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Mahmoud A, Pomar L, Lambert V, Picone O, Hcini N. Prenatal and Postnatal Ocular Abnormalities Following Congenital Zika Virus Infections: A Systematic Review. Ocul Immunol Inflamm 2024:1-11. [PMID: 38350011 DOI: 10.1080/09273948.2024.2314086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To assess fetal and neonatal eyes abnormalities and their progression during the last ZIKV outbreak and summarize learned lessons. METHODS A systematic review and meta-analysis was conducted by a team of obstetricians and ophthalmologists. RESULTS Studies reporting ocular abnormalities during the prenatal (n = 5) and postnatal (n = 24) periods were included in the analysis. In the prenatal period, the most common ocular findings were intraocular calcification cases (4/6, 66.6%) and microphthalmia (3/6, 50%). Postnatal ocular abnormalities of congenital ZIKV infection were described after birth in 479 cases. Among them microphthalmia was reported in 13 cases (13/479, 2.7%). Posterior segment (retina and optic nerve) was the most affected structure, consisting of pigmentary changes (229/479, 47.8%), macular chorioretinal atrophy (216/479, 45%), optic nerve atrophy (181/479, 37.8%), increased cup-to-disk ratio (190/479, 39.6.%), optic nerve hypoplasia (93/479,19.4%), vascular changes (26/479, 5.4%), and retinal coloboma (20/479, 4.1%). The anterior segment was involved in 4.6% (22/479) of cases, including cataract (9/479, 1.8%), lens subluxation (1/479, 0.2%), iris coloboma (5/479, 1%), and congenital glaucoma (7/479, 1.4%). These ocular anomalies were isolated in one case (1/479, 0.2%) and multiple anomalies were found in the other cases. Long-term visual disorders have been described, with no possible improvement and even a worsening of some of the ocular anomalies previously observed. No reactivation of ocular lesions was observed. CONCLUSION This review highlights the severe ocular abnormalities associated with congenital ZIKV infections. The importance of multidisciplinary communication between the obstetrician, the maternal-fetal medicine specialist, and the ophthalmologist is emphasized. PROTOCOL REGISTRATION This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration440 188.
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Affiliation(s)
- Anis Mahmoud
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Léo Pomar
- Ultrasound and Fetal Medicine, Department "Woman-Mother-Child", Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Veronique Lambert
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - Olivier Picone
- Service Gynécologie Obstétrique, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique : Hôpitaux de Paris, Université Paris Diderot, Colombes, France
| | - Najeh Hcini
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
- INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Cayenne, French Guiana
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2
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Zina SM, Hoarau G, Labetoulle M, Khairallah M, Rousseau A. Ocular Manifestations of Flavivirus Infections. Pathogens 2023; 12:1457. [PMID: 38133340 PMCID: PMC10747099 DOI: 10.3390/pathogens12121457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Flaviviruses are a group of positive-sense, single-stranded RNA viruses predominantly transmitted by arthropods (mainly mosquitoes) that cause severe endemic infections and epidemics on a global scale. They represent a major cause of systemic morbidity and death and are expanding worldwide. Among this group, dengue fever, the West Nile virus, yellow fever, Japanese Encephalitis, and, recently, the Zika virus have been linked to a spectrum of ocular manifestations. These manifestations encompass subconjunctival hemorrhages and conjunctivitis, anterior and posterior uveitis (inclusive of vitritis, chorioretinitis, and retinal vasculitis), maculopathy, retinal hemorrhages, and optic neuritis. Clinical diagnosis of these infectious diseases is primarily based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. Diagnosis confirmation relies on laboratory testing, including RT-PCR and serological testing. Ocular involvement typically follows a self-limited course but can result in irreversible visual impairment. Effective treatments of flavivirus infections are currently unavailable. Prevention remains the mainstay for arthropod vector and zoonotic disease control. Effective vaccines are available only for the yellow fever virus, dengue virus, and Japanese Encephalitis virus. This review comprehensively summarizes the current knowledge regarding the ophthalmic manifestations of the foremost flavivirus-associated human diseases.
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Affiliation(s)
- Sourour Meziou Zina
- Department of Ophthalmology, Bicêtre Hospital, Public Assistance, Hospitals of Paris, Reference Network for Rare Diseases in Ophthalmology (OPHTARA), 94270 Le Kremlin-Bicêtre, France; (S.M.Z.); (G.H.); (M.L.)
- Department of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir 5019, Tunisia;
| | - Gautier Hoarau
- Department of Ophthalmology, Bicêtre Hospital, Public Assistance, Hospitals of Paris, Reference Network for Rare Diseases in Ophthalmology (OPHTARA), 94270 Le Kremlin-Bicêtre, France; (S.M.Z.); (G.H.); (M.L.)
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, Public Assistance, Hospitals of Paris, Reference Network for Rare Diseases in Ophthalmology (OPHTARA), 94270 Le Kremlin-Bicêtre, France; (S.M.Z.); (G.H.); (M.L.)
- Center for Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), Infectious Diseases Models for Innovative Therapies (IDMIT), French Alternative Energies and Atomic Commission (CEA), 92260 Fontenay-aux-Roses, France
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir 5019, Tunisia;
| | - Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Public Assistance, Hospitals of Paris, Reference Network for Rare Diseases in Ophthalmology (OPHTARA), 94270 Le Kremlin-Bicêtre, France; (S.M.Z.); (G.H.); (M.L.)
- Center for Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), Infectious Diseases Models for Innovative Therapies (IDMIT), French Alternative Energies and Atomic Commission (CEA), 92260 Fontenay-aux-Roses, France
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3
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Ball EE, Bennett JL, Keesler RI, Van Rompay KKA, Coffey LL, Bliss-Moreau E. Prenatal Zika virus exposure is associated with lateral geniculate nucleus abnormalities in juvenile rhesus macaques. Neuroreport 2023; 34:786-791. [PMID: 37695589 PMCID: PMC10699751 DOI: 10.1097/wnr.0000000000001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Zika virus' neural tropism causes significant neural pathology, particularly in developing fetuses. One of the consistent findings from humans and animal models is that prenatal exposure to Zika virus (ZIKV) causes pathology in the eyes and visual pathways of the brain, although the extent to which this pathology persists over development is not clear. In the present report, we build upon our previous work which demonstrated that full-term rhesus monkey ( Macaca mulatta ) fetuses who were exposed to ZIKV early in gestation had significant pathological abnormalities to the organization of the lateral geniculate nucleus (LGN), a major hub of the visual network. The objective of the present work was to replicate those LGN findings and determine whether such pathology persisted across childhood development. We carried out histological analyses of the LGNs of two juvenile rhesus monkeys who were prenatally exposed to ZIKV and two age-matched controls. Pregnant rhesus monkeys were infected with ZIKV via the intravenous and intra-amniotic routes and tracked across development. Following sacrifice and perfusion, brains were subjected to quantitative neuroanatomical analyses with a focus on the size and structure of the LGN and its composite layers. Early fetal ZIKV exposure resulted in developmental abnormalities within the brains' visual pathway: specifically disorganization, blending of layers, laminar discontinuities, and regions of low cell density within the LGN. These abnormalities were not observed in the control animals. Our findings demonstrate that the ZIKV's damage to the LGN that occurs during fetal development persists into childhood.
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Affiliation(s)
- Erin E Ball
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California
- United States Army, Veterinary Corps, USA
- Currently Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Jeffrey L Bennett
- California National Primate Center, University of California
- Department of Psychology, University of California, Davis, California
| | - Rebekah I Keesler
- California National Primate Center, University of California
- Currently Charles River Laboratories, Reno, Nevada, USA
| | - Koen K A Van Rompay
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California
- California National Primate Center, University of California
| | - Lark L Coffey
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California
| | - Eliza Bliss-Moreau
- California National Primate Center, University of California
- Department of Psychology, University of California, Davis, California
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4
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Mangalesh S, Toth CA. Preterm infant retinal OCT markers of perinatal health and retinopathy of prematurity. Front Pediatr 2023; 11:1238193. [PMID: 37808559 PMCID: PMC10551634 DOI: 10.3389/fped.2023.1238193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
The increasing survival of preterm infants has led to the importance of improving long-term outcomes associated with preterm birth. Antenatal and perinatal insults not only impact mortality, but also long-term disability. While in the intensive care nursery, preterm infants are also exposed to various stressors that lead to long-term cognitive deficits. It is therefore critical to identify early, low-stress, non-invasive biomarkers for preterm infant health. Optical coherence tomography (OCT) is a powerful imaging modality that has recently been adapted to the infant population and provides noninvasive, high-resolution, cross-sectional imaging of the infant eye at the bedside with low stress relative to conventional examination. In this review we delve into discussing the associations between preterm systemic health factors and OCT-based retinal findings and their potential contribution to the development of non-invasive biomarkers for infant health and for retinopathy of prematurity (ROP).
