Síndrome congênita associada ao Zika vírus: além da microcefalia

Detalhes bibliográficos
Autor(a) principal: Oliveira, Marco Antonio Valadares
Data de Publicação: 2019
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da UFS
Texto Completo: http://ri.ufs.br/jspui/handle/riufs/13055
Resumo: Introduction: in October 2015, an international alert was issued for an outbreak of congenital microcephaly on Zika virus (ZIKV) infection, recently detected in Brazil, with the objective of reducing the prevalence of microcephaly at birth in the country. The absence of new cases of microcephaly in the affected regions, together with a clinical picture and common morphological alterations, led to the need to respond to a new clinical syndrome associated with a congenital infection that was not in agreement with the differential diagnosis of microcephaly. Objectives: to describe a congenital syndrome associated with a maternal infection by ZIKV and to evaluate the encephalic changes of the microcephalic population studied, as well as ophthalmologic alterations, echocardiographic findings and other malformations. Patients and Methods: descriptive crosssectional observational study, with non-random and consecutive sample. It included 65 infants diagnosed with microcephaly and attended at the University Hospital of the Federal University of Sergipe. The data sheet of the microcephaly service was the source for the clinical information, as well as the neonatal period and gestation data. Transfontanel ultrasonography was performed in all patients in the sample. Ophthalmologic evaluation occurred in 62 children of the group, while 59 were submitted to echocardiography. Quantitative and categorical variables were expressed according to the best suitability. For the outcome-variables, the frequency estimation was carried out with its respective Confidence Interval to 95%, using the Bootstrap technique. Results: there was a predominance of full-term, female and vaginal delivery. There was also a predominance of adequacy of birth weight and a total absence of perinatal damage described. In less than half of the mothers there was a positive history of exanthema, fever and polyarthralgia; but there was a predominance of these reports in the first trimester of gestation. A significant majority (80.0%) was classified as severe microcephaly. Otorhinolaryngological changes in the posterior segment were predominant, with atrophy of the retinal pigment epithelium (24.2%) and chorioretinitis (22.6%). Alterations in the anterior segment were also described, as well as pathological strabismus and nystagmus. Bilateral cryptorchidism was reported in 28.6% of the boys' population. Orthopedic alterations were described in 27.7% of the patients, with emphasis on multiple arthrogryposes (6.2%). The most frequent echocardiographic findings were patent foramen ovale (42.4%) and patent ductus arteriosus (10.2%). Cerebral atrophy (75.4%), calcifications (73.8%), corpus callosum dysgenesis (70.8%) and ventricular dilatation (64.6%) and lysencephaly (61.5%). Conclusions: the ophthalmologic alterations described are more serious than those reported for other causes of congenital infection associated with microcephaly, especially for funduscopy alterations. It also awakens to other malformations not yet documented for congenital virus infection, such as echocardiographic findings and cryptorchidism. Orthopedic and encephalic alterations agree with recent literature reports on the subject.
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spelling Oliveira, Marco Antonio ValadaresAlmeida, Maria Luiza Doria2020-03-17T19:20:24Z2020-03-17T19:20:24Z2019-02-22OLIVEIRA, Marco Antonio Valadares. Síndrome congênita associada ao Zika vírus: além da microcefalia. 2019. 