Congenital Zika Virus Infection Beyond Neonatal Microcephaly
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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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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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1814268284236726272 |