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Arraes de Alencar Ximenes R, de Barros Miranda-Filho D, Brickley EB, Barreto de Araújo TV, Montarroyos UR, Abtibol-Bernardino MR, Mussi-Pinhata MM, Duarte G, Coutinho CM, Biason de Moura Negrini SF, Alecrim MDGC, Albuquerque de Almeida Peixoto LDF, Lopes Moreira ME, Zin A, Pereira Júnior JP, Nielsen-Saines K, Turchi Martelli CM, Rodrigues LC, Vieira de Souza W, Ventura LO, Silva de Oliveira C, de Matos H, Furtado Serra EM, Souza Gomes LT, Nogueira ML, Estofolete C, Vaz-Oliani DC, Passos SD, Moron A, Duarte Rodrigues MM, Pereira Sarmento SG, Turchi MD, Pela Rosado LE, de Sene Amâncio Zara AL, Franco Gomes MB, Schuler-Faccini L, Herrero-Silva J, Amorim MM, Melo AO, Ledo Alves da Cunha AJ, Prata-Barbosa A, Amim J, Rezende-Filho J, Calcagno JI, Júnior Alcântara LC, Lima de Almeida B, Hofer CB, Machado ES, de Siqueira IC, Martinez-Espinosa FE, Brasil P. Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium. Lancet Reg Health Am 2023; 17:100395. [PMID: 36714276 PMCID: PMC9880800 DOI: 10.1016/j.lana.2022.100395] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%.
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Affiliation(s)
- Ricardo Arraes de Alencar Ximenes
- Postgraduate Program in Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil,Post-Graduation in Health Sciences, University of Pernambuco, Recife, PE, Brazil,Corresponding author. Professional address: Postgraduate Program in Tropical Medicine, Federal University of Pernambuco, Av. Prof. Moraes Rego, s/n., Cidade Universitária, Recife, PE 50670-901, Brazil; University of Pernambuco, Rua Arnóbio Marques, n. 310, Santo Amaro, Recife, PE 50100-130, Brazil.
| | | | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | | | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | - Conrado Milani Coutinho
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | | | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Lucíola de Fátima Albuquerque de Almeida Peixoto
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | | | - Andrea Zin
- Clinical Research Unit, Instituto Fernandes Figueira, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen University of California at Los Angeles School of Medicine, LA, United States
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Liana O. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, PE, Brazil,Pernambuco Eyes Hospital, Recife, PE, Brazil
| | | | - Haroldo de Matos
- Department of Epidemiology, Evandro Chagas Institute, Ananindeua, PA, Brazil
| | | | - Luna Thais Souza Gomes
- Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua, PA, Brazil
| | - Maurício L. Nogueira
- Department of Infectious Disease, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Cassia Estofolete
- Department of Infectious Disease, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Denise Cristina Vaz-Oliani
- Department of Gynecology and Obstetrics, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Saulo Duarte Passos
- Infectious Pediatric Laboratory, Medicine School of Jundiaí, Jundiaí, SP, Brazil
| | - Antonio Moron
- Department of Fetal Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO, Brazil
| | | | | | | | - Lavínia Schuler-Faccini
- Departamento de Genética, Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brazil
| | - Juliana Herrero-Silva
- City Hall of Tangará da Serra, Municipal Health Department, Tangará da Serra, MT, Brazil
| | - Melania M. Amorim
- Medical Academic Unit, Federal University of Campina Grande, Campina Grande, PB, Brazil
| | - Adriana Oliveira Melo
- Medical Academic Unit, Federal University of Campina Grande, Campina Grande, PB, Brazil
| | | | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D’Or Institute for Research & Education, Rio de Janeiro, RJ, Brazil
| | - Joffre Amim
- Department of Obstectrics, Federal University of Rio de Janeiro Maternity School, Rio de Janeiro, RJ, Brazil
| | - Jorge Rezende-Filho
- Department of Obstectrics, Federal University of Rio de Janeiro Maternity School, Rio de Janeiro, RJ, Brazil
| | - Juan Ignacio Calcagno
- Reference Maternity Prof. José Maria de Magalhães Netto, Bahia Health Department, Salvador, BA, Brazil
| | | | | | - Cristina Barroso Hofer
- Department of Infecitous Diseases, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Elizabeth S. Machado
- Department of Infecitous Diseases, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Flor Ernestina Martinez-Espinosa
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil,Leonidas and Maria Deane Institute, Fiocruz, Manaus, AM, Brazil
| | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, Brazil
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Schuler-Faccini L, Del Campo M, García-Alix A, Ventura LO, Boquett JA, van der Linden V, Pessoa A, van der Linden Júnior H, Ventura CV, Leal MC, Kowalski TW, Rodrigues Gerzson L, Skilhan de Almeida C, Santi L, Beys-da-Silva WO, Quincozes-Santos A, Guimarães JA, Garcez PP, Gomes JDA, Vianna FSL, Anjos da Silva A, Fraga LR, Vieira Sanseverino MT, Muotri AR, Lopes da Rosa R, Abeche AM, Marcolongo-Pereira C, Souza DO. Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects. Front Genet 2022; 13:758715. [PMID: 35350244 PMCID: PMC8957982 DOI: 10.3389/fgene.2022.758715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Five years after the identification of Zika virus as a human teratogen, we reviewed the early clinical manifestations, collectively called congenital Zika syndrome (CZS). Children with CZS have a very poor prognosis with extremely low performance in motor, cognitive, and language development domains, and practically all feature severe forms of cerebral palsy. However, these manifestations are the tip of the iceberg, with some children presenting milder forms of deficits. Additionally, neurodevelopment can be in the normal range in the majority of the non-microcephalic children born without brain or eye abnormalities. Vertical transmission and the resulting disruption in development of the brain are much less frequent when maternal infection occurs in the second half of the pregnancy. Experimental studies have alerted to the possibility of other behavioral outcomes both in prenatally infected children and in postnatal and adult infections. Cofactors play a vital role in the development of CZS and involve genetic, environmental, nutritional, and social determinants leading to the asymmetric distribution of cases. Some of these social variables also limit access to multidisciplinary professional treatment.
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Affiliation(s)
- Lavínia Schuler-Faccini
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Miguel Del Campo
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Liana O Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil.,Universidade Estadual do Ceará, Fortaleza, Brazil
| | | | - Camila V Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | - Thayne Woycinck Kowalski
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,CESUCA-Centro Universitário, Cachoeirinha, Brazil
| | | | | | - Lucélia Santi
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Walter O Beys-da-Silva
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Jorge A Guimarães
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | | | - Fernanda Sales Luiz Vianna
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - André Anjos da Silva
- School of Medicine, Graduate Program in Medical Sciences-Universidade do Vale do Taquari-UNIVATES, Lajeado, Brazil.,School of Medicine, Universidade do Vale do Rio dos Sinos-UNISINOS, São Leopoldo, Brazil
| | - Lucas Rosa Fraga
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Maria Teresa Vieira Sanseverino
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Alysson R Muotri
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Alberto Mantovani Abeche
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Diogo O Souza
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
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Medeiros ALD, Martins T, Kattah M, Soares AKA, Ventura LO, Ventura CV, Barros E. Isolated abducens nerve palsy associated with coronavirus disease: an 8-month follow-up. Arq Bras Oftalmol 2021; 85:517-519. [PMID: 34852059 DOI: 10.5935/0004-2749.20220063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/06/2021] [Indexed: 11/20/2022] Open
Abstract
We report the case of a previously healthy 48-year-old man who developed an isolated abducens nerve palsy 18 days after presenting with coronavirus disease (COVID-19) confirmed by reverse transcriptase polymerase chain reaction. His main complaint at arrival was double vision. Ocular examination revealed a sixth cranial nerve palsy in the left eye. The incomitant esotropia at arrival was 30 prism diopters. Abduction was markedly limited, while adduction was normal in the left eye. The patient underwent complete clinical, neurological, and neuroimaging investigations, including cerebrospinal fluid sample analysis to rule out infectious causes. A conservative approach with orthoptic therapy and Fresnel prism was opted. Eight months after the onset of COVID-19, regression of the strabismus was observed, and the patient reported complete recovery of the diplopia. This case suggests that isolated abducens nerve palsy caused by severe acute respiratory syndrome coronavirus 2 infection may improve with a conservative approach.
