1
|
Aromolaran A, Araujo K, Ladines-Lim JB, Nery N, do Rosário MS, Rastely VN, Archanjo G, Daltro D, Carvalho GBDS, Pimentel K, de Almeida JRM, de Siqueira IC, Ribeiro HC, Oliveira-Filho J, de Oliveira D, Henriques DF, Rodrigues SG, Vasconcelos PFDC, de Almeida ARP, Sacramento GA, Cruz JS, Sarno M, Freitas BDP, Mattos A, Khouri R, Reis MG, Ko AI, Costa F. Unequal burden of Zika-associated microcephaly among populations with public and private healthcare in Salvador, Brazil. Int J Infect Dis 2022; 120:201-204. [PMID: 35470025 PMCID: PMC9119857 DOI: 10.1016/j.ijid.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe the differences in clinical presentation and relative disease burden of congenital Zika syndrome (CZS)-associated microcephaly at 2 large hospitals in Salvador, Brazil that serve patients of different socioeconomic status (SES). METHODS Clinical and serologic data were collected prospectively from pregnant women and their infants, who delivered at 2 study centers during the 2015-2016 Zika virus (ZIKV) epidemic in Salvador, Brazil. RESULTS Pregnant women from Salvador, Brazil delivering in a low SES hospital had 3 times higher ZIKV exposure rate than women at a high SES hospital. However, different SES hospitals had similar prevalence of infants with CZS-associated microcephaly (10% vs 6%, p = 0.16) after controlling for ZIKV exposure in their mothers. CONCLUSIONS Our study supports the positive association between low SES, high maternal ZIKV exposure, and high rates of CZS-associated microcephaly.
Collapse
Affiliation(s)
| | | | | | | | - Mateus S do Rosário
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Valmir N Rastely
- Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Gracinda Archanjo
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Dina Daltro
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | | | - Kleber Pimentel
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - João Ricardo Maltez de Almeida
- Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Hugo C Ribeiro
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Jamary Oliveira-Filho
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Antonio R P de Almeida
- Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Manoel Sarno
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil; Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK; Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Bruno de Paula Freitas
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil; Escola Paulista de Medicina, esc, São Paulo, Brazil
| | - Adriana Mattos
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | | | - Mitermayer G Reis
- Yale School of Public Health, New Haven, USA; Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Albert I Ko
- Yale School of Public Health, New Haven, USA
| | - Federico Costa
- Yale School of Public Health, New Haven, USA; Universidade Federal da Bahia, Salvador, Brazil.
| |
Collapse
|
2
|
Ventura CV, Zin A, Paula Freitas BD, Ventura LO, Rocha C, Costa F, Nery N, De Senna TCR, Lopes Moreira ME, Maia M, Belfort R. Ophthalmological manifestations in congenital Zika syndrome in 469 Brazilian children. J AAPOS 2021; 25:158.e1-158.e8. [PMID: 34082114 DOI: 10.1016/j.jaapos.2021.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To analyze the spectrum of ophthalmologic manifestations in a large sample of children with congenital Zika syndrome (CZS) in Brazil. METHODS The medical records of infants born in the states of Pernambuco, Bahia, and Rio de Janeiro, Brazil, between December 2015 and December 2016 with clinical manifestations of CZS and positive reverse transcription polymerase-chain-reaction (RT-PCR) and/or serology for the Zika virus were reviewed retrospectively. Data were collected from the record of the first ophthalmological assessment, performed on admission. Children with other congenital infectious diseases, genetic conditions, and incomplete medical records were excluded. RESULTS A total of 469 infants (242 female [51.6%]) were included. Mean age at examination was 5.0 ± 7.1 months (range, 0.0-36.0 months). Of the 469 infants, 197 (42.0%) were from Rio de Janeiro, 144 (30.7%) from Pernambuco, and 128 (27.3%) from Bahia States. Microcephaly at birth was detected in 214 (45.6%) children; 62 cases (29.0%) were severe. Pernambuco had significantly more children born with microcephaly compared with Bahia and Rio de Janeiro (P < 0.001). Ocular manifestations were found in 269 of 938 eyes (28.7%; 148/469 children [31.6%]). The main ocular alterations were optic nerve pallor in 122 of 938 eyes (13.0%), focal pigment mottling in 112 eyes (11.9%), and chorioretinal scars in 101 eyes (10.8%). A higher prevalence of ocular manifestations was seen in Pernambuco (P < 0.001). No microcephaly was observed in 252 of 466 children (54.1%); of these, 19 children (7.5%) had funduscopic findings. CONCLUSIONS One-third of children with CZS had ocular manifestations. Children from Pernambuco were more affected. Ocular abnormalities were found in 7.5% of children without microcephaly.
