Visual impairment evaluation in 119 children with congenital Zika syndrome

Ventura, Liana O.; Ventura, Camila V.; Dias, Natalia de Carvalho; Vilar, Isabelle G.; Gois, Adriana L.; Arantes, Tiago Eugênio Faria e; Fernandes, Luciene Chaves; Chiang, Michael F.; Miller, Marilyn T.; Lawrence, Linda

doi:10.1016/j.jaapos.2018.01.009

Cited by 35 publications

(59 citation statements)

References 21 publications

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“…In a report by Fernandez et al, postmortem examination of fetuses from terminated pregnancies revealed micro-calcifications of the retina, increased amount of autolysis of tissues at the front of the ocular tract, detachment of retinal and RPE layers, and a distinct lack of neural differentiation of retinal neurons ( 81 ). This study by Fernandez et al corroborates with other clinical cases, such as those reported in Brazil, where 34.5% of all ZIKV microcephalic infants reported in the first 2 months of 2016 had ocular abnormalities, such as retinal mottling, optic nerve degeneration, and a lack of differentiation of retinal neurons ( 82 – 90 ).…”

Section: Zikv Transmission and Tissue Tropismsupporting

confidence: 87%

Evolution of Two Major Zika Virus Lineages: Implications for Pathology, Immune Response, and Vaccine Development

et al. 2018

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Zika virus (ZIKV) became a public health emergency of global concern in 2015 due to its rapid expansion from French Polynesia to Brazil, spreading quickly throughout the Americas. Its unexpected correlation to neurological impairments and defects, now known as congenital Zika syndrome, brought on an urgency to characterize the pathology and develop safe, effective vaccines. ZIKV genetic analyses have identified two major lineages, Asian and African, which have undergone substantial changes during the past 50 years. Although ZIKV infections have been circulating throughout Africa and Asia for the later part of the 20th century, the symptoms were mild and not associated with serious pathology until now. ZIKV evolution also took the form of novel modes of transmission, including maternal–fetal transmission, sexual transmission, and transmission through the eye. The African and Asian lineages have demonstrated differential pathogenesis and molecular responses in vitro and in vivo. The limited number of human infections prior to the 21st century restricted ZIKV research to in vitro studies, but current animal studies utilize mice deficient in type I interferon (IFN) signaling in order to invoke enhanced viral pathogenesis. This review examines ZIKV strain differences from an evolutionary perspective, discussing how these differentially impact pathogenesis via host immune responses that modulate IFN signaling, and how these differential effects dictate the future of ZIKV vaccine candidates.

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Section: Zikv Transmission and Tissue Tropismsupporting

confidence: 87%

Evolution of Two Major Zika Virus Lineages: Implications for Pathology, Immune Response, and Vaccine Development

et al. 2018

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“…These children need regular follow-ups, even the ones with normal initial screening tests, because hearing loss, like in other congenital viral infections, can be delayed and progressive. Severe visual impairment has been reported in all cases with CZS, as a consequence of retinal and/or optic nerve alterations [16]. In our cases, this may be a consequence of cortical and subcortical alterations.…”

Section: Discussionsupporting

confidence: 58%

“…ZIKV was included in the list of infectious agents that cause congenital malformations, with a spectrum of neurological manifestations beyond microcephaly. Neurological manifestations were described as multiple and severe brain abnormalities [5,9,10], arthrogryposes [11,12,13], hearing loss [14], seizures [12,13,15], pyramidal/extrapyramidal syndrome [12,13], retinal and/or optic nerve alterations [16], and dysphagia [17].…”

Section: Introductionmentioning

confidence: 99%

Clinical, Neuroimaging, and Neurophysiological Findings in Children with Microcephaly Related to Congenital Zika Virus Infection