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Affiliation(s)
| | - Thayze Martins
- Department of Ophthalmology, Fundação Altino Ventura, Recife, PE, Brazil.,Department of Ophthalmology, Hospital de Olhos de Pernambuco, Recife, PE, Brazil
| | - Marisa Kattah
- Department of Ophthalmology, Fundação Altino Ventura, Recife, PE, Brazil.,Department of Ophthalmology, Hospital de Olhos de Pernambuco, Recife, PE, Brazil
| | - Ana Karine A Soares
- Department of Scientific Research, Fundação Altino Ventura, Recife, PE, Brazil
| | - Liana O Ventura
- Department of Ophthalmology, Fundação Altino Ventura, Recife, PE, Brazil.,Department of Ophthalmology, Hospital de Olhos de Pernambuco, Recife, PE, Brazil
| | - Camila V Ventura
- Department of Ophthalmology, Fundação Altino Ventura, Recife, PE, Brazil.,Department of Ophthalmology, Hospital de Olhos de Pernambuco, Recife, PE, Brazil
| | - Eveline Barros
- Department of Ophthalmology, Fundação Altino Ventura, Recife, PE, Brazil.,Department of Ophthalmology, Hospital de Olhos de Pernambuco, Recife, PE, Brazil
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Ventura CV, Aragão I, Ventura LO. Color Fundus Imaging Using a High-Magnification Lens for Detecting Subtle Macular Changes in Infants With Congenital Zika Syndrome. Journal of VitreoRetinal Diseases 2021; 5:425-430. [PMID: 37008703 PMCID: PMC9976117 DOI: 10.1177/2474126420972256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: We describe subtle macular changes that were detected by high-magnification color fundus imaging in infants with congenital Zika syndrome. Methods: This series included 4 infants (age: 1.4 ± 0.1 years [range, 1.3-1.5 years]) who were serologically confirmed with congenital Zika syndrome, examined under anesthesia, and underwent fundus examination and color fundus documentation. The fundus images were captured using 130° and 80° field lenses. Fluorescein angiography confirmed macular lesions. Results: Wide-angle color fundus images detected unilateral retinal findings in all 4 infants. Chorioretinal atrophy was identified in 2 eyes (25%) of 2 infants (50%) and pigment mottling in 3 eyes (37.5%) of 2 infants (50%). High-magnification imaging revealed subtle macular changes in the contralateral eyes of the 4 infants that were confirmed by fluorescein angiography imaging. Conclusions: High-magnification fundus imaging can be effective and reliable in revealing and documenting subtle structural changes in the macula of infants with congenital Zika syndrome.
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Affiliation(s)
- Camila V. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
- Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
- Department of Research, Altino Ventura Foundation, Recife, Brazil
| | - Itamara Aragão
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
| | - Liana O. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
- Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
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5
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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.
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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
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6
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de Barros Miranda-Filho D, Brickley EB, Ramond A, Martelli CMT, Sanchez Clemente N, Velho Barreto de Araújo T, Rodrigues LC, Montarroyos UR, de Souza WV, de Albuquerque MDFPM, Ventura LO, Marques ETA, Leal MC, Eickmann SH, Wanderley Rocha MA, Sobral da Silva PF, Gomes Carvalho MDC, Ramos RCF, da Silva Oliveira DM, Xavier MDN, Vasconcelos RAL, Veras Gonçalves A, Brainer AM, Tenório Cordeiro M, Arraes de Alencar Ximenes R. The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile. Viruses 2021; 13:v13040602. [PMID: 33916084 PMCID: PMC8067191 DOI: 10.3390/v13040602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/30/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG–PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG–PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic. MERG–PC includes children from four groups recruited at different stages of the ZIKV microcephaly epidemic in Pernambuco, i.e., the Outpatient Group (OG/n = 195), the Microcephaly Case–Control Study (MCCS/n = 80), the MERG Pregnant Women Cohort (MERG-PWC/n = 336), and the Control Group (CG/n = 100). We developed a comprehensive array of clinical, laboratory, and imaging assessments that were undertaken by a ‘task force’ of clinical specialists in a single day at 3, 6, 12, 18 months of age, and annually from 24 months. Children from MCCS and CG had their baseline assessment at birth and children from the other groups, at the first evaluation by the task force. The baseline cohort includes 711 children born between February 2015 and February 2019. Children’s characteristics at baseline, excluding CG, were as follows: 32.6% (184/565) had microcephaly, 47% (263/559) had at least one physical abnormality, 29.5% (160/543) had at least one neurological abnormality, and 46.2% (257/556) had at least one ophthalmological abnormality. This ongoing cohort has contributed to the understanding of the congenital Zika syndrome (CZS) spectrum. The cohort has provided descriptions of paediatric neurodevelopment and early epilepsy, including EEG patterns and treatment response, and information on the frequency and characteristics of oropharyngeal dysphagia; cryptorchidism and its surgical findings; endocrine dysfunction; and adenoid hypertrophy in children with Zika-related microcephaly. The study protocols and questionnaires were shared across Brazilian states to enable harmonization across the different studies investigating microcephaly and CZS, providing the opportunity for the Zika Brazilian Cohorts Consortium to be formed, uniting all the ZIKV clinical cohorts in Brazil.
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Affiliation(s)
- Demócrito de Barros Miranda-Filho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Correspondence:
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Celina Maria Turchi Martelli
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Ulisses Ramos Montarroyos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
| | - Wayner Vieira de Souza
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Maria de Fátima P. M. de Albuquerque
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Liana O. Ventura
- Departamento de Oftalmologia, Fundação Altino Ventura, Recife 52171-011, Brazil;
| | - Ernesto T. A. Marques
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Mariana C. Leal
- Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife 50670-420, Brazil;
| | - Sophie H. Eickmann
- Departamento Materno-Infantil, Universidade Federal de Pernambuco, Recife 50670-420, Brazil;
| | | | - Paula Fabiana Sobral da Silva
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Maria Durce Costa Gomes Carvalho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Regina Coeli F. Ramos
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
| | - Danielle Maria da Silva Oliveira
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Morgana do Nascimento Xavier
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Rômulo A. L. Vasconcelos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Andreia Veras Gonçalves
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
| | - Alessandra Mertens Brainer
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Marli Tenório Cordeiro
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Ricardo Arraes de Alencar Ximenes
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
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Almeida LFB, Kattah M, Ventura LO, Gois AL, Rocha C, Andrade CG, Mendonza-Santiesteban C, Ventura CV. Pattern-Reversal Visual Evoked Potential in Children With Congenital Zika Syndrome. J Pediatr Ophthalmol Strabismus 2021; 58:78-83. [PMID: 34038265 DOI: 10.3928/01913913-20201110-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To objectively evaluate the visual function in children with congenital Zika syndrome using pattern-reversal visual evoked potential (PR-VEP). METHODS This was a cross-sectional study composed of two patient groups: children aged between 18 and 24 months who were positive for the Zika virus (congenital Zika syndrome group) and age-matched healthy children (control group). All patients underwent a comprehensive ophthalmologic examination and PR-VEP was performed binocularly in a room with constant dim illumination. The P100 peak time in the 60' arc stimuli was used, and the results were correlated with visual acuity, cephalic perimeter at birth, and funduscopic findings. RESULTS Thirty-seven children were included in the congenital Zika syndrome group and 15 in the control group. The mean age was 18.5 ± 0.9 months (range: 17 to 20 months) in the congenital Zika syndrome group and 24.3 ± 1.6 months (range: 21 to 28 months) in the control group. The P100 response was normal in 7 patients (18.9%) with congenital Zika syndrome, borderline in 2 (5.4%), abnormal with prolonged latency in 18 (48.6%), and abnormal with no response in 10 (27.0%). A significant correlation between the visual acuity and P100 peak time was observed (P < .001). The P100 values were not correlated significantly with the cephalic perimeter at birth (P = .412) or the funduscopic findings (P = .510). PR-VEP in children with congenital Zika syndrome and no funduscopic findings was significantly worse than in the control group (P = .001). CONCLUSIONS Children with congenital Zika syndrome have characteristically abnormal PR-VEPs regardless of the funduscopic findings and severe microcephaly. The PR-VEP findings supported the diagnosis of cortical visual impairment in these children. [J Pediatr Ophthalmol Strabismus. 2021;58(2):78-83.].