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Affiliation(s)
| | - Cynthia A. Toth
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, United States
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5
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Pathogenesis and Manifestations of Zika Virus-Associated Ocular Diseases. Trop Med Infect Dis 2022; 7:tropicalmed7060106. [PMID: 35736984 PMCID: PMC9229560 DOI: 10.3390/tropicalmed7060106] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 12/18/2022] Open
Abstract
Zika virus (ZIKV) is mosquito-borne flavivirus that caused a significant public health concern in French Polynesia and South America. The two major complications that gained the most media attention during the ZIKV outbreak were Guillain-Barré syndrome (GBS) and microcephaly in newborn infants. The two modes of ZIKV transmission are the vector-borne and non-vector borne modes of transmission. Aedes aegypti and Aedes albopictus are the most important vectors of ZIKV. ZIKV binds to surface receptors on permissive cells that support infection and replication, such as neural progenitor cells, dendritic cells, dermal fibroblasts, retinal pigment epithelial cells, endothelial cells, macrophages, epidermal keratinocytes, and trophoblasts to cause infection. The innate immune response to ZIKV infection is mediated by interferons and natural killer cells, whereas the adaptive immune response is mediated by CD8+T cells, Th1 cells, and neutralizing antibodies. The non-structural proteins of ZIKV, such as non-structural protein 5, are involved in the evasion of the host's immune defense mechanisms. Ocular manifestations of ZIKV arise from the virus' ability to cross both the blood-brain barrier and blood-retinal barrier, as well as the blood-aqueous barrier. Most notably, this results in the development of GBS, a rare neurological complication in acute ZIKV infection. This can yield ocular symptoms and signs. Additionally, infants to whom ZIKV is transmitted congenitally develop congenital Zika syndrome (CZS). The ocular manifestations are widely variable, and include nonpurulent conjunctivitis, anterior uveitis, keratitis, trabeculitis, congenital glaucoma, microphthalmia, hypoplastic optic disc, and optic nerve pallor. There are currently no FDA approved therapeutic agents for treating ZIKV infections and, as such, a meticulous ocular examination is an important aspect of the diagnosis. This review utilized several published articles regarding the ocular findings of ZIKV, antiviral immune responses to ZIKV infection, and the pathogenesis of ocular manifestations in individuals with ZIKV infection. This review summarizes the current knowledge on the viral immunology of ZIKV, interactions between ZIKV and the host's immune defense mechanism, pathological mechanisms, as well as anterior and posterior segment findings associated with ZIKV infection.
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6
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Costa CBDC, Freitas D. Ocular findings of congenital Zika virus infection with microcephaly. Int Ophthalmol 2022; 42:3117-3127. [DOI: 10.1007/s10792-022-02311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
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7
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Beckman D, Seelke AMH, Bennett J, Dougherty P, Van Rompay KKA, Keesler R, Pesavento PA, Coffey LLA, Morrison JH, Bliss-Moreau E. Neuroanatomical abnormalities in a nonhuman primate model of congenital Zika virus infection. eLife 2022; 11:64734. [PMID: 35261339 PMCID: PMC8906804 DOI: 10.7554/elife.64734] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
We evaluated neuropathological consequences of fetal ZIKV exposure in rhesus monkeys, a translatable animal model for human neural development, by carrying out quantitative neuroanatomical analyses of the nearly full-term brains of fetuses infected with ZIKV and procedure-matched controls. For each animal, a complete cerebral hemisphere was evaluated using immunohistochemical (IHC) and neuroanatomical techniques to detect virus, identify affected cell types, and evaluate gross neuroanatomical abnormalities. IHC staining revealed the presence of ZIKV in the frontal lobe, which contained activated microglia and showed increased apoptosis of immature neurons. ZIKV-infected animals exhibited macrostructural changes within the visual pathway. Regional differences tracked with the developmental timing of the brain, suggesting inflammatory processes related to viral infiltration swept through the cortex, followed by a wave of cell death resulting in morphological changes. These findings may help explain why some infants born with normal sized heads during the ZIKV epidemic manifest developmental challenges as they age.
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Affiliation(s)
- Danielle Beckman
- California National Primate Research Center, UC Davis, Davis, United States
| | - Adele M H Seelke
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
| | - Jeffrey Bennett
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
| | - Paige Dougherty
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
| | - Koen K A Van Rompay
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, UC Davis, Davis, United States
| | - Rebekah Keesler
- California National Primate Research Center, UC Davis, Davis, United States
| | - Patricia A Pesavento
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, UC Davis, Davis, United States
| | - Lark L A Coffey
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, UC Davis, Davis, United States
| | - John H Morrison
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Neurology, School of Medicine, UC Davis, Davis, United States
| | - Eliza Bliss-Moreau
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
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8
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Abroug N, Khairallah M, Zina S, Ksiaa I, Amor HB, Attia S, Jelliti B, Khochtali S, Khairallah M. Ocular Manifestations of Emerging Arthropod-Borne Infectious Diseases. J Curr Ophthalmol 2021; 33:227-235. [PMID: 34765808 PMCID: PMC8579803 DOI: 10.4103/joco.joco_134_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/25/2021] [Accepted: 04/25/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To review the clinical features, diagnosis, treatment modalities, and prognosis of arthropod-borne infectious diseases. Methods This is a narrative review on arthropod-borne infectious diseases including general and ophthalmological aspects of these infectious diseases. A comprehensive literature review between January 1983 and September 2020 was conducted in PubMed database. Epidemiology, clinical features, diagnosis, treatment, and prognosis of arthropod-borne infectious diseases were reviewed. Results Emergent and resurgent arthropod-borne infectious diseases are major causes of systemic morbidity and death that are expanding worldwide. Among them, bacterial and viral agents including rickettsial disease, West Nile virus, Dengue fever, Chikungunya, Rift valley fever, and Zika virus have been associated with an array of ocular manifestations. These include anterior uveitis, retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement. Proper clinical diagnosis of any of these infectious diseases is primarily based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is confirmed by laboratory tests. Ocular involvement usually has a self-limited course, but it can result in persistent visual impairment. Doxycycline is the treatment of choice for rickettsial disease. There is currently no proven specific treatment for arboviral diseases. Prevention remains the mainstay for arthropod vector and zoonotic disease control. Conclusions Emerging arthropod vector-borne diseases should be considered in the differential diagnosis of uveitis, especially in patient living or with recent travel to endemic countries. Early clinical diagnosis, while laboratory testing is pending, is essential for proper management to prevent systemic and ocular morbidity.
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Affiliation(s)
- Nesrine Abroug
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sourour Zina
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Ksiaa
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Hager Ben Amor
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sonia Attia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Bechir Jelliti
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Sana Khochtali
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Departement of Ophthalmology, Faculty of Medicine, University of Monastir, Monastir, Tunisia
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9
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Abstract
Optical coherence tomography (OCT) is widely applied in diagnosis and management of retina diseases particularly macular diseases in adult retina practices. However, it has been under-utilized in pediatric retinal diseases especially in neonates and infants. Utilization of OCT in primary macular diseases in this age group is also uncommon and is less reported. Challenges involved in image acquisition and limitations with available devices technique can explain the limited research and accurate data availability in the literature in this field. Purpose of this review article is to summarize the use of OCT and its importance in various infantile retinal pathologies such as vascular diseases, tumors, retinal dystrophies, and optic nerve pathologies with primary focus on neonates and infants, along with infant choroid. In addition, we also discuss about future directions including OCT angiography for infants.
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Affiliation(s)
- Sushma Jayanna
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Subhadra Jalali
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas R Padhi
- Consultant Ophthalmologist, Department of Retina and Vitreous, Mithu Tulasi Chanrai Campus, Bhubaneswar, LV Prasad Eye Institute, India
| | - Komal Agarwal
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA
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10
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Li M, Brokaw A, Furuta AM, Coler B, Obregon-Perko V, Chahroudi A, Wang HY, Permar SR, Hotchkiss CE, Golos TG, Rajagopal L, Adams Waldorf KM. Non-human Primate Models to Investigate Mechanisms of Infection-Associated Fetal and Pediatric Injury, Teratogenesis and Stillbirth. Front Genet 2021; 12:680342. [PMID: 34290739 PMCID: PMC8287178 DOI: 10.3389/fgene.2021.680342] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/25/2021] [Indexed: 12/25/2022] Open
Abstract
A wide array of pathogens has the potential to injure the fetus and induce teratogenesis, the process by which mutations in fetal somatic cells lead to congenital malformations. Rubella virus was the first infectious disease to be linked to congenital malformations due to an infection in pregnancy, which can include congenital cataracts, microcephaly, hearing impairment and congenital heart disease. Currently, human cytomegalovirus (HCMV) is the leading infectious cause of congenital malformations globally, affecting 1 in every 200 infants. However, our knowledge of teratogenic viruses and pathogens is far from complete. New emerging infectious diseases may induce teratogenesis, similar to Zika virus (ZIKV) that caused a global pandemic in 2016-2017; thousands of neonates were born with congenital microcephaly due to ZIKV exposure in utero, which also included a spectrum of injuries to the brain, eyes and spinal cord. In addition to congenital anomalies, permanent injury to fetal and neonatal organs, preterm birth, stillbirth and spontaneous abortion are known consequences of a broader group of infectious diseases including group B streptococcus (GBS), Listeria monocytogenes, Influenza A virus (IAV), and Human Immunodeficiency Virus (HIV). Animal models are crucial for determining the mechanism of how these various infectious diseases induce teratogenesis or organ injury, as well as testing novel therapeutics for fetal or neonatal protection. Other mammalian models differ in many respects from human pregnancy including placentation, labor physiology, reproductive tract anatomy, timeline of fetal development and reproductive toxicology. In contrast, non-human primates (NHP) most closely resemble human pregnancy and exhibit key similarities that make them ideal for research to discover the mechanisms of injury and for testing vaccines and therapeutics to prevent teratogenesis, fetal and neonatal injury and adverse pregnancy outcomes (e.g., stillbirth or spontaneous abortion). In this review, we emphasize key contributions of the NHP model pre-clinical research for ZIKV, HCMV, HIV, IAV, L. monocytogenes, Ureaplasma species, and GBS. This work represents the foundation for development and testing of preventative and therapeutic strategies to inhibit infectious injury of human fetuses and neonates.
