliation(s)
- Elisa Barroso de Aguiar
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
- Correspondence: ; Tel.: +55-21-99584-9013
| | - Sheila Moura Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Saint Clair dos Santos Gomes Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Fernanda Valente Mendes Soares
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Andrea Araujo Zin
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Zilton Farias Meira Vasconcelos
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Carla Trevisan Martins Ribeiro
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - José Paulo Pereira Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Maria Elisabeth Lopes Moreira
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Karin Nielsen-Saines
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Marcos Vinicius da Silva Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
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9
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Congenital Zika Infection and the Risk of Neurodevelopmental, Neurological, and Urinary Track Disorders in Early Childhood. A Systematic Review. Viruses 2021; 13:v13081671. [PMID: 34452535 PMCID: PMC8402620 DOI: 10.3390/v13081671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 01/25/2023] Open
Abstract
It was late 2015 when Northeast Brazil noticed a worrying increase in neonates born with microcephaly and other congenital malformations. These abnormalities, characterized by an abnormally small head and often neurological impairment and later termed Congenital Zika Syndrome, describe the severity of neurodevelopmental and nephrological outcomes in early childhood, and the implication of microcephaly at birth. The purpose of the study was to describe the neurodevelopmental outcomes in children exposed to Zika virus during fetal life, with and without microcephaly at birth. The systematic review included research studies about the neurodevelopmental outcomes with and without microcephaly, as well as nephrological outcomes in early childhood. We searched PubMed, Crossref, PsycINFO, Scopus, and Google Scholar publications and selected 19 research articles published from 2018 to 2021. Most studies have linked the severity of microcephaly in childbirth to the neurodevelopmental and urinary outcomes in early childhood. However, most children without microcephaly at birth develop typically, while others may be at risk for language impairment.
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10
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Cruz GN, Monteiro AC, Gomes Junior SC, Fontes JM, Saad T, Costa Monteiro LM. Virus-related neurological lower urinary tract dysfunction: Lessons learned during 4-year follow-up of patients with Congenital Zika Syndrome. J Pediatr Urol 2021; 17:523.e1-523.e9. [PMID: 33934997 PMCID: PMC10105604 DOI: 10.1016/j.jpurol.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/08/2021] [Accepted: 04/11/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We have previously reported on neurogenic bladder dysfunction among Congenital Zika Vírus Syndrome (CZS) patients, but it is unknown how they will respond to treatment. OBJECTIVE To assess whether children with neurological lower urinary tract dysfunction and CZS will respond to Standard therapies. METHODOLOGY A prospective observational cohort study of children with CZS referred for urological assessment between 2016 and 2020 to our quaternary center in Brazil. Urological protocol included clinical history, urinalysis and culture, renal and bladder ultrasonography and urodynamic study. Patients were treated based on findings from the first evaluation, with oxybutynin chloride for overactive bladder and low bladder compliance, clean intermittent catheterization for ineffective bladder emptying, or dual therapy when both were observed. Urological outcomes were evaluated between the first and second visits considering patient's adherence. Outcomes measured included clinical, imaging, and urodynamic variables. Data was analyzed using the IBM SPSS 22 software. RESULTS From the cohort of 90 patients, 56 completed the second urodynamic assessment and were included. One presented underactive bladder and 55 overactive bladder. Among these 55, 39 were adherent and 16 non-adherents to the prescribed treatment. Among the 39 adherents, 8 adhered regularly to oxybutynin and clean intermittent catheterization (CIC), 29 to oxybutynin alone, and two to catheterization alone. During follow-up, the number of patients with urinary tract infection and postvoid residual increased, but all other parameters had improved. Renal and bladder ultrasonography improved in 10, maximum bladder pressure decreased in 22 and maximum cystometric capacity and compliance increased in 14 patients. Sixteen patients did not adhere regularly to the prescribed treatment and although the number of patients with urinary tract infection reduced with antibiotic therapy, their bladder capacity and compliance did not improve during follow-up. DISCUSSION Ultrasonographic and urodynamic improvements were observed after 10.8 ± 7.5 months of treatment, including one patient with ureterohydronephrosis that resolved. Adherence to CIC remains a challenge and reflected in the number of patients presenting urinary tract infection and postvoid residual. The immediate clinical relevance is the major study strength, given the previously uncharacterized therapy options for this patient population. The number of patients remains one of the study limitations, reducing our ability to perform more advanced statistical analyses. CONCLUSION Patients with Zika-related neurological lower urinary tract dysfunction may benefit from conventional therapies. Results confirmed ultrasonographic and urodynamic improvements after treatment, although not statically significant. Adherence to treatment, specifically to CIC, remains a challenge.