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Veras Gonçalves A, Miranda-Filho DDB, Rocha Vilela LC, Ramos RCF, de Araújo TVB, de Vasconcelos RAL, Wanderley Rocha MA, Eickmann SH, Cordeiro MT, Ventura LO, Montarroyos UR, Mertens Brainer A, Costa Gomes MD, da Silva PFS, Martelli CMT, Brickley EB, Ximenes RAA. Endocrine Dysfunction in Children with Zika-Related Microcephaly Who Were Born during the 2015 Epidemic in the State of Pernambuco, Brazil. Viruses 2020; 13:v13010001. [PMID: 33374895 PMCID: PMC7821916 DOI: 10.3390/v13010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
Congenital viral infections and the occurrence of septo-optic dysplasia, which is a combination of optic nerve hypoplasia, abnormal formation of structures along the midline of the brain, and pituitary hypofunction, support the biological plausibility of endocrine dysfunction in Zika-related microcephaly. In this case series we ascertained the presence and describe endocrine dysfunction in 30 children with severe Zika-related microcephaly from the MERG Pediatric Cohort, referred for endocrinological evaluation between February and August 2019. Of the 30 children, 97% had severe microcephaly. The average age at the endocrinological consultation was 41 months and 53% were female. The most frequently observed endocrine dysfunctions comprised short stature, hypothyroidism, obesity and variants early puberty. These dysfunctions occurred alone 57% or in combination 43%. We found optic nerve hypoplasia (6/21) and corpus callosum hypoplasia (20/21). Seizure crises were reported in 86% of the children. The most common-and clinically important-endocrine dysfunctions were pubertal dysfunctions, thyroid disease, growth impairment, and obesity. These dysfunctions require careful monitoring and signal the need for endocrinological evaluation in children with Zika-related microcephaly, in order to make early diagnoses and implement appropriate treatment when necessary.
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Affiliation(s)
- Andréia Veras Gonçalves
- Department of Tropical Medicine, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil; (L.C.R.V.); (R.A.A.X.)
- Unit Endocrinology, Oswaldo Cruz University Hospital, Recife 50100-130, Brazil
- Correspondence: ; Tel.: +55-81-3183-3510
| | - Demócrito de B. Miranda-Filho
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Líbia Cristina Rocha Vilela
- Department of Tropical Medicine, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil; (L.C.R.V.); (R.A.A.X.)
| | - Regina Coeli Ferreira Ramos
- Department Pediatric Infectious Disease, Oswaldo Cruz University Hospital, Recife 50100-130, Brazil; (R.C.F.R.); (M.A.W.R.)
| | - Thalia V. B. de Araújo
- Department of Social Medicine, Federal University of Pernambuco, Recife 50670-901, Brazil;
| | - Rômulo A. L. de Vasconcelos
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Maria Angela Wanderley Rocha
- Department Pediatric Infectious Disease, Oswaldo Cruz University Hospital, Recife 50100-130, Brazil; (R.C.F.R.); (M.A.W.R.)
| | - Sophie Helena Eickmann
- Maternal and Child Department, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil;
| | - Marli Tenório Cordeiro
- Unit of Oswaldo Cruz Foundation (Fiocruz), Research Center Aggeu Magalhães (CPqAM), Recife 50670-420, Brazil; (M.T.C.); (C.M.T.M.)
| | - Liana O. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife 52171-011, Brazil;
| | - Ulisses Ramos Montarroyos
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Alessandra Mertens Brainer
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Maria Durce Costa Gomes
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Paula Fabiana Sobral da Silva
- Postgraduation in Health Sciences, University of Pernambuco, Recife 50100-010, Brazil; (D.d.B.M.-F.); (R.A.L.d.V.); (U.R.M.); (A.M.B.); (M.D.C.G.); (P.F.S.d.S.)
| | - Celina M. T. Martelli
- Unit of Oswaldo Cruz Foundation (Fiocruz), Research Center Aggeu Magalhães (CPqAM), Recife 50670-420, Brazil; (M.T.C.); (C.M.T.M.)
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Ricardo A. A. Ximenes
- Department of Tropical Medicine, Health Sciences Center, Federal University of Pernambuco, Recife 50670-901, Brazil; (L.C.R.V.); (R.A.A.X.)
- Department of Internal Medicine, University of Pernambuco, Recife 50100-010, Brazil
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9
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Gallo LG, Martinez-Cajas J, Peixoto HM, Pereira ACEDS, Carter JE, McKeown S, Schaub B, Ventura CV, de França GVA, Pomar L, Ventura LO, Nerurkar VR, de Araújo WN, Velez MP. Another piece of the Zika puzzle: assessing the associated factors to microcephaly in a systematic review and meta-analysis. BMC Public Health 2020; 20:827. [PMID: 32487247 PMCID: PMC7266116 DOI: 10.1186/s12889-020-08946-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/01/2019] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although it is known that Zika virus (ZIKV) infection during pregnancy may lead to microcephaly in the fetus, the prognostic factors associated with this tragic disorder remain unclear. We conducted a systematic review and meta-analysis to assess the prognostic factors associated with the incidence of microcephaly in congenital ZIKV infection. METHODS We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of print, Embase, Embase Classic, Web of Science, CINAHL, Cochrane CENTRAL, LILACS, and various thesis databases to identify human studies reporting microcephaly associated with congenital ZIKV infection. We requested primary data from the authors of the included studies to calculate summary estimates and conduct the meta-analysis of the most prevalent factors. RESULTS We screened 4106 titles and abstracts, and identified 12 studies for inclusion in the systematic review. The assessment of ZIKV infection and the definition of microcephaly varied among studies. A total of 6154 newborns/fetuses were enrolled; of those, 1120 (18.20%) had a diagnostic of ZIKV infection, of which 509 (45.45%) were diagnosed with microcephaly. Nine studies addressed the link between congenital ZIKV infection and neurological findings in newborns/fetuses. Half of the studies provided primary data. Three out of 11 factors of interest seem to be prognostic factors of microcephaly: infant's sex - males compared to females: Relative Risk (RR) 1.30, 95% Confidence Interval (95% CI) 1.14 to 1.49; the stage of pregnancy when infection occurred - infection in the first trimester of pregnancy compared to infection at other stages of pregnancy: RR 1.41, 95% CI 1.09 to 1.82; and asymptomatic infection compared to symptomatic infection during pregnancy: RR 0.68; 95% CI 0.60 to 0.77. CONCLUSION Our findings support the female-biased resistance hypothesis and reinforce the risk associated with the stage of pregnancy when ZIKV infection occurs. Continued surveillance of ZIKV infection during pregnancy is needed to identify additional factors that could contribute to developing microcephaly in affected fetuses. PROTOCOL REGISTRATION This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD 42018088075.