Lage

Carvalho

Ventura

et al. 2019

IJERPH

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Zika virus (ZIKV) infection appeared in Brazil in 2015, causing an epidemic outbreak with increased rates of microcephaly and other serious birth disorders. We reviewed 102 cases of children who were diagnosed with microcephaly at birth and who had gestational exposure to ZIKV during the outbreak. We describe the clinical, neuroimaging, and neurophysiological findings. Most mothers (81%) reported symptoms of ZIKV infection, especially cutaneous rash, during the first trimester of pregnancy. The microcephaly was severe in 54.9% of the cases. All infants presented with brain malformations. The most frequent neuroimaging findings were cerebral atrophy (92.1%), ventriculomegaly (92.1%), malformation of cortical development (85.1%), and cortical–subcortical calcifications (80.2%). Abnormalities in neurological exams were found in 97.0% of the cases, epileptogenic activity in 56.3%, and arthrogryposis in 10.8% of the infants. The sensorineural screening suggested hearing loss in 17.3% and visual impairment in 14.1% of the infants. This group of infants who presented with microcephaly and whose mothers were exposed to ZIKV early during pregnancy showed clinical and radiological criteria for congenital ZIKV infection. A high frequency of brain abnormalities and signs of early neurological disorders were found, and epileptogenic activity and signs of sensorineural alterations were common. This suggests that microcephaly can be associated with a worst spectrum of neurological manifestations.

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“…5,12–14,16–22 In addition, abnormal visual function has been reported in infants infected with ZIKV and neurological abnormalities. 23 In this study we were able to investigate visual function in an expanded cohort of less severely affected infants with either symptomatic pregnancies, PCR confirmation of infection, or prenatal ultrasound abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Visual function in infants with antenatal Zika virus exposure

Zin

Tsui

Rossetto

et al. 2018

Journal of American Association for Pediatric Ophthalmology and

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Purpose To report the findings of a cross-sectional study of visual function in infants with confirmed or suspected antenatal Zika virus (ZIKV) infection seen at a single referral center in Rio de Janeiro. Methods Infants were examined following the ZIKV outbreak period at Fernandes Figueira Institute/FIOCRUZ. Visual function was considered abnormal if an infant could not fix and follow a standardized high-contrast target (10 cm) by 3–6 months of age. Visual function and associations with structural eye abnormalities, central nervous system (CNS) abnormalities, microcephaly, and nystagmus were assessed. Sensitivity and specificity of screening criteria for structural eye abnormalities was assessed. Results A total of 173 infants met inclusion criteria. Reduced visual function was found in 52 infants (30.0%) and was significantly associated with eye abnormalities (40/52; OR = 44.2; 95% CI, 16.6–117.6), CNS abnormalities (50/52; OR = 64.0; 95% CI, 14.7–277.6), microcephaly (44/52; OR = 31.5; 95% CI,12.7–77.8), and nystagmus (26/52; OR = 120.0; 95% CI, 15.6–924.5). Using microcephaly as screening criteria for the detection of eye abnormalities provided a sensitivity of 88.9% (95% CI,76.0–96.3) and specificity of 82.8% (95% CI, 75.1–88.9). Using both abnormal visual function and microcephaly increased sensitivity to 100% (95% CI, 92.1–100.0) and decreased specificity to 80.5% (95% CI, 72.5–86.9). Conclusions Infants with suspected antenatal ZIKV infection and reduced visual function should be referred to an ophthalmologist. Visual function assessments are helpful in screening for antenatal ZIKV exposure in resource-limited settings and can identify infants who may benefit from visual habilitation.

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Visual impairment evaluation in 119 children with congenital Zika syndrome

Cited by 35 publications

References 21 publications

Evolution of Two Major Zika Virus Lineages: Implications for Pathology, Immune Response, and Vaccine Development

Evolution of Two Major Zika Virus Lineages: Implications for Pathology, Immune Response, and Vaccine Development

Clinical, Neuroimaging, and Neurophysiological Findings in Children with Microcephaly Related to Congenital Zika Virus Infection

Visual function in infants with antenatal Zika virus exposure

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