Collapse
Affiliation(s)
- Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil.
| | - Andrea Zin
- Clinical Research Unit, Fernandes Figueira Institute-FIOCRUZ, Rio de Janeiro, Brazil
| | - Bruno de Paula Freitas
- Department of Ophthalmology, Hospital Geral Roberto Santos, Salvador, Brazil; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Camilla Rocha
- Department of Research, Altino Ventura Foundation, Recife, Brazil
| | - Federico Costa
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | - Nivison Nery
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Tatiana C R De Senna
- Clinical Research Unit, Fernandes Figueira Institute-FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Mauricio Maia
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Aguilar Ticona JP, Nery N, Ladines-Lim JB, Gambrah C, Sacramento G, de Paula Freitas B, Bouzon J, Oliveira-Filho J, Borja A, Adhikarla H, Montoya M, Chin A, Wunder EA, Ballalai V, Vieira C, Belfort R, P. Almeida AR, Reis MG, Harris E, Ko AI, Costa F. Developmental outcomes in children exposed to Zika virus in utero from a Brazilian urban slum cohort study. PLoS Negl Trop Dis 2021; 15:e0009162. [PMID: 33544730 PMCID: PMC7891708 DOI: 10.1371/journal.pntd.0009162] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/18/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background The prevalence of developmental alterations associated with in-utero Zika virus (ZIKV) exposure in children is not well understood. Furthermore, estimation of the Population Attributable Fraction (PAF) of developmental alterations attributed to ZIKV has not been performed due to lack of population-based cohorts with data on symptomatic and asymptomatic ZIKV exposures and an appropriate control group. The aim of this study was to characterize neurodevelopmental outcomes of children at 11 to 32 months of age with intrauterine ZIKV exposure and estimate the PAF of alterations secondary to ZIKV exposure. Methodology/Principal findings We performed a cohort of biannual community-based prospective serosurveys in a slum community in Salvador, Brazil. We recruited women participating in our cohort, with a documented pregnancy from January 2015 to December 2016 and children born to those mothers. Children were classified as ZIKV exposed in utero (born from women with ZIKV seroconversion during pregnancy) or unexposed (born from women without ZIKV seroconversion or that seroconverted before/after pregnancy) by using an IgG monoclonal antibody blockade-of-binding (BoB). We interviewed mothers and performed anthropometric, audiometric, ophthalmological, neurologic, and neurodevelopmental evaluations of their children at 11 to 32 months of age. Among the 655 women participating in the cohort, 66 (10%) were pregnant during the study period. 46 (70%) of them completed follow-up, of whom ZIKV seroconversion occurred before, during, and after pregnancy in 25 (54%), 13 (28%), and 1 (2%), respectively. The rest of women, 7 (21.2%), did not present ZIKV seroconversion. At 11 to 32 months of life, the 13 ZIKV-exposed children had increased risk of mild cognitive delay (RR 5.1; 95%CI 1.1–24.4) compared with the 33 children unexposed, with a PAF of 53.5%. Exposed children also had increased risk of altered auditory behavior (RR 6.0; 95%CI 1.3–26.9), with a PAF of 59.5%. Conclusions A significant proportion of children exposed in utero to ZIKV developed mild cognitive delay and auditory behavioral abnormalities even in the absence of gross birth defects such as microcephaly and other neurodevelopmental domains. Furthermore, our findings suggest that over half of these abnormalities could be attributed to intrauterine ZIKV exposure. ZIKV is a neurotropic virus associated with congenital abnormalities that have been grouped under congenital Zika syndrome (CZS), the most prominent being microcephaly. Recent studies have uncovered a spectrum of other abnormalities. However, what remains unclear is the Population Attributable Fraction (PAF) of developmental alterations attributable to ZIKV intrauterine exposure in children (> one year of life). In this population-based cohort study, we found that children (without microcephaly) exposed in utero to ZIKV have an increased incidence of mild cognitive delay and auditory behavior abnormalities, with over half of these events attributable to intrauterine exposure. The results of this study suggest that more than half of alterations found in the population study can be attributed to intrauterine ZIKV exposure, thus demonstrating the importance of monitoring apparently healthy children born during the epidemic, even to asymptomatic mothers. Health services should implement early interventions to limit the morbidity of congenital ZIKV infection.