104 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2019.http://ri.ufs.br/jspui/handle/riufs/13055Introduction: in October 2015, an international alert was issued for an outbreak of congenital microcephaly on Zika virus (ZIKV) infection, recently detected in Brazil, with the objective of reducing the prevalence of microcephaly at birth in the country. The absence of new cases of microcephaly in the affected regions, together with a clinical picture and common morphological alterations, led to the need to respond to a new clinical syndrome associated with a congenital infection that was not in agreement with the differential diagnosis of microcephaly. Objectives: to describe a congenital syndrome associated with a maternal infection by ZIKV and to evaluate the encephalic changes of the microcephalic population studied, as well as ophthalmologic alterations, echocardiographic findings and other malformations. Patients and Methods: descriptive crosssectional observational study, with non-random and consecutive sample. It included 65 infants diagnosed with microcephaly and attended at the University Hospital of the Federal University of Sergipe. The data sheet of the microcephaly service was the source for the clinical information, as well as the neonatal period and gestation data. Transfontanel ultrasonography was performed in all patients in the sample. Ophthalmologic evaluation occurred in 62 children of the group, while 59 were submitted to echocardiography. Quantitative and categorical variables were expressed according to the best suitability. For the outcome-variables, the frequency estimation was carried out with its respective Confidence Interval to 95%, using the Bootstrap technique. Results: there was a predominance of full-term, female and vaginal delivery. There was also a predominance of adequacy of birth weight and a total absence of perinatal damage described. In less than half of the mothers there was a positive history of exanthema, fever and polyarthralgia; but there was a predominance of these reports in the first trimester of gestation. A significant majority (80.0%) was classified as severe microcephaly. Otorhinolaryngological changes in the posterior segment were predominant, with atrophy of the retinal pigment epithelium (24.2%) and chorioretinitis (22.6%). Alterations in the anterior segment were also described, as well as pathological strabismus and nystagmus. Bilateral cryptorchidism was reported in 28.6% of the boys' population. Orthopedic alterations were described in 27.7% of the patients, with emphasis on multiple arthrogryposes (6.2%). The most frequent echocardiographic findings were patent foramen ovale (42.4%) and patent ductus arteriosus (10.2%). Cerebral atrophy (75.4%), calcifications (73.8%), corpus callosum dysgenesis (70.8%) and ventricular dilatation (64.6%) and lysencephaly (61.5%). Conclusions: the ophthalmologic alterations described are more serious than those reported for other causes of congenital infection associated with microcephaly, especially for funduscopy alterations. It also awakens to other malformations not yet documented for congenital virus infection, such as echocardiographic findings and cryptorchidism. Orthopedic and encephalic alterations agree with recent literature reports on the subject.Introdução: em outubro de 2015 houve a emissão de um alerta internacional para um surto de microcefalia congênita presumidamente relacionada à infecção pelo vírus Zika (ZIKV), inicialmente detectado no nordeste do Brasil, elevando muito o coeficiente de prevalência de microcefalia ao nascer no país. O crescente número de casos novos de microcefalia nas regiões afetadas, associado a achados clínicos e alterações morfológicas em comum, despertou para a necessidade de se descrever essa nova síndrome clínica associada a uma infecção congênita que até então não fazia parte do rol de diagnósticos diferenciais da microcefalia. Objetivos: descrever a síndrome congênita associada à presumida infecção materna pelo ZIKV e avaliar as alterações encefálicas da população de microcefálicos estudada, assim como as alterações oftalmológicas, os achados ecocardiográficos e outras malformações. Pacientes e Métodos: estudo observacional transversal descritivo, com amostra não aleatória e consecutiva. Incluiu 65 lactentes com diagnóstico de microcefalia e atendidos no Hospital Universitário da Universidade Federal de Sergipe. A ficha de atendimento do serviço de microcefalia foi a fonte para as informações clínicas, assim como sobre o período neonatal e dados da gestação. Ultrassonografia transfontanela foi realizada em todos os pacientes da amostra. Avaliação oftalmológica aconteceu em 62 crianças do grupo, enquanto 59 foram submetidos à ecocardiografia. As variáveis quantitativas e as categóricas foram expressas conforme melhor adequação. Para as variáveis-desfecho realizou-se a estimativa de frequência com seu respectivo Intervalo de Confiança para 95%, utilizando-se da técnica de Bootstrap. Resultados: houve um predomínio de nascidos a termo, do sexo feminino e do parto