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Fontes JM, Oliveira EM, Monteiro de Melo Prazeres TC, Nisya de Oliveira Cruz G, Rizzini M, Passos SD, Lisboa LL, Ferreira de Araújo G, Azevedo de Almeida V, Malacarne J, Emília de Domenico Garcia M, Linhares Barreto LC, Calado AA, Fernandes da Nóbrega L, Moura Nascimento Santos MJ, Gonçalves RP, Farache L, Feliciano da Silva M, Rizzo FV, Dias da Silva L, Maria de Jesus Amorim N, Guedes Pinheiro HC, Suely de Oliveira Melo A, de Oliveira Melo F, Moreira RD, Santos da Costa BJ, de Almeida Melo Maciel Mangueira M, Varela MC, Costa Monteiro LM. Prevalence of urologic sequelae and bladder and bowel dysfunctions in patients with congenital Zika syndrome: A multicenter evaluation of the Zika virus bladder and bowel sequelae assistance network. J Pediatr Urol 2024; 20:220.e1-220.e9. [PMID: 38097421 DOI: 10.1016/j.jpurol.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Neurogenic bladder was first confirmed as a urological sequela of Congenital Zika Syndrome (CZS) in 2018. Further clinical-epidemiological evidence also confirmed neurogenic bowel dysfunction and cryptorchidism. To strengthen the care for these children, the Congenital Zika Virus Bladder and Bowel Sequelae Network (RASZ in Brazilian) was created, including six integrated centers in Brazil. This article represents the initial outcome of the efforts by RASZ. OBJECTIVE To evaluate the prevalence of bladder and bowel dysfunction, cryptorchidism and other urological sequelae related to CZS in cohorts attended in six Brazilian states. STUDY DESIGN Observational, prospective, multicenter study including children with CZS assisted in one of six RASZ collaborative centers between June 2016 and February 2023. Data were collected from patient's first assessment using the same protocols for urological and bowel evaluation. Categorical variables were analyzed by frequency of occurrence and numerical variables by mean, median, and standard deviation. The study was approved by the Research Ethics Committees of each center, all parents/caregivers provided written informed consent. RESULTS The study included 414 children aged 2 months to 7 years (mean 2.77 years, SD 1.73), 227 (54.8 %) were male and 140 (33,8 %) referred urological and bowel symptoms on arrival. Prevalence of both urological and bowel sequelae was 66.7 %, 51 % of children aged 4 years and older had urinary incontinence (UI). UTI was confirmed in 23.4 % (two presented toxemia) and among males, 18.1 % had cryptorchidism. Renal ultrasonography, performed in 186 children, was abnormal in 25 (13.4 %), 7 had hydronephrosis. Among the 287 children who performed urodynamics, 283 (98.6 %) were altered: 232 had a lower bladder capacity, 144 a maximum bladder pressure of ≥40 cm H2O, and 127 did not satisfactorily empty their bladder. DISCUSSION A higher prevalence of NLUTD, neurogenic bowel and cryptorchidism was confirmed in children with CZS. Early diagnosis and appropriate treatment, including a multidisciplinary approach, may reduce the risk of UTIs, UI and kidney damage. A limitation of the study was the inability of children to complete the protocol, specifically urodynamic evaluation, and ultrasonography. In both exams, the percentage of abnormal cases was higher than that expected in the normal population. CONCLUSION A 66,7 % prevalence of combined urological sequelae and bladder-bowel dysfunction related to CZS was confirmed in patients evaluated in six Brazilian cohorts. The most frequent changes were related to NLUTD, neurogenic bowel, and cryptorchidism. Prevalence may be underestimated due to access restrictions to diagnostic tests.
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Affiliation(s)
- Juliana Marin Fontes
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil.
| | | | | | - Glaura Nisya de Oliveira Cruz
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Marta Rizzini
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | - Saulo Duarte Passos
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Lilian Lira Lisboa
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Grace Ferreira de Araújo
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Valéria Azevedo de Almeida
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Jociele Malacarne
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | - Lilian Cagliari Linhares Barreto
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Rafael Pauletti Gonçalves
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Luana Farache
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | | | - Fábio Valente Rizzo
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Luiz Dias da Silva
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | | | - Hannah Cavalcante Guedes Pinheiro
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Adriana Suely de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Fabiana de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Rômulo Dias Moreira
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | | | | | - Margareth Catoia Varela
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional Infectologia (INI), Laboratório de Pesquisa em Imunização e Vigilância em Saúde - Oswaldo Cruz Foundation (Fiocruz), Health Surveillance and Immunization Research Unit - Rio de Janeiro, RJ, Brazil
| | - Lucia Maria Costa Monteiro
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
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Neelam V, Woodworth KR, Chang DJ, Roth NM, Reynolds MR, Akosa A, Carr CP, Anderson KN, Mulkey SB, DeBiasi RL, Biddle C, Lee EH, Elmore AL, Scotland SJ, Sowunmi S, Longcore ND, Ahmed M, Langlois PH, Khuwaja S, Browne SE, Lind L, Shim K, Gosciminski M, Blumenfeld R, Khuntia S, Halai UA, Locklear A, Chan M, Willabus T, Tonzel J, Marzec NS, Barreto NA, Sanchez C, Fornoff J, Hale S, Nance A, Iguchi L, Adibhatla SN, Potts E, Schiffman E, Raman D, McDonald MF, Stricklin B, Ludwig E, Denson L, Contreras D, Romitti PA, Ferrell E, Marx M, Signs K, Cook A, Leedom VO, Beauregard S, Orantes LC, Cronquist L, Roush L, Godfred-Cato S, Gilboa SM, Meaney-Delman D, Honein MA, Moore CA, Tong VT. Outcomes up to age 36 months after congenital Zika virus infection-U.S. states. Pediatr Res 2024; 95:558-565. [PMID: 37658124 PMCID: PMC10913023 DOI: 10.1038/s41390-023-02787-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.