Collapse
Affiliation(s)
| | - Nivison Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
| | - Joseph B. Ladines-Lim
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Claudia Gambrah
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Gielson Sacramento
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
| | - Bruno de Paula Freitas
- Hospital Geral Roberto Santos (HGRS), Salvador, Brazil
- Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jamary Oliveira-Filho
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Programa de Pòs-Graduação em Ciencias da Saude (PPgCS) Universidade Federal da Bahia, Salvador, Brazil
| | - Ana Borja
- Departamento de Fonoaudiologia. Instituto de Ciências da Saúde. Universidade Federal da Bahia, Salvador, Brazil
| | - Haritha Adhikarla
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Magelda Montoya
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Athena Chin
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Elsio A. Wunder
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Carina Vieira
- Hospital Geral Roberto Santos (HGRS), Salvador, Brazil
| | - Rubens Belfort
- Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Mitermayer G. Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Albert I. Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail: (AIK); (FC)
| | - Federico Costa
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail: (AIK); (FC)
| |
Collapse
|
4
|
Robbiani DF, Olsen PC, Costa F, Wang Q, Oliveira TY, Nery N, Aromolaran A, do Rosário MS, Sacramento GA, Cruz JS, Khouri R, Wunder EA, Mattos A, de Paula Freitas B, Sarno M, Archanjo G, Daltro D, Carvalho GBS, Pimentel K, de Siqueira IC, de Almeida JRM, Henriques DF, Lima JA, Vasconcelos PFC, Schaefer-Babajew D, Azzopardi SA, Bozzacco L, Gazumyan A, Belfort R, Alcântara AP, Carvalho G, Moreira L, Araujo K, Reis MG, Keesler RI, Coffey LL, Tisoncik-Go J, Gale M, Rajagopal L, Adams Waldorf KM, Dudley DM, Simmons HA, Mejia A, O'Connor DH, Steinbach RJ, Haese N, Smith J, Lewis A, Colgin L, Roberts V, Frias A, Kelleher M, Hirsch A, Streblow DN, Rice CM, MacDonald MR, de Almeida ARP, Van Rompay KKA, Ko AI, Nussenzweig MC. Risk of Zika microcephaly correlates with features of maternal antibodies. J Exp Med 2019; 216:2302-2315. [PMID: 31413072 PMCID: PMC6781003 DOI: 10.1084/jem.20191061] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/15/2023] Open
Abstract
Zika virus (ZIKV) infection during pregnancy causes congenital abnormalities, including microcephaly. However, rates vary widely, and the contributing risk factors remain unclear. We examined the serum antibody response to ZIKV and other flaviviruses in Brazilian women giving birth during the 2015-2016 outbreak. Infected pregnancies with intermediate or higher ZIKV antibody enhancement titers were at increased risk to give birth to microcephalic infants compared with those with lower titers (P < 0.0001). Similarly, analysis of ZIKV-infected pregnant macaques revealed that fetal brain damage was more frequent in mothers with higher enhancement titers. Thus, features of the maternal antibodies are associated with and may contribute to the genesis of ZIKV-associated microcephaly.