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Affiliation(s)
- G N Cruz
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | | | - S C Gomes Junior
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | - Juliana M Fontes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | - T Saad
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
| | - L M Costa Monteiro
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
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11
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do Amaral YNDV, Malacarne J, Brandão PG, Brasil P, Nielsen-Saines K, Moreira MEL. Time to Evaluate the Clinical Repercussions of Zika Virus Vertical Transmission? A Systematic Review. Front Psychiatry 2021; 12:699115. [PMID: 34526920 PMCID: PMC8435783 DOI: 10.3389/fpsyt.2021.699115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
| | - Jocieli Malacarne
- Department of Pediatrics, Instituto Fernandes Figueira, Rio de Janeiro, Brazil
| | | | - Patrícia Brasil
- Department of Acute Febrile Illnesses, Instituto Nacional de Infectologia, Rio de Janeiro, Brazil
| | - Karin Nielsen-Saines
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Ramond A, Lobkowicz L, Clemente NS, Vaughan A, Turchi MD, Wilder-Smith A, Brickley EB. Postnatal symptomatic Zika virus infections in children and adolescents: A systematic review. PLoS Negl Trop Dis 2020; 14:e0008612. [PMID: 33006989 PMCID: PMC7556487 DOI: 10.1371/journal.pntd.0008612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/14/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. However, little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence. METHODS We conducted a systematic review on the clinical presentation and complications of children and adolescents aged 0 to 18 years with a robust diagnosis of ZIKV infection. We searched PubMed, Web of Science, LILACs, and EMBASE until 13 February 2020 and screened reference lists of eligible articles. We assessed the studies' risk of bias using pre-specified criteria. FINDINGS Our review collated the evidence from 2543 pediatric ZIKV cases representing 17 countries and territories, identified in 1 cohort study, 9 case series and 22 case reports. The most commonly observed signs and symptoms of ZIKV infection in children and adolescents were mild and included fever, rash, conjunctivitis and arthralgia. The frequency of neurological complications was reported only in the largest case series (identified in 1.0% of cases) and in an additional 14 children identified from hospital-based surveillance studies and case reports. ZIKV-related mortality was primarily accompanied by co-morbidity and was reported in one case series (<0.5% of cases) and three case reports. One death was attributed to complications of Guillain-Barré Syndrome secondary to ZIKV infection. CONCLUSIONS AND RELEVANCE Based on the current evidence, the clinical presentation of ZIKV infection in children and adolescents appears to be primarily mild and similar to the presentation in adults, with rare instances of severe complications and/or mortality. However, reliable estimation of the risks of ZIKV complications in these age groups is limited by the scarcity and quality of published data. Additional prospective studies are needed to improve understanding of the relative frequency of the signs, symptoms, and complications associated with pediatric ZIKV infections and to investigate any potential effects of early life ZIKV exposure on neurodevelopment.
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Affiliation(s)
- Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ludmila Lobkowicz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aisling Vaughan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil (Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil)
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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13
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de Vasconcelos RAL, Ximenes RAA, Calado AA, Martelli CMT, Gonçalves AV, Brickley EB, de Araújo TVB, Wanderley Rocha MA, Miranda-Filho DDB. Cryptorchidism in Children with Zika-Related Microcephaly. Am J Trop Med Hyg 2020; 102:982-984. [PMID: 32157994 PMCID: PMC7204599 DOI: 10.4269/ajtmh.19-0753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The genitourinary tract was recently identified as a potential site of complications related to the congenital Zika syndrome (CZS). We provide the first report of a series of cryptorchidism cases in 3-year-old children with Zika-related microcephaly who underwent consultations between October 2018 and April 2019 as part of the follow-up of the children cohort of the Microcephaly Epidemic Research Group, Pernambuco, Brazil. Of the 22 males examined, eight (36.4%) presented with cryptorchidism. Among 14 undescended testis cases, 11 (78.6%) could be palpated in the inguinal region. Seven of the eight children had severe microcephaly. Conventional risk factors for cryptorchidism were relatively infrequent in these children. We hypothesize that cryptorchidism is an additional manifestation of CZS present in children with severe microcephaly. As in our cases, for most of the children, the testes were located in the inguinal region, and the possible mechanisms for cryptorchidism were gubernaculum disturbance or cremasteric abnormality.
