Neurogenic bladder findings in patients with Congenital Zika Syndrome: A novel condition

Abstract

IntroductionCongenital Zika Syndrome (CZS) has been associated with microcephaly and other central nervous system abnormalities including areas that have been implicated in the control of the lower urinary tract. As such, this descriptive case series has aimed to investigate whether CZS is linked with neurogenic bladder. Identifying such an association is paramount in the effort to recognize CZS complications that have putative treatment options that could mitigate the impact of CZS in infected children.MethodsFollowing IRB approval, urological assessment was performed in all patients referred to our clinic between June 2016 and May 2017 who presented with confirmed CZS-associated microcephaly. The research protocol consisted of obtaining clinical history, laboratory tests, lower and upper urinary tract ultrasounds, as well as a diagnostic urodynamic evaluation. ZIKA virus infection was previously confirmed by maternal history and positive PCR in babies and mothers. Microcephaly and other central nervous system abnormalities were established based on neurological assessment and associated imaging of the central nervous system (CT head and/or Brain MRI).ResultsTwenty-two consecutive CZS patients were tested and confirmed to have neurogenic bladder. Of the 22 patients assessed, 21 presented with an overactive bladder combined with reduced bladder capacity and elevated detrusor filling pressures. Clinically significant increases in postvoid residual (PVR) were confirmed in 40% of cases while a urinary tract infection (UTI) was identified in 23% of cases.ConclusionNeurogenic bladder, a known treatable health condition, was confirmed in 100% of patients tested in this study, most presenting with high-risk urodynamic patterns known to lead to renal damage when left untreated. Follow up studies are necessary to provide further insight onto long-term disease progression and to investigate the response to standard therapies for neurogenic bladder. Nonetheless, we emphasize the importance of proactive management of neurogenic bladder and prompt referral so as to help mitigate CZS disease burden for patients and their families.

Adequate Placental Sampling for the Diagnosis and Characterization of Placental Infection by Zika Virus

“…This syndrome is characterized by a broad spectrum of fetal changes, with microcephaly being the most striking, even if present only in part of the affected newborns (Petersen et al, 2016;Rasmussen et al, 2016;van der Eijk et al, 2016;Ministério da Saúde, 2017). Clinical consequences of CZS include the presence of pronounced brain damage and intracerebral calcification, cortical reduction, atrophy, cerebellar hypoplasia, arthrogryposis, ocular lesions, and neurogenic bladder (Chimelli et al, 2017;Honein et al, 2017;Costa Monteiro et al, 2018). In Brazil, 2865 cases of newborns and children with growth alterations and microcephaly caused by Zika infection during pregnancy were reported from November 8, 2015, to December 29, 2018, not counting those who died (Ministério da Saúde, 2019).…”

Postnatal symptomatic Zika virus infections in children and adolescents: A systematic review

“…The strongest evidence for the neurotropic activity of ZIKV arises from prenatal exposure to the virus, which can lead to Congenital Zika Syndrome, one of the most severe manifestations being microcephaly [ 25 ]. Additional manifestations associated with congenital ZIKV infection that have been identified to date include epilepsy, motor abnormalities and bladder dysfunction [ 60 , 61 ]. While the exact mechanism for the neurotropic activity of ZIKV remains unclear, a suggested mechanism is through the virus’s ability to halt the proliferation of neural progenitor cells and possibly induce cell death [ 62 , 63 ].…”

Zika virus infection and implications for kidney disease

“…If left untreated, it could lead to recurrent urinary tract infections, urinary incontinence, and ultimately chronic and end-stage renal diseases. To the best of my knowledge, this is the first report that confirms a diagnosis of neurogenic bladder in infants with CZS [ 43 ]. The high incidence of neurogenic bladder observed in this study implies that all infants born with CZS should be screened for this condition in order to provide early treatment interventions to improve long-term clinical outcomes.…”

“…Although I have observed full lytic replication of ZIKV in primary human glomerular cells in vitro, I have not encountered reports on immunocompetent patients having renal disease that is directly associated with ZIKV infection. However, a recent study by Costa-Monteiro et al reported on the development of neurogenic bladder in 21 pediatric patients with CZS [ 43 ]. All 21 patients clinically presented with an overactive bladder, with reduced bladder capacity and elevated detrusor pressure [ 43 ].…”

“…However, a recent study by Costa-Monteiro et al reported on the development of neurogenic bladder in 21 pediatric patients with CZS [ 43 ]. All 21 patients clinically presented with an overactive bladder, with reduced bladder capacity and elevated detrusor pressure [ 43 ]. All patients were tested and confirmed to have neurogenic bladder.…”