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Affiliation(s)
- Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel J Chang
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Nicole M Roth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan R Reynolds
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Akosa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kayla N Anderson
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah B Mulkey
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Roberta L DeBiasi
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Cara Biddle
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Ellen H Lee
- New York City Department of Health & Mental Hygiene, New York City, NY, USA
| | | | | | | | | | | | | | | | | | - Leah Lind
- Pennsylvania Department of Health, Pittsburgh, PA, USA
| | - Kyoo Shim
- Dallas County Health and Human Services, Dallas, TX, USA
| | | | | | - Shreya Khuntia
- District of Columbia Department of Health, Washington, D. C, USA
| | - Umme-Aiman Halai
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Autumn Locklear
- North Carolina Department of Health and Human Services, Chapel Hill, NC, USA
| | - Mary Chan
- Washington State Department of Health, Seattle, WA, USA
| | | | - Julius Tonzel
- Louisiana Department of Health, New Orleans, LA, USA
| | - Natalie S Marzec
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | - Connie Sanchez
- Hidalgo County Health & Human Services Department, Hidalgo, TX, USA
| | - Jane Fornoff
- Illinois Department of Public Health, Springfield, IL, USA
| | - Shelby Hale
- Ohio Department of Health, Columbus, OH, USA
| | - Amy Nance
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | | | | | - Emily Potts
- Indiana Department of Health, Indianapolis, IN, USA
| | | | - Devin Raman
- Southern Nevada Health District, Las Vegas, NV, USA
| | | | | | - Elizabeth Ludwig
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Lindsay Denson
- Oklahoma State Department of Health, Oklahoma City, OK, USA
| | | | - Paul A Romitti
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Emily Ferrell
- Kentucky Department for Public Health, Georgetown, KY, USA
| | - Meghan Marx
- South Dakota Department of Health, Pierre, SD, USA
| | - Kimberly Signs
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Amie Cook
- Kansas Department of Health and Environment, Topeka, KS, USA
| | - Vinita Oberoi Leedom
- South Carolina Department of Health and Environmental Control, Florence, SC, USA
| | - Suzann Beauregard
- New Hampshire Department of Health and Human Services, Concord, NH, USA
| | | | | | - Lesley Roush
- West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shana Godfred-Cato
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ayupe KMA, Dias IMBC, Cazeiro APM, de Campos AC, Longo E. Rehabilitation Practices Delivered by Physical and Occupational Therapists to Brazilian Children With Congenital Zika Syndrome: A Cross-Sectional Study. Glob Health Sci Pract 2023; 11:e2300219. [PMID: 38123996 PMCID: PMC10749651 DOI: 10.9745/ghsp-d-23-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Congenital Zika syndrome (CZS) is a health condition that has affected the development of thousands of children in Brazil. Because it is a new condition, its understanding is an ongoing process. Therefore, it is important to know the rehabilitation interventions being delivered to improve the functioning of these children. We aimed to describe the practices of physical therapists (PTs) and occupational therapists (OTs) who provide follow-up care for children with CZS in Brazil. METHODS This cross-sectional study included PTs and OTs who assist children with CZS in Brazil. An online questionnaire was used to verify the participants' personal characteristics and professional work environment, as well as the rehabilitation programs they implemented in Brazil for children with CZS. Data were analyzed using descriptive statistics. RESULTS A total of 116 professionals (79 PT and 37 OT) who work mainly in public health services (81.9%) participated in the study. Of these, 24.1% plan interventions based on reading scientific articles, 66.4% did not report using the biopsychosocial model, 52.6% do not perform any assessments before starting an intervention, 31.9% use neurodevelopmental treatment, and 22.4% use sensorimotor stimulation interventions. The majority of the interventions are delivered 1 to 2 times a week, lasting up to 1 hour. CONCLUSIONS Professional training and knowledge translation strategies are needed to implement evidence-based practices and improve the quality of rehabilitation programs for Brazilian children with CZS.
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Affiliation(s)
- Kennea Martins Almeida Ayupe
- Department of Integrated Health Education, Center for Health Sciences, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
| | - Ianka Maria Bezerra Cunha Dias
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Faculty of Health Sciences of Trairi, Santa Cruz, Rio Grande do Norte, Brazil
| | | | - Ana Carolina de Campos
- Postgraduate Program in Physical Therapy, Universidade Federal do São Carlos, São Carlos, São Paulo, Brazil
| | - Egmar Longo
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal do Rio Grande do Norte, Faculty of Health Sciences of Trairi, Santa Cruz, Rio Grande do Norte, Brazil
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de Lima Nascimento Coutinho DL, Feldner H, Coelho MLG, Monteiro KS, Longo E. The burden of global outbreaks: Photos of the daily lives of children with congenital Zika syndrome during the COVID-19 pandemic. Health Expect 2023; 26:2500-2513. [PMID: 37596733 PMCID: PMC10632653 DOI: 10.1111/hex.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION In Brazil, more than 3500 children with congenital Zika syndrome (CZS) face difficulties participating in activities of daily living, which may be aggravated by health emergencies, such as the COVID-19 pandemic. Participation could be defined as the individual's involvement in daily life situations, and participation restrictions are problems that may arise in involvement in everyday situations. AIM To explore the daily lives of children with CZS during the COVID-19 pandemic using photographic narratives captured by mothers and discuss possible strategies to improve participation results. METHODS In this participatory action research, seven young Brazilian mothers acted as co-researchers using photovoice to describe the experiences of their children with CZS (from 2 to 5 years old). Also, mothers contributed to validate the contents. The research was conducted online and included the following steps: pilot study, recruitment, individualized training, sociodemographic interview, photovoice training, photo taking, focus group for contextualization, data transcription and analysis and validation of analyses by the mothers. RESULTS Content analysis revealed five categories that influenced the participation of the children: participation preferences, family relationships, access to healthcare, access to education and social isolation. Regarding participation preferences, mothers reported their children's desire to play with peers and family members and have autonomy. Mothers described the family environment as a happy, peaceful and safe place for the children. Lack of therapy was perceived to negatively impact the health of children; thus, treatments were considered essential for child development. Access to education included accessibility of remote education and a perceived lack of infrastructure and pedagogical preparation. Last, social isolation due to COVID-19 directly affected the daily lives and behaviour of the children, interrupting therapies and medical appointments. CONCLUSION The photos and narratives captured several aspects of the daily lives of children with CZS impacted by the COVID-19 pandemic, reinforcing the importance of considering the negative effects of social isolation and offering education and social assistance to promote participation and integral health. PATIENT/PUBLIC CONTRIBUTION Consistent with a participatory action research framework, Mothers acted as co-researchers and participated in all stages of the research, especially in validating the data analysed by the researchers.
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Affiliation(s)
| | - Heather Feldner
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Monique L. G. Coelho
- Faculty of Health Science of TrairiFederal University of Rio Grande do NorteSanta CruzBrazil
| | - Karolinne S. Monteiro
- Faculty of Health Science of TrairiFederal University of Rio Grande do NorteSanta CruzBrazil
| | - Egmar Longo
- Faculty of Health Science of TrairiFederal University of Rio Grande do NorteSanta CruzBrazil
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Rodrigues CDS, Souza RKS, Rocha Neto CV, Otani RH, Batista DDM, Maia AKNDO, Filho KPDO, de Andrade TD, de Andrade Almeida E, Maciel LHG, Castro LDFAAP, Abtibol-Bernardino MR, Baia-da-Silva DC, Benzecry SG, Castilho MDC, Martínez-Espinosa FE, Alecrim MDGC, Santos RS, Botto-Menezes C. Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study. Viruses 2023; 15:2363. [PMID: 38140604 PMCID: PMC10747239 DOI: 10.3390/v15122363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.
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Affiliation(s)
- Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Cosmo Vieira Rocha Neto
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Rodrigo Haruo Otani
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Daniel de Medeiros Batista
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Ana Karla Nelson de Oliveira Maia
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | | | | | - Luiz Henrique Gonçalves Maciel
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Maternal and Child Health, Medical School, Federal University of Amazonas, Manaus 69020-160, Brazil
| | - Djane Clarys Baia-da-Silva
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Faculty of Pharmacy, University Nilton Lins, Manaus 69058-030, Brazil; (K.P.d.O.F.); (T.D.d.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Silvana Gomes Benzecry
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | - Flor Ernestina Martínez-Espinosa
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Medical Course Coordination at Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders (PPGDIC), University of Tuiuti do Paraná (UTP), Paraná 82010-210, Brazil;
| | - Camila Botto-Menezes
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
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6
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Tavares CSS, Marques RS, Santos VS, Santos HP, Reis MCDS, Martins-Filho PR. Prevalence of sleep disorders in children with Congenital Zika Syndrome. J Trop Pediatr 2023; 69:fmad033. [PMID: 37794754 DOI: 10.1093/tropej/fmad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Studies have reported that children with Congenital Zika Syndrome (CZS) experience changes in their sleep patterns, which can result in mood disturbances, behavioral issues and delays in growth and development. This systematic review synthesized the available evidence on the prevalence of sleep disorders in children with CZS. Eligible studies were those with an observational design that reported sleep disorders in children with CZS using validated questionnaires, polysomnography/electroencephalographic recording or parent/caregiver reports. Searches were conducted in PubMed, Web of Science, SCOPUS and Embase, as well as a gray literature search using Google Scholar. The Freeman-Tukey double-arcsine transformation with a random-effects model was used to estimate the pooled prevalence of sleep disorders with a 95% confidence interval (CI). Five studies were included and data from 340 Brazilian children with CZS were analyzed. The overall prevalence of sleep disorders was 27.4% (95% CI 16.7-39.4), without differences among studies using validated questionnaires (29.4%, 95% CI 21.4-37.8) or report from parents and caregivers (27.4%, 95% CI 11.5-47.0). Sleep disorders are prevalent in children with CZS, impacting their development and quality of life. It is critical to examine the quality of sleep in these children to develop appropriate interventions that can mitigate these issues.
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Affiliation(s)
| | - Raquel Souza Marques
- Graduate Program in Dentistry, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Victor Santana Santos
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Hudson P Santos
- Department of Nursing, University of Miami, Coral Gables, FL, USA
| | | | - Paulo Ricardo Martins-Filho
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Graduate Program in Dentistry, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Abstract
PURPOSE OF REVIEW Congenital infections are a major cause of childhood multidomain neurodevelopmental disabilities. They contribute to a range of structural brain abnormalities that can cause severe neurodevelopmental impairment, cerebral palsy, epilepsy, and neurosensory impairments. New congenital infections and global viral pandemics have emerged, with some affecting the developing brain and causing neurodevelopmental concerns. This review aims to provide current understanding of fetal infections and their impact on neurodevelopment. RECENT FINDINGS There are a growing list of congenital infections causing neurodevelopmental issues, including cytomegalovirus, Zika virus, syphilis, rubella, lymphocytic choriomeningitis virus, and toxoplasmosis. Fetal exposure to maternal SARS-CoV-2 may also pose risk to the developing brain and impact neurodevelopmental outcomes, although studies have conflicting results. As Zika virus was a recently identified congenital infection, there are several new reports on child neurodevelopment in the Caribbean and Central and South America. For many congenital infections, children with in-utero exposure, even if asymptomatic at birth, may have neurodevelopmental concerns manifest over time. SUMMARY Congenital infections should be considered in the differential diagnosis of a child with neurodevelopmental impairments. Detailed pregnancy history, exposure risk, and testing should guide diagnosis and multidisciplinary evaluation. Children with congenital infections should have long-term follow-up to assess for neurodevelopmental delays and other neurosensory impairments. Children with confirmed delays or high-risk should be referred for rehabilitation therapies.