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Affiliation(s)
| | - Ricardo A A Ximenes
- Universidade Federal de Pernambuco, Recife, Brazil.,Universidade de Pernambuco, Recife, Brazil
| | | | | | - Andreia V Gonçalves
- Universidade Federal de Pernambuco, Recife, Brazil.,Universidade de Pernambuco, Recife, Brazil
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14
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Mora-Salamanca AF, Porras-Ramírez A, De la Hoz Restrepo FP. Estimating the burden of arboviral diseases in Colombia between 2013 and 2016. Int J Infect Dis 2020; 97:81-89. [PMID: 32434085 DOI: 10.1016/j.ijid.2020.05.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE During the 2013-2016 period, Dengue, Chikungunya, and Zika affected more than 1 million people in Colombia. These arboviruses and their chronic manifestations pose a public health challenge. Therefore, we estimated the burden of disease by Dengue, Chikungunya, and Zika in Colombia between 2013 and 2016. METHODS An exploratory ecological study was carried out using the disability-adjusted life years (DALYs) as a unit of measure. The mortality databases of the National Administrative Department of Statistics (DANE) and the morbidity databases of the National Public Health Surveillance System (SIVIGILA) were used. Deaths and cases for each arbovirus were grouped and then adjusted to control biases. Subsequently, we performed a sensitivity analysis. RESULTS In the 2013-2016 period, 491,629.2 DALYs were lost due to arboviruses in Colombia. By disease, 26.6% of the total DALYs were caused by Dengue, 71.3% by Chikungunya, and the remaining 2.2%, by Zika. The majority of DALYs (68.2%) were caused by chronic complications. Five out of 32 departments (Valle del Cauca, Tolima, Norte de Santander, Huila, and Bolívar) contributed 50.5% of total DALYs. CONCLUSION The burden of disease by arboviruses in the 2013-2016 period exceeded the burden of other infectious diseases such as HIV/AIDS and tuberculosis in Colombia. Public health efforts must be made to mitigate new epidemics of these arboviruses.
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Affiliation(s)
| | - Alexandra Porras-Ramírez
- Grupo de Epidemiología y Evaluación en Salud pública, Universidad Nacional de Colombia, Bogotá, Colombia; Grupo Medicina Comunitaria y Salud Colectiva, Universidad El Bosque, Bogotá, Colombia; Coordinación de Epidemiología e Investigación, Los Cobos Medical Center. Bogotá, Colombia.
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15
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Pereira HVFS, Dos Santos SP, Amâncio APRL, de Oliveira-Szejnfeld PS, Flor EO, de Sales Tavares J, Ferreira RVB, Tovar-Moll F, de Amorim MMR, Melo A. Neurological outcomes of congenital Zika syndrome in toddlers and preschoolers: a case series. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:378-387. [PMID: 32199080 DOI: 10.1016/s2352-4642(20)30041-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Congenital Zika syndrome causes a spectrum of neurological symptoms with varying effects on function that require different therapeutic strategies. To date, this spectrum of effects and its clinical implications have not been completely described. We describe the neurological examination findings in toddlers and preschoolers, including predominant symptom complexes and comorbidities. METHODS This study is a case-series neurological evaluation of 75 children with congenital Zika syndrome in Campina Grande, Brazil. The study is part of a cohort of children with congenital Zika syndrome that started in 2015 and is still ongoing. Children with Zika virus infection detected during pregnancy (mothers exhibited rash and were followed and diagnosed by fetal ultrasound abnormalities or RT-PCR) or through microcephaly screening after birth, using Intergrowth 21 guidelines, were selected by laboratory and radiological criteria. Children were examined during a 10-day period in September, 2018, and underwent neurological interview, examination, and assessment of functional outcomes and comorbidities. Children were divided in groups of predominant corticospinal or neuromuscular clinical signs and the associations between these groups and clinical comorbidities were assessed. FINDINGS All of the children recruited to the study from Nov 29, 2015 to Nov 30, 2017 had imaging correlates of congenital Zika syndrome. Children were assigned to groups depending on the signs exhibited, either corticospinal or neuromuscular, with or without dyskinetic signs. 