Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection

Abstract

Approved by the following research ethics committee: Altino Ventura Foundation (protocol #1.361.143) and was conducted at the Altino Ventura Foundation. ABSTRACTPurpose: In 2015, a twenty-fold increase in the prevalence of microcephaly in Brazil was reported, and the Ministry of Health associated this abnormal prevalence with the maternal-fetal Zika virus (ZIKV) transmission. Methods:We assessed the ophthalmological findings of ten mothers and their infants that had been clinically diagnosed with ZIKV-related microcephaly and presented ocular abnormalities, born from May to December 2015. Results: Seven mothers (70.0%) referred symptoms during pregnancy (malaise, rash and arthralgia), of which six (85.7%) were in the first trimester. At the time of exam, no ophthalmological abnormalities were identified in the mothers and they did not report ocular symptoms during pregnancy. Serology was negative in all infants for Toxoplasmosis, Rubella, Cytomegalovirus, Syphilis and Human Immunodeficiency Viruses. Ocular findings included macular alterations (gross pigment mottling and/or chorioretinal atrophy) in fifteen eyes (75.0%), and optic nerve abnormalities (hypoplasia with double-ring sign, pallor, and/or increased cup-to-disk ratio) in nine eyes (45.0%). Conclusions: Patients presented normal anterior segment and important macular and optic nerve abnormalities. Further studies will assess the visual significance of these alterations.

Risks associated with viral infections during pregnancy

“…This virus, a member of the family Flaviviridae, is transmitted by mosquito bite and is also potentially sexually transmitted (113)(114)(115)(116)(117). While historically an infection has been described as causing symptoms ranging from fever and rash to Guillain-Barre syndrome (118)(119)(120)(121)(122)(123)(124), during the most recent outbreak there was also a startling increase in the incidence of fetal brain and CNS abnormalities when mothers acquired the virus during pregnancy (32,(125)(126)(127)(128)(129)(130)(131)(132)(133)(134). A causal link between ZIKV and these defects was established when the ZIKV genome was identified in the amniotic fluid of women whose fetuses had microcephaly detected during fetal ultrasound (125-127, 132, 133, 135).…”

Zika virus: what do we know about the viral structure, mechanisms of transmission, and neurological outcomes?

“…Ocular lesions have been observed in 34.5% of microcephalic newborns (71) and can be extensive, with macular atrophy, optical nerve alterations, optic disc hypoplasia, gross macular pigment mottling, and juxtafoveal chorioretinal atrophic lesions (71) (72) . Most of the reports, however, have been published at the beginning of the Brazilian outbreak and additional detailed studies are needed to establish a link between Zika virus and ocular lesions.…”

Desenvolvimento Neuropsicomotor Em Crianças Com Microcefalia Associado Ao Zika Vírus

“…Conclusão: Os portadores de microcefalia associada ao ZIKAV apresentam atraso no desenvolvimento neuropsicomotor,alterações visuais, auditivas e sensoriais, impactando na independência funcional e na inserção social dessa população. Pode-se dizer que a aquisição de marcos de desenvolvimento pelas crianças depende do funcionamento do SNC e de outras dimensões do funcionamento orgânico, bem como da carga e da qualidade dos estímulos e das relações que a criança vivencia 1 .…”