title: Risk Factors Associated With the Ophthalmoscopic Findings Identified in Infants With Presumed Zika Virus Congenital Infection.
abstract: OBJECTIVE
  The Zika virus (ZIKV) might cause microcephaly and ophthalmoscopic findings in infants of mothers infected during pregnancy.
  
  
  OBJECTIVE
  To assess and identify possible risk factors for ophthalmoscopic findings in infants born with microcephaly and a presumed clinical diagnosis of ZIKV intrauterine infection.
  
  
  METHODS
  We conducted a cross-sectional study at the Altino Ventura Foundation in Recife, Brazil, that included 40 infants with microcephaly born in Pernambuco state, Brazil, between May and December 2015. Toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus were ruled out in all of them. Testing of cerebrospinal fluid for ZIKV using IgM antibody-capture enzyme-linked immunosorbent assay was performed in 24 of 40 infants (60.0%). The infants and mothers underwent ocular examinations. The infants were divided into 2 groups, those with and without ophthalmoscopic alterations, for comparison.
  
  
  METHODS
  Identification of risk factors for ophthalmoscopic findings in infants born with microcephaly and ZIKV intrauterine infection.
  
  
  RESULTS
  Among the 40 infants, the mean (SD) age was 2.2 (1.2) months (range, 0.1-7.3 months). Of the 24 infants tested, 100% had positive results for ZIKV infection: 14 of 22 infants (63.6%) from the group with ophthalmoscopic findings and 10 of 18 infants (55.6%) from the group without ophthalmoscopic findings. The major symptoms reported in both groups were rash by 26 mothers (65.0%), fever by 9 mothers (22.5%), headache by 9 mothers (22.5%), and arthralgia by 8 mothers (20.0%). No mothers reported conjunctivitis or other ocular symptoms during pregnancy or presented signs of uveitis at the time of examination. Thirty-seven eyes (46.3%) of 22 infants (55.0%) had ophthalmoscopic alterations. Ten mothers (71.4%) of infants with ocular findings reported symptoms during the first trimester (frequency, 0.48; 95% CI, 0.02-0.67; P = .04). A difference was also observed between the groups of infants with and without ocular findings regarding the cephalic perimeter: mean (SD) of 28.8 (1.7) and 30.3 (1.5), respectively (frequency, -1.50; 95% CI, -2.56 to -0.51; P = .004).
  
  
  CONCLUSIONS
  Ocular involvement in infants with presumed ZIKV congenital infection were more often seen in infants with smaller cephalic diameter at birth and in infants whose mothers reported symptoms during the first trimester.
authors.affiliation: Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil3Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil.
authors.forename: Camila V
authors.initials: CV
authors.lastname: Ventura
authors.affiliation: Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Maia
authors.affiliation: Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil.
authors.forename: Simone B
authors.initials: SB
authors.lastname: Travassos
authors.affiliation: Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil.
authors.forename: Thayze T
authors.initials: TT
authors.lastname: Martins
authors.affiliation: Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Patriota
authors.affiliation: Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil.
authors.forename: Marcos Eugênio
authors.initials: ME
authors.lastname: Nunes
authors.affiliation: Pernambuco's Eye Hospital (HOPE), Recife, Brazil.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Agra
authors.affiliation: Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil.
authors.forename: Virginia L
authors.initials: VL
authors.lastname: Torres
authors.affiliation: Barão de Lucena Hospital, Recife, Brazil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: van der Linden
authors.affiliation: Oswaldo Cruz University Hospital, Recife, Brazil.
authors.forename: Regina C
authors.initials: RC
authors.lastname: Ramos
authors.affiliation: Oswaldo Cruz University Hospital, Recife, Brazil.
authors.forename: Maria Ângela W
authors.initials: MÂ
authors.lastname: Rocha
authors.affiliation: Oswaldo Cruz University Hospital, Recife, Brazil.
authors.forename: Paula S
authors.initials: PS
authors.lastname: Silva
authors.affiliation: Altino Ventura Foundation, Recife, Brazil2Pernambuco's Eye Hospital (HOPE), Recife, Brazil.
authors.forename: Liana O
authors.initials: LO
authors.lastname: Ventura
authors.affiliation: Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil.
authors.forename: Rubens
authors.initials: R
authors.lastname: Belfort
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis*; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D015828:Eye Infections, Viral / Q000151:congenital / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000821:virology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009887:Ophthalmoscopy / Q000379:methods*; D011247:Pregnancy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D000071244:Zika Virus / Q000276:immunology*; D000071243:Zika Virus Infection / Q000151:congenital / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral