Evaluation of bladder and bowel functions in children with microcephaly and congenital zika syndrome

An outbreak of Zika virus in western India in the metropolis of Pune in the monsoon of 2024

BACKGROUND

Sporadic cases and rare outbreaks of Zika Virus (ZIKV) have been reported in India since 2016. Between June to early September 2024; the city of Pune in western India was affected with a large outbreak of ZIKV. Here we report the analysis of epidemiological; clinical and genomic characteristics of the outbreak.

METHODS

Suspected ZIKV cases and pregnant women within 3 km radius of ZIKV positive cases and household contacts were included in the study. The study area included parts of the Pune metropolitan region. ZIKV RNA in serum and urine samples was detected by a single-plex Realtime RT-PCR assay. Representative samples were characterized by whole-genome sequencing.

RESULTS

Among clinically suspected ZIKV cases 63/433 (14.55 %); and 45/1615 (2.78 %) pregnant women surveyed; were found positive for acute ZIKV infection. Majority of positive cases were asymptomatic or had mild symptoms. Two cases reported complications of pyelonephritis and encephalitis respectively. There was no evidence of microcephaly in the fetuses of the pregnant women surveyed. The ZIKV strains were found to belong to the Asian lineage and clustered close to the Rajasthan strain reported previously in India. Mutation linked with microcephaly was not found in these sequences. Follow-up of pregnant women till October 2024 indicated 22 % (10/45) of women delivered healthy babies.

CONCLUSION

The ZIKV strain associated with the present outbreak did not have mutations linked with microcephaly; but had mutations linked with enhanced transmission. Symptoms such as thrombocytopenia; bleeding manifestations; retro-orbital-pain; in a small subset of patients were unique; which were not reported in previous outbreaks in India. The findings highlight the urgent need for enhanced surveillance to plan strategies for public health measures to control the disease spread. Study highlights the need for monitoring the mutations and follow up of ZIKV infected pregnant women and their children to confirm absence of congenital anomalies.

Zika-Related Microcephaly and Its Repercussions for the Urinary Tract: Clinical, Urodynamic, Scintigraphic and Radiological Aspects

Aims: Describing the urodynamic parameters of children aged 3 to 5 years with microcephaly related to congenital Zika syndrome and verifying the association with clinical, imaging and neurological characteristics. Methods: From October 2018 to March 2020, children with Zika-related microcephaly underwent urological, ultrasonographic and urodynamic evaluation. In selected cases, complementary exams such as urethrocystography and scintigraphy were performed. The children also underwent a complete neurological evaluation. To compare frequency between groups, we used Pearson’s chi-squared test or Fisher’s exact test. Results: This study evaluated 40 children, of whom 85% were 4 years old, and all had abnormalities on the urodynamic study, with low bladder capacity (92.5%) and detrusor overactivity (77.5%) as the most frequent findings. Only three children had ultrasound abnormalities, but no child had cystographic or scintigraphic abnormalities, and the postvoid residual volume was normal in 80% of cases. In spite of a frequency of 67.5% of intestinal constipation, there was no record of febrile urinary tract infection after the first year of life. All children presented severe microcephaly and at least one neurological abnormality in addition to microcephaly. The homogeneity of the children in relation to microcephaly severity and neurological abnormalities limited the study of the association with the urodynamic parameters. Conclusions: Urodynamic abnormalities in children aged 3 to 5 years with Zika-related microcephaly do not seem to characterize a neurogenic bladder with immediate risks for the upper urinary tract. The satisfactory bladder emptying suggests that the voiding pattern is reflex.

Urological outcomes in children with congenital Zika syndrome: The experience of a cohort in Campina Grande, Brazil

OBJECTIVE

To describe the urological outcomes in children with congenital Zika syndrome (CZS) and investigate the relationship between clinical and urological findings in this population.

METHODS

This cross-sectional study involved children with CZS followed up by a referral centre for children with microcephaly in the state of Paraiba in northeast Brazil. The urological evaluation included clinical history, urine culture results, ultrasonography of the urinary tract, and urodynamic evaluation, following the protocol proposed by Costa Monteiro et al. (2017). Descriptive statistical analysis was performed in addition to association and correlation tests, considering clinical and urodynamic variables.

RESULTS

Among the 88 children with CZS (35.5 ± 5.5 months), 97.7% had microcephaly, and 51% presented urinary tract infection (UTI) confirmed with clinical history and lab tests. The number of confirmed UTI episodes varied from one to 14 per child. The urodynamic evaluation confirmed the presence of an overactive bladder in 78 children and incomplete voiding in 50. Urodynamic findings were associated with the number of confirmed UTI episodes, child's sex, and actual weight, in addition to the use of anticonvulsant and myorelaxant drugs.

CONCLUSIONS

UTIs were confirmed in most children. Other urological outcomes observed were overactive bladder and low bladder capacity, which were associated with the number of confirmed UTI episodes, use of anticonvulsants and myorelaxants, and the child's sex and weight. These are treatable conditions, and it is paramount that paediatricians, neonatologists, and infectious disease specialists are aware of them to make clinical decisions and help reduce the risk of renal damage and other morbidities.

Congenital Zika Infection and the Risk of Neurodevelopmental, Neurological, and Urinary Track Disorders in Early Childhood. A Systematic Review

It was late 2015 when Northeast Brazil noticed a worrying increase in neonates born with microcephaly and other congenital malformations. These abnormalities, characterized by an abnormally small head and often neurological impairment and later termed Congenital Zika Syndrome, describe the severity of neurodevelopmental and nephrological outcomes in early childhood, and the implication of microcephaly at birth. The purpose of the study was to describe the neurodevelopmental outcomes in children exposed to Zika virus during fetal life, with and without microcephaly at birth. The systematic review included research studies about the neurodevelopmental outcomes with and without microcephaly, as well as nephrological outcomes in early childhood. We searched PubMed, Crossref, PsycINFO, Scopus, and Google Scholar publications and selected 19 research articles published from 2018 to 2021. Most studies have linked the severity of microcephaly in childbirth to the neurodevelopmental and urinary outcomes in early childhood. However, most children without microcephaly at birth develop typically, while others may be at risk for language impairment.