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Affiliation(s)
- Miranda Li
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
- Department of Biological Sciences, Columbia University, New York, NY, United States
| | - Alyssa Brokaw
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anna M. Furuta
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Veronica Obregon-Perko
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Hsuan-Yuan Wang
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Sallie R. Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Charlotte E. Hotchkiss
- Washington National Primate Research Center, University of Washington, Seattle, WA, United States
| | - Thaddeus G. Golos
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Lakshmi Rajagopal
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Kristina M. Adams Waldorf
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Li Y, Shi S, Xia F, Shan C, Ha Y, Zou J, Adam A, Zhang M, Wang T, Liu H, Shi PY, Zhang W. Zika virus induces neuronal and vascular degeneration in developing mouse retina. Acta Neuropathol Commun 2021; 9:97. [PMID: 34034828 PMCID: PMC8147371 DOI: 10.1186/s40478-021-01195-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 01/07/2023] Open
Abstract
Zika virus (ZIKV), a mosquito-borne flavivirus, can cause severe eye disease and even blindness in newborns. However, ZIKV-induced retinal lesions have not been studied in a comprehensive way, mechanisms of ZIKV-induced retinal abnormalities are unknown, and no therapeutic intervention is available to treat or minimize the degree of vision loss in patients. Here, we developed a novel mouse model of ZIKV infection to evaluate its impact on retinal structure. ZIKV (20 plaque-forming units) was inoculated into neonatal wild type C57BL/6J mice at postnatal day (P) 0 subcutaneously. Retinas of infected mice and age-matched controls were collected at various ages, and retinal structural alterations were analyzed. We found that ZIKV induced progressive neuronal and vascular damage and retinal inflammation starting from P8. ZIKV-infected retina exhibited dramatically decreased thickness with loss of neurons, initial neovascular tufts followed by vessel dilation and degeneration, increased microglia and leukocyte recruitment and activation, degeneration of astrocyte network and gliosis. The above changes may involve inflammation and endoplasmic reticulum stress-mediated cell apoptosis and necroptosis. Moreover, we evaluated the efficacy of preclinical drugs and the safety of ZIKV vaccine candidate in this mouse model. We found that ZIKV-induced retinal abnormalities could be blocked by a selective flavivirus inhibitor NITD008 and a live-attenuated ZIKV vaccine candidate could potentially induce retinal abnormalities. Overall, we established a novel mouse model and provide a direct causative link between ZIKV and retinal lesion in vivo, which warrants further investigation of the underlying mechanisms of ZIKV-induced retinopathy and the development of effective therapeutics.
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Affiliation(s)
- Yi Li
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
| | - Shuizhen Shi
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
| | - Fan Xia
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
| | - Chao Shan
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
| | - Yonju Ha
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
| | - Jing Zou
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
| | - Awadalkareem Adam
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX USA
| | - Ming Zhang
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA USA
| | - Tian Wang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX USA
| | - Hua Liu
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
- Sealy Center for Vector-Borne and Zoonotic Diseases, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Pei-Yong Shi
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Wenbo Zhang
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0144 USA
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555 USA
- Departments of Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX USA
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Almeida LFB, Kattah M, Ventura LO, Gois AL, Rocha C, Andrade CG, Mendonza-Santiesteban C, Ventura CV. Pattern-Reversal Visual Evoked Potential in Children With Congenital Zika Syndrome. J Pediatr Ophthalmol Strabismus 2021; 58:78-83. [PMID: 34038265 DOI: 10.3928/01913913-20201110-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To objectively evaluate the visual function in children with congenital Zika syndrome using pattern-reversal visual evoked potential (PR-VEP). METHODS This was a cross-sectional study composed of two patient groups: children aged between 18 and 24 months who were positive for the Zika virus (congenital Zika syndrome group) and age-matched healthy children (control group). All patients underwent a comprehensive ophthalmologic examination and PR-VEP was performed binocularly in a room with constant dim illumination. The P100 peak time in the 60' arc stimuli was used, and the results were correlated with visual acuity, cephalic perimeter at birth, and funduscopic findings. RESULTS Thirty-seven children were included in the congenital Zika syndrome group and 15 in the control group. The mean age was 18.5 ± 0.9 months (range: 17 to 20 months) in the congenital Zika syndrome group and 24.3 ± 1.6 months (range: 21 to 28 months) in the control group. The P100 response was normal in 7 patients (18.9%) with congenital Zika syndrome, borderline in 2 (5.4%), abnormal with prolonged latency in 18 (48.6%), and abnormal with no response in 10 (27.0%). A significant correlation between the visual acuity and P100 peak time was observed (P < .001). The P100 values were not correlated significantly with the cephalic perimeter at birth (P = .412) or the funduscopic findings (P = .510). PR-VEP in children with congenital Zika syndrome and no funduscopic findings was significantly worse than in the control group (P = .001). CONCLUSIONS Children with congenital Zika syndrome have characteristically abnormal PR-VEPs regardless of the funduscopic findings and severe microcephaly. The PR-VEP findings supported the diagnosis of cortical visual impairment in these children. [J Pediatr Ophthalmol Strabismus. 2021;58(2):78-83.].
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13
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Menezes K, Mancera N, Patel H, Kattih Z, Mhaskar R. Torpedo Maculopathy: A Systematic Review of Case Reports. Ophthalmic Surg Lasers Imaging Retina 2021; 52:78-83. [DOI: 10.3928/23258160-20210201-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
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14
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Abstract
Digital retinal imaging is at the core of a revolution that is continually improving the screening, diagnosis, documentation, monitoring, and treatment of infant retinal diseases. Historically, imaging the retina of infants had been limited and difficult to obtain. Recent advances in photographic instrumentation have significantly improved the ability to obtain high quality multimodal images of the infant retina. These include color fundus photography with different camera angles, ultrasonography, fundus fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. We provide a summary of the current literature on retinal imaging in infants and highlight areas where further research is required.
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15
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Yiu G, Thomasy SM, Casanova MI, Rusakevich A, Keesler RI, Watanabe J, Usachenko J, Singapuri A, Ball EE, Bliss-Moreau E, Guo W, Webster H, Singh T, Permar S, Ardeshir A, Coffey LL, Van Rompay KK. Evolution of ocular defects in infant macaques following in utero Zika virus infection. JCI Insight 2020; 5:143947. [PMID: 33180748 PMCID: PMC7819741 DOI: 10.1172/jci.insight.143947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/04/2020] [Indexed: 12/28/2022] Open
Abstract
Congenital Zika syndrome (CZS) is associated with microcephaly and various neurological, musculoskeletal, and ocular abnormalities, but the long-term pathogenesis and postnatal progression of ocular defects in infants are not well characterized. Rhesus macaques are superior to rodents as models of CZS because they are natural hosts of the virus and share similar immune and ocular characteristics, including blood–retinal barrier characteristics and the unique presence of a macula. Using a previously described model of CZS, we infected pregnant rhesus macaques with Zika virus (ZIKV) during the late first trimester and characterized postnatal ocular development and evolution of ocular defects in 2 infant macaques over 2 years. We found that one of them exhibited colobomatous chorioretinal atrophic lesions with macular and vascular dragging as well as retinal thinning caused by loss of retinal ganglion neuron and photoreceptor layers. Despite these congenital ocular malformations, axial elongation and retinal development in these infants progressed at normal rates compared with healthy animals. The ZIKV-exposed infants displayed a rapid loss of ZIKV-specific antibodies, suggesting the absence of viral replication after birth, and did not show any behavioral or neurological defects postnatally. Our findings suggest that ZIKV infection during early pregnancy can impact fetal retinal development and cause congenital ocular anomalies but does not appear to affect postnatal ocular growth.
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Affiliation(s)
- Glenn Yiu
- Department of Ophthalmology & Vision Science, School of Medicine, and
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - M Isabel Casanova
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | | | | | | | - Jodie Usachenko
- California National Primate Research Center, Davis, California, USA
| | - Anil Singapuri
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, and
| | - Erin E Ball
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, and
| | - Eliza Bliss-Moreau
- California National Primate Research Center, Davis, California, USA.,Department of Psychology, University of California, Davis, Davis, California, USA
| | - Wendi Guo
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Helen Webster
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Tulika Singh
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Sallie Permar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Amir Ardeshir
- California National Primate Research Center, Davis, California, USA
| | - Lark L Coffey
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, and
| | - Koen Ka Van Rompay
- California National Primate Research Center, Davis, California, USA.,Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, and
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16
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Rosa-Fernandes L, Barbosa RH, dos Santos MLB, Angeli CB, Silva TP, Melo RCN, de Oliveira GS, Lemos B, Van Eyk JE, Larsen MR, Cardoso CA, Palmisano G. Cellular Imprinting Proteomics Assay: A Novel Method for Detection of Neural and Ocular Disorders Applied to Congenital Zika Virus Syndrome. J Proteome Res 2020; 19:4496-4515. [PMID: 32686424 PMCID: PMC7640952 DOI: 10.1021/acs.jproteome.0c00320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Indexed: 12/24/2022]
Abstract
Congenital Zika syndrome was first described due to increased incidence of congenital abnormalities associated with Zika virus (ZIKV) infection. Since the eye develops as part of the embryo central nervous system (CNS) structure, it becomes a specialized compartment able to display symptoms of neurodegenerative diseases and has been proposed as a noninvasive approach to the early diagnosis of neurological diseases. Ocular lesions result from defects that occurred during embryogenesis and can become apparent in newborns exposed to ZIKV. Furthermore, the absence of microcephaly cannot exclude the occurrence of ocular lesions and other CNS manifestations. Considering the need for surveillance of newborns and infants with possible congenital exposure, we developed a method termed cellular imprinting proteomic assay (CImPA) to evaluate the ocular surface proteome specific to infants exposed to ZIKV during gestation compared to nonexposure. CImPA combines surface cells and fluid capture using membrane disks and a large-scale quantitative proteomics approach, which allowed the first-time report of molecular alterations such as neutrophil degranulation, cell death signaling, ocular and neurological pathways, which are associated with ZIKV infection with and without the development of congenital Zika syndrome, CZS. Particularly, infants exposed to ZIKV during gestation and without early clinical symptoms could be detected using the CImPA method. Lastly, this methodology has broad applicability as it could be translated in the study of several neurological diseases to identify novel diagnostic biomarkers. Data are available via ProteomeXchange with identifier PXD014038.