Collapse
Affiliation(s)
- Davide F Robbiani
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY
| | - Priscilla C Olsen
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Federico Costa
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Faculdade de Medicina and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Qiao Wang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Thiago Y Oliveira
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY
| | - Nivison Nery
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Bahia, Brazil
| | - Adeolu Aromolaran
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Mateus S do Rosário
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | | | - Jaqueline S Cruz
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Bahia, Brazil
| | - Ricardo Khouri
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Bahia, Brazil
| | - Elsio A Wunder
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Adriana Mattos
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Bruno de Paula Freitas
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Manoel Sarno
- Faculdade de Medicina and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Gracinda Archanjo
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Dina Daltro
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Gustavo B S Carvalho
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Kleber Pimentel
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | | | - João R M de Almeida
- Faculdade de Medicina and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Juliana A Lima
- Instituto Evandro Chagas, Ministério da Saúde Ananindeua, Pará, Brazil
| | | | | | - Stephanie A Azzopardi
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY
| | - Leonia Bozzacco
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY
| | - Anna Gazumyan
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY
| | | | | | | | | | | | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Faculdade de Medicina and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Rebekah I Keesler
- California National Primate Research Center, University of California, Davis, Davis, CA
| | - Lark L Coffey
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Jennifer Tisoncik-Go
- Washington National Primate Research Center, Seattle, WA
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA
- Department of Immunology, University of Washington, Seattle, WA
| | - Michael Gale
- Washington National Primate Research Center, Seattle, WA
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA
- Department of Immunology, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | - Lakshmi Rajagopal
- Department of Global Health, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA
| | - Kristina M Adams Waldorf
- Washington National Primate Research Center, Seattle, WA
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Dawn M Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI
| | - Heather A Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - David H O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI
| | - Rosemary J Steinbach
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
| | - Nicole Haese
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Beaverton, OR
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Portland, OR
| | - Jessica Smith
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Portland, OR
| | - Anne Lewis
- Pathology Services Unit, Division of Comparative Medicine, Oregon National Primate Research Center, Beaverton, OR
| | - Lois Colgin
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Beaverton, OR
| | - Victoria Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
| | - Antonio Frias
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Meredith Kelleher
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
| | - Alec Hirsch
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Beaverton, OR
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Portland, OR
| | - Daniel N Streblow
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Beaverton, OR
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Portland, OR
| | - Charles M Rice
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY
| | - Margaret R MacDonald
- Laboratory of Virology and Infectious Disease, The Rockefeller University, New York, NY
| | - Antonio R P de Almeida
- Faculdade de Medicina and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Koen K A Van Rompay
- California National Primate Research Center, University of California, Davis, Davis, CA
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Albert I Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Michel C Nussenzweig
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY
- Howard Hughes Medical Institute, The Rockefeller University, New York, NY
| |
Collapse
|
5
|
de Oliveira Dias JR, Ventura CV, de Paula Freitas B, Prazeres J, Ventura LO, Bravo-Filho V, Aleman T, Ko AI, Zin A, Belfort R, Maia M. Zika and the Eye: Pieces of a Puzzle. Prog Retin Eye Res 2018; 66:85-106. [PMID: 29698814 DOI: 10.1016/j.preteyeres.2018.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
Abstract
Zika virus (ZIKV) is an arbovirus mainly transmitted to humans by mosquitoes from Aedes genus. Other ways of transmission include the perinatal and sexual routes, blood transfusion, and laboratory exposure. Although the first human cases were registered in 1952 in African countries, outbreaks were only reported since 2007, when entire Pacific islands were affected. In March 2015, the first cases of ZIKV acute infection were notified in Brazil and, to date, 48 countries and territories in the Americas have confirmed local mosquito-borne transmission of ZIKV. Until 2015, ZIKV infection was thought to only cause asymptomatic or mild exanthematous febrile infections. However, after explosive ZIKV outbreaks in Polynesia and Latin American countries, it was confirmed that ZIKV could also lead to Guillain-Barré syndrome and congenital birth abnormalities. These abnormalities, which can include neurologic, ophthalmologic, audiologic, and skeletal findings, are now considered congenital Zika syndrome (CZS). Brain abnormalities in CZS include cerebral calcifications, malformations of cortical development, ventriculomegaly, lissencephaly, hypoplasia of the cerebellum and brainstem. The ocular findings, which are present in up to 70% of infants with CZS, include iris coloboma, lens subluxation, cataract, congenital glaucoma, and especially posterior segment findings. Loss of retinal pigment epithelium, the presence of a thin choroid, a perivascular choroidal inflammatory infiltrate, and atrophic changes within the optic nerve were seen in histologic analyses of eyes from deceased fetuses. To date, there is no ZIKV licensed vaccines or antiviral therapies are available for treatment. Preventive measures include individual protection from mosquito bites, control of mosquito populations and the use of barriers measures such as condoms during sexual intercourse or sexual abstinence for couples either at risk or after confirmed infection. A literature review based on studies that analyzed ocular findings in mothers and infants with CZS, with or without microcephaly, was conducted and a theoretical pathophysiologic explanation for ZIKV-ocular abnormalities was formulated.
