Screening Criteria for Ophthalmic Manifestations of Congenital Zika Virus Infection

Abstract

IMPORTANCECurrent guidelines recommend screening eye examinations for infants with microcephaly or laboratory-confirmed Zika virus infection but not for all infants potentially exposed to Zika virus in utero.OBJECTIVE To evaluate eye findings in a cohort of infants whose mothers had polymerase chain reaction-confirmed Zika virus infection during pregnancy.DESIGN, SETTING, AND PARTICIPANTS In this descriptive case series performed from January 2 through October 30, 2016, infants were examined from birth to 1 year of age by a multidisciplinary medical team, including a pediatric ophthalmologist, from Fernandes Figueira Institute, a Ministry of Health referral center for high-risk pregnancies and infectious diseases in children in Rio de Janeiro, Brazil.PARTICIPANTS Mother-infant pairs from Rio de Janeiro, Brazil, who presented with suspected Zika virus infection during pregnancy were referred to our institution and had serum, urine, amniotic fluid, or placenta samples tested by real-time polymerase chain reaction for Zika virus.MAIN OUTCOMES AND MEASURES Description of eye findings, presence of microcephaly or other central nervous system abnormalities, and timing of infection in infants with confirmed Zika virus during pregnancy. Eye abnormalities were correlated with central nervous system findings, microcephaly, and the timing of maternal infection. RESULTSOf the 112 with polymerase chain reaction-confirmed Zika virus infection in maternal specimens, 24 infants (21.4%) examined had eye abnormalities (median age at first eye examination, 31 days; range, 0-305 days). Ten infants (41.7%) with eye abnormalities did not have microcephaly, and 8 (33.3%) did not have any central nervous system findings. Fourteen infants with eye abnormalities (58.3%) were born to women infected in the first trimester, 8 (33.3%) in the second trimester, and 2 (8.3%) in the third trimester. Optic nerve and retinal abnormalities were the most frequent findings. Eye abnormalities were statistically associated with microcephaly (odds ratio [OR], 19.1; 95% CI, 6.0-61.0), other central nervous system abnormalities (OR, 4.

Zika virus during pregnancy: From maternal exposure to congenital Zika virus syndrome

“…In future epidemics, other more subtle signs might be associated with CZS, and some infected infants may only develop anomalies in childhood …”

Zika virus and the nonmicrocephalic fetus: why we should still worry

“…optic nerve hypoplasia) that cannot be detected by ultrasound. (16, 35) Even though intracranial calcifications should be easily detected by antenatal ultrasound, there are reports of calcifications first being detected using postnatal cranial ultrasound. (29) It is also possible that neurologic injury, which began with fetal exposure to ZIKV, may continue to evolve in the first year of life and become more obvious over time.…”

“…(42) In addition, 21% of infants had eye abnormalities; nearly half of these infants were not microcephalic and one-third had no abnormalities identified within the central nervous system at all. (35) In a U.S. cohort of 86 pregnancies from Miami-Dade county with laboratory evidence of ZIKV infection, there was a 9% rate of microcephaly and an even greater frequency of abnormalities on postnatal cranial ultrasound (17%) and eye examination (13%). (29) In both case series, ocular injuries and abnormal postnatal imaging were approximately twice as common as the outcome of microcephaly, which underscores the complexity of congenital ZIKV infections.…”

Public Health Approach to Addressing the Needs of Children Affected by Congenital Zika Syndrome

“…A second study in 2017 reported eye findings in infants without microcephaly or other brain anomalies who were born to mothers with laboratory evidence of ZIKV infection. 21 These findings have important implications for infants who are born without visible evidence of congenital Zika infection. Information is lacking to better characterize the complete phenotype of CZS, describe the clustering of anomalies, and define the timing of when these anomalies occur.…”