Lessons Learned at the Epicenter of Brazil's Congenital Zika Epidemic: Evidence From 87 Confirmed Cases.
Congenital Zika virus infection has stimulated great international concern. A prospective case series of 87 infants with laboratory-confirmed congenital Zika syndrome (CZS) at the epicenter of the Brazilian Zika epidemic in Pernambuco state is presented. Mothers were interviewed for symptoms of possible Zika virus (ZIKV) infection during pregnancy, and fetal ultrasounds were obtained. Infant cerebrospinal fluid (CSF) samples were tested for ZIKV-specific antibodies, and sera were screened for other congenital infections. Neuroimaging and ophthalmologic evaluations were also performed. Sixty-six mothers (76%) reported symptoms of ZIKV infection during gestation. Fetal ultrasounds were available from 90% of the mothers, and all demonstrated brain structural abnormalities. All of the CSF samples tested positive for ZIKV immunoglobulin M. The majority of infants (89%) were term; the mean birth weight was 2577 ± 260 g, and the mean head circumference was 28.1 ± 1.8 cm. Severe microcephaly, defined as head circumference 3 SD below the mean for sex and gestational age, was found in 72 (82%) infants. All infants had an abnormal neurological exam, and 18 (20.7%) had arthrogryposis. The main abnormalities detected in computed tomography scans were calcifications (99%), followed by ventricular enlargement (94%), cortical hypogyration (81%), and less commonly, cerebellar hypoplasia (52%). Unilateral diaphragm paralysis was identified in 3 infants. Maternal young age, term infant, small for gestational age, and the presence of ophthalmologic abnormalities were significantly associated with a smaller head circumference Z score. Our findings, based on laboratory-confirmed ZIKV infection, add valuable evidence for the understanding of CZS.
Division of Neonatology, Professor Fernando Figueira Integral Medicine Institute.
Jucille do Amaral
JDA
Meneses
Division of Neonatology, Professor Fernando Figueira Integral Medicine Institute.
Ana Catarina
AC
Ishigami
Division of Neonatology, Professor Fernando Figueira Integral Medicine Institute.
Luisa Medeiros
LM
de Mello
Division of Neonatology, Professor Fernando Figueira Integral Medicine Institute.
Luciano Lira
LL
de Albuquerque
Department of Clinical Medicine, Federal University of Pernambuco, Recife, Brazil.
Carlos Alexandre Antunes
CAA
de Brito
Department of Virology, Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, and.
Marli Tenório
MT
Cordeiro
Department of Virology, Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, and.
Lindomar José
LJ
Pena
D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D001176:Arthrogryposis / Q000453:epidemiology / Q000821:virology; D001921:Brain / Q000002:abnormalities / Q000821:virology; D001938:Brazil / Q000453:epidemiology; D002531:Cerebellum / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000821:virology; D002658:Developmental Disabilities / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000821:virology; D058872:Epidemics / Q000706:statistics & numerical data; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology / Q000821:virology; D005865:Gestational Age; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000134:cerebrospinal fluid; D007223:Infant; D008831:Microcephaly / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000821:virology; D009035:Mothers; D009421:Nervous System Malformations / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000821:virology; D059906:Neuroimaging; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000821:virology; D011446:Prospective Studies; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000821:virology; D014463:Ultrasonography; D000071244:Zika Virus / Q000276:immunology / Q000302:isolation & purification; D000071243:Zika Virus Infection / Q000151:congenital* / Q000453:epidemiology* / Q000821:virology
D000914:Antibodies, Viral; D007075:Immunoglobulin M
Zika virus; congenital Zika syndrome (CZS); diaphragm paralysis; immunoglobulin M.; microcephaly