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Affiliation(s)
- Olivier Fortin
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
| | - Sarah B. Mulkey
- Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Gomes JA, Sgarioni E, Kowalski TW, Giudicelli GC, Recamonde-Mendoza M, Fraga LR, Schüler-Faccini L, Vianna FSL. Downregulation of Microcephaly-Causing Genes as a Mechanism for ZIKV Teratogenesis: A Meta-analysis of RNA-Seq Studies. J Mol Neurosci 2023; 73:566-577. [PMID: 37428363 DOI: 10.1007/s12031-023-02126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023]
Abstract
Zika virus (ZIKV) is a neurotropic teratogen that causes congenital Zika syndrome (CZS), characterized by brain and eye anomalies. Impaired gene expression in neural cells after ZIKV infection has been demonstrated; however, there is a gap in the literature of studies comparing whether the differentially expressed genes in such cells are similar and how it can cause CZS. Therefore, the aim of this study was to compare the differential gene expression (DGE) after ZIKV infection in neural cells through a meta-analysis approach. Through the GEO database, studies that evaluated DGE in cells exposed to the Asian lineage of ZIKV versus cells, of the same type, not exposed were searched. From the 119 studies found, five meet our inclusion criteria. Raw data of them were retrieved, pre-processed, and evaluated. The meta-analysis was carried out by comparing seven datasets, from these five studies. We found 125 upregulated genes in neural cells, mainly interferon-stimulated genes, such as IFI6, ISG15, and OAS2, involved in the antiviral response. Furthermore, 167 downregulated, involved with cellular division. Among these downregulated genes, classic microcephaly-causing genes stood out, such as CENPJ, ASPM, CENPE, and CEP152, demonstrating a possible mechanism by which ZIKV impairs brain development and causes CZS.
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Affiliation(s)
- Julia A Gomes
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
- Laboratório de Medicina Genômica (LMG), Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
| | - Eduarda Sgarioni
- Laboratório de Medicina Genômica (LMG), Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Thayne W Kowalski
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratório de Medicina Genômica (LMG), Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- CESUCA - Centro Universitário, Cachoeirinha, Brazil
- Núcleo de Bioinformática, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Giovanna C Giudicelli
- Laboratório de Medicina Genômica (LMG), Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Núcleo de Bioinformática, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Mariana Recamonde-Mendoza
- Núcleo de Bioinformática, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Instituto de Informática, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas R Fraga
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Laboratório de Medicina Genômica (LMG), Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lavínia Schüler-Faccini
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernanda S L Vianna
- Instituto Nacional de Genética Médica Populacional (INAGEMP), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
- Laboratório de Medicina Genômica (LMG), Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
- Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Departamento de Genética, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Christoff RR, Nani JV, Lessa G, Rabello T, Rossi AD, Krenn V, Higa LM, Tanuri A, Garcez PP, Hayashi MAF. Assessing the role of Ndel1 oligopeptidase activity in congenital Zika syndrome: Potential predictor of congenital syndrome endophenotype and treatment response. J Neurochem 2023; 166:763-776. [PMID: 37497817 DOI: 10.1111/jnc.15918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
Maternal infections are among the main risk factors for cognitive impairments in the offspring. Zika virus (ZIKV) can be transmitted vertically, causing a set of heterogeneous birth defects, such as microcephaly, ventriculomegaly and corpus callosum dysgenesis. Nuclear distribution element like-1 (Ndel1) oligopeptidase controls crucial aspects of cerebral cortex development underlying cortical malformations. Here, we examine Ndel1 activity in an animal model for ZIKV infection, which was associated with deregulated corticogenesis. We observed here a reduction in Ndel1 activity in the forebrain associated with the congenital syndrome induced by ZIKV isolates, in an in utero and postnatal injections of different inoculum doses in mice models. In addition, we observed a strong correlation between Ndel1 activity and brain size of animals infected by ZIKV, suggesting the potential of this measure as a biomarker for microcephaly. More importantly, the increase of interferon (IFN)-beta signaling, which was used to rescue the ZIKV infection outcomes, also recovered Ndel1 activity to levels similar to those of uninfected healthy control mice, but with no influence on Ndel1 activity in uninfected healthy control animals. Taken together, we demonstrate for the first time here an association of corticogenesis impairments determined by ZIKV infection and the modulation of Ndel1 activity. Although further studies are still necessary to clarify the possible role(s) of Ndel1 activity in the molecular mechanism(s) underlying the congenital syndrome induced by ZIKV, we suggest here the potential of monitoring the Ndel1 activity to predict this pathological condition at early stages of embryos or offspring development, during while the currently employed methods are unable to detect impaired corticogenesis leading to microcephaly. Ndel1 activity may also be possibly used to follow up the positive response to the treatment, such as that employing the IFN-beta that is able to rescue the ZIKV-induced brain injury.
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Affiliation(s)
- Raissa R Christoff
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - João V Nani
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- National Institute for Translational Medicine (INCT-TM, CNPq/FAPESP/CAPES), Ribeirão Preto, Brazil
| | - Gabriel Lessa
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Tailene Rabello
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Atila D Rossi
- Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Veronica Krenn
- Department of Biotechnology and Bioscience, University of Milan-Bicocca, Milano, Italy
| | - Luiza M Higa
- Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Amilcar Tanuri
- Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Patricia P Garcez
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mirian A F Hayashi
- Department of Pharmacology, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- National Institute for Translational Medicine (INCT-TM, CNPq/FAPESP/CAPES), Ribeirão Preto, Brazil
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Arrais NMR, Arrais RF, Coelho MC, Deghaide NHS, Donadi EA, Maia CRS, de Moraes-Pinto MI. Congenital Zika Virus Syndrome and Autoimmunity: Two Case Reports of Type 1 Diabetes Mellitus. Pediatr Infect Dis J 2023; 42:e183-e185. [PMID: 36795588 DOI: 10.1097/inf.0000000000003864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
| | | | - Marília Costa Coelho
- Pediatric Endocrinology Unit, Department of Pediatrics, Federal University of Rio Grande do Norte, Natal, Brazil
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Abstract
INTRODUCTION Congenital Zika virus syndrome is a distinct pattern of birth defects in fetuses infected by the Zika virus. It presents a broad clinical spectrum that includes occurrences of microcephaly, hypertonia, dysphagia, hyperexcitability, seizures, and arthrogryposis. Imaging findings show neuronal migration disorders. METHODOLOGY Case reports have suggested that arthrogryposis has a neurogenic cause. We analyzed needle electromyography and nerve conduction examinations on 77 patients aged 2-24 months presenting highly probable congenital Zika virus syndrome, with or without arthrogryposis. RESULTS All those with arthrogryposis presented with chronic muscle denervation in the electromyography examination. Similarly, children with single or reversible joint abnormalities at birth showed the same findings. Denervation in the paravertebral musculature was found in all of the children with diaphragmatic paralysis or thoracic deformities. CONCLUSIONS We propose that congenital contractures associated with congenital Zika virus syndrome are caused by the malformation of upper and lower motor neurons during embryogenesis.
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Affiliation(s)
| | | | - Sarah C Serpa
- Pediatric Neurology Service, Hospital Jorge de Medeiros, Recife, Brazil
| | - Epitácio L Rolim Filho
- Pediatric Orthopedics Service, Association for Assistance of Children with Deficiencies (AACD), Recife, Brazil
- Department of Orthopedics, Medical School, Federal University of Pernambuco, Recife, Brazil; and
| | - Otávio G Lins
- Department of Neurology, Medical School, Federal University of Pernambuco, Recife, Brazil
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12
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Barker Ladd S, Williams NA, Villachan-Lyra P, Chaves E, Hollist C, Trefiglio Mendes Gomes R, Barbosa LNF. Translation and preliminary validation of the Brazilian family resources scale in a sample of parents of children with congenital Zika virus syndrome. J Pediatr Rehabil Med 2023; 16:337-350. [PMID: 36847025 DOI: 10.3233/prm-220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
PURPOSE Family-centered rehabilitative care optimizes outcomes for children with significant developmental disabilities. Family-centered services involve assessing family resources that promote positive developmental outcomes for children. Little is known regarding family resources in the context of caring for a child with developmental disabilities in Brazil due to an absence of validated measures. This study describes the translation and cultural adaptation of the Family Resource Scale and explored the measurement quality of the resulting measure (the Brazilian-Family Resource Scale, or B-FRS). METHODS A rigorous serial translation process that emphasized linguistic accuracy as well as cultural adaptation was utilized. The resulting 27-item B-FRS was theoretically related and reflected the contextual intent of the original measure. RESULTS A four-factor scoring approach yielded acceptable internal consistency estimates for the subscales and total scale score. Overall, low levels of family resources were reported by caregivers of children with Congenital Zika Syndrome. Low family resources were associated with parental depressive and stress-related symptoms. CONCLUSION Confirmatory factor analysis of the B-FRS in a larger sample is recommended. Practitioners in Brazil should broadly consider family needs and resources to provide family-centered care that is effective for the child and engages the family in a way that highlights their strengths and promotes positive developmental trajectories.
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Affiliation(s)
- Sarah Barker Ladd
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Natalie A Williams
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospital, Lincoln, NE, USA
| | | | - Emmanuelle Chaves
- Department of Education, Universidade Federal Rural de Pernambuco, Recife, PE, Brazil
| | - Cody Hollist
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE, USA
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Pone MVDS, Gomes da Silva TO, Ribeiro CTM, de Aguiar EB, Mendes PHB, Gomes Junior SCDS, Hamanaka T, Zin AA, Pereira Junior JP, Moreira MEL, Nielsen-Saines K, Pone SM. Acquired Hip Dysplasia in Children with Congenital Zika Virus Infection in the First Four Years of Life. Viruses 2022; 14:v14122643. [PMID: 36560649 PMCID: PMC9788141 DOI: 10.3390/v14122643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Acquired hip dysplasia has been described in children with cerebral palsy (CP); periodic surveillance is recommended in this population to prevent hip displacement and dislocation. Children with congenital zika syndrome (CZS) may present a spectrum of neurological impairments with changes in tonus, posture, and movement similar to children with CP. However, the relationship between CZS and hip dysplasia has not been characterized. In this prospective cohort study, we aimed to describe the occurrence of hip dysplasia in patients with CZS. Sixty-four children with CZS from 6 to 48 months of age were included and followed at a tertiary referral center in Rio de Janeiro, Brazil, with periodic radiologic and clinical hip assessments. Twenty-six (41%) patients were diagnosed with hip dysplasia during follow-up; mean age at diagnosis was 23 months. According to the Gross Motor Function Classification System (GMFCS), 58 (91%) patients had severe impairment (GMFCS IV and V) at the first evaluation. All patients with progression to hip dysplasia had microcephaly and were classified as GMFCS IV or V. Pain and functional limitation were reported by 22 (84%) caregivers of children with hip dysplasia. All patients were referred to specialized orthopedic care; eight (31%) underwent surgical treatment during follow-up. Our findings highlight the importance of implementing a hip surveillance program and improving access to orthopedic treatment for children with CZS in order to decrease the chances of dysplasia-related complications and improve quality of life.
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Affiliation(s)
- Marcos Vinicius da Silva Pone
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Tallita Oliveira Gomes da Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Carla Trevisan Martins Ribeiro
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Elisa Barroso de Aguiar
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
- Correspondence: ; Tel.: +55-21-99584-9013
| | - Pedro Henrique Barros Mendes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Saint Clair dos Santos Gomes Junior
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Tatiana Hamanaka
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Andrea Araujo Zin
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - José Paulo Pereira Junior
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
| | - Karin Nielsen-Saines
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Sheila Moura Pone
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira—Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, Brazil
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O'Donnell JM, Metz L, Swarup I. Surgical Correction of Neuromuscular Scoliosis Secondary to Congenital Zika Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00016. [PMID: 36302062 DOI: 10.2106/jbjs.cc.22.00342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
CASE Congenital Zika syndrome (CZS) has been noted after the South American pandemic of Zika virus which peaked in 2015 to 2016, and the associated sequelae are still being described. Scoliosis has been noted in patients with CZS; however, there is a paucity of literature on the prevalence or management of scoliosis secondary to this condition. We report the case of a 5-year-old girl with severe neuromuscular scoliosis due to CZS that was managed with halo-gravity traction, followed by a growth-friendly construct. CONCLUSION This case report highlights the need for more research focusing on the survivors of the Zika pandemic.
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Affiliation(s)
| | - Lionel Metz
- University of California-San Francisco, San Francisco, California
- UCSF Benioff Children's Hospital of Oakland, Oakland, California
| | - Ishaan Swarup
- University of California-San Francisco, San Francisco, California
- UCSF Benioff Children's Hospital of Oakland, Oakland, California
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15
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de Vasconcelos RAL, Ximenes RADA, Calado AA, Martelli CMT, Veras Gonçalves A, Brickley EB, de Araújo TVB, Wanderley Rocha MA, Miranda-Filho DDB. Zika-Related Microcephaly and Its Repercussions for the Urinary Tract: Clinical, Urodynamic, Scintigraphic and Radiological Aspects. Viruses 2022; 14:v14071512. [PMID: 35891492 PMCID: PMC9320115 DOI: 10.3390/v14071512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Rômulo Augusto Lucena de Vasconcelos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Correspondence: (R.A.L.d.V.); (D.d.B.M.-F.); Tel./Fax: +558131833510 (R.A.L.d.V. & D.d.B.M.-F.)
| | - Ricardo Arraes de Alencar Ximenes
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Adriano Almeida Calado
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
| | | | - Andreia Veras Gonçalves
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Elizabeth Bailey Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | | | - Maria Angela Wanderley Rocha
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
| | - Demócrito de Barros Miranda-Filho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Correspondence: (R.A.L.d.V.); (D.d.B.M.-F.); Tel./Fax: +558131833510 (R.A.L.d.V. & D.d.B.M.-F.)
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Aromolaran A, Araujo K, Ladines-Lim JB, Nery N, do Rosário MS, Rastely VN, Archanjo G, Daltro D, Carvalho GBDS, Pimentel K, de Almeida JRM, de Siqueira IC, Ribeiro HC, Oliveira-Filho J, de Oliveira D, Henriques DF, Rodrigues SG, Vasconcelos PFDC, de Almeida ARP, Sacramento GA, Cruz JS, Sarno M, Freitas BDP, Mattos A, Khouri R, Reis MG, Ko AI, Costa F. Unequal burden of Zika-associated microcephaly among populations with public and private healthcare in Salvador, Brazil. Int J Infect Dis 2022; 120:201-204. [PMID: 35470025 PMCID: PMC9119857 DOI: 10.1016/j.ijid.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe the differences in clinical presentation and relative disease burden of congenital Zika syndrome (CZS)-associated microcephaly at 2 large hospitals in Salvador, Brazil that serve patients of different socioeconomic status (SES). METHODS Clinical and serologic data were collected prospectively from pregnant women and their infants, who delivered at 2 study centers during the 2015-2016 Zika virus (ZIKV) epidemic in Salvador, Brazil. RESULTS Pregnant women from Salvador, Brazil delivering in a low SES hospital had 3 times higher ZIKV exposure rate than women at a high SES hospital. However, different SES hospitals had similar prevalence of infants with CZS-associated microcephaly (10% vs 6%, p = 0.16) after controlling for ZIKV exposure in their mothers. CONCLUSIONS Our study supports the positive association between low SES, high maternal ZIKV exposure, and high rates of CZS-associated microcephaly.
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Affiliation(s)
| | | | | | | | - Mateus S do Rosário
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Valmir N Rastely
- Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Gracinda Archanjo
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Dina Daltro
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | | | - Kleber Pimentel
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - João Ricardo Maltez de Almeida
- Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Hugo C Ribeiro
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | - Jamary Oliveira-Filho
- Programa de Pos-Graduacao em Ciencias da Saude, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Antonio R P de Almeida
- Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Manoel Sarno
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil; Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK; Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Bruno de Paula Freitas
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil; Escola Paulista de Medicina, esc, São Paulo, Brazil
| | - Adriana Mattos
- Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil
| | | | - Mitermayer G Reis
- Yale School of Public Health, New Haven, USA; Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Albert I Ko
- Yale School of Public Health, New Haven, USA
| | - Federico Costa
- Yale School of Public Health, New Haven, USA; Universidade Federal da Bahia, Salvador, Brazil.
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17
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Hamanaka T, Ribeiro CTM, Pone S, Gomes SC, Nielsen-Saines K, Brickley EB, Moreira ME, Pone M. Longitudinal Follow-Up of Gross Motor Function in Children with Congenital Zika Virus Syndrome from a Cohort in Rio de Janeiro, Brazil. Viruses 2022; 14:v14061173. [PMID: 35746646 PMCID: PMC9229488 DOI: 10.3390/v14061173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Knowledge of how congenital Zika syndrome (CZS) impacts motor development of children longitudinally is important to guide management. The objective of the present study was to describe the evolution of gross motor function in children with CZS in a Rio de Janeiro hospital. In children with CZS without arthrogryposis or other congenital osteoarticular malformations who were followed in a prospective cohort study, motor performance was evaluated at two timepoints using the Gross Motor Function Classification System (GMFCS) and the Gross Motor Function Measurement test (GMFM-88). Among 74 children, at the baseline evaluation, the median age was 13 (8–24) months, and on follow-up, 28 (24–48) months. According to GMFCS at the second timepoint, 6 children were classified as mild, 11 as moderate, and 57 as severe. In the GMFM-88 assessment, children in the severe group had a median score of 10.05 in the baseline evaluation and a follow-up score of 12.40, the moderate group had median scores of 25.60 and 29.60, and the mild group had median scores of 82.60 and 91.00, respectively. Although a small developmental improvement was observed, the motor impairment of children was mainly consistent with severe cerebral palsy. Baseline motor function assessments were predictive of prognosis.
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Affiliation(s)
- Tatiana Hamanaka
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro 22250-020, Brazil; (T.H.); (S.P.); (S.C.G.); (M.E.M.); (M.P.)
| | - Carla Trevisan M. Ribeiro
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro 22250-020, Brazil; (T.H.); (S.P.); (S.C.G.); (M.E.M.); (M.P.)
- Correspondence:
| | - Sheila Pone
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro 22250-020, Brazil; (T.H.); (S.P.); (S.C.G.); (M.E.M.); (M.P.)
| | - Saint Clair Gomes
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro 22250-020, Brazil; (T.H.); (S.P.); (S.C.G.); (M.E.M.); (M.P.)
| | - Karin Nielsen-Saines
- David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA 90095, USA;
| | | | - Maria Elisabeth Moreira
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro 22250-020, Brazil; (T.H.); (S.P.); (S.C.G.); (M.E.M.); (M.P.)
| | - Marcos Pone
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro 22250-020, Brazil; (T.H.); (S.P.); (S.C.G.); (M.E.M.); (M.P.)
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18
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van der Linden H, Pessoa A, van der Linden A, Florêncio RN, Carvalho MDCG, van der Linden V. Epilepsy and EEG Abnormalities in Congenital Zika Syndrome. J Clin Neurophysiol 2022; 39:248-252. [PMID: 34999638 DOI: 10.1097/wnp.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY The congenital Zika syndrome is a new entity of a group of etiologies that can lead to microcephaly and other brain damages during pregnancy, such as toxoplasmosis, rubeola, cytomegalovirus, and herpes simplex. The Zika virus crosses the placental barrier and, predominantly, affects neuronal progenitor cells. This disruptive process results in severe cortical developmental disorder, calcifications, cortical and subcortical atrophies, and malformations of the cerebellum, brain stem, and spinal cord. Children with congenital Zika syndrome have a set of clinical findings, such as cerebral palsy, dysphagia, orthopedic deformities, visual and auditory impairment, and, rarely, hydrocephalus. Because of the severity of brain lesions, epilepsy is a common finding and a frequent cause of increased morbidity. The prevalence of epilepsy in different series of patients ranges from 37.7% to 71.4%. The aim of this study is to review the studies published so far regarding epilepsy and the EEG pattern in series of patients with congenital Zika syndrome.
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Affiliation(s)
- Hélio van der Linden
- Rehabilitation Center Dr. Henrique Santillo, Goiânia, Brazil
- Neurology Institute of Goiânia, Goiânia, Brazil
| | - André Pessoa
- Children's Hospital Albert Sabin, Fortaleza Brazil
- Ceará State University, Fortaleza, Brazil
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19
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de Aguiar EB, Pone SM, Gomes Junior SCDS, Soares FVM, Zin AA, Vasconcelos ZFM, Ribeiro CTM, Pereira Junior JP, Moreira MEL, Nielsen-Saines K, Pone MVDS. Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life. Viruses 2022; 14:v14050876. [PMID: 35632618 PMCID: PMC9147871 DOI: 10.3390/v14050876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/20/2022] Open
Abstract
Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from −0.45 ± 0.1 to 0.27 ± 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus −1.84 ± 0.2 to −2.15 ± 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from −0.3 ± 0.1 at 1 month to 0.17 ± 0.2 SD between 31 and 36 months in the NCZS group, versus −2.3 ± 0.3 to −2.0 ± 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 ± 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 ± 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.
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Affiliation(s)
- Elisa Barroso de Aguiar
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
- Correspondence: ; Tel.: +55-21-99584-9013
| | - Sheila Moura Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Saint Clair dos Santos Gomes Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Fernanda Valente Mendes Soares
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Andrea Araujo Zin
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Zilton Farias Meira Vasconcelos
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Carla Trevisan Martins Ribeiro
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - José Paulo Pereira Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Maria Elisabeth Lopes Moreira
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Karin Nielsen-Saines
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Marcos Vinicius da Silva Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
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Abstract
Zika virus (ZIKV) is linked to congenital defects including microcephaly. An infection model that can recapitulate most microcephaly-related phenotypes is crucial for understanding ZIKV pathogenesis. Here, we present a protocol to generate ZIKV from an infectious clone through a reverse genetic system and subsequently perform embryonic brain infection with the rescued ZIKV in pregnant mice. We optimized several aspects of the procedures including virus rescue and in utero injection. This protocol facilitates reproducible investigation of virus-induced cortical development defects. For complete details on the use and execution of this protocol, please refer to Zeng et al. (2020) Workflow of Zika virus (ZIKV) preparation from an infectious clone Protocol for in utero ZIKV injection Details for brain sampling after ZIKV injection Guidelines for ZIKV-related microcephaly phenotype analysis
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Affiliation(s)
- Shupeng Dong
- Research Center of Translational Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
- Shanghai Institute of Immunology, Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiaochun Xie
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, CA 90033, USA
- Zikha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650201, China
- Kunming National High-level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
| | - Yujie Chen
- Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Shanghai Institute for Biological Science, Chinese Academy of Sciences, Shanghai, China
| | - Gang Long
- Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Shanghai Institute for Biological Science, Chinese Academy of Sciences, Shanghai, China
| | - Qiming Liang
- Research Center of Translational Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200062, China
- Shanghai Institute of Immunology, Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Key Laboratory of Cell Differentiation and Apoptosis of Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- State Key Laboratory of Microbial Metabolism, Shanghai Jiao Tong University, Shanghai 200340, China
- Corresponding author
| | - Zhen Zhao
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, CA 90033, USA
- Zikha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Corresponding author
| | - Jianxiong Zeng
- Department of Physiology and Neuroscience, University of Southern California, Los Angeles, CA 90033, USA
- Zikha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650201, China
- Kunming National High-level Biosafety Research Center for Non-Human Primates, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- National Resource Center for Non-Human Primates, National Research Facility for Phenotypic & Genetic Analysis of Model Animals (Primate Facility), Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan 650107, China
- Corresponding author
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21
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Paixao ES, Cardim LL, Costa MCN, Brickley EB, de Carvalho-Sauer RCO, Carmo EH, Andrade RFS, Rodrigues MS, Veiga RV, Costa LC, Moore CA, França GVA, Smeeth L, Rodrigues LC, Barreto ML, Teixeira MG. Mortality from Congenital Zika Syndrome - Nationwide Cohort Study in Brazil. N Engl J Med 2022; 386:757-767. [PMID: 35196428 PMCID: PMC7612437 DOI: 10.1056/nejmoa2101195] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prenatal exposure to Zika virus has potential teratogenic effects, with a wide spectrum of clinical presentation referred to as congenital Zika syndrome. Data on survival among children with congenital Zika syndrome are limited. METHODS In this population-based cohort study, we used linked, routinely collected data in Brazil, from January 2015 through December 2018, to estimate mortality among live-born children with congenital Zika syndrome as compared with those without the syndrome. Kaplan-Meier curves and survival models were assessed with adjustment for confounding and with stratification according to gestational age, birth weight, and status of being small for gestational age. RESULTS A total of 11,481,215 live-born children were followed to 36 months of age. The mortality rate was 52.6 deaths (95% confidence interval [CI], 47.6 to 58.0) per 1000 person-years among live-born children with congenital Zika syndrome, as compared with 5.6 deaths (95% CI, 5.6 to 5.7) per 1000 person-years among those without the syndrome. The mortality rate ratio among live-born children with congenital Zika syndrome, as compared with those without the syndrome, was 11.3 (95% CI, 10.2 to 12.4). Among infants born before 32 weeks of gestation or with a birth weight of less than 1500 g, the risks of death were similar regardless of congenital Zika syndrome status. Among infants born at term, those with congenital Zika syndrome were 14.3 times (95% CI, 12.4 to 16.4) as likely to die as those without the syndrome (mortality rate, 38.4 vs. 2.7 deaths per 1000 person-years). Among infants with a birth weight of 2500 g or greater, those with congenital Zika syndrome were 12.9 times (95% CI, 10.9 to 15.3) as likely to die as those without the syndrome (mortality rate, 32.6 vs. 2.5 deaths per 1000 person-years). The burden of congenital anomalies, diseases of the nervous system, and infectious diseases as recorded causes of deaths was higher among live-born children with congenital Zika syndrome than among those without the syndrome. CONCLUSIONS The risk of death was higher among live-born children with congenital Zika syndrome than among those without the syndrome and persisted throughout the first 3 years of life. (Funded by the Ministry of Health of Brazil and others.).