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Affiliation(s)
- Luciana Guerra Gallo
- Postgraduate Program in Tropical Medicine, University of Brasilia, Brasilia, Brazil
- Department of Obstetrics and Gynecology and Department of Public Health Sciences, Queen's University, Kingston, Canada
| | | | - Henry Maia Peixoto
- Postgraduate Program in Tropical Medicine, University of Brasilia, Brasilia, Brazil
| | | | - Jillian E Carter
- Department of Obstetrics and Gynecology and Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen's University, Kingston, Canada
| | - Bruno Schaub
- Centre Pluridisciplinaire de Diagnostic Prénatal de le Martinique, Maison de la Femme, de la Mère et de l'Enfant, University Hospital of Martinique, Fort-de-France, Martinique
| | - Camila V Ventura
- Department of Scientific Investigation, Altino Ventura Foundation, Recife, Brazil
| | | | - Léo Pomar
- Materno-fetal and Obstetrics Research Unit, Département "Femme-Mère Enfant", University Hospital, Lausanne, Switzerland
- Department of Obstetrics and Gynaecology, Centre Hospitalier de l'Ouest Guyanais Franck Joly, Saint-Laurent-du-Maroni, French Guiana
| | - Liana O Ventura
- Department of Pediatric Ophthalmology and Strabismus, Altino Ventura Foundation, Recife, Brazil
| | - Vivek R Nerurkar
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | | | - Maria P Velez
- Department of Obstetrics and Gynecology and Department of Public Health Sciences, Queen's University, Kingston, Canada.
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Ventura LO, Travassos S, Ventura Filho MC, Marinho P, Lawrence L, Wilson ME, Carreiro N, Xavier V, Gois AL, Ventura CV. Congenital Zika Syndrome: Surgical and Visual Outcomes After Surgery for Infantile Strabismus. J Pediatr Ophthalmol Strabismus 2020; 57:169-175. [PMID: 32453850 DOI: 10.3928/01913913-20200331-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/17/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the surgical and functional outcomes in children with congenital Zika syndrome who underwent strabismus surgery. METHODS This prospective case series included children with congenital Zika syndrome who presented with horizontal infantile strabismus and underwent strabismus surgery. Ocular motility and visual fields were assessed preoperatively and postoperatively. Visual fields were considered normal if they exceeded 70 degrees in the temporal meridian. Postoperatively, parents and caregivers answered a questionnaire that assessed their child's behavioral improvements. A final ocular alignment within ±10 prism diopters (PD) and expansion of the visual fields were considered satisfactory motor surgical results at 6 months postoperatively. RESULTS Five children (3 girls [60%]) with congenital Zika syndrome (age: 36.4 ± 0.9 months) were included in this study. All children (100%) presented with moderate to severe visual impairment and 4 (80%) presented with funduscopic abnormalities. Preoperatively, 4 children (80%) had infantile esotropia (mean preoperative angle of deviation: 41.3 ± 6.3 PD) and 1 (20%) had infantile exotropia measuring 65 PD. The postoperative outcomes demonstrated ocular alignment in 4 children (80%) at the 6-month follow-up visit. Expansion of the temporal visual field was observed in 7 eyes (70%) of 4 children (80%). Four caregivers (80%) reported behavioral improvement in daily activities, and all caregivers (100%) reported improved peripheral target detection and socialization skills. CONCLUSIONS Strabismus surgery can be an effective procedure for treating horizontal strabismus in children with congenital Zika syndrome because it can improve ocular alignment, expand the visual field, and improve the child's social, functional, and behavioral skills. [J Pediatr Ophthalmol Strabismus. 2020;57(3):169-175.].
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11
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Wheeler AC, Toth D, Ridenour T, Lima Nóbrega L, Borba Firmino R, Marques da Silva C, Carvalho P, Marques D, Okoniewski K, Ventura LO, Bailey DB, Ventura CV. Developmental Outcomes Among Young Children With Congenital Zika Syndrome in Brazil. JAMA Netw Open 2020; 3:e204096. [PMID: 32369180 PMCID: PMC7201309 DOI: 10.1001/jamanetworkopen.2020.4096] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Although birth defects in children with congenital Zika syndrome (CZS) are expected to result in significant intellectual disabilities, the extent of delay and profiles of development have yet to be fully described. OBJECTIVES To describe the neurodevelopmental profiles of children with CZS and to test whether prenatal and postpartum characteristics were associated with the severity of developmental delays. DESIGN, SETTING, AND PARTICIPANTS This is a case series of the trajectories of developmental, behavioral, and medical needs of 121 young children with CZS who were assessed at a specialized rehabilitation center in Recife, Brazil, beginning in January 2018 as part of 5-year longitudinal study. Children were included if they had serologic confirmation of Zika virus and met clinical criteria accompanied by parental report of suspected exposure to Zika virus during pregnancy. EXPOSURES Prenatal Zika virus exposure. MAIN OUTCOMES AND MEASURES The Brazilian version of the Bayley Scales of Infant and Toddler Development, Third Edition, was administered by trained assessors as part of an initial comprehensive assessment battery. Caregiver interviews and medical record reviews were conducted to gather basic demographic information and medical comorbidities. Linear regression was used to identify potential factors for development. RESULTS The sample included 121 young children (mean [SD] age, 31.2 [1.9] months; 61 [50.4%] girls). At age approximately 2.5 years, nearly all children in this sample demonstrated profound developmental delays across all domains of functioning, with a mean (SD) developmental age equivalent to approximately 2 to 4 months (eg, cognitive domain, 2.24 [3.09] months; fine motor subscale, 2.15 [2.93] months; expressive language subscale, 2.30 [2.52] months). A relative strength was found in receptive language, with scores on this scale significantly higher than most other domains (eg, cognition: t = 3.73; P < .001; fine motor: t = 6.99; P < .001). Head circumference at birth was the single strongest factor associated with outcomes across all developmental domains (eg, cognitive: β = 1.41; SE, 0.67; P = .04; fine motor: β = 1.36; SE, 0.49; P = .007). CONCLUSIONS AND RELEVANCE The findings of this study provide important information regarding the severity of disability that these children and their families will experience. The findings also establish an initial point from which to monitor developmental trajectories, medical comorbidities (eg, seizures), effectiveness of interventions, and cumulative consequences on families.
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Affiliation(s)
- Anne C. Wheeler
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Danielle Toth
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Ty Ridenour
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Lucélia Lima Nóbrega
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Raíne Borba Firmino
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | | | - Pollyanna Carvalho
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Douglas Marques
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Katherine Okoniewski
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Liana O. Ventura
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Donald B. Bailey
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Camila V. Ventura
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
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12
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Ventura CV, Gois AL, Freire BO, de Almeida DC, MacKeen LD, Ventura Filho MC, Berrocal AM, Paul Chan RV, Belfort R, Maia M, Ventura LO. Fluorescein Angiography Findings in Children With Congenital Zika Syndrome. Ophthalmic Surg Lasers Imaging Retina 2020; 50:702-708. [PMID: 31755969 DOI: 10.3928/23258160-20191031-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/25/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the retinal and vasculature changes in infants with congenital Zika syndrome (CZS) using fluorescein angiography (FA). PATIENTS AND METHODS This consecutive case series included six infants with CZS. FA and color fundus imaging were performed under general anesthesia in both eyes of all infants using a contact widefield digital imaging system. All color fundus images were obtained using a 130° field of view lens, and the FA images were captured using either a 130° or 80° field of view lens. The immunoglobulin M antibody capture enzyme-linked immunosorbent assay was positive for Zika virus in the cerebrospinal fluid samples of all infants. Other congenital infections were ruled out. RESULTS The mean ± standard deviation age of the infants at the time of examination was 1.4 years ± 0.1 years (range: 1.3 years to 1.5 years). Contact fundus photographs showed macular abnormalities in seven eyes (58%) and retinal vasculature changes in two eyes (17%). FA detected macular abnormalities in all 12 eyes (100%) and retinal vasculature changes in five eyes (42%). The main retinal vasculature changes were peripheral avascularity in five eyes (42%) and microvasculature abnormalities in three eyes (25%). CONCLUSION FA may be an important tool for detecting subtle macular and retinal vasculature changes in CZS. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:702-708.].
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Ventura CV, Menezes CA, Ventura LO. Systemic and Ophthalmic Manifestations of Zika. Clin Ophthalmol 2020; 60:3-12. [DOI: 10.1097/iio.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
The recent Zika virus (ZIKV) outbreak and the link to birth defects in newborns exposed in utero, caught international attention. Due to its rapid spread throughout the Americas, authorities declared ZIKV a Public Health Emergency of International Concern that lasted from February to November 2016."Congenital Zika Syndrome" (CZS) is a new entity that reflects a broad spectrum of symptoms and signs observed in newborns infected by the ZIKV in utero. A recent review concluded that CZS differs from other congenital infections for its five distinct features: "(1) severe microcephaly with partially collapsed skull; (2) thin cerebral cortices with subcortical calcifications; (3) macular scarring and focal pigmentary retinal mottling; (4) congenital contractures; and (5) marked early hypertonia and symptoms of extrapyramidal involvement."Diagnosing and managing CZS has become a challenge for health professionals including ophthalmologists. The ocular manifestations of CZS are unique and have important consequences on vision. This article reviews the ocular manifestations of the CZS, addresses the visual outcomes of affected infants, and elucidates the early intervention protocols for visual improvement.
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Affiliation(s)
- Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
- Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | | | - Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
- Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
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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] [Grants] [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.
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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.
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16
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Wheeler AC, Ventura CV, Ridenour T, Toth D, Nobrega LL, Silva de Souza Dantas LC, Rocha C, Bailey DB, Ventura LO. Skills attained by infants with congenital Zika syndrome: Pilot data from Brazil. PLoS One 2018; 13:e0201495. [PMID: 30048541 PMCID: PMC6062124 DOI: 10.1371/journal.pone.0201495] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 05/01/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022] Open
Abstract
The recent Zika outbreak and its link to microcephaly and other birth defects in infants exposed in utero have garnered widespread international attention. Based on the severity of birth defects the extent of impairment in these infants is expected to be profound; however, virtually nothing is known regarding the developmental and behavioral sequela of congenital Zika syndrome. This pilot study collected parent-reported patterns of development and sleep in 47 infants with confirmed congenital Zika syndrome who are being followed for clinical services at the Altino Ventura Foundation (FAV) in Recife, Brazil. With assistance from clinicians at FAV, caregivers completed Brazilian Portuguese versions of the Ages and Stages Questionnaire, 3rd edition (ASQ-3) and the Brief Infant Sleep Questionnaire (BISQ). All infants were between 13–22 months of age at the time of the assessment. At 16 months of age, none of the children displayed age appropriate developmental skills. Most (~ 75%) mastered some communication and gross motor skills at around a 6–8-month level. Communication and gross motor skills were relative strengths for the sample, while problem-solving and fine motor skills were relative weaknesses. Sleep was noted to be a problem for around 18% of the sample. In utero exposure to the Zika virus will have lifelong consequences for affected children and their families. Understanding the developmental and behavioral trajectories of affected infants will help identify appropriate family supports to improve quality of life.
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MESH Headings
- Adolescent
- Adult
- Brazil/epidemiology
- Child Development/physiology
- Cognition/physiology
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/psychology
- Male
- Microcephaly/epidemiology
- Microcephaly/physiopathology
- Microcephaly/psychology
- Microcephaly/virology
- Motor Skills/physiology
- Pilot Projects
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/psychology
- Retrospective Studies
- Young Adult
- Zika Virus Infection/congenital
- Zika Virus Infection/epidemiology
- Zika Virus Infection/physiopathology
- Zika Virus Infection/psychology
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Affiliation(s)
- Anne C. Wheeler
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
- * E-mail:
| | - Camila V. Ventura
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
| | - Ty Ridenour
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
| | - Danielle Toth
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
| | - Lucélia Lima Nobrega
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
| | | | - Camilla Rocha
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
| | - Donald B. Bailey
- RTI Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC, United States of America
| | - Liana O. Ventura
- Rehabilitation Center “Menina dos Olhos”, Altino Ventura Foundation (FAV), Recife, Brazil
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17
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Ventura LO, Ventura CV, Dias NDC, Vilar IG, Gois AL, Arantes TE, Fernandes LC, Chiang MF, Miller MT, Lawrence L. Visual impairment evaluation in 119 children with congenital Zika syndrome. J AAPOS 2018; 22:218-222.e1. [PMID: 29654909 DOI: 10.1016/j.jaapos.2018.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 07/13/2017] [Revised: 01/04/2018] [Accepted: 01/28/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess visual impairment in a large sample of infants with congenital Zika syndrome (CZS) and to compare with a control group using the same assessment protocol. METHODS The study group was composed of infants with confirmed diagnosis of CZS. Controls were healthy infants matched for age, sex, and socioeconomic status. All infants underwent comprehensive ophthalmologic evaluation including visual acuity, visual function assessment, and visual developmental milestones. RESULTS The CZS group included 119 infants; the control group, 85 infants. At examination, the mean age of the CZS group was 8.5 ± 1.2 months (range, 6-13 months); of the controls, 8.4 ± 1.8 months (range, 5-12 months; P = 0.598). Binocular Teller Acuity Card (TAC) testing was abnormal in 107 CZS infants and in 4 controls (89.9% versus 5% [P < 0.001]). In the study group, abnormal monocular TAC results were more frequent in eyes with funduscopic alterations (P = 0.008); however, 104 of 123 structurally normal eyes (84.6%) also presented abnormal TAC results. Binocular contrast sensitivity was reduced in 87 of 107 CZS infants and in 8 of 80 controls (81.3% versus 10% [P < 0.001]). The visual development milestones were less achieved by infants with CZS compared to controls (P < 0.001). CONCLUSIONS Infants with CZS present with severe visual impairment. A protocol for assessment of the ocular findings, visual acuity, and visual developmental milestones tested against age-matched controls is suggested.
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Affiliation(s)
- Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil.
| | - Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Natália de C Dias
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Isabelle G Vilar
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Adriana L Gois
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Tiago E Arantes
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Luciene C Fernandes
- Department of Low Vision, Federal University of Minas Gerais, Belo Horizonte, Minas Gerias, Brazil
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon
| | | | - Linda Lawrence
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, Kansas
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Abstract
Vision plays an important role in the development of communication, social interaction, spatial awareness, and the motor skills needed to explore the environment. In the past 2 years, researchers have described the broad spectrum of clinical features that comprise congenital Zika syndrome (CZS). The ocular manifestations are considered 1 important pillar of this new entity. The most characteristic ophthalmic findings include chorioretinal scars and focal pigmentary changes seen in the macular region. Since these findings were first reported, other researchers have validated and extended them, leading to a more complete picture of the spectrum of ocular manifestations related to CZS. In this article, we summarize the current knowledge on the ocular implications of CZS and emphasize the importance of early rehabilitation to enhance visual performance in affected children.
