Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/17877
Title: Congenital Zika Virus Infection: Beyond Neonatal Microcephaly
Authors: Melo, Adriana Suely de Oliveira
Aguiar, Renato Santana
Amorim, Melania Maria Ramos
Arruda, Monica B.
Melo, Fabiana de Oliveira
Ribeiro, Suelem Taís Clementino
Batista, Alba Gean Medeiros
Ferreira, Thales
Santos, Mayra Pereira dos
Sampaio, Virgínia Vilar
Moura, Sarah Rogéria Martins
Rabello, Luciana Portela
Gonzaga, Clarissa Emanuelle
Malinger, Gustavo
Ximenes, Renato
Szejnfeld, Patricia Soares de Oliveira
Tovar-Moll, Fernanda
Chimelli, Leila
Silveira, Paola Paz
Delvechio, Rodrigo
Higa, Luiza
Campanati, Loraine
Nogueira, Rita M. R.
Filippis, Ana Maria Bispo
Szejnfeld, Jacob
Voloch, Carolina Moreira
Ferreira, Orlando C.
Brindeiro, Rodrigo M.
Tanuri, Amilcar
Affilliation: Instituto de Pesquisa Professor Amorim Neto (IPESQ). Campina Grande, PB, Brasil / Instituto de Saúde Elpidio de Almeida. Campina Grande, PB, Brasil / Faculdade de Ciências Médicas de Campina Grande, Campina Grande, PB, Brasil /Hospital Municipal Pedro I, Campina Grande, PB, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Instituto de Pesquisa Professor Amorim Neto (IPESQ). Campina Grande, PB, Brasil / Universidade Federal de Campina Grande. Campina Grande, PB, Brasil / Instituto de Saúde Elpidio de Almeida. Campina Grande, PB, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Instituto de Pesquisa Professor Amorim Neto (IPESQ). Campina Grande, PB, Brasil / Instituto de Saúde Elpidio de Almeida. Campina Grande, PB, Brasil.
Instituto de Saúde Elpidio de Almeida. Campina Grande, PB, Brasil / Faculdade de Ciências Médicas de Campina Grande. Campina Grande, PB, Brasil.
Hospital Municipal Pedro I, Campina Grande, PB, Brasil.
Universidade Federal de Campina Grande, Paraíba, Brasil.
Instituto de Saúde Elpidio de Almeida. Campina Grande, PB, Brasil.
Faculdade de Ciências Médicas de Campina Grande, Campina Grande, PB, Brasil / Hospital Municipal Pedro I, Campina Grande, PB, Brasil.
Faculdade de Ciências Médicas de Campina Grande, Campina Grande, PB, Brasil / Hospital Municipal Pedro I, Campina Grande, PB, Brasil.
Faculdade de Ciências Médicas de Campina Grande, Campina Grande, PB, Brasil / Hospital Municipal Pedro I, Campina Grande, PB, Brasil.
Hospital Municipal Pedro I, Campina Grande, PB, Brasil.
Tel Aviv University. Sackler Faculty of Medicine. Tel Aviv Sourasky Medical Center. Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital. Tel Aviv, Israel.
Fundação de Medicina Fetal Latino Americana. Campinas, SP, Brasil.
Universidade Federal de São Paulo, Fundação Instituto de Pesquisa e Ensino de Diagnostico por Imagem. São Paulo, SP, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Ciências Biomédicas. Rio de Janeiro, RJ, Brasil.
Instituto Estadual do Cérebro Paulo Niemeyer. Laboratório de Neuropatologia. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Ciências Biomédicas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Flavivírus. Rio de Janeiro, RJ, Brasil.
Universidade Federal de São Paulo.Departamento de Diagnóstico por Imagem. São Paulo, SP, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Biologia. Departamento de Genética. Rio de Janeiro, RJ, Brasil.
Abstract: Importance Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. Objective To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. Design, Setting, and Participants We observed 11 infants with congenital ZIKV infection from gestation to 6 months in the state of Paraíba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. Main Outcomes and Measures Description of the major lesions caused by ZIKV congenital infection. Results Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. Conclusions and Relevance Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.
Keywords: Zika Virus
Microcephaly
Congenital Zika virus infection
Pregnancy
keywords: Zika virus
Gravidez
Microcefalia
Infecção
Issue Date: 2016
Publisher: American Medical Association
Citation: MELO, Adriana Suely de Oliveira; et al. Congenital Zika Virus Infection Beyond Neonatal Microcephaly. JAMA Neurology, v.73, n.12, p.1407-1416, Oct. 2016.
Description: Contém Suplemento
DOI: 10.1001/jamaneurol.2016.3720
ISSN: 2168-6157
Copyright: restricted access
Appears in Collections:IOC - Artigos de Periódicos

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