75 children completed the evaluation, 38 (51%) girls and 37 (49%) boys. Median age was 33 months (range 26-40 months; IQR 29-34). Microcephaly was present at birth in 56 (75%) children, and 19 (25%) children were born with normal head circumference, 15 of whom later developed microcephaly. Neurological examination grouped four children as having isolated dyskinetic signs, 48 children were assigned to the corticospinal group and 23 into the neuromuscular group. Dyskinetic findings were present in 30 (40%) children, either alone (four [5%]) or combined with corticospinal (19 [40%] of 48) or neuromuscular (seven [30%] of 23) findings. Comorbidities were highly prevalent, and the neuromuscular group had worse functional outcomes, evaluated by gross motor function (p=0·026), manual abilities (p=0·0013), and communication function (p<0·0005) classification scales, than the corticospinal group, whereas pneumonia (p<0·0005) and urinary tract infections (p<0·0005) were more frequent in the corticospinal group. Cortical hyperexcitability was supported by several clinical correlates, such as early onset epilepsy, persistence of primitive reflexes, and dystonia. INTERPRETATION We describe distinct neurological profiles in the congenital Zika syndrome spectrum, with functional outcomes tending to correlate with these groups. The clinical division of children based on the disease signs proposed here is supported by the literature on central and peripheral nervous system pathology in congenital Zika syndrome. The high prevalence of dyskinetic symptoms merits special attention. FUNDING Brazilian National Council for Scientific and Technological Development and by the Coordination for the Improvement of Higher Education Personnel.
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Affiliation(s)
- Heloisa Viscaino Fernandes Souza Pereira
- Department of Pediatrics, Pediatric Neurology Clinic, Rio de Janeiro State University, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
| | - Stella Pinto Dos Santos
- Department of Pediatrics, Pediatric Neurology Clinic, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Patricia Soares de Oliveira-Szejnfeld
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil; Foundation Institute for Education and Research in Diagnostic Imaging, Federal University of São Paulo, São Paulo, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Edneusa Oliveira Flor
- Department of Pediatrics, Pediatric Neurology Clinic, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Fernanda Tovar-Moll
- Institute of Biomedical Sciences and National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Melania Maria Ramos de Amorim
- Research Institute Professor Amorim Neto, Campina Grande, Brazil; Federal University of Campina Grande, Campina Grande, Brazil; The Professor Fernando Figueira Integral Medicine Institute, Recife, Brazil
| | - Adriana Melo
- Research Institute Professor Amorim Neto, Campina Grande, Brazil; Federal University of Campina Grande, Campina Grande, Brazil; UNIFACISA - University Center, Campina Grande, Brazil
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16
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Fuzo CA, de Araujo LFL, Pontes RDS, Évora PM, Stabeli RG. Adjacent dimer epitope of envelope protein as an important region for Zika virus serum neutralization: a computational investigation. J Biomol Struct Dyn 2020; 39:1082-1092. [PMID: 32090677 DOI: 10.1080/07391102.2020.1728385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The recent emergence of Zika virus (ZIKV) has affected many countries, with severe clinical manifestations such as fetal microcephaly and Guillain-Barré syndrome. However, even though it is a major public health concern, there is no approved treatment available. Structural knowledge of the main neutralization regions of the envelope (E) protein of ZIKV and its interactions with neutralizing antibodies (nAbs) are crucial for the rational development of subunit vaccines and establishment of antibody-based interventions. In this study we screened from public data hot spot epitopes in conserved regions of ZIKV E protein that are nAbs targets. The result points to a conserved epitope located at domain II of the ZIKV E protein, namely adjacent dimer epitope, which is the ZIKV-117 and Z20 nAbs target. Although these two nAbs have been isolated from different donors, we have demonstrated, from structural and energetic details obtained by molecular dynamics of