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Affiliation(s)
- Livia Rosa-Fernandes
- GlycoProteomics
Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
- Department
of Biochemistry and Molecular Biology, University
of Southern Denmark, Odense, Denmark
| | - Raquel Hora Barbosa
- GlycoProteomics
Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
- Molecular
and Integrative Physiological Sciences Program, Department of Environmental
Health, Harvard School of Public Health, Boston, Massachusetts, United States
- Maternal
and Child Department, Faculty of Medicine, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
- Genetics
Program, National Cancer Institute, Rio de Janeiro, Brazil
| | - Maria Luiza B. dos Santos
- Maternal
and Child Department, Faculty of Medicine, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - Claudia B. Angeli
- GlycoProteomics
Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Thiago P. Silva
- Laboratory
of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Rossana C. N. Melo
- Laboratory
of Cellular Biology, Department of Biology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Gilberto Santos de Oliveira
- GlycoProteomics
Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Bernardo Lemos
- Molecular
and Integrative Physiological Sciences Program, Department of Environmental
Health, Harvard School of Public Health, Boston, Massachusetts, United States
| | - Jennifer E Van Eyk
- Advanced
Clinical BioSystems Research Institute, Cedars Sinai Precision Biomarker
Laboratories, Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Martin R. Larsen
- Department
of Biochemistry and Molecular Biology, University
of Southern Denmark, Odense, Denmark
| | - Claudete Araújo Cardoso
- Maternal
and Child Department, Faculty of Medicine, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - Giuseppe Palmisano
- GlycoProteomics
Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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17
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Abstract
PURPOSE OF REVIEW This review provides a historic perspective of the impact that major pandemics have had on human and their relationship with ophthalmology. The novel coronavirus epidemic is also analyzed, highlighting the relevance of the eye as a possible source of transmission, infection, and prognosis for the disease. RESULTS Smallpox is suspected to be present for more than 12 000 years. However, trachoma seems to be the first recorded ophthalmological infectious disease. The deadliest pandemics include the bubonic plague, smallpox, and Spanish flu. The CoVID-19 epidemic is still developing and measures need to be implemented to prevent further escalation of the crisis. SUMMARY Understanding the current facts in light of earlier historical evidence may help us prepare better to minimize the spread of infections in the future.
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Affiliation(s)
| | | | - Aaron Gold
- Murray Ocular Oncology and Retina, Miami, Florida, USA
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18
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Ilin JV, Syed MF, Hussein S, Lima LCDF, Ramos C. Bilateral optic neuritis as a complication of successive Flaviviridae virus infections. Can J Ophthalmol 2020; 55:e112-e115. [DOI: 10.1016/j.jcjo.2019.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/10/2019] [Accepted: 10/29/2019] [Indexed: 11/27/2022]
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Gundlach BS, Tsui I. Optical coherence tomography in pediatric patients: a clinical review. Ther Adv Ophthalmol 2020; 12:2515841420904612. [PMID: 32076655 PMCID: PMC7003168 DOI: 10.1177/2515841420904612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/06/2020] [Indexed: 12/30/2022] Open
Abstract
Optical coherence tomography has improved the ophthalmic clinical examination due to its ability to more accurately characterize pathology of the eye. Optical coherence tomography is now an integral imaging modality for many adult diseases of the retina and is a ubiquitous part of a retinal practice. However, although its use in adults is well recognized, the adoption of optical coherence tomography in pediatric patients may be undervalued as macular diseases in children are relatively uncommon. Recent technological advancements have made optical coherence tomography scans quicker and more precise, generating normative data and leading to more widespread use in children. In this review article, we discuss how pediatric optical coherence tomography data can be used to understand normal development, as well as diagnose and monitor retinal disease. In particular, we highlight clinical optical coherence tomography findings of several pediatric retinal conditions, including retinopathy of prematurity, congenital infections, retinal dystrophies, and phakomatoses such as neurofibromatosis.
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Affiliation(s)
- Bradley S Gundlach
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Irena Tsui
- Retina Division, Stein Eye Institute and Doheny Eye Institute, University of California, Los Angeles, 100 Stein Plaza, Los Angeles, CA 90095, USA
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20
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Lima DDS, Baran LCP, Hamer RD, Costa MFD, Vidal KS, Damico FM, Barboni MTS, França VDCRDM, Martins CMG, Tabares HS, Dias SL, Silva LA, Decleva D, Zatz M, Bertozzi APAP, Gazeta RE, Passos SD, Ventura DF. Longitudinal visual acuity development in ZIKV-exposed children. J AAPOS 2020; 24:23.e1-23.e6. [PMID: 31926367 DOI: 10.1016/j.jaapos.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 11/03/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To follow the visual acuity development of children exposed to or infected with the Zika virus (ZIKV) during gestation and to relate potential visual acuity deficits to their clinical condition. METHODS In this prospective study, visual acuity was measured via Teller Acuity Cards in three groups of children: (1) those with confirmed ZIKV exposure (ZE) through the mother only, (2) those with confirmed infection (ZI), and (3) unaffected controls. Visual acuity was measured 2-4 times in each child during the first 30 months of age. RESULTS The study included 22 children in the ZE group, 11 in the ZI group, and 27 controls. Visual acuity developed normally in both patient groups, including infected patients (ZI) that did not manifest clinical symptoms. In a small subgroup of patients with characteristics consistent with congenital Zika syndrome (CZS), visual acuity was within normative values, with the exception of single child with chorioretinal atrophy. CONCLUSIONS In this southeastern Brazil study cohort, visual acuity development seemed to progress normally in infected children without CZS symptoms.
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Affiliation(s)
- Diego da Silva Lima
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil.
| | - Luiz Claudio Portnoi Baran
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Russell David Hamer
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil; Department of Psychology, Florida Atlantic University, Boca Raton, Florida
| | - Marcelo Fernandes da Costa
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Kallene Summer Vidal
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Francisco Max Damico
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil; Department of Ophthalmology, São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Mirella Telles Salgueiro Barboni
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil; Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | | | - Heydi Segundo Tabares
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Sarah Leonardo Dias
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Leonardo Aparecido Silva
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Diego Decleva
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Stem Cell and Human Genome Research Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Dora Fix Ventura
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil
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21
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Boucoiran I, Kakkar F, Renaud C. Maternal infections. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:401-422. [PMID: 32958187 DOI: 10.1016/b978-0-444-64150-2.00029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Congenital infections are infections transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum). They have the potential to adversely affect fetal development and long-term neurodevelopmental outcome through inflammatory, destructive, developmental, or teratogenic lesions of the brain. Because the fetal/neonatal brain has a limited capacity to respond to injury, early inflammatory changes may be difficult to visualize and only manifest as neurocognitive disability later in life. Teratogenic effects, which may include aberrations of neuronal proliferation and migration, are more easily visible on imaging, but may be equally difficult to use to predict long-term neurocognitive outcomes. This chapter reviews the general pathophysiology of congenital infection and describes the epidemiology, the antenatal and postnatal diagnosis, and the treatment of congenital infections as well as the long-term neurodevelopmental outcomes.
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Affiliation(s)
- Isabelle Boucoiran
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.
| | - Fatima Kakkar
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Christian Renaud
- Mother and Child Infection Center, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada; Department of Microbiology and Immunology, University of Montreal, Montreal, QC, Canada
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Ventura CV, Menezes CA, Ventura LO. Systemic and Ophthalmic Manifestations of Zika. Clin Ophthalmol 2020; 60:3-12. [DOI: 10.1097/iio.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Trigueiro SA, Neves BF, Aguiar MSBD, Araújo JSSD. Correlation between cephalic circumference at birth and ocular alterations in patients with microcephaly potentially associated with Zika Virus infection. ACTA ACUST UNITED AC 2019; 65:909-913. [PMID: 31340324 DOI: 10.1590/1806-9282.65.6.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The Zika virus (ZIKV) is an arbovirus isolated for the first time in 1947 and transmitted to humans by the Aedes aegypti mosquito. In Brasil, it was first detected in May 2015. Since then, ZIKV has been identified as the etiological agent of acute exanthematous disease in Brasil, and Neuropediatricians of the Recife warned about an epidemic of microcephaly, and the Brazilian Ministry of Health confirmed the association between ZIKV and Congenital malformations and neurological syndromes. The eye, as an extension of the developing brain, has been examined in patients with microcephaly and maternal history of ZIKV infection. METHODS Twenty newborn patients with microcephaly, whose mothers had presumed Zika virus during pregnancy, were analyzed through medical records. The nonparametric chi-square statistic was used to verify the association between head circumference and ocular alteration at a significance level of 0.0001. RESULTS The significance of P = 0.000 in the value of non-parametric chi-square statistics was lower than the value of α = 0.0001, demonstrating that, at a level of 0.0001, there is an association between head circumference and ocular alteration. CONCLUSION Although the knowledge of the natural evolution of the disease is still scarce, the current evidence is strong enough to establish a causal relationship between ZIKV infection during pregnancy and the increased incidence of the microcephaly and serious eye alterations that lead to the severe lower vision of these children.
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Affiliation(s)
| | | | - Michelle Salles Barros de Aguiar
- Doctorate; Professor and researcher at the University Center of João Pessoa - Unipê; President Director of the Nikola Tesla Research Center, João Pessoa-PB, Brasil
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Ventura CV, Bandstra ES, Fernandez MP, Cooper JM, Saigal GM, Bauer CR, Hofheimer JA, Berkovits MD, Fifer RC, Pensirikul AD, Gonzalez IA, Curry CL, Andreansky S, Younis RT, Liu XZ, Banker TP, Dubovy SR, Langer SM, Berrocal AM. First Locally Acquired Congenital Zika Syndrome Case in the United States: Neonatal Clinical Manifestations. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e93-e98. [PMID: 30222826 DOI: 10.3928/23258160-20180907-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
In the spring of 2017, a full-term infant with microcephaly was delivered in South Florida. During first trimester, the mother presented with fever, nausea, and vomiting. She reported no foreign travel for herself or her partner. The infant's neurologic, ophthalmologic, neuroradiologic, and audiologic findings were highly suggestive of congenital Zika syndrome (CZS), confirmed by IgM antibodies and plaque reduction neutralization test. New observations, including peripheral temporal retinal avascularity and peripapillary retinal nerve fiber layer thinning, are presented from this first known case of non-travel-associated CZS in the United States. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e93-e98.].
