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https://www.arca.fiocruz.br/handle/icict/13025
OCULAR FINDINGS IN INFANTS WITH MICROCEPHALY ASSOCIATED WITH PRESUMED ZIKA VIRUS CONGENITAL INFECTION IN SALVADOR, BRAZIL
recém-nascidos
Virus Zika
Vírus
Infecção congênita
Visão
Nerco óptico
Degeneração macular
Author
Affilliation
Hospital Geral Roberto Santos. Department of Ophthalmology. Salvador, BA, Brasil
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil
Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Yale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, Connecticut
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil
Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Yale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, Connecticut
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Federal University of São Paulo. Paulista Medical School. Vision Institute. Department of Ophthalmology, São Paulo, SP, Brasil
Abstract
IMPORTANCE The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in
northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase
in the prevalence of microcephaly in newborn infants and vision-threatening findings in these
infants is likely associated with the rapid spread of ZIKV.
OBJECTIVE To evaluate the ocular findings in infants with microcephaly associated with
presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil.
DESIGN, SETTING, AND PARTICIPANTS Case series at a tertiary hospital. Twenty-nine infants
with microcephaly (defined by a cephalic circumference of 32 cm) with a presumed
diagnosis of congenital ZIKV were recruited through an active search and referrals from other
hospitals and health unities. The study was conducted between December 1 and December
21, 2015.
INTERVENTIONS All infants and mothers underwent systemic and ophthalmic examinations
from December 1 through December 21, 2015, in the Roberto Santos General Hospital,
Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were
documented using a wide-field digital imaging system. The differential diagnosis included
toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human
immunodeficiency virus, which were ruled out through serologic and clinical examinations.
MAIN OUTCOMES AND MEASURES Ocular abnormalities associated with ZIKV.
RESULTS Twenty-three of 29 mothers (79.3%) reported suspected ZIKV infection signs and
symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the
third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular
abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were
found in 7 of 10 patients presenting with ocular lesions, the most common of which were
focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with
abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris
coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%
CONCLUSIONS AND RELEVANCE Congenital infection due to presumed ZIKV exposure is
associated with vision-threatening findings, which include bilateral macular and perimacular
lesions as well as optic nerve abnormalities in most cases.
Keywords in Portuguese
Microcefaliarecém-nascidos
Virus Zika
Vírus
Infecção congênita
Visão
Nerco óptico
Degeneração macular
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