Congenital Zika Virus Infection Beyond Neonatal Microcephaly

Detalhes bibliográficos
Autor(a) principal: de Oliveira Melo, Adriana Suely
Data de Publicação: 2016
Outros Autores: Aguiar, Renato Santana, Ramos Amorim, Melania Maria, Arruda, Monica B., Melo, Fabiana de Oliveira, Clementino Ribeiro, Suelem Tais, Medeiros Batista, Alba Gean, Ferreira, Thales, dos Santos, Mayra Pereira, Sampaio, Virginia Vilar, Martins Moura, Sarah Rogeria, Rabello, Luciana Portela, Gonzaga, Clarissa Emanuelle, Malinger, Gustavo, Ximenes, Renato, Oliveira-Szejnfeld, Patricia Soares de [UNIFESP], Tovar-Moll, Fernanda, Chimelli, Leila, Silveira, Paola Paz, Delvechio, Rodrigo, Higa, Luiza, Campanati, Loraine, Nogueira, Rita M. R., Bispo Filippis, Ana Maria, Szejnfeld, Jacob [UNIFESP], Voloch, Carolina Moreira, Ferreira, Orlando C., Jr., Brindeiro, Rodrigo M., Tanuri, Amilcar
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1001/jamaneurol.2016.3720
https://repositorio.unifesp.br/handle/11600/56615
Resumo: IMPORTANCE Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. OBJECTIVE To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. DESIGN, SETTING, AND PARTICIPANTS We observed 11 infants with congenital ZIKV infection from gestation to 6 monthus in the state of Paraba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. MAIN OUTCOMES AND MEASURES Description of the major lesions caused by ZIKV congenital infection. RESULTS Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. CONCLUSIONS AND RELEVANCE Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.
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spelling Congenital Zika Virus Infection Beyond Neonatal MicrocephalyIMPORTANCE Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. OBJECTIVE To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. DESIGN, SETTING, AND PARTICIPANTS We observed 11 infants with congenital ZIKV infection from gestation to 6 monthus in the state of Paraba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. MAIN OUTCOMES AND MEASURES Description of the major lesions caused by ZIKV congenital infection. RESULTS Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. CONCLUSIONS AND RELEVANCE Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.Inst Pesquisa Prof Amorim Neto IPESQ, Campina Grande, Paraiba, BrazilInst Saude Elpidio de Almeida, Campina Grande, Paraiba, BrazilFac Ciencias Med Campina Grande, Campina Grande, Paraiba, BrazilHosp Municipal Pedro I, Campina Grande, Paraiba, BrazilUniv Fed Rio de Janeiro, Inst Biol, Dept Genet, Rio De Janeiro, BrazilUniv Fed Campina Grande, Campina Grande, Paraiba, BrazilTel Aviv Univ, Div Ultrasound Obstet & Gynecol, Lis Matern Hosp, Tel Aviv Sourasky Med Ctr,Sackler Fac Med, Tel Aviv, IsraelFundacao Med Fetal Latino Amer, Sao Paulo, BrazilUniv Fed Sao Paulo, Fundacao Inst Pesquisa & Ensino Diagnost Imagem, Sao Paulo, BrazilUniv Fed Rio de Janeiro, Inst Ciencias Biomed, Rio De Janeiro, BrazilInst DOr Pesquisa & Ensino, Rio De Janeiro, BrazilInst Estadual Cerebro Paulo Niemeyer, Lab Neuropatol, Rio De Janeiro, BrazilFundacao Oswaldo Cruz, Inst Oswaldo Cruz, Lab Flavivirus, Rio De Janeiro, BrazilUniv Fed Sao Paulo, Dept Diagnost Imagem, Sao Paulo, BrazilFundação Instituto de Pesquisa e Ensino de Diagnostico por Imagem, Universidade Federal de São Paulo, São Paulo, BrazilDepartamento de Diagnóstico por Imagem, Universidade Federal de São Paulo, São Paulo, BrazilWeb of ScienceConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Prefeitura Municipal de Campina GrandeAmer Medical Assoc2020-07-31T12:47:08Z2020-07-31T12:47:08Z2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion1407-1416http://dx.doi.org/10.1001/jamaneurol.2016.3720Jama Neurology. Chicago, v. 73, n. 12, p. 1407-1416, 2016.10.1001/jamaneurol.2016.37202168-6149https://repositorio.unifesp.br/handle/11600/56615WOS:000391122200011engJama NeurologyChicagoinfo:eu-repo/semantics/openAccessde Oliveira Melo, Adriana SuelyAguiar, Renato SantanaRamos Amorim, Melania MariaArruda, Monica B.Melo, Fabiana de OliveiraClementino Ribeiro, Suelem TaisMedeiros Batista, Alba GeanFerreira, Thalesdos Santos, Mayra PereiraSampaio, Virginia VilarMartins Moura, Sarah RogeriaRabello, Luciana PortelaGonzaga, Clarissa EmanuelleMalinger, GustavoXimenes, RenatoOliveira-Szejnfeld, Patricia Soares de [UNIFESP]Tovar-Moll, FernandaChimelli, LeilaSilveira, Paola PazDelvechio, RodrigoHiga, LuizaCampanati, LoraineNogueira, Rita M. R.Bispo Filippis, Ana MariaSzejnfeld, Jacob [UNIFESP]Voloch, Carolina MoreiraFerreira, Orlando C., Jr.Brindeiro, Rodrigo M.Tanuri, Amilcarreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2021-09-30T15:28:03Zoai:repositorio.unifesp.br/:11600/56615Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652021-09-30T15:28:03Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Congenital Zika Virus Infection Beyond Neonatal Microcephaly
title Congenital Zika Virus Infection Beyond Neonatal Microcephaly
spellingShingle Congenital Zika Virus Infection Beyond Neonatal Microcephaly
de Oliveira Melo, Adriana Suely
title_short Congenital Zika Virus Infection Beyond Neonatal Microcephaly
title_full Congenital Zika Virus Infection Beyond Neonatal Microcephaly
title_fullStr Congenital Zika Virus Infection Beyond Neonatal Microcephaly
title_full_unstemmed Congenital Zika Virus Infection Beyond Neonatal Microcephaly
title_sort Congenital Zika Virus Infection Beyond Neonatal Microcephaly
author de Oliveira Melo, Adriana Suely
author_facet de Oliveira Melo, Adriana Suely
Aguiar, Renato Santana
Ramos Amorim, Melania Maria
Arruda, Monica B.