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Affiliation(s)
- Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; and Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; and Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
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Abstract
Congenital Zika virus infection has obvious implications for infants, and considerable research has addressed the nature and consequences of congenital Zika syndrome (CZS). Children with classic CZS meet the criteria for "children with medical complexity," and ongoing research is required to understand the range of needs and optimal treatment options. Far less attention has been given to the consequences of CZS for families, which are both immediate and lifelong. Although families of children with CZS have much in common with families of other children with disabilities, at least 4 features of CZS have special family implications: (1) the severity of the impact on children with obvious abnormalities at birth, coupled with the anticipation of a lifetime of caregiving and economic burdens; (2) uncertainty about the unfolding consequences, both for obviously affected children and for exposed children with no symptoms at birth; (3) a lack of specialized professional knowledge about the course of the disease or treatment options; and (4) social isolation, a lack of social or community supports, and potential stigma. Supporting families will require a family-centered approach to services, extensive care coordination, access to evolving new information, ongoing surveillance, formal and informal supports, and individualized child and family services.
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Affiliation(s)
- Donald B Bailey
- RTI International, Research Triangle Park, North Carolina; and
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20
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Ventura LO, Ventura CV, Lawrence L, van der Linden V, van der Linden A, Gois AL, Cavalcanti MM, Barros EA, Dias NC, Berrocal AM, Miller MT. Visual impairment in children with congenital Zika syndrome. J AAPOS 2017; 21:295-299.e2. [PMID: 28450178 DOI: 10.1016/j.jaapos.2017.04.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 11/25/2016] [Accepted: 03/22/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the visual impairment associated with ocular and neurological abnormalities in a cohort of children with congenital Zika syndrome (CZS). METHODS This cross-sectional study included infants with microcephaly born in Pernambuco, Brazil, from May to December 2015. Immunoglobulin M antibody capture enzyme-linked immunosorbent assay for the Zika virus on the cerebrospinal fluid samples was positive for all infants. Clinical evaluation consisted of comprehensive ophthalmologic examination including visual acuity, visual function assessment, visual developmental milestone, neurologic examination, and neuroimaging. RESULTS A total of 32 infants (18 males [56%]) were included. Mean age at examination was 5.7 ± 0.9 months (range, 4-7 months). Visual function and visual developmental milestone could not be tested in 1 child (3%). Visual impairment was detected in 32 infants (100%). Retinal and/or optic nerve findings were observed in 14 patients (44%). There was no statistical difference between the patients with ocular findings and those without (P = 0.180). All patients (100%) demonstrated neurological and neuroimaging abnormalities; 3 (9%) presented with late-onset of microcephaly. CONCLUSIONS Children with CZS demonstrated visual impairment regardless of retina and/or optic nerve abnormalities. This finding suggests that cortical/cerebral visual impairment may be the most common cause of blindness identified in children with CZS.
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Affiliation(s)
- Liana O Ventura
- Altino Ventura Foundation (FAV), Recife, PE, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, PE, Brazil
| | - Camila V Ventura
- Altino Ventura Foundation (FAV), Recife, PE, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, PE, Brazil; Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Vanessa van der Linden
- Department of Pediatric Neurology, Disabled Children's Assistance Association (AACD), Recife, PE, Brazil
| | - Ana van der Linden
- Department of Pediatric Neurology, Materno Infantil Institute of Pernambuco (IMIP Hospital), Recife, PE, Brazil
| | - Adriana L Gois
- Altino Ventura Foundation (FAV), Recife, PE, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, PE, Brazil
| | - Milena M Cavalcanti
- Altino Ventura Foundation (FAV), Recife, PE, Brazil; Department of Pediatric Neurology, Disabled Children's Assistance Association (AACD), Recife, PE, Brazil
| | - Eveline A Barros
- Altino Ventura Foundation (FAV), Recife, PE, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, PE, Brazil
| | | | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
| | - Marilyn T Miller
- Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Illinois
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21
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Linden VVD, Linden HVD, Leal MDC, Rolim EL, Linden AVD, Aragão MDFVV, Brainer-Lima AM, Cruz DDCS, Ventura LO, Florêncio TLT, Cordeiro MT, Caudas SDS, Ramos RC. Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies. Arq Neuropsiquiatr 2017; 75:381-386. [PMID: 28658408 DOI: 10.1590/0004-282x20170066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/06/2017] [Indexed: 11/22/2022]
Abstract
Congenital Zika syndrome is an emergent cause of a congenital infectious disorder, resulting in severe damage to the central nervous system and microcephaly. Despite advances in understanding the pathophysiology of the disease, we still do not know all the mechanisms enrolled in the vertical transmission of the virus. As has already been reported in other types of congenital infectious disorders in dizygotic twin pregnancies, it is possible that the virus affects only one of the fetuses. In this article, we report on two cases of twin pregnancies exposed to the Zika virus, but with only one of the fetuses affected with microcephaly and brain damage. This indicates the urgent need for more studies regarding the pathophysiology of viral infection and the mechanisms involved in the natural protection against the virus.
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Affiliation(s)
- Vanessa van der Linden
- Hospital Barão de Lucena, Recife PE, Brasil.,Associação de Assistência à Criança Deficiente (AACD), Recife PE, Brasil
| | | | - Mariana de Carvalho Leal
- Universidade Federal de Pernambuco, Recife PE, Brasil.,Hospital Agamenon Magalhães, Recife PE, Brasil
| | - Epitacio Leite Rolim
- Associação de Assistência à Criança Deficiente (AACD), Recife PE, Brasil.,Universidade Federal de Pernambuco, Recife PE, Brasil
| | - Ana van der Linden
- Instituto de Medicina Integral Professor Fernando Figueira, Recife PE, Brasil
| | | | | | | | - Liana O Ventura
- Fundação Altino Ventura, Recife PE, Brasil.,Hospital de Olhos de Pernambuco (HOPE), Recife PE, Brasil
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Ventura CV, Maia M, Travassos SB, Martins TT, Patriota F, Nunes ME, Agra C, Torres VL, van der Linden V, Ramos RC, Rocha MÂW, Silva PS, Ventura LO, Belfort R. Risk Factors Associated With the Ophthalmoscopic Findings Identified in Infants With Presumed Zika Virus Congenital Infection. JAMA Ophthalmol 2017; 134:912-8. [PMID: 27228275 DOI: 10.1001/jamaophthalmol.2016.1784] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [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) might cause microcephaly and ophthalmoscopic findings in infants of mothers infected during pregnancy. OBJECTIVE To assess and identify possible risk factors for ophthalmoscopic findings in infants born with microcephaly and a presumed clinical diagnosis of ZIKV intrauterine infection. DESIGN, SETTING, AND PARTICIPANTS We conducted a cross-sectional study at the Altino Ventura Foundation in Recife, Brazil, that included 40 infants with microcephaly born in Pernambuco state, Brazil, between May and December 2015. Toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus were ruled out in all of them. Testing of cerebrospinal fluid for ZIKV using IgM antibody-capture enzyme-linked immunosorbent assay was performed in 24 of 40 infants (60.0%). The infants and mothers underwent ocular examinations. The infants were divided into 2 groups, those with and without ophthalmoscopic alterations, for comparison. MAIN OUTCOMES AND MEASURES Identification of risk factors for ophthalmoscopic findings in infants born with microcephaly and ZIKV intrauterine infection. RESULTS Among the 40 infants, the mean (SD) age was 2.2 (1.2) months (range, 0.1-7.3 months). Of the 24 infants tested, 100% had positive results for ZIKV infection: 14 of 22 infants (63.6%) from the group with ophthalmoscopic findings and 10 of 18 infants (55.6%) from the group without ophthalmoscopic findings. The major symptoms reported in both groups were rash by 26 mothers (65.0%), fever by 9 mothers (22.5%), headache by 9 mothers (22.5%), and arthralgia by 8 mothers (20.0%). No mothers reported conjunctivitis or other ocular symptoms during pregnancy or presented signs of uveitis at the time of examination. Thirty-seven eyes (46.3%) of 22 infants (55.0%) had ophthalmoscopic alterations. Ten mothers (71.4%) of infants with ocular findings reported symptoms during the first trimester (frequency, 0.48; 95% CI, 0.02-0.67; P = .04). A difference was also observed between the groups of infants with and without ocular findings regarding the cephalic perimeter: mean (SD) of 28.8 (1.7) and 30.3 (1.5), respectively (frequency, -1.50; 95% CI, -2.56 to -0.51; P = .004). CONCLUSIONS AND RELEVANCE Ocular involvement in infants with presumed ZIKV congenital infection were more often seen in infants with smaller cephalic diameter at birth and in infants whose mothers reported symptoms during the first trimester.