Collapse
Affiliation(s)
- João Rafael de Oliveira Dias
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Camila V Ventura
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Altino Ventura Foundation, Recife, Pernambuco, Brazil; HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Bruno de Paula Freitas
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Department of Ophthalmology, Roberto Santos General Hospital, Salvador, Brazil
| | - Juliana Prazeres
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Liana O Ventura
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Altino Ventura Foundation, Recife, Pernambuco, Brazil; HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Vasco Bravo-Filho
- Altino Ventura Foundation, Recife, Pernambuco, Brazil; HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Tomas Aleman
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia, United States
| | - Albert Icksang Ko
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Andréa Zin
- Clinical Research Unit, Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rubens Belfort
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil; Brazilian Institute of Fight Against Blindness, Assis and Presidente Prudente, São Paulo, Brazil.
| |
Collapse
|
6
|
de Paula Freitas B, Zin A, Ko A, Maia M, Ventura CV, Belfort R. Anterior-Segment Ocular Findings and Microphthalmia in Congenital Zika Syndrome. Ophthalmology 2017; 124:1876-1878. [PMID: 28676282 DOI: 10.1016/j.ophtha.2017.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 05/24/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Bruno de Paula Freitas
- Department of Ophthalmology, Hospital Geral Roberto Santos, Salvador, Brazil; Vision Institute and Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Andrea Zin
- Clinical Research Unit, Instituto Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Albert Ko
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Maurício Maia
- Vision Institute and Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Camila V Ventura
- Vision Institute and Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Rubens Belfort
- Vision Institute and Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
7
|
de Paula Freitas B, Ko AI, Khouri R, Mayoral M, Henriques DF, Maia M, Belfort R. Glaucoma and Congenital Zika Syndrome. Ophthalmology 2017; 124:407-408. [PMID: 27914834 DOI: 10.1016/j.ophtha.2016.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bruno de Paula Freitas
- Department of Ophthalmology, Hospital Geral Roberto Santos, Salvador, Brazil; Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Albert I Ko
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Ricardo Khouri
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Monica Mayoral
- Department of Ophthalmology, Hospital Geral Roberto Santos, Salvador, Brazil
| | - Daniele Freitas Henriques
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | - Maurício Maia
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
8
|
de Oliveira Dias JR, de Paula Freitas B, Belfort R. Similarities in the Retinal Appearance of Patients With Zika Virus Compared With Cobalamin C Deficiency—Reply. JAMA Ophthalmol 2016; 134:1201. [DOI: 10.1001/jamaophthalmol.2016.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- João Rafael de Oliveira Dias
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | | | - Rubens Belfort
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
9
|
Affiliation(s)
- Rubens Belfort
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | | | - João Rafael de Oliveira Dias
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
10
|
Costa F, Sarno M, Khouri R, de Paula Freitas B, Siqueira I, Ribeiro GS, Ribeiro HC, Campos GS, Alcântara LC, Reis MG, Weaver SC, Vasilakis N, Ko AI, Almeida AR. Emergence of Congenital Zika Syndrome: Viewpoint From the Front Lines. Ann Intern Med 2016; 164:689-91. [PMID: 26914810 PMCID: PMC5444536 DOI: 10.7326/m16-0332] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Federico Costa
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Manoel Sarno
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Ricardo Khouri
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Bruno de Paula Freitas
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Isadora Siqueira
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Guilherme S. Ribeiro
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Hugo C. Ribeiro
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Gubio S. Campos
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Luiz C. Alcântara
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Mitermayer G. Reis
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Scott C. Weaver
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Nikos Vasilakis
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Albert I. Ko
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Antonio Raimundo Almeida
- From Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude; Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia; and Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador BA, Brazil; Institute for Human Infections and Immunity, and Department of Microbiology and Immunology, Department of Pathology, and The University of Texas Medical Branch, Galveston, Texas
- and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
11
|
de Paula Freitas B, de Oliveira Dias JR, Prazeres J, Sacramento GA, Ko AI, Maia M, Belfort R. Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol 2016; 134:529-535. [PMID: 26865554 DOI: 10.1001/jamaophthalmol.2016.0267] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV. Objective To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil. Design, Setting, and Participants Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of ≤32 cm) with a presumed diagnosis of congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015. Interventions All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations. Main Outcomes and Measures Ocular abnormalities associated with ZIKV. Results Twenty-three of 29 mothers (79.3%) reported suspected ZIKV infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%). Conclusions and Relevance Congenital infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.