vaginal. Também houve um predomínio de adequação do peso ao nascer e uma totalidade de ausência de dano perinatal descrito. Em menos de metade das mães houve história positiva para exantema, febre e poliartralgia; mas ocorreu um predomínio desses relatos no primeiro trimestre da gestação. Uma maioria significativa (80,0%) foi classificada como microcefalia grave. As alterações oftalmológicas em segmento posterior foram predominantes, com destaque para a atrofia do epitélio pigmentar da retina (24,2%) e a coriorretinite (22,6%). Alterações no segmento anterior também foram descritas, assim como o estrabismo patológico e o nistagmo. A criptorquidia bilateral foi relatada em 28,6% da população de meninos. Alterações ortopédicas foram descritas em 27,7% dos pacientes, com destaque para as artrogriposes múltiplas (6,2%). O achado ecocardiográfico mais frequente foi o forame oval patente (42,4%) e o canal arterial pérvio (10,2%). As alterações encefálicas mais encontradas foram a atrofia cerebral (75,4%), as calcificações (73,8%), as disgenesias de corpo caloso (70,8%) e a dilatação ventricular (64,6%) e a lisencefalia (61,5%). Conclusões: as alterações oftalmológicas descritas são mais graves que as relatadas para outras causas de infecção congênita associada à microcefalia, com destaque paras as alterações da fundoscopia. Também desperta para outras malformações ainda não documentadas para a infecção congênita pelo virus, como os achados ecocardiográficos e a criptorquidia. Alterações ortopédicas e encefálicas concordam com os relatos recentes da literatura a cerca do tema.AracajuporMicrocefaliaInfecções congênitasSíndrome congênitaZika virusMalformaçõesMicrocephalyCongenital infectionsCongenital syndromeZika virusMalformationsCIENCIAS DA SAUDESíndrome congênita associada ao Zika vírus: além da microcefaliaCongenital syndrome associated with the Zika virus: beyond the microcephalyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisPós-Graduação em Ciências da SaúdeUniversidade Federal de Sergipereponame:Repositório Institucional da UFSinstname:Universidade Federal de Sergipe (UFS)instacron:UFSinfo:eu-repo/semantics/openAccessTEXTMARCO_ANTONIO_VALADARES_OLIVEIRA.pdf.txtMARCO_ANTONIO_VALADARES_OLIVEIRA.pdf.txtExtracted texttext/plain143117https://ri.ufs.br/jspui/bitstream/riufs/13055/3/MARCO_ANTONIO_VALADARES_OLIVEIRA.pdf.txt072e9d9a11f102cbfcd81e5f4f5d9c3fMD53THUMBNAILMARCO_ANTONIO_VALADARES_OLIVEIRA.pdf.jpgMARCO_ANTONIO_VALADARES_OLIVEIRA.pdf.jpgGenerated Thumbnailimage/jpeg1179https://ri.ufs.br/jspui/bitstream/riufs/13055/4/MARCO_ANTONIO_VALADARES_OLIVEIRA.pdf.jpgf9a49463b4df2e9b3771531d21d01125MD54LICENSElicense.txtlicense.txttext/plain; charset=utf-81475https://ri.ufs.br/jspui/bitstream/riufs/13055/1/license.txt098cbbf65c2c15e1fb2e49c5d306a44cMD51ORIGINALMARCO_ANTONIO_VALADARES_OLIVEIRA.pdfMARCO_ANTONIO_VALADARES_OLIVEIRA.pdfapplication/pdf1903172https://ri.ufs.br/jspui/bitstream/riufs/13055/2/MARCO_ANTONIO_VALADARES_OLIVEIRA.pdf2d46244e80c461438d3c1584d44004a9MD52riufs/130552020-03-17 16:20:24.939oai:ufs.br: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Repositório InstitucionalPUBhttps://ri.ufs.br/oai/requestrepositorio@academico.ufs.bropendoar:2020-03-17T19:20:24Repositório Institucional da UFS - Universidade Federal de Sergipe (UFS)false
dc.title.pt_BR.fl_str_mv Síndrome congênita associada ao Zika vírus: além da microcefalia
dc.title.alternative.eng.fl_str_mv Congenital syndrome associated with the Zika virus: beyond the microcephaly
title Síndrome congênita associada ao Zika vírus: além da microcefalia
spellingShingle Síndrome congênita associada ao Zika vírus: além da microcefalia
Oliveira, Marco Antonio Valadares
Microcefalia
Infecções congênitas
Síndrome congênita
Zika virus
Malformações
Microcephaly
Congenital infections
Congenital syndrome
Zika virus
Malformations
CIENCIAS DA SAUDE
title_short Síndrome congênita associada ao Zika vírus: além da microcefalia
title_full Síndrome congênita associada ao Zika vírus: além da microcefalia
title_fullStr Síndrome congênita associada ao Zika vírus: além da microcefalia
title_full_unstemmed Síndrome congênita associada ao Zika vírus: além da microcefalia
title_sort Síndrome congênita associada ao Zika vírus: além da microcefalia
author Oliveira, Marco Antonio Valadares
author_facet Oliveira, Marco Antonio Valadares
author_role author
dc.contributor.author.fl_str_mv Oliveira, Marco Antonio Valadares