native and mutants, that hot spots residues of the epitope are the same for these nAbs, thereby indicating that they may share similar binding and neutralization mechanism. This convergence of information between these nAbs is important because both are potential targets for the development of therapies against ZIKV and only Z20 has its sequence and its complex structure with ZIKV E protein determined. Finally, these findings also contribute to existing knowledge, by fine mapping of the epitope/paratope residue pairs that are important for biotechnological development of therapies such as epitope mimetics for subunit vaccines and the rational design for antibody-based interventions against ZIKV. Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Carlos Alessandro Fuzo
- Plataforma de Pesquisa em Medicina Translacional, Fundação Oswaldo Cruz - Fiocruz SP, São Paulo, Brazil.,Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Felipe Lemes de Araujo
- Plataforma de Pesquisa em Medicina Translacional, Fundação Oswaldo Cruz - Fiocruz SP, São Paulo, Brazil.,Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rafael de Souza Pontes
- Plataforma de Pesquisa em Medicina Translacional, Fundação Oswaldo Cruz - Fiocruz SP, São Paulo, Brazil.,Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Patricia Martinez Évora
- Plataforma de Pesquisa em Medicina Translacional, Fundação Oswaldo Cruz - Fiocruz SP, São Paulo, Brazil.,Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Guerino Stabeli
- Plataforma de Pesquisa em Medicina Translacional, Fundação Oswaldo Cruz - Fiocruz SP, São Paulo, Brazil.,Departamento de Bioquímica e Imunologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Venceslau EM, Guida JPS, Nobrega GDM, Samogim AP, Parise PL, Japecanga RR, de Toledo-Teixeira DA, Forato J, Antolini-Tavares A, Souza A, Altemani A, Consonni SR, Passini R, Amaral E, Proenca-Modena JL, Costa ML. Adequate Placental Sampling for the Diagnosis and Characterization of Placental Infection by Zika Virus. Front Microbiol 2020; 11:112. [PMID: 32153521 PMCID: PMC7047998 DOI: 10.3389/fmicb.2020.00112] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/17/2020] [Indexed: 11/13/2022] Open
Abstract
The detection of Zika virus (ZIKV) in immunoprivileged anatomical sites, potential sites for viral persistence, may guide the confirmation of undefined cases of ZIKV infection and also bring to light unknown pathways of viral transmission. Thus, this study aimed to characterize ZIKV infection in stratified, standardized placental samples in women with exanthematic febrile manifestations during pregnancy and compare findings to the standard investigation protocol of official health agencies. To this end, a case series of placental findings within a prospective cohort study was conducted over a period of 24 months. Serum/urine were obtained at the time of clinical case identification. Placental sampling was performed following standard investigation protocol (samples of 1.0 cm sent to a reference laboratory) and in a systematic way at various regions, such as chorionic plate, chorionic villi, basal plate, amniotic membrane, and umbilical cord, for subsequent ZIKV identification and quantification. Clinical information was obtained and histological preparation with hematoxylin–eosin staining for morphological evaluation was performed. This case series included 17 placentas systematically collected. Of these, 14 were positive by qRT-PCR for ZIKV, 5 in the umbilical cord, 7 in the amniotic membrane, 7 in the chorionic plate, 13 in the chorionic villi, and 7 in the basal plate, whereas none were reported by the reference laboratory. The most common morphological and anatomopathological findings were increased stromal cellularity, villitis, calcification, maternal vascular malperfusion, placental hypoplasia, and maternal–fetal hemorrhage (intervillous thrombi). Seven women presented positive testing for ZIKV in serological and/or molecular tests during gestation in urine. While viral quantification in urine ranged from 101 to 103 FFU eq/ml, that in different placental regions ranged from 103 to 108 FFU eq/g. Thus, ZIKV can infect different regions of the placenta and umbilical cord of pregnant women, showing that the systematic collection and adequate storage of the placenta is fundamental for the detection of ZIKV in this organ. The detection of ZIKV in the placenta after several months of initial symptoms suggests that this tissue may be a site for viral persistence during pregnancy.
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Affiliation(s)
- Emanuella Meneses Venceslau
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - José Paulo Siqueira Guida
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Guilherme de Moraes Nobrega
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Ana Paula Samogim
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Pierina Lorencini Parise
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Rodolfo Rosa Japecanga
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Julia Forato
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Arthur Antolini-Tavares
- Department of Pathological Anatomy, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Arethusa Souza
- Department of Pathological Anatomy, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Albina Altemani
- Department of Pathological Anatomy, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Silvio Roberto Consonni
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Renato Passini
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Eliana Amaral
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose Luiz Proenca-Modena
- Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, Brazil
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Costa Monteiro LM, Cruz GNDO, Fontes JM, de Araujo GF, Ventura T, Monteiro AC, Moreira MEL. Neurogenic bladder in the settings of congenital Zika syndrome: a confirmed and unknown condition for urologists. J Pediatr Urol 2019; 15:450.e1-450.e7. [PMID: 31142443 DOI: 10.1016/j.jpurol.2019.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/20/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Congenital Zika syndrome (CZS) is a recently discovered condition that affects central nervous system structures that control the lower urinary tract. The first cases of neurogenic bladder (NB) were recently reported as a sequalae of CZS in neurologically impaired children. OBJECTIVE Our goal is to further evaluate NB in the setting of CZS, identifying urological risk indicators in hopes that early diagnosis will mitigate the impact of the disease. STUDY DESIGN Urological assessment was performed in all patients with CZS and neurological impairment who were referred to our urodynamic clinic between June 2016 and May 2018. Neurogenic bladder was confirmed by urodynamic evaluation, and urological risk was based on urodynamic results. RESULTS Sixty-nine patients with CZS were tested. The majority (63 patients, 91.3%) presented with overactive bladder with increased pressures and reduced capacity for age (table 1). Different urodynamic patterns were observed, and the association of reduced bladder capacity for age, high bladder-filling pressure, and increased postvoid residual were frequently observed. DISCUSSION NB continues to be consistently diagnosed in our cohort of CZS, mostly with high-risk indicators for renal impairment. When not intervened upon in a timely manner, NB can cause progressive damage to the urinary tract, but the lack of knowledge that CZS causes NB delays investigation and treatment. Parents and health professionals will need to be sensitized to the risks that ZIKV can pose to the urinary tract so that appropriate therapies are initiated to prevent irreversible renal damage. CONCLUSION NB is a common condition among our patients with CZS and microcephaly. This is a new cause of NB, unknown to urologists. While further investigation is necessary to understand long-term disease behavior and therapeutic response, increased knowledge among urologists may help to reduce morbidity related to untreated NB and to mitigate the disease burden for patients and families.
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Affiliation(s)
- L M Costa Monteiro
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil.
| | - G N de O Cruz
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil
| | - J M Fontes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil
| | - G F de Araujo
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil
| | - T Ventura
- CAPES Research Student at Instituto Nacional de Saúde da Mulher, da Criança e Do Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil
| | - A C Monteiro
- UCLA. Division of Pulmonary and Critical Care Medicine, CA, USA
| | - M E L Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), RJ, Brazil
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Counotte MJ, Meili KW, Taghavi K, Calvet G, Sejvar J, Low N. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review. F1000Res 2019; 8:1433. [PMID: 31754425 PMCID: PMC6852328 DOI: 10.12688/f1000research.19918.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The Zika virus (ZIKV) caused a large outbreak in the Americas leading to the declaration of a Public Health Emergency of International Concern in February 2016. A causal relation between infection and adverse congenital outcomes such as microcephaly was declared by the World Health Organization (WHO) informed by a systematic review structured according to a framework of ten dimensions of causality, based on the work of Bradford Hill. Subsequently, the evidence has continued to accumulate, which we incorporate in regular updates of the original work, rendering it a living systematic review. Methods: We present an update of our living systematic review on the causal relation between ZIKV infection and adverse congenital outcomes and between ZIKV and GBS for four dimensions of causality: strength of association, dose-response, specificity, and consistency. We assess the evidence published between January 18, 2017 and July 1, 2019. Results: We found that the strength of association between ZIKV infection and adverse outcomes from case-control studies differs according to whether exposure to ZIKV is assessed in the mother (OR 3.8, 95% CI: 1.7-8.7, I
2=19.8%) or the foetus/infant (OR 37.4, 95% CI: 11.0-127.1, I
2=0%). In cohort studies, the risk of congenital abnormalities was 3.5 times higher after ZIKV infection (95% CI: 0.9-13.5, I
2=0%). The strength of association between ZIKV infection and GBS was higher in studies that enrolled controls from hospital (OR: 55.8, 95% CI: 17.2-181.7, I
2=0%) than in studies that enrolled controls at random from the same community or household (OR: 2.0, 95% CI: 0.8-5.4, I
2=74.6%). In case-control studies, selection of controls from hospitals could have biased results. Conclusions: The conclusions that ZIKV infection causes adverse congenital outcomes and GBS are reinforced with the evidence published between January 18, 2017 and July 1, 2019.