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Mohr EL. Modeling Zika Virus-Associated Birth Defects in Nonhuman Primates. J Pediatric Infect Dis Soc 2018; 7:S60-S66. [PMID: 30590626 PMCID: PMC8506225 DOI: 10.1093/jpids/piy120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/31/2018] [Indexed: 01/22/2023]
Abstract
In utero infection with Zika virus (ZIKV) during pregnancy can lead to the development of birth defects and postnatal deficits. A nonhuman primate (NHP) model of congenital ZIKV infection can help fill the gaps in knowledge where tissue studies are required to define viral pathogenesis and identify targets for therapeutic intervention. This model system has already identified critical features of ZIKV pathogenesis in congenital infection. Before translating these NHP studies to human clinical trials, we must understand the similarities and differences between human and NHP fetal immune system development, neural development, and infant assessment tools. Because of the overall similarity between fetal and infant development in humans and NHPs, this NHP model can complement human clinical trials by defining immune correlates of protection and evaluating therapeutic interventions.
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Affiliation(s)
- Emma L Mohr
- Department of Pediatrics, University of Wisconsin-Madison,Correspondence: E. L. Mohr, MD, PhD, 600 Highland Ave., Madison, WI 53792 ()
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Tsui I, Moreira MEL, Rossetto JD, Vasconcelos Z, Gaw SL, Neves LM, Zin OA, Haefeli L, Silveira Filho JCB, Gomes SC, Adachi K, Pone MVDS, Pone SM, Pereira JP, Belfort R, Arumugaswami V, Brasil P, Nielsen-Saines K, Zin AA. Eye Findings in Infants With Suspected or Confirmed Antenatal Zika Virus Exposure. Pediatrics 2018; 142:peds.2018-1104. [PMID: 30213843 PMCID: PMC6317824 DOI: 10.1542/peds.2018-1104] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2018] [Indexed: 01/01/2023] Open
Abstract
UNLABELLED : media-1vid110.1542/5804915134001PEDS-VA_2018-1104Video Abstract OBJECTIVES: To characterize ophthalmic manifestations of confirmed or suspected antenatal Zika virus (ZIKV) exposure. METHODS Infants with antenatal ZIKV exposure were referred for evaluation during the 2015-2016 Rio de Janeiro outbreak. Mothers with symptomatic ZIKV infection during pregnancy and/or infants with microcephaly or other findings that were suggestive of suspected antenatal exposure were tested with reverse transcriptase polymerase chain reaction (RT-PCR). Complete eye examinations were performed by pediatric ophthalmologists between January 2016 and February 2017. The main outcome measure was eye abnormalities in RT-PCR-positive and suspected (ie, not tested or RT-PCR-negative) antenatal ZIKV cases. RESULTS Of 224 infants, 189 had RT-PCR testing performed. Of 189 patients, 156 had positive RT-PCR results in their blood, urine, and/or placenta. Of 224 infants, 90 had central nervous system (CNS) abnormalities, including microcephaly (62 infants). Eye abnormalities were present in 57 of 224 (25.4%) infants. Optic nerve (44 of 57; 77.2%) and retina abnormalities (37 of 57; 64.9%) were the most common. The group with suspected ZIKV infection (68 infants) had proportionally more eye (36.8% vs 20.5%; P = .022) and CNS abnormalities (68.3% vs 28.1%; P = .008), likely because of referral patterns. Eye abnormalities consistent with ZIKV infection were clinically comparable in both RT-PCR-positive and unconfirmed groups, including 4 RT-PCR-positive infants of 5 without any CNS abnormalities. CONCLUSIONS Similar eye manifestations were identified regardless of laboratory confirmation. Well-appearing infants were also found to have eye abnormalities. Therefore, all infants born after ZIKV outbreaks should be universally screened for eye abnormalities.
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Affiliation(s)
- Irena Tsui
- Department of Opthalmology, Retina Division,
and
| | | | - Julia D. Rossetto
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and
| | - Zilton Vasconcelos
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of
Obstetrics, Gynecology, and Reproductive Services, University of California, San
Francisco, San Francisco, California
| | - Luiza M. Neves
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and,Hospital Federal dos Servidores do Estado, Rio de
Janeiro, Brazil
| | - Olivia A. Zin
- Hospital Federal dos Servidores do Estado, Rio de
Janeiro, Brazil
| | - Lorena Haefeli
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and
| | | | - Saint Clair Gomes
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and
| | - Kristina Adachi
- Department of Pediatrics, Division of Infectious
Disease, University of California, Los Angeles, Los Angeles, California
| | | | - Sheila Moura Pone
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and
| | - Jose Paulo Pereira
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de
São Paulo, São Paulo, Brazil
| | | | - Patricia Brasil
- Instituto Nacional de Infectologia Evandro Chagas,
Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Karin Nielsen-Saines
- Department of Pediatrics, Division of Infectious
Disease, University of California, Los Angeles, Los Angeles, California
| | - Andrea A. Zin
- Instituto Nacional de Saúde da Mulher da
Criança e do Adolescente Fernandes Figueira and
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Peloggia A, Ali M, Nanda K, Bahamondes L. Zika virus exposure in pregnancy and its association with newborn visual anomalies and hearing loss. Int J Gynaecol Obstet 2018; 143:277-281. [PMID: 30191558 DOI: 10.1002/ijgo.12663] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/29/2018] [Accepted: 09/05/2018] [Indexed: 01/09/2023]
Abstract
Exposure to Zika virus (ZIKV) in pregnancy leads to a spectrum of congenital effects in the newborn. Recent studies have begun to evaluate the impact of ZIKV during pregnancy. Among 39 relevant studies, nine were related specifically to clinical studies of ophthalmologic disorders and one was related to hearing loss impairment; most of these studies were case reports and case series reports. Importantly, congenital toxoplasmosis was ruled out in all studies. The data show that, in addition to microcephaly, ZIKV exposure in pregnancy may result in subtle ocular impairments in the newborn. The most common anomalies are macular pigment mottling and/or chorioretinal atrophy, and optic nerve disorders. Sensorineural hearing loss has also been noted in 5.8% of infants with microcephaly. The effects of ZIKV infection during pregnancy are potentially devastating to the fetus and newborn. Although microcephaly is an important signal, the current information emphasizes the importance of ocular and auditory screenings, otherwise sight and hearing anomalies may be underestimated. Healthcare providers should fully understand the spectrum of anomalies related to ZIKV exposure in pregnancy in order to counsel pregnant women living in high-risk areas, in addition to those wanting to become pregnant.
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Affiliation(s)
- Alessandra Peloggia
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kavita Nanda
- Contraceptive Technology Innovation Department, Durham, NC, USA
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Papageorgiou E, Pilat A, Proudlock F, Lee H, Purohit R, Sheth V, Vasudevan P, Gottlob I. Retinal and optic nerve changes in microcephaly: An optical coherence tomography study. Neurology 2018; 91:e571-e585. [PMID: 29997194 PMCID: PMC6105049 DOI: 10.1212/wnl.0000000000005950] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/27/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To investigate the morphology of the retina and optic nerve (ON) in microcephaly. METHODS This was a prospective case-control study including 27 patients with microcephaly and 27 healthy controls. All participants underwent ophthalmologic examination and handheld optical coherence tomography (OCT) of the macula and ON head. The thickness of individual retinal layers was quantified at the foveal center and the parafovea (1,000 μm nasal and temporal to the fovea). For the ON head, disc diameter, cup diameter, cup-to-disc ratio, cup depth, horizontal rim diameter, rim area, peripapillary retinal thickness, and retinal nerve fiber layer thickness were measured. RESULTS Seventy-eight percent of patients had ophthalmologic abnormalities, mainly nystagmus (56%) and strabismus (52%). OCT abnormalities were found in 85% of patients. OCT revealed disruption of the ellipsoid zone, persistent inner retinal layers, and irregular foveal pits. Parafoveal retinal thickness was significantly reduced in patients with microcephaly compared to controls, nasally (307 ± 44 vs 342 ± 19 μm, p = 0.001) and temporally (279 ± 56 vs 325 ± 16 μm, p < 0.001). There was thinning of the ganglion cell layer and the inner segments of the photoreceptors in microcephaly. Total peripapillary retinal thickness was smaller in patients with microcephaly compared to controls for both temporal (275 vs 318 μm, p < 0.001) and nasal sides (239 vs 268 μm, p = 0.013). CONCLUSIONS Retinal and ON anomalies in microcephaly likely reflect retinal cell reduction and lamination alteration due to impaired neurogenic mitosis. OCT allows diagnosis and quantification of retinal and ON changes in microcephaly even if they are not detected on ophthalmoscopy.
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Affiliation(s)
- Eleni Papageorgiou
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK
| | - Anastasia Pilat
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK
| | - Frank Proudlock
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK
| | - Helena Lee
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK
| | - Ravi Purohit
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK
| | - Viral Sheth
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK
| | - Pradeep Vasudevan
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK
| | - Irene Gottlob
- From the Department of Ophthalmology (E.P., A.P., F.P., H.L., R.P., V.S., I.G.), Leicester Royal Infirmary, University of Leicester; and Department of Clinical Genetics (P.V.), University Hospitals of Leicester, Leicester Royal Infirmary, UK.
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Khan AO, Patel N, Ghazi NG, Alzahrani SS, Arold ST, Alkuraya FS. Familial non-syndromic macular pseudocoloboma secondary to homozygous CLDN19 mutation. Ophthalmic Genet 2018; 39:577-583. [PMID: 30067419 DOI: 10.1080/13816810.2018.1498528] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to uncover the genetic cause for non-syndromic macular "coloboma" (pseudocoloboma) in three brothers from a consanguineous family. METHODS Homozygosity mapping for the three affected brothers and whole-exome sequencing in one affected brother, followed by confirmatory Sanger sequencing and segregation analysis of the candidate gene for all immediate family members; molecular modeling of the candidate mutation; and review of clinical, imaging, and laboratory findings. RESULTS Three otherwise-healthy brothers (age 10, 10, and 6 years) had macular pseudocoloboma. Both parents and the fourth brother were not affected. Parents were first cousins. A novel homozygous missense variant in claudin 19 (CLND19: NM_148960.2:c. 263T>A; p.Val88Glu) segregated with the phenotype, and molecular modeling predicts an unfavorable effect to protein function. All prior reported biallelic CLND19 mutations cause symptomatic hypomagnesemia with hypercalciuria and nephrocalcinosis, often with concurrent macular pseudocoloboma. However, general physical assessment, metabolic profile, and renal imaging for the three affected brothers were normal. CONCLUSIONS A homozygous CLDN19 mutation can cause macular pseudocoloboma without evidence for systemic disease in children. This is the first reported family with CLDN19 mutations to have an ocular phenotype only; however, those identified to harbor biallelic CLDN19 mutations should be considered at risk for the extraocular manifestations that have previously been associated with mutations in the gene.
