Presumed congenital infection by Zika virus: findings on psychomotor development - a case report

Abstract

Introduction: the identification of Zika virus (ZikV) in the amniotic fluid, in the placenta and in newborns' brains suggests a neurotropism of this agent in the brain development, resulting in neuro-psycho-motor alterations. Thus, this present study reports the assessment of children diagnosed by a congenital infection, presumably by ZikV, followed-up at the Rehabilitation Center Prof. Ruy Neves Baptist at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). Description: as proposed by the Ministry of Health, the following instruments were used to evaluate the neuro-motor functions of four children with microcephaly aged between three and four months: The Test of Infant Motor Performance (TIMP); the functional vision assessment; the manual function scale development; and the clinical evaluation protocol on pediatric dysphagia (PAD-PED). Discussion: the children evaluated presented atypical motor performance, muscle tone and spontaneous motricity which encompass the symmetry and the motion range of the upper and lower limbs proven to be altered. The functional vision showed alterations which can cause limitations in the performance of functional activities and the learning process. Regarding to the speech articulator's functions observed that the maturation and coordination of sucking, swallowing and breathing did not yet encounter the appropriate age maturity level.

Early stimulation in the development of children with microcephaly: maternal perception

“…It was observed that the mothers recognized the damages caused by microcephaly in the development of their children, and that the damages in the motor system were the most frequently mentioned. These reports are similar to those found in a study that evaluated the neuropsychomotor development of children with congenital zika virus infection, which showed that they had atypical motor performance and immaturity in suction, swallowing and breathing (12) .…”

“…Faced with this scenario, research has been developed and, today, several studies that demonstrate the neurotropism of the virus (5)(6)(7) , as well as its ability to cross the transplacental barrier and infect the fetus are reported in the literature (8)(9) . This affinity for the CNS may result in the development of cerebral calcifications, cerebellar hypoplasia and ventriculomegaly, which increases the risk of the child with microcephaly presenting, in an associated way, epilepsy, visual and auditory impairments and retardation in neuropsychomotor development (10)(11)(12) .…”

Motor Abnormalities and Epilepsy in Infants and Children With Evidence of Congenital Zika Virus Infection

“…77 Because the terms used to describe motor dysfunction varied considerably, a direct comparison of abnormalities was not possible. Nevertheless, some indication of hypertonia and other signs of pyramidal involvement ranged from 37% in the report by Schuler-Faccini et al 10 to 100% in the 2 smallest series reported by van der Linden et al 12 and Botelho et al, 64 and 42.9% in the cohort study from Brasil et al 62 The frequency of extrapyramidal signs was less well documented in these series; in 3 reports, Moura da Silva et al, 5 van der Linden et al, 12 and Del Campo et al 66 specifically described extrapyramidal signs, and 1 of those reports 12 noted that 12 of 13 (92.3%) infants had extrapyramidal findings of dyskinesia or dystonia.…”

Crises convulsivas em neonato com microcefalia associada à infecção pelo Zika vírus [Seizures in newborn with microcephaly associated to Zika virus infection] [Crisis convulsivas en neonato con microcefalia asociada a la infección por el virus de Zika]

“…As malformações congênitas representam um desafio para a equipe multidisciplinar, principalmente no que diz respeito ao diagnóstico e tratamento, devido à complexidade do prognóstico e do cuidado com o recém-nascido, visto que o cuidado qualificado e eficaz está intimamente relacionado à evolução clínica 13,14 .…”