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Affiliation(s)
| | - Kaspar Walter Meili
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
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The Spectrum of Developmental Disability with Zika Exposure: What Is Known, What Is Unknown, and Implications for Clinicians. J Dev Behav Pediatr 2019; 40:387-395. [PMID: 30921103 PMCID: PMC7713528 DOI: 10.1097/dbp.0000000000000665] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Clinicians who treat children with neurodevelopmental disabilities may encounter infants with congenital Zika syndrome or those exposed to Zika virus (ZIKV), either in utero or postnatally, in their practice and may have questions about diagnosis, management, and prognosis. In this special report, we reviewed the current literature to provide a comprehensive understanding of the findings and needs of children exposed to ZIKV in utero and postnatally. The current literature is sparse, and thus, this review is preliminary. We found that infants and children exposed to ZIKV in utero have a variety of health and developmental outcomes that suggest a wide range of lifelong physical and developmental needs. Postnatal exposure does not seem to have significant long-lasting health or developmental effects. We provide a comprehensive examination of the current knowledge on health and developmental care needs in children exposed to Zika in utero and postnatally. This can serve as a guide for health care professionals on the management and public health implications of this newly recognized population.
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Villamil-Gómez WE, Padilla-Ruiz D, Mendoza A, Álvarez Á, Baldrich-Gomez O, Posso H, Campo-Urbina M, Parra-Saad EA, Rodríguez-Morales AJ. Urinary bladder agenesis and renal hypoplasia potentially related to in utero Zika virus infection. Int J Infect Dis 2019; 85:54-56. [PMID: 31129423 DOI: 10.1016/j.ijid.2019.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022] Open
Abstract
This case report describes the clinical findings of a 22-year-old pregnant woman with confirmed Zika virus infection, at 16 weeks of gestation, in Sucre, Colombia. Her ultrasound revealed severe oligohydramnios, intrauterine growth restriction, and a complete absence of the urinary bladder of the fetus. The poor prognosis led to the decision to terminate the pregnancy. Autopsy of the fetus revealed severe bilateral renal hypoplasia.
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Affiliation(s)
- Wilmer E Villamil-Gómez
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia; Programa del Doctorado de Medicina Tropical, SUE Caribe, Universidad del Atlántico, Barranquilla, Colombia
| | - Dionny Padilla-Ruiz
- Grupo Caribe de Investigación en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana, Barranquilla, Atlántico, Colombia
| | - Anibal Mendoza
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia
| | - Álvaro Álvarez
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia
| | - Oldrih Baldrich-Gomez
- Gynecology Service, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Huila, Colombia
| | - Heidi Posso
- Grupo Caribe de Investigación en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana, Barranquilla, Atlántico, Colombia
| | - Myrna Campo-Urbina
- Grupo Caribe de Investigación en Enfermedades de Tipo Infeccioso y Resistencia Microbiana, Universidad Metropolitana, Barranquilla, Atlántico, Colombia
| | | | - Alfonso J Rodríguez-Morales
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia; Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Medical School, Faculty of Health Sciences, UniFranz, Cochabamba, Bolivia.
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22
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Alcendor DJ. Zika virus infection and implications for kidney disease. J Mol Med (Berl) 2018; 96:1145-1151. [PMID: 30171265 PMCID: PMC6208949 DOI: 10.1007/s00109-018-1692-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 12/22/2022]
Abstract
High-level and persistent viruria observed in patients infected by Zika virus (ZIKV) has been well documented. However, renal pathology in acutely infected, immunocompetent patients remains subclinical. Moreover, the long-term impact of ZIKV infection, replication, and persistence in the renal compartment of adults and infants as well as immunosuppressed patients and solid organ transplant (SOT) recipients is unknown. Mechanisms involving host and viral factors that limit or control ZIKV pathogenesis in the renal compartment are important yet unexplored. The observation that long-term viral shedding occurs in the renal compartment in the absence of clinical disease requires further investigation. In this review, I explore Zika virus-induced renal pathology in animal models, the dynamics of virus shedding in urine, virus replication in glomerular cells, ZIKV infection in human renal transplantation, and the potential impact of long-term persistent ZIKV infection in the renal compartment.
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Affiliation(s)
- Donald J Alcendor
- Center for AIDS Health Disparities Research, Department of Microbiology, Immunology, and Physiology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., Hubbard Hospital, 5th Floor, Rm. 5025, Nashville, TN, 37208, USA.
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23
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Academy News. Neonatal Netw 2018; 37:254-259. [PMID: 30567925 DOI: 10.1891/0730-0832.37.4.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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