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Affiliation(s)
- Arif O Khan
- a Eye Institute, Cleveland Clinic Abu Dhabi , Abu Dhabi , United Arab Emirates.,b Department of Ophthalmology , Cleveland Clinic Lerner College of Medicine of Case Western University , Cleveland , Ohio , USA.,c Department of Genetics , King Faisal Specialist Hospital and Research Center , Riyadh , Saudi Arabia
| | - Nisha Patel
- c Department of Genetics , King Faisal Specialist Hospital and Research Center , Riyadh , Saudi Arabia
| | - Nicola G Ghazi
- a Eye Institute, Cleveland Clinic Abu Dhabi , Abu Dhabi , United Arab Emirates.,d Department of Ophthalmology , Lebanese American University, Lebanese American University Medical Center-Rizk Hospital , Beirut , Lebanon
| | - Shahad S Alzahrani
- a Eye Institute, Cleveland Clinic Abu Dhabi , Abu Dhabi , United Arab Emirates
| | - Stefan T Arold
- e Division of Biological and Environmental Sciences and Engineering (BESE) , Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST) , Thuwal , Saudi Arabia
| | - Fowzan S Alkuraya
- c Department of Genetics , King Faisal Specialist Hospital and Research Center , Riyadh , Saudi Arabia.,f Department of Anatomy and Cell Biology, College of Medicine , Alfaisal University , Riyadh , Saudi Arabia.,g Saudi Human Genome Program , King Abdulaziz City for Science and Technology , Riyadh , Saudi Arabia
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30
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Zika Virus Infection during Pregnancy; Maternofetal Risk Assessment, Transmission, Complications, and Management: A Review of the Literature. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2018. [DOI: 10.5812/archcid.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Guevara JG, Agarwal-Sinha S. Ocular abnormalities in congenital Zika syndrome: a case report, and review of the literature. J Med Case Rep 2018; 12:161. [PMID: 29884243 PMCID: PMC5994093 DOI: 10.1186/s13256-018-1679-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background As the number of children with Zika virus-related complications grows, the long-term developmental trajectory and its effects on families are unknown. We present the first known case of congenital Zika syndrome seen at our institution with significant fundus findings. Case presentation A 3-day-old Hispanic baby girl presented with severe microcephaly of 24 cm and temperature instability at birth. Her mother had traveled to Honduras early in pregnancy and testing of amniotic fluid was positive for Zika virus via polymerase chain reaction. A dilated fundus examination was significant for bilateral severe colobomatous chorioretinal atrophy of the macula and pigmentary changes. Neonatal magnetic resonance imaging revealed diffuse lissencephaly with decreased brain volume, atrophic corpus callosum and brainstem, periventricular calcifications, and ventriculomegaly of the lateral ventricles. Conclusions Our patient, who presented with the first known case of congenital Zika syndrome in Northern Florida, demonstrated profound bilateral colobomatous chorioretinal atrophy of the macula. The ophthalmologic findings along with severe microcephaly emphasize the neurotropism of the Zika virus, and ultimately are indicative of poor developmental and visual prognosis for affected infants. With the increased prevalence of Zika virus, ophthalmologists should be aware of the associated findings and the importance of an eye-screening examination with a dilated fundus examination within 1 month of life of infants in which congenital Zika syndrome is suspected. A multidisciplinary care approach is essential for the care of affected infants and their families.
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Affiliation(s)
| | - Swati Agarwal-Sinha
- Department of Ophthalmology, University of Florida, Gainesville, FL, USA. .,Department of Ophthalmology, Retinopathy of Prematurity Services, University of Florida, Gainesville, FL, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
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32
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Ventura LO, Ventura CV, Dias NDC, Vilar IG, Gois AL, Arantes TE, Fernandes LC, Chiang MF, Miller MT, Lawrence L. Visual impairment evaluation in 119 children with congenital Zika syndrome. J AAPOS 2018; 22:218-222.e1. [PMID: 29654909 DOI: 10.1016/j.jaapos.2018.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/04/2018] [Accepted: 01/28/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess visual impairment in a large sample of infants with congenital Zika syndrome (CZS) and to compare with a control group using the same assessment protocol. METHODS The study group was composed of infants with confirmed diagnosis of CZS. Controls were healthy infants matched for age, sex, and socioeconomic status. All infants underwent comprehensive ophthalmologic evaluation including visual acuity, visual function assessment, and visual developmental milestones. RESULTS The CZS group included 119 infants; the control group, 85 infants. At examination, the mean age of the CZS group was 8.5 ± 1.2 months (range, 6-13 months); of the controls, 8.4 ± 1.8 months (range, 5-12 months; P = 0.598). Binocular Teller Acuity Card (TAC) testing was abnormal in 107 CZS infants and in 4 controls (89.9% versus 5% [P < 0.001]). In the study group, abnormal monocular TAC results were more frequent in eyes with funduscopic alterations (P = 0.008); however, 104 of 123 structurally normal eyes (84.6%) also presented abnormal TAC results. Binocular contrast sensitivity was reduced in 87 of 107 CZS infants and in 8 of 80 controls (81.3% versus 10% [P < 0.001]). The visual development milestones were less achieved by infants with CZS compared to controls (P < 0.001). CONCLUSIONS Infants with CZS present with severe visual impairment. A protocol for assessment of the ocular findings, visual acuity, and visual developmental milestones tested against age-matched controls is suggested.
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Affiliation(s)
- Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil.
| | - Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Natália de C Dias
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Isabelle G Vilar
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Adriana L Gois
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil
| | - Tiago E Arantes
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil
| | - Luciene C Fernandes
- Department of Low Vision, Federal University of Minas Gerais, Belo Horizonte, Minas Gerias, Brazil
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon
| | | | - Linda Lawrence
- Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, Kansas
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33
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De Moraes CG, Pettito M, Yepez JB, Sakuntabhai A, Simon-Loriere E, Zaidi MB, Prot M, Ruffie C, Kim SS, Allikmets R, Terwilliger JD, Lee JH, Maestre GE. Optic neuropathy and congenital glaucoma associated with probable Zika virus infection in Venezuelan patients. JMM Case Rep 2018; 5:e005145. [PMID: 29896405 PMCID: PMC5994708 DOI: 10.1099/jmmcr.0.005145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Although the current Zika virus (ZIKV) epidemic is a major public health concern, most reports have focused on congenital ZIKV syndrome, its most devastating manifestation. Severe ocular complications associated with ZIKV infections and possible pathogenetic factors are rarely described. Here, we describe three Venezuelan patients who developed severe ocular manifestations following ZIKV infections. We also analyse their serological response to ZIKV and dengue virus (DENV). Case presentation One adult with bilateral optic neuritis, a child of 4 years of age with retrobulbar neuritis [corrected]. and a newborn with bilateral congenital glaucoma had a recent history of an acute exanthematous infection consistent with ZIKV infection. The results of ELISA tests indicated that all patients were seropositive for ZIKV and four DENV serotypes. Conclusion Patients with ZIKV infection can develop severe ocular complications. Anti-DENV antibodies from previous infections could play a role in the pathogenesis of these complications. Well-designed epidemiological studies are urgently needed to measure the risk of ZIKV ocular complications and confirm whether they are associated with the presence of anti-flaviviral antibodies.
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Affiliation(s)
- C Gustavo De Moraes
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Anavaj Sakuntabhai
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Etienne Simon-Loriere
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Mussaret B Zaidi
- Infectious Diseases Research Laboratory, Hospital General O'Horan, Merida, Mexico.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Matthieu Prot
- Pasteur Institute, Functional Genetics of Infectious Diseases Unit, Paris, France.,CNRS, URA 3012, Paris, France
| | - Claude Ruffie
- Pasteur Institute, Viral Genomics and Vaccination Unit, Paris, France.,CNRS, URA3015, Paris, France
| | - Susan S Kim
- In-patient Diabetes Unit, St. Peter's Hospital, Albany, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Joseph D Terwilliger
- Departments of Psychiatry and Genetics and Development, Columbia University Medical Center, New York, NY, USA.,Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Division of Medical Genetics, New York State Psychiatric Institute, New York, NY, USA.,Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Joseph H Lee
- Sergievsky Center, Columbia University Medical Center, New York, NY, USA.,Taub Institute and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Gladys E Maestre
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Venezuela.,Department of Biomedical Sciences, Division of Neurosciences, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA.,Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
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34
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Ventura CV, Ventura LO. Ophthalmologic Manifestations Associated With Zika Virus Infection. Pediatrics 2018; 141:S161-S166. [PMID: 29437049 PMCID: PMC5795515 DOI: 10.1542/peds.2017-2038e] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Vision plays an important role in the development of communication, social interaction, spatial awareness, and the motor skills needed to explore the environment. In the past 2 years, researchers have described the broad spectrum of clinical features that comprise congenital Zika syndrome (CZS). The ocular manifestations are considered 1 important pillar of this new entity. The most characteristic ophthalmic findings include chorioretinal scars and focal pigmentary changes seen in the macular region. Since these findings were first reported, other researchers have validated and extended them, leading to a more complete picture of the spectrum of ocular manifestations related to CZS. In this article, we summarize the current knowledge on the ocular implications of CZS and emphasize the importance of early rehabilitation to enhance visual performance in affected children.