dc.contributor.advisor1.fl_str_mv Almeida, Maria Luiza Doria
contributor_str_mv Almeida, Maria Luiza Doria
dc.subject.por.fl_str_mv Microcefalia
Infecções congênitas
Síndrome congênita
Zika virus
Malformações
topic Microcefalia
Infecções congênitas
Síndrome congênita
Zika virus
Malformações
Microcephaly
Congenital infections
Congenital syndrome
Zika virus
Malformations
CIENCIAS DA SAUDE
dc.subject.eng.fl_str_mv Microcephaly
Congenital infections
Congenital syndrome
Zika virus
Malformations
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE
description Introduction: in October 2015, an international alert was issued for an outbreak of congenital microcephaly on Zika virus (ZIKV) infection, recently detected in Brazil, with the objective of reducing the prevalence of microcephaly at birth in the country. The absence of new cases of microcephaly in the affected regions, together with a clinical picture and common morphological alterations, led to the need to respond to a new clinical syndrome associated with a congenital infection that was not in agreement with the differential diagnosis of microcephaly. Objectives: to describe a congenital syndrome associated with a maternal infection by ZIKV and to evaluate the encephalic changes of the microcephalic population studied, as well as ophthalmologic alterations, echocardiographic findings and other malformations. Patients and Methods: descriptive crosssectional observational study, with non-random and consecutive sample. It included 65 infants diagnosed with microcephaly and attended at the University Hospital of the Federal University of Sergipe. The data sheet of the microcephaly service was the source for the clinical information, as well as the neonatal period and gestation data. Transfontanel ultrasonography was performed in all patients in the sample. Ophthalmologic evaluation occurred in 62 children of the group, while 59 were submitted to echocardiography. Quantitative and categorical variables were expressed according to the best suitability. For the outcome-variables, the frequency estimation was carried out with its respective Confidence Interval to 95%, using the Bootstrap technique. Results: there was a predominance of full-term, female and vaginal delivery. There was also a predominance of adequacy of birth weight and a total absence of perinatal damage described. In less than half of the mothers there was a positive history of exanthema, fever and polyarthralgia; but there was a predominance of these reports in the first trimester of gestation. A significant majority (80.0%) was classified as severe microcephaly. Otorhinolaryngological changes in the posterior segment were predominant, with atrophy of the retinal pigment epithelium (24.2%) and chorioretinitis (22.6%). Alterations in the anterior segment were also described, as well as pathological strabismus and nystagmus. Bilateral cryptorchidism was reported in 28.6% of the boys' population. Orthopedic alterations were described in 27.7% of the patients, with emphasis on multiple arthrogryposes (6.2%). The most frequent echocardiographic findings were patent foramen ovale (42.4%) and patent ductus arteriosus (10.2%). Cerebral atrophy (75.4%), calcifications (73.8%), corpus callosum dysgenesis (70.8%) and ventricular dilatation (64.6%) and lysencephaly (61.5%). Conclusions: the ophthalmologic alterations described are more serious than those reported for other causes of congenital infection associated with microcephaly, especially for funduscopy alterations. It also awakens to other malformations not yet documented for congenital virus infection, such as echocardiographic findings and cryptorchidism. Orthopedic and encephalic alterations agree with recent literature reports on the subject.
publishDate 2019
dc.date.issued.fl_str_mv 2019-02-22
dc.date.accessioned.fl_str_mv 2020-03-17T19:20:24Z
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dc.identifier.citation.fl_str_mv OLIVEIRA, Marco Antonio Valadares. Síndrome congênita associada ao Zika vírus: além da microcefalia. 2019. 104 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2019.
dc.identifier.uri.fl_str_mv http://ri.ufs.br/jspui/handle/riufs/13055
identifier_str_mv OLIVEIRA, Marco Antonio Valadares. Síndrome congênita associada ao Zika vírus: além da microcefalia. 2019. 104 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2019.
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