The central nervous system damage seen with prenatal ZIKV infection is likely due to direct cellular injury, as ZIKV RNA15, 17,32 and live virus15 have been identified in the brain tissue of
infants with microcephaly.
To evaluate the ocular findings in
infants with microcephaly associated with presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil.
Objective To evaluate the ocular findings in
infants with microcephaly associated with presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil.
The 3 largest case series of
infants with microcephaly also reporting congenital contractures found that, among 35, 48, and 52
infants with microcephaly and presumed congenital ZIKV infection, isolated clubfoot occurred in 14 %, 10.4 %, and 3.8 % and arthrogryposis in 11 %, 10.4 %, and 5.7 %, respectively.36 - 38 Among a series of 104 infants under clinical investigation, 7 (6.7 %) with presumed (5 infants) and laboratory - confirmed (2 infants) congenital ZIKV infection had arthrogryposis; 6 of these infants had a head circumference of at least 2 SD below the mean.41 All had bilateral congenital hip dislocation, which previously has been reported to occur in 30 % to 40 % of children with arthrogryposis of various etiologies and 3 of 7 had dislocation or partial dislocation of 1 or both knees.41, 57
A 2006 study of 77 pregnant women infected with West Nile virus reported that two had
infants with microcephaly, the birth defect lately associated with Zika that results in unusually small and damaged brains.
In a study conducted in Brazil, 70
infants with microcephaly were examined at CAVIVER, a nongovernmental organization clinic and referral center dedicated to visually disabled children in Fortaleza.
Not exact matches
There's still a lot that we don't know about Zika, including whether or not it's definitively the cause of
infants being born
with microcephaly or other neurological problems.
Mothers and families of
infants born
with congenital anomalies (e.g.
microcephaly) should be supported to breastfeed their
infants in line
with WHO recommendations.
As most studies have only carefully examined
infants with presumed or confirmed congenital ZIKV infection who have
microcephaly, more studies are needed to understand ocular findings in those
infants with congenital ZIKV infection without
microcephaly.
Stella Guerra performs physical therapy on an
infant born
with microcephaly in Recife, Brazil.
Other infections also can cause
microcephaly; in fact, out of 121
infants tested for other pathogens, 26 had evidence of infection
with either toxoplasmosis, herpes simplex, cytomegalovirus, and syphilis.
An association between Zika infections during pregnancy and the birth of babies
with microcephaly (a birth defect in which an
infant's brain does not develop properly resulting in a smaller than normal head) was first suggested by Brazilian physicians in August 2015, and in November
microcephaly cases potentially associated
with Zika started to be recorded; three months later WHO made its announcement.
The infection has been linked to
microcephaly, a condition in which
infants are born
with unusually small heads and brain damage.
The disease has also been confirmed to cause
microcephaly in more than 2,700
infants born to women infected
with the virus while pregnant.
Even as the Zika virus becomes more prevalent — the Centers for Disease Control reports that the number of U.S.
infants born
with microcephaly and other birth defects is 20 times over the normal rate — researchers are still trying to fully pin down the identifying consequences of the viral infection.
We next estimated the maximum number of births potentially affected by ZIKV in Latin America, as this region is the focus of the recent outbreak and the first to point to a possible association
with microcephaly in newborn
infants to mothers infected
with ZIKV.
Petersen's remarks were among the strongest suggestions yet from a top CDC scientist that Zika infection during pregnancy can — at least in some cases — cause
microcephaly, a condition in which
infants are born
with abnormally small heads and possibly brain damage.
Although most
infants had
microcephaly by head circumference measure, some patients had a measurement that was consistent
with their gestational age, as brain atrophy was compensated by an enlargement in ventricular size.19
The main birth defect attributed to Zika is
microcephaly, a rare neurological condition in which an
infant is born
with a much smaller head — an effect of abnormal brain development.
The rate of
infants and fetuses who had
microcephaly in Colombia from 2015 to the end of 2016 is shown
with a dotted line.
In the recent case series, most
infants with probable congenital ZIKV infection were noted to have craniofacial disproportion (95.8 %) and, to a lesser degree, biparietal depression (83.3 %), prominent occiput (75 %), and excess nuchal skin (47.9 %).38 Features supportive of the FBDS phenotype scattered through published reports include redundant scalp, 27,36,39,41 occipital prominence and / or overlapping sutures,14,20,22 - 24, 26,27,38 and typical craniofacial appearance
with disproportion.13, 27,33,34,40 The FBDS phenotype is also prevalent in ZIKV - related media.47 Among
infants with severe
microcephaly, the pattern appears to be consistent, although the degree of cranial vault deformation varies.
Structural eye anomalies (in particular, microphthalmia and coloboma), cataracts, intraocular calcifications, and posterior ocular findings have been reported in
infants with presumed and laboratory - confirmed prenatal ZIKV infection; however, posterior findings have been the most prevalent.21,25,28,33,35,36,41 - 43 Case series report chorioretinal atrophy, focal pigmentary mottling of the retina, and optic nerve atrophy / anomalies.28, 34,37,41 - 43,55 Series of 20 or more
infants with presumed ZIKV - associated
microcephaly report ocular findings in 24 % to 55 %.28, 33,42 In one study, testing for ZIKV IgM was performed in 24 of 40
infants (60 %)
with microcephaly and the results were positive in the cerebrospinal fluid in 100 % of those tested.42 The proportion of
infants with ocular lesions did not differ in those
with and without testing.42 In that series, first trimester maternal infection and smaller head circumference significantly correlated
with the presence of abnormal ocular findings.42
Contracted through the bite of an infected mosquito or through sexual or other modes of transmission, Zika virus (ZIKV) infection can be prenatally passed from mother to fetus.1 The virus was first identified in the region of the Americas in early 2015, when local transmission was reported in Brazil.2 Six months later, a notable increase in the number of
infants with congenital
microcephaly was observed in northeast Brazil.3, 4 Clinical, epidemiologic, and laboratory evidence led investigators to conclude that intrauterine ZIKV infection was a cause of
microcephaly and serious brain anomalies.5 - 7 However, as
with other newly recognized teratogens, these features likely represent a portion of a broader spectrum.
The FBDS phenotype has been reported in an
infant with laboratory - confirmed ZIKV infection, 13 in a neuroimaging report documenting cranial bone collapse in
infants born to mothers
with suspected ZIKV infection during pregnancy, 14 and a recent case series of
infants with probable ZIKV - associated
microcephaly.38 In 3 of the largest case series reporting 35, 48, and 104
infants primarily
with suspected congenital ZIKV infection, 33,37,38 approximately two - thirds of
infants had severe
microcephaly.
Eighty - five percent of the fetuses or
infants with potentially Zika - associated birth defects in this report had brain abnormalities or
microcephaly,
with most having both
microcephaly and specific brain abnormalities.
A recent increase in the prevalence of
microcephaly in newborn
infants and vision - threatening findings in these
infants is likely associated
with the rapid spread of ZIKV.
The most devastating of these defects is
microcephaly — when
infants are born
with abnormally small heads and underdeveloped brains.
In the analysis, Mariana Leal, of the Hospital Agamenon Magalhaes and the Federal University of Pernambuco in Brazil, and colleagues looked at 70
infants in Brazil who had been diagnosed
with Zika - linked
microcephaly.
One
infant was born in the state
with Zika - related
microcephaly.