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Affiliation(s)
- Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; and Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Liana O Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil; and Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
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35
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Mohr EL, Block LN, Newman CM, Stewart LM, Koenig M, Semler M, Breitbach ME, Teixeira LBC, Zeng X, Weiler AM, Barry GL, Thoong TH, Wiepz GJ, Dudley DM, Simmons HA, Mejia A, Morgan TK, Salamat MS, Kohn S, Antony KM, Aliota MT, Mohns MS, Hayes JM, Schultz-Darken N, Schotzko ML, Peterson E, Capuano S, Osorio JE, O’Connor SL, Friedrich TC, O’Connor DH, Golos TG. Ocular and uteroplacental pathology in a macaque pregnancy with congenital Zika virus infection. PLoS One 2018; 13:e0190617. [PMID: 29381706 PMCID: PMC5790226 DOI: 10.1371/journal.pone.0190617] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/18/2017] [Indexed: 12/03/2022] Open
Abstract
Congenital Zika virus (ZIKV) infection impacts fetal development and pregnancy outcomes. We infected a pregnant rhesus macaque with a Puerto Rican ZIKV isolate in the first trimester. The pregnancy was complicated by preterm premature rupture of membranes (PPROM), intraamniotic bacterial infection and fetal demise 49 days post infection (gestational day 95). Significant pathology at the maternal-fetal interface included acute chorioamnionitis, placental infarcts, and leukocytoclastic vasculitis of the myometrial radial arteries. ZIKV RNA was disseminated throughout fetal tissues and maternal immune system tissues at necropsy, as assessed by quantitative RT-PCR for viral RNA. Replicating ZIKV was identified in fetal tissues, maternal uterus, and maternal spleen by fluorescent in situ hybridization for viral replication intermediates. Fetal ocular pathology included a choroidal coloboma, suspected anterior segment dysgenesis, and a dysplastic retina. This is the first report of ocular pathology and prolonged viral replication in both maternal and fetal tissues following congenital ZIKV infection in a rhesus macaque. PPROM followed by fetal demise and severe pathology of the visual system have not been described in macaque congenital ZIKV infection previously. While this case of ZIKV infection during pregnancy was complicated by bacterial infection with PPROM, the role of ZIKV on this outcome cannot be precisely defined, and further nonhuman primate studies will determine if increased risk for PPROM or other adverse pregnancy outcomes are associated with congenital ZIKV infection.
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Affiliation(s)
- Emma L. Mohr
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (ELM); (TGG)
| | - Lindsey N. Block
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Christina M. Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Laurel M. Stewart
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michelle Koenig
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Matthew Semler
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Meghan E. Breitbach
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Leandro B. C. Teixeira
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Xiankun Zeng
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland, United States of America
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gabrielle L. Barry
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Troy H. Thoong
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gregory J. Wiepz
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Dawn M. Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Terry K. Morgan
- Departments of Pathology and Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - M. Shahriar Salamat
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Sarah Kohn
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kathleen M. Antony
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Matthew T. Aliota
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Mariel S. Mohns
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jennifer M. Hayes
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Nancy Schultz-Darken
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michele L. Schotzko
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Eric Peterson
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Saverio Capuano
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jorge E. Osorio
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Shelby L. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - David H. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Thaddeus G. Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (ELM); (TGG)
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Mittal R, Nguyen D, Debs LH, Patel AP, Liu G, Jhaveri VM, S. Kay SI, Mittal J, Bandstra ES, Younis RT, Chapagain P, Jayaweera DT, Liu XZ. Zika Virus: An Emerging Global Health Threat. Front Cell Infect Microbiol 2017; 7:486. [PMID: 29276699 PMCID: PMC5727043 DOI: 10.3389/fcimb.2017.00486] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/13/2017] [Indexed: 01/07/2023] Open
Abstract
Zika virus (ZIKV) is an emerging healthcare threat. The presence of the mosquito Aedes species across South and Central America in combination with complementary climates have incited an epidemic of locally transmitted cases of ZIKV infection in Brazil. As one of the most significant current public health concerns in the Americas, ZIKV epidemic has been a cause of alarm due to its known and unknown complications. At this point, there has been a clear association between ZIKV infection and severe clinical manifestations in both adults and neonates, including but not limited to neurological deficits such as Guillain-Barré syndrome (GBS) and microcephaly, respectively. The gravity of the fetal anomalies linked to ZIKV vertical transmission from the mother has prompted a discussion on whether to include ZIKV as a formal member of the TORCH [Toxoplasma gondii, other, rubella virus, cytomegalovirus (CMV), and herpes] family of pathogens known to breach placental barriers and cause congenital disease in the fetus. The mechanisms of these complex phenotypes have yet to be fully described. As such, diagnostic tools are limited and no effective modalities are available to treat ZIKV. This article will review the recent advancements in understanding the pathogenesis of ZIKV infection as well as diagnostic tests available to detect the infection. Due to the increase in incidence of ZIKV infections, there is an immediate need to develop new diagnostic tools and novel preventive as well as therapeutic modalities based on understanding the molecular mechanisms underlying the disease.
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Affiliation(s)
- Rahul Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States,*Correspondence: Rahul Mittal
| | - Desiree Nguyen
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Luca H. Debs
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Amit P. Patel
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - George Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Vasanti M. Jhaveri
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sae-In S. Kay
- Department of Surgery, Division of Otorhinolaryngology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Jeenu Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emmalee S. Bandstra
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ramzi T. Younis
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States,Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States,Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Prem Chapagain
- Department of Physics and Biomolecular Sciences Institute, Florida International University, Miami, FL, United States
| | - Dushyantha T. Jayaweera
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Xue Zhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States,Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States,Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, United States,Xue Zhong Liu
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Response to correction of refractive errors and hypoaccommodation in children with congenital Zika syndrome. J AAPOS 2017; 21:480-484.e1. [PMID: 29066355 DOI: 10.1016/j.jaapos.2017.07.206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/17/2017] [Accepted: 07/29/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe the immediate response to correction of refractive errors and hypoaccommodation in children with congenital Zika syndrome (CZS). METHODS Children born between May and December 2015 with a confirmed diagnosis of CZS and enrolled in a multidisciplinary early intervention program were included in this study. All children received a comprehensive ophthalmic examination, including dynamic retinoscopy and cycloplegic refraction. Children were prescribed their full correction if they met the criteria for refractive error, and additional plus 3.00 overcorrection for strabismus, accommodative dysfunction, and/or low vision. Monocular and binocular visual responses to Lea Grating Test at 30 cm, with and without eyeglasses, were measured on day 1 of glasses wear. RESULTS A total of 60 children were evaluated (mean age at evaluation, 11.5 ± 1.1 months; range, 9.0-16.0 months). Lea Grating Test responses were abnormal in all children prior to spectacle correction. Hypoaccommodation was present in 17 of 21 children (81%). Overcorrection was prescribed for all children. Visual responses were subnormal even with glasses use; however, immediate improvement in binocular vision was found in 37 children (62%) and in 74 of 119 eyes (62.2%). For the monocular visual improvement, 27 of 115 eyes (23.5%) had structural abnormalities, and 44 of 115 eyes (38.3%) were structurally normal. There was a statistical difference between the cycloplegic refraction of the children in August and in November, including emmetropia (P = 0.001), hyperopia (P = 0.000), myopia (P = 0.007), and astigmatism (P = 0.004). CONCLUSIONS Eyeglasses can improve visual acuity in children with CZS. Significant changes in their refractive status over time requires periodic updates.
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Fernandez MP, Parra Saad E, Ospina Martinez M, Corchuelo S, Mercado Reyes M, Herrera MJ, Parra Saavedra M, Rico A, Fernandez AM, Lee RK, Ventura CV, Berrocal AM, Dubovy SR. Ocular Histopathologic Features of Congenital Zika Syndrome. JAMA Ophthalmol 2017; 135:1163-1169. [PMID: 28975230 DOI: 10.1001/jamaophthalmol.2017.3595] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Congenital Zika syndrome (CZS) is known to be associated with severe malformations in newborns. Although microcephaly is the hallmark of this disease, the ocular findings are important given the severe visual impairment that has been observed in these patients. Regardless of the increased number of CZS cases reported, to date, no studies have described the ocular histopathologic findings of this entity. Objectives To evaluate the presence of Zika virus (ZIKV) antigens and describe the associated ocular histopathologic features of 4 cases of CZS. Design, Setting, and Participants In this observational case series performed from June 19, 2015, through April 30, 2017, ocular tissue samples from 4 deceased fetuses with a diagnosis of CZS from the National Institute of Health in Colombia were sent to the Florida Lions Ocular Pathology Laboratory for evaluation. Main Outcomes and Measures The microscopic features of each specimen were described, and immunostaining was performed using a ZIKV NS2B protein antibody. Results Ocular tissue samples from the 4 deceased fetuses (2 female, 2 male) ranging from 21.5 to 29 weeks' gestation with a diagnosis of CZS were studied. The 4 eyes manifested with pupillary membranes, immature anterior chamber angles, loss of pigment and thinning of the retinal pigment epithelium, choroidal thinning, undifferentiated nuclear layers of the retina, and a perivascular inflammatory infiltrate within the choroid. The optic nerve, present in 2 of the eyes, demonstrated atrophy. Expression of ZIKV antigen was present in the iris in cases 1, 3, and 4; the neural retina and choroid in case 1; and in the optic nerve in case 4. Conclusions and Relevance Loss of retinal pigment epithelium, the presence of a thin choroid, a perivascular choroidal inflammatory infiltrate, and atrophic changes within the optic nerve were consistently present. These findings may be attributed to ZIKV infection and warrant further study.