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Affiliation(s)
- Camila V Ventura
- Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil3Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil
| | - Simone B Travassos
- Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil
| | - Thayze T Martins
- Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil
| | - Felipe Patriota
- Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil
| | - Marcos Eugênio Nunes
- Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil
| | | | - Virginia L Torres
- Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil
| | | | | | | | | | - Liana O Ventura
- Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil
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23
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Ventura CV, Ventura LO, Bravo-Filho V, Martins TT, Berrocal AM, Gois AL, de Oliveira Dias JR, Araújo L, Escarião P, van der Linden V, Belfort R, Maia M. Optical Coherence Tomography of Retinal Lesions in Infants With Congenital Zika Syndrome. JAMA Ophthalmol 2017; 134:1420-1427. [PMID: 27832267 DOI: 10.1001/jamaophthalmol.2016.4283] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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 Zika virus (ZIKV) can cause severe changes in the retina and choroid that may result in marked visual impairment in infants with congenital Zika syndrome (CZS), the term created for a variety of anomalies associated with intrauterine ZIKV infection. Objective To evaluate the affected retinal layers in infants with CZS and associated retinal abnormalities using optical coherence tomography (OCT). Design, Setting, and Participants This cross-sectional, consecutive case series included 8 infants (age range, 3.0-5.1 months) with CZS. Optical coherence tomographic images were obtained in the affected eyes of 7 infants with CZS who had undergone previous ophthalmologic examinations on March 17, 2016, and in 1 infant on January 1, 2016. An IgM antibody-capture enzyme-linked immunosorbent assay for ZIKV was performed on the cerebrospinal fluid samples of 7 of the 8 infants (88%), and other congenital infections were ruled out. Main Outcomes and Measures Observation of retinal and choroidal findings in the OCT images. Results Among the 8 infants included in the study (3 male; 5 female; mean [SD] age at examination, 4.1 [0.7] months), 7 who underwent cerebrospinal fluid analysis for ZIKV had positive findings for IgM antibodies. Eleven of the 16 eyes (69%) of the 8 infants had retinal alterations and OCT imaging was performed in 9 (82%) of them. Optical coherence tomography was also performed in 1 unaffected eye. The main OCT findings in the affected eyes included discontinuation of the ellipsoid zone and hyperreflectivity underlying the retinal pigment epithelium in 9 eyes (100%), retinal thinning in 8 eyes (89%), choroidal thinning in 7 eyes (78%), and colobomatouslike excavation involving the neurosensory retina, retinal pigment epithelium, and choroid in 4 eyes (44%). Conclusions and Relevance Zika virus can cause severe damage to the retina, including the internal and external layers, and the choroid. The colobomatouslike finding seen in the OCT images relate to the excavated chorioretinal scar observed clinically.
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Affiliation(s)
- Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil3Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil4Bascom Palmer Eye Institute, Miami, Florida
| | - Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil
| | - Vasco Bravo-Filho
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil
| | - Thayze T Martins
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil
| | | | - Adriana L Gois
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil
| | - João Rafael de Oliveira Dias
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil4Bascom Palmer Eye Institute, Miami, Florida
| | - Leandro Araújo
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil
| | - Paulo Escarião
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil2Department of Ophthalmology, Pernambuco Eye Hospital, Recife, Brazil
| | | | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Moore CA, Staples JE, Dobyns WB, Pessoa A, Ventura CV, da Fonseca EB, Ribeiro EM, Ventura LO, Neto NN, Arena JF, Rasmussen SA. Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians. JAMA Pediatr 2017; 171:288-295. [PMID: 27812690 PMCID: PMC5561417 DOI: 10.1001/jamapediatrics.2016.3982] [Citation(s) in RCA: 609] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Zika virus infection can be prenatally passed from a pregnant woman to her fetus. There is sufficient evidence to conclude that intrauterine Zika virus infection is a cause of microcephaly and serious brain anomalies, but the full spectrum of anomalies has not been delineated. To inform pediatric clinicians who may be called on to evaluate and treat affected infants and children, we review the most recent evidence to better characterize congenital Zika syndrome. Observations We reviewed published reports of congenital anomalies occurring in fetuses or infants with presumed or laboratory-confirmed intrauterine Zika virus infection. We conducted a comprehensive search of the English literature using Medline and EMBASE for Zika from inception through September 30, 2016. Congenital anomalies were considered in the context of the presumed pathogenetic mechanism related to the neurotropic properties of the virus. We conclude that congenital Zika syndrome is a recognizable pattern of structural anomalies and functional disabilities secondary to central and, perhaps, peripheral nervous system damage. Although many of the components of this syndrome, such as cognitive, sensory, and motor disabilities, are shared by other congenital infections, there are 5 features that are rarely seen with other congenital infections or are unique to congenital Zika virus infection: (1) severe microcephaly with partially collapsed skull; (2) thin cerebral cortices with subcortical calcifications; (3) macular scarring and focal pigmentary retinal mottling; (4) congenital contractures; and (5) marked early hypertonia and symptoms of extrapyramidal involvement. Conclusions and Relevance Although the full spectrum of adverse reproductive outcomes caused by Zika virus infection is not yet determined, a distinctive phenotype-the congenital Zika syndrome-has emerged. Recognition of this phenotype by clinicians for infants and children can help ensure appropriate etiologic evaluation and comprehensive clinical investigation to define the range of anomalies in an affected infant as well as determine essential follow-up and ongoing care.
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Affiliation(s)
- Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - J. Erin Staples
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
| | - William B. Dobyns
- University of Washington and Seattle Children’s Research Institute, Seattle, WA
| | - André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil
| | - Camila V. Ventura
- Altino Ventura Foundation, Recife, Pernambuco, Brazil
- HOPE Eye Hospital, Recife, Pernambuco, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Eduardo Borges da Fonseca
- NOVA Diagnóstico Por Imagem, João Pessoa, Paraíba, Brazil
- Federal University of Paraiba (UFPB), João Pessoa, Paraíba, Brazil
| | - Erlane Marques Ribeiro
- Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil
- Estacio Faculdade de Medicina de Juazeiro do Norte, Juazeiro do Norte, Ceará, Brazil
| | - Liana O. Ventura
- Altino Ventura Foundation, Recife, Pernambuco, Brazil
- HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | | | | | - Sonja A. Rasmussen
- Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
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Ventura CV, Maia M, Ventura BV, Linden VVD, Araújo EB, Ramos RC, Rocha MAW, Carvalho MDCG, Belfort R, Ventura LO. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol 2016; 79:1-3. [PMID: 26840156 DOI: 10.5935/0004-2749.20160002] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/17/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In 2015, a twenty-fold increase in the prevalence of microcephaly in Brazil was reported, and the Ministry of Health associated this abnormal prevalence with the maternal-fetal Zika virus (ZIKV) transmission. METHODS We assessed the ophthalmological findings of ten mothers and their infants that had been clinically diagnosed with ZIKV-related microcephaly and presented ocular abnormalities, born from May to December 2015. RESULTS Seven mothers (70.0%) referred symptoms during pregnancy (malaise, rash and arthralgia), of which six (85.7%) were in the first trimester. At the time of exam, no ophthalmological abnormalities were identified in the mothers and they did not report ocular symptoms during pregnancy. Serology was negative in all infants for Toxoplasmosis, Rubella, Cytomegalovirus, Syphilis and Human Immunodeficiency Viruses. Ocular findings included macular alterations (gross pigment mottling and/or chorioretinal atrophy) in fifteen eyes (75.0%), and optic nerve abnormalities (hypoplasia with double-ring sign, pallor, and/or increased cup-to-disk ratio) in nine eyes (45.0%). CONCLUSIONS Patients presented normal anterior segment and important macular and optic nerve abnormalities. Further studies will assess the visual significance of these alterations.