Collapse
Affiliation(s)
| | - João Rafael de Oliveira Dias
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Juliana Prazeres
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | | | - Albert Icksang Ko
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Brazil4Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Maurício Maia
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Vision Institute, Department of Ophthalmology, Paulista Medical School, Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
12
|
Guerra RLL, Freitas BDP, Parcero CMFM, Maia ODO, Marback RL. An outbreak of forty five cases of Pseudomonas aeruginosa acute endophthalmitis after phacoemulsification. Arq Bras Oftalmol 2013; 75:344-7. [PMID: 23471330 DOI: 10.1590/s0004-27492012000500010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/30/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe an outbreak of Pseudomonas aeruginosa endophthalmitis post cataract surgery. Clinical findings, treatment and outcome are discussed. METHODS Clinical charts review of forty-five patients treated for endophthalmitis in a two-day period. The patients underwent primary vitrectomy, anterior chamber irrigation and intravitreous antibiotic injection. Cultures from vitreous and anterior chamber samples were performed in all patients. RESULTS Forty-five patients (twenty-three men and twenty-two women) were identified. The average age was 71.2 years (range, 56-83 years). The right eye (62%) was affected more often than the left eye (38%). The median interval between surgery and endophthalmitis onset was 5.5 days (range, 5-6 days). The visual acuity at the diagnosis was better than 20/40 in one patient (2%), from 20/40 to 20/200 in one patient (2%), from 20/400 to counting fingers in two patients (4%), hand movements in eleven patients (24%), and light perception in thirty patients (68%). Pseudomonas aeruginosa was the isolated agent in twenty-six vitreous samples and in three anterior chamber samples. Overall, one patient (2%) achieved a final visual acuity better than 20/40; eight patients (18%) achieved a final visual acuity from 20/40 to 20/200; six patients (13%) achieved a final visual acuity from 20/400 to counting fingers; eleven patients (25%) achieved a final acuity of hand movements; thirteen patients (29%) achieved a final acuity of light perception and six (13%) patients had no light perception at the last examination. None of these eyes underwent evisceration or enucleation in a three-month follow-up period. CONCLUSION Even with all the safety that cataract surgery has achieved, today, endophthalmitis remains a risk and a fearful complication of this procedure. In the present study, it was impossible to identify the source of the outbreak.
Collapse
|
13
|
Guerra RLL, Freitas BDP, Parcero CMFM, Maia Júnior ODO, Marback RL. Authors' reply. Arq Bras Oftalmol 2013; 76:133-134. [PMID: 24000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
|
14
|
Parcero CMFM, Freitas BDP, Marback EF, Maia ODO, Marback RL. Optical coherence tomography findings in acute phase of branch retinal artery occlusion: case report. Arq Bras Oftalmol 2010; 73:189-92. [PMID: 20549053 DOI: 10.1590/s0004-27492010000200019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Accepted: 10/08/2009] [Indexed: 05/26/2023] Open
Abstract
PURPOSE to report a case of branch retinal artery occlusion in the acute phase, using optical coherence tomography to evaluate the morphologic changes. A 27 year-old man had a sudden superior scotoma in the right eye, with fundus examination compatible with inferior temporal branch retinal artery obstruction. The optical coherence tomography revealed increase in thickness and hyper-reflectivity of the inner retinal layers in affected area, with decreased reflectivity of photoreceptor and retinal pigment epithelial layers. The optical coherence tomography findings are consistent with intracellular edema, and not with secondary vascular leakage of extracellular fluid, according to histopathological theories of retinal ischemia and necrosis that occurs after retinal artery occlusion.
Collapse
|
15
|
Bastos ALCDM, Freitas BDP, Villas Boas O, Ramiro AC. Use of topical dorzolamide for patients with X-linked juvenile retinoschisis: case report. Arq Bras Oftalmol 2008; 71:286-90. [DOI: 10.1590/s0004-27492008000200030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 07/30/2007] [Indexed: 11/22/2022] Open
|