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Affiliation(s)
- Maria P Fernandez
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | | | - Maria Jose Herrera
- Facultad de Ciencias de la Salud, Universidad del Norte, Antigua vía a Puerto Colombia, Barranquilla Colombia
| | | | | | | | - Richard K Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Camila V Ventura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Sander R Dubovy
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Aleman TS, Ventura CV, Cavalcanti MM, Serrano LW, Traband A, Nti AA, Gois AL, Bravo-Filho V, Martins TT, Nichols CW, Maia M, Belfort R. Quantitative Assessment of Microstructural Changes of the Retina in Infants With Congenital Zika Syndrome. JAMA Ophthalmol 2017; 135:1069-1076. [PMID: 28880978 DOI: 10.1001/jamaophthalmol.2017.3292] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance A better pathophysiologic understanding of the neurodevelopmental abnormalities observed in neonates exposed in utero to Zika virus (ZIKV) is needed to develop treatments. The retina as an extension of the diencephalon accessible to in vivo microcopy with spectral-domain optical coherence tomography (SD-OCT) can provide an insight into the pathophysiology of congenital Zika syndrome (CZS). Objective To quantify the microstructural changes of the retina in CZS and compare these changes with those of cobalamin C (cblC) deficiency, a disease with potential retinal maldevelopment. Design, Setting, and Participants This case series included 8 infants with CZS and 8 individuals with cblC deficiency. All patients underwent ophthalmologic evaluation at 2 university teaching hospitals and SD-OCT imaging in at least 1 eye. Patients with cblC deficiency were homozygous or compound heterozygotes for mutations in the methylmalonic aciduria and homocystinuria type C (MMACHC) gene. Data were collected from January 1 to March 17, 2016, for patients with CZS and from May 4, 2015, to April 23, 2016, for patients with cblC deficiency. Main Outcomes and Measures The SD-OCT cross-sections were segmented using automatic segmentation algorithms embedded in the SD-OCT systems. Each retinal layer thickness was measured at critical eccentricities using the position of the signal peaks and troughs on longitudinal reflectivity profiles. Results Eight infants with CZS (5 girls and 3 boys; age range, 3-5 months) and 8 patients with cblC deficiency (3 girls and 5 boys; age range, 4 months to 15 years) were included in the analysis. All 8 patients with CZS had foveal abnormalities in the analyzed eyes (8 eyes), including discontinuities of the ellipsoid zone, thinning of the central retina with increased backscatter, and severe structural disorganization, with 3 eyes showing macular pseudocolobomas. Pericentral retina with normal lamination showed a thinned (<30% of normal thickness) ganglion cell layer (GCL) that colocalized in 7 of 8 eyes with a normal photoreceptor layer. The inner nuclear layer was normal or had borderline thinning. The central retinal degeneration was similar to that of cblC deficiency. Conclusions and Relevance Congenital Zika syndrome showed a central retinal degeneration with severe GCL loss, borderline inner nuclear layer thinning, and less prominent photoreceptor loss. The findings provide the first, to date, in vivo evidence in humans for possible retinal maldevelopment with a predilection for retinal GCL loss in CZS, consistent with a murine model of the disease and suggestive of in utero depletion of this neuronal population as a consequence of Zika virus infection.
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Affiliation(s)
- Tomas S Aleman
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil.,Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil.,Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, Brazil
| | - Milena M Cavalcanti
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Leona W Serrano
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Anastasia Traband
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Akosua A Nti
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Adriana L Gois
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil.,Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Vasco Bravo-Filho
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil.,Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Thayze T Martins
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil.,Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Charles W Nichols
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Mauricio Maia
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW The aim of this study was to review the ocular findings related to the Zika virus (ZIKV) based on the main studies published to date, describe the patterns of the lesions and risk factors, and identify the public health implications and scientific importance of this emerging disease. RECENT FINDINGS In most studies, the ZIKV seems related to congenital ocular lesions and most mothers reported mild symptoms during the first pregnancy trimester. Five fundus patterns were seen most often: macular chorioretinal atrophy, chorioretinal atrophy elsewhere, focal pigmentary changes in the macular region, optic nerve abnormalities and combined types. A few studies have suggested that the ZIKV might damage the anterior segment of these babies' eyes. Few reports have described the ocular complications seen in adults during the acute infection, including conjunctivitis, iridocyclitis and chorioretinitis. SUMMARY Infants with congenital Zika syndrome might have vision-threatening fundus abnormalities. Although the full spectrum of ocular lesions caused by the ZIKV infection is not yet determined, a distinctive new disease has been observed. Recognition of these lesions by ophthalmologists can help ensure appropriate etiologic evaluation and clinical investigation to define the range of anomalies in an affected infant and determine essential follow-up and ongoing care.
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Li X, Ma W, Wong G, Ma S, Li S, Bi Y, Gao GF. A new threat to human reproduction system posed by Zika virus (ZIKV): From clinical investigations to experimental studies. Virus Res 2017; 254:10-14. [PMID: 28893652 DOI: 10.1016/j.virusres.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
Zika virus (ZIKV) was first isolated in 1947 from a rhesus monkey in the Zika forest of Uganda. ZIKV has since been silently circulating in a number of equatorial countries for over 50 years. The largest outbreak in humans occurred in Brazil in 2015-2016. Unlike its flavivirus relatives, sexual and post-transfusion transmissions of ZIKV have been reported. In addition, fetal infection can result in microcephaly and congenital Zikv syndrome has been reported in neonates. Moreover, ZIKV RNA can persist for at least 6 months in semen and 11 weeks in vaginal secretions after the infection, suggesting potential tropism for the male and female genital tracts. Accordingly, it is important to determine whether genital ZIKV infection could have deleterious effects on the male and female reproductive systems.
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Affiliation(s)
- Xiangdong Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China; State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China.
| | - Wenqiang Ma
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China; State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China
| | - Gary Wong
- CAS Key Laboratory of Pathogenic Microbiology & Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Shuoqian Ma
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China; State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China
| | - Shihua Li
- CAS Key Laboratory of Pathogenic Microbiology & Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yuhai Bi
- CAS Key Laboratory of Pathogenic Microbiology & Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - George F Gao
- CAS Key Laboratory of Pathogenic Microbiology & Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
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Zika Virus and the Eye: Where Are We Now and Where Are We Heading? CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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Verçosa I, Carneiro P, Verçosa R, Girão R, Ribeiro EM, Pessoa A, Almeida NG, Verçosa P, Tartarella MB. The visual system in infants with microcephaly related to presumed congenital Zika syndrome. J AAPOS 2017; 21:300-304.e1. [PMID: 28652051 DOI: 10.1016/j.jaapos.2017.05.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/21/2017] [Accepted: 05/22/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe and analyze ocular features in infants with microcephaly due to presumed congenital Zika syndrome. METHODS Ophthalmologic evaluation, including indirect ophthalmoscopy and eye fundus imaging, visual acuity testing with Teller Acuity Cards, and strabismus assessment were performed in infants with microcephaly at a nongovernmental organization clinic for visually disabled children. RESULTS A total of 70 infants with microcephaly were referred to the clinic. Of these, 25 (mean age, 3 months; 14 males) had ophthalmologic changes: 18 (26%) had intraocular abnormalities, including macular chorioretinal atrophy, mottled retinal pigment epithelium and optic nerve pallor; 7 patients (10%) had strabismus or nystagmus without intraocular abnormalities. Visual acuity was below normal range in all 11 infants tested. CONCLUSIONS Ophthalmologic abnormalities occurred in 36% of the patients. Macular circumscribed chorioretinal atrophy, focal mottled retinal pigment epithelium, optic nerve pallor, early-onset strabismus, nystagmus and low visual acuity were common ophthalmological features in infants with microcephaly due to presumed congenital Zika syndrome.
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Affiliation(s)
| | | | | | | | | | - Andre Pessoa
- Albert Sabin Pediatric Hospital, Fortaleza, Ceara, Brazil
| | - Nadia G Almeida
- University of the State of Ceara(UECE), Fortaleza, Ceara, Brazil
| | | | - Marcia B Tartarella
- Department of Ophthalmology and Visual Science, Federal University of São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
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Oo HH, Balne PK, Agrawal R. Author's Reply: Zika Virus Infection and Ophthalmic Examination in Newborn. Ocul Immunol Inflamm 2017. [PMID: 28622059 DOI: 10.1080/09273948.2017.1328246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hnin Hnin Oo
- a Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | - Praveen Kumar Balne
- b Translational Pre-Clinical Model Platform, Singapore Eye Research Institute , Singapore
| | - Rupesh Agrawal
- a Yong Loo Lin School of Medicine, National University of Singapore , Singapore.,b Translational Pre-Clinical Model Platform, Singapore Eye Research Institute , Singapore.,c National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore
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45
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Abstract
Zika virus was considered an innocent pathogen while restricted to the African and Asian population; however, after reaching the Americas in March 2015, it became a global threat. Despite usually causing mild or no symptoms in infected adults, Zika virus displays a different behavior toward fetuses. When infected during gestation, fetuses have their immature neural cells killed by the virus and consequently have devastating findings at birth. In the past year the drastic effects of Zika virus infection in newborns include neurological, ophthalmological, audiological, and skeletal abnormalities. These findings represent a new entity called congenital Zika syndrome. We summarize the ocular findings of congenital Zika Syndrome, as well as the current understanding of the illness, systemic manifestations, laboratory investigation, differential diagnosis, prophylaxis, and treatment for this disorder.
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46
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[Ocular manifestations of Zika virus: What we do and do not know]. J Fr Ophtalmol 2017; 40:138-145. [PMID: 28189347 DOI: 10.1016/j.jfo.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 01/12/2017] [Indexed: 11/24/2022]
Abstract
Zika virus (ZIKV) disease outbreak, which was declared by the end of 2015 in Brazil, has become the largest one to date. Being reported in the Americas and in certain islands of the Pacific, it has the potential to spread worldwide. Although ZIKV infections are mostly self-limiting and/or asymptomatic in the healthy adult, they are responsible for devastating congenital neurologic malformations ZIKV (mainly microcephaly) when contracted during the first months of pregnancy. Ocular manifestations during the acute adult infection include conjunctivitis and more rarely ocular inflammation. Congenital infection is associated with chorioretinal atrophy pigment mottling of the retina retinal vasculature abnormalities and optic nerve atrophy. Therefore, complete ophthalmological evaluation is recommended for suspected congenital infections.
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