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Affiliation(s)
| | - Mauricio Maia
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Affiliation(s)
- Camila V Ventura
- Altino Ventura Foundation, Recife, Brazil; Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil
| | | | | | - Liana O Ventura
- Altino Ventura Foundation, Recife, Brazil; Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil
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Ventura MC, Ventura BV, Ventura CV, Ventura LO, Arantes TE, Nosé W. Reply: To PMID 24530023. J Cataract Refract Surg 2014; 40:1057. [PMID: 24857456 DOI: 10.1016/j.jcrs.2014.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Indexed: 11/25/2022]
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Strömland K, Ventura LO, Mirzaei L, Fontes de Oliveira K, Marcelino Bandim J, Parente Ivo A, Brandt C. Fetal alcohol spectrum disorders among children in a Brazilian orphanage. ACTA ACUST UNITED AC 2014; 103:178-85. [DOI: 10.1002/bdra.23326] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kerstin Strömland
- Institute of Neuroscience and Physiology; Department of Ophthalmology; University of Gothenburg; Gothenburg Sweden
| | - Liana O. Ventura
- Department of Pediatric Ophthalmology; Altino Ventura Foundation and Hospital de Olhos de Pernambuco; Recife Brazil
| | - Layla Mirzaei
- Department of Surgery; Skaraborg Hospital; Skövde Sweden
| | | | - José Marcelino Bandim
- Department of Neuropsychiatry of the Federal University of Pernambuco; Department of Child and Adolescent Psychiatry; Instituto Materno Infantil de Pernambuco and Altino Ventura Foundation; Recife Brazil
| | | | - Carlos Brandt
- Department of Pediatric Surgery; Federal University of Pernambuco, Department of Pediatrics, Altino Ventura Foundation; Recife Brazil
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Ventura MC, Ventura BV, Ventura CV, Ventura LO, Arantes TE, Nosé W. Outcomes of congenital cataract surgery: intraoperative intracameral triamcinolone injection versus postoperative oral prednisolone. J Cataract Refract Surg 2014; 40:601-8. [PMID: 24530023 DOI: 10.1016/j.jcrs.2013.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/02/2013] [Accepted: 09/08/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare the outcomes of congenital cataract surgery using intraoperative intracameral triamcinolone versus postoperative oral prednisolone to modulate ocular inflammation. SETTING Department of Congenital Cataract, Altino Ventura Foundation, Recife, Brazil. DESIGN Randomized clinical trial. METHODS Children younger than 2 years were randomly divided into 2 groups. The study group received an intraoperative intracameral injection of 1.2 mg/0.03 mL of triamcinolone acetonide. The control group (29 eyes) received 1 mg/kg per day of prednisolone syrup for 15 days postoperatively, which was then tapered over the following 2 weeks. Intraocular pressure (IOP), central corneal thickness (CCT), cell deposits on the intraocular lens (IOL), posterior synechiae, visual axis obscuration, additional surgical procedures, and IOL centration were assessed 12 months postoperatively. RESULTS The mean patient age at surgery was 10.45 months±6.22 (SD) in the study group (31 eyes) and 10.0±6.15 months in the control group (29 eyes) (P=.779). In both groups, the mean IOP and CCT did not change significantly postoperatively (study group P=.922 and P=.149, respectively; control group P=.483 and P=.416, respectively). The groups had similar incidences of cell deposits (P=.517) and posterior synechiae (P=.247). No eye developed visual axis obscuration or had additional surgical procedures. All eyes had a clinically centered IOL. CONCLUSION One year postoperatively, the outcomes were similar with intraoperative intracameral triamcinolone injection and postoperative oral prednisolone for modulating inflammation after congenital cataract surgery. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Marcelo C Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil.
| | - Bruna V Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Camila V Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Liana O Ventura
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Tiago E Arantes
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
| | - Walton Nosé
- From the Department of Congenital Cataract (M.C. Ventura, B.V. Ventura, C.V. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Altino Ventura Foundation, and the Department of Congenital Cataract (M.C. Ventura), Department of Pediatric Ophthalmology and Strabismus (L.O. Ventura), and Department of Uveitis (Arantes), Pernambuco Eye Hospital, Recife; the Department of Ophthalmology (Nosé), Federal University of São Paulo, São Paulo, Brazil
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Ventura CV, Ventura LO, Miller MT, Cronemberger MF, Dias CS, Dias MJM, Gonzalez CH, Polati M, Nakanami CR, Brandt CT, Kuczynski E, Goldchmit M. Teratogen exposure and congenital ocular abnormalities in Brazilian patients with Möbius sequence. Arq Bras Oftalmol 2014; 77:300-304. [DOI: 10.5935/0004-2749.20140076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/12/2014] [Indexed: 11/20/2022] Open
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Ventura LO, Brandt CT. Projeto Mutirão de Catarata em centro de referência oftalmológico, em Pernambuco: perfil, grau de satisfação e benefício visual do usuário. Arq Bras Oftalmol 2004. [DOI: 10.1590/s0004-27492004000200009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bandim JM, Ventura LO, Miller MT, Almeida HC, Costa AES. Autism and Möbius sequence: an exploratory study of children in northeastern Brazil. Arq Neuropsiquiatr 2003; 61:181-5. [PMID: 12806493 DOI: 10.1590/s0004-282x2003000200004] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The psychiatric examination was performed with diagnostic instruments for autism (DSM-IV and Childhood Autism Rating Scale-CARS) in 23 children with Möbius sequence. From the 23 patients studied with Möbius sequence, five (26.1%) met the diagnostic criteria for infantile autism according DSM-IV and two (8.6%), under two years old, showed autistic-like behavior. The scores for six children were compatible to severe autism symptoms according CARS and one child met the criteria for moderate autism symptoms. Among five children with autism, three (60%) had positive history of misoprostol exposure during the first trimester of pregnancy and from two cases autistic-like, one (50%) had positive history of misoprostol exposure during pregnancy. According to our data, this is the first report of Möbius sequence with autism and positive history of misoprostol use during pregnancy.
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Affiliation(s)
- José Marcelino Bandim
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco, Recife, PE, Brasil.
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Abreu AA, Ventura LO, Abreu SS, Regis L, Morais V, Calheiros LMC. Epidemiologic Study of Retinoblastoma in Recife, Pernambuco - Brazil: January 1985 - July 1997. Arq Bras Oftalmol 1999. [DOI: 10.1590/s0004-27491999000500011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Ventura LO, Leal DB, Tavares SS, Araújo A, Linhares O, Gonçalves S. Catarata congênita bilateral: Estudo comparativo dos achados clínicos observados em dois grupos pertencentes a níveis sócio-econômicos distintos em Pernambuco. Arq Bras Oftalmol 1995. [DOI: 10.5935/0004-2749.19950006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Leal DB, Tavares SS, Ventura LO, Florêncio T. Atendimento a portadores de visão subnormal: estudo retrospectivo de 317 casos. Arq Bras Oftalmol 1995. [DOI: 10.5935/0004-2749.19950008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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