Melo, Fabiana de Oliveira
Clementino Ribeiro, Suelem Tais
Medeiros Batista, Alba Gean
Ferreira, Thales
dos Santos, Mayra Pereira
Sampaio, Virginia Vilar
Martins Moura, Sarah Rogeria
Rabello, Luciana Portela
Gonzaga, Clarissa Emanuelle
Malinger, Gustavo
Ximenes, Renato
Oliveira-Szejnfeld, Patricia Soares de [UNIFESP]
Tovar-Moll, Fernanda
Chimelli, Leila
Silveira, Paola Paz
Delvechio, Rodrigo
Higa, Luiza
Campanati, Loraine
Nogueira, Rita M. R.
Bispo Filippis, Ana Maria
Szejnfeld, Jacob [UNIFESP]
Voloch, Carolina Moreira
Ferreira, Orlando C., Jr.
Brindeiro, Rodrigo M.
Tanuri, Amilcar
author_role author
author2 Aguiar, Renato Santana
Ramos Amorim, Melania Maria
Arruda, Monica B.
Melo, Fabiana de Oliveira
Clementino Ribeiro, Suelem Tais
Medeiros Batista, Alba Gean
Ferreira, Thales
dos Santos, Mayra Pereira
Sampaio, Virginia Vilar
Martins Moura, Sarah Rogeria
Rabello, Luciana Portela
Gonzaga, Clarissa Emanuelle
Malinger, Gustavo
Ximenes, Renato
Oliveira-Szejnfeld, Patricia Soares de [UNIFESP]
Tovar-Moll, Fernanda
Chimelli, Leila
Silveira, Paola Paz
Delvechio, Rodrigo
Higa, Luiza
Campanati, Loraine
Nogueira, Rita M. R.
Bispo Filippis, Ana Maria
Szejnfeld, Jacob [UNIFESP]
Voloch, Carolina Moreira
Ferreira, Orlando C., Jr.
Brindeiro, Rodrigo M.
Tanuri, Amilcar
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv de Oliveira Melo, Adriana Suely
Aguiar, Renato Santana
Ramos Amorim, Melania Maria
Arruda, Monica B.
Melo, Fabiana de Oliveira
Clementino Ribeiro, Suelem Tais
Medeiros Batista, Alba Gean
Ferreira, Thales
dos Santos, Mayra Pereira
Sampaio, Virginia Vilar
Martins Moura, Sarah Rogeria
Rabello, Luciana Portela
Gonzaga, Clarissa Emanuelle
Malinger, Gustavo
Ximenes, Renato
Oliveira-Szejnfeld, Patricia Soares de [UNIFESP]
Tovar-Moll, Fernanda
Chimelli, Leila
Silveira, Paola Paz
Delvechio, Rodrigo
Higa, Luiza
Campanati, Loraine
Nogueira, Rita M. R.
Bispo Filippis, Ana Maria
Szejnfeld, Jacob [UNIFESP]
Voloch, Carolina Moreira
Ferreira, Orlando C., Jr.
Brindeiro, Rodrigo M.
Tanuri, Amilcar
description IMPORTANCE Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. OBJECTIVE To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. DESIGN, SETTING, AND PARTICIPANTS We observed 11 infants with congenital ZIKV infection from gestation to 6 monthus in the state of Paraba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. MAIN OUTCOMES AND MEASURES Description of the major lesions caused by ZIKV congenital infection. RESULTS Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. CONCLUSIONS AND RELEVANCE Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.
publishDate 2016
dc.date.none.fl_str_mv 2016
2020-07-31T12:47:08Z
2020-07-31T12:47:08Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1001/jamaneurol.2016.3720
Jama Neurology. Chicago, v. 73, n. 12, p. 1407-1416, 2016.
10.1001/jamaneurol.2016.3720
2168-6149
https://repositorio.unifesp.br/handle/11600/56615
WOS:000391122200011
url http://dx.doi.org/10.1001/jamaneurol.2016.3720
https://repositorio.unifesp.br/handle/11600/56615
identifier_str_mv Jama Neurology. Chicago, v. 73, n. 12, p. 1407-1416, 2016.
10.1001/jamaneurol.2016.3720
2168-6149
WOS:000391122200011
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Jama Neurology
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 1407-1416
dc.coverage.none.fl_str_mv Chicago
dc.publisher.none.fl_str_mv Amer Medical Assoc
publisher.none.fl_str_mv Amer Medical Assoc
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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