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Affiliation(s)
- Enny S Paixao
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Luciana L Cardim
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Maria C N Costa
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Elizabeth B Brickley
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Rita C O de Carvalho-Sauer
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Eduardo H Carmo
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Roberto F S Andrade
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Moreno S Rodrigues
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Rafael V Veiga
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Larissa C Costa
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Cynthia A Moore
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Giovanny V A França
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Liam Smeeth
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Laura C Rodrigues
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Mauricio L Barreto
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Maria G Teixeira
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
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22
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Santos DN, de Araújo TM, dos Santos LM, Kuper H, Aquino R, Da Silveira IH, Miranda SS, Pereira M, Werneck GL. The Salvador Primary Care Longitudinal Study of Child Development (CohortDICa) Following the Zika Epidemic: Study Protocol. Int J Environ Res Public Health 2022; 19:ijerph19052514. [PMID: 35270212 PMCID: PMC8909628 DOI: 10.3390/ijerph19052514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022]
Abstract
This article describes the Salvador Primary Care Longitudinal Study of Child Development (CohortDICa). The exposed group was defined by confirmation of Congenital Zika Syndrome (CZS) diagnosed through computed tomography, magnetic resonance or transfontanellar ultrasound. A random selection of the 169 exposed children led to a subgroup of 120 children who were paired with children from the Live Birth Information System, according to birthdate, residence in the same street or neighborhood, and gestational age, resulting in 115 subjects in the non-exposed group. Following recruitment and before the participants completed 42 months, three measures were applied to assess cognitive, motor, and language performance, corresponding to three home visits. Social characteristics of the families and children, and the neurocognitive development of the children will be compared across the CZS exposed group (n = 147), the typical children with no exposure to CZS (n = 115) and the STORCH exposed group (Syphilis, Toxoplasma gondii, Rubella, Cytomegalovirus, and Herpes simplex) (n = 20). Primary Health Care (PHC) should include long-term care strategies for the care of children and family members, and might benefit from the research, teaching, and extension activities provided in this study. In the face of the consequences of the Zika virus epidemic, an opportunity arose to intervene in the integrated care of child development within PHC, including, on an equal basis, typical children and those with delays or disabilities in the first six years of life.
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Affiliation(s)
- Darci Neves Santos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
- Correspondence: (D.N.S.); (M.P.)
| | - Tânia Maria de Araújo
- Núcleo de Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana 44036-900, Brazil;
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Rosana Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
| | - Ismael Henrique Da Silveira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
| | - Samilly Silva Miranda
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
| | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
- Correspondence: (D.N.S.); (M.P.)
| | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20559-900, Brazil;
- Fiocruz Piauí, Teresina 64000-128, Brazil
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23
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Update Imaging Findings of Congenital Zika Syndrome: A Disease Story That is Still Being Written. Top Magn Reson Imaging 2022; 31:23. [PMID: 35225841 DOI: 10.1097/RMR.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Rossi ÁD, Faucz FR, Melo A, de Azevedo GS, Pezzuto P, Bezerra OCDL, Manta FSDN, Azamor T, Schamber-Reis BLF, Tanuri A, Moraes MO, Aguiar RS, Stratakis CA, Cardoso CC. Association between Maternal Non-Coding Interferon-λ Polymorphisms and Congenital Zika Syndrome in a Cohort from Brazilian Northeast. Viruses 2021; 13:2253. [PMID: 34835060 PMCID: PMC8622836 DOI: 10.3390/v13112253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Congenital Zika syndrome (CZS) is characterized by a diverse group of congenital malformations induced by ZIKV infection during pregnancy. Type III interferons have been associated with placental immunity against ZIKV and restriction of vertical transmission in mice, and non-coding single-nucleotide polymorphisms (SNPs) on these genes are well known to influence susceptibility to other viral infections. However, their effect on ZIKV pathogenesis has not yet been explored. To investigate whether maternal non-coding SNPs at IFNL genes are associated with CZS, 52 women infected with ZIKV during pregnancy were enrolled in a case-control association study. A total of 28 women were classified as cases and 24 as controls based on the presence or absence of CZS in their infants, and seven Interferon-λ non-coding SNPs (rs12980275, rs8099917, rs4803217, rs4803219, rs8119886, rs368234815, rs12979860) were genotyped. The results of logistic regression analyses show an association between the G allele at rs8099917 and increased susceptibility to CZS under a log-additive model (adjustedOR = 2.80; 95%CI = 1.14-6.91; p = 0.02), after adjustment for trimester of infection and genetic ancestry. These results provide evidence of an association between Interferon-λ SNPs and CZS, suggesting rs8099917 as a promising candidate for further studies on larger cohorts.
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Affiliation(s)
- Átila Duque Rossi
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (Á.D.R.); (P.P.); (A.T.); (R.S.A.)
| | - Fabio Rueda Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA; (F.R.F.); (C.A.S.)
| | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande 58406-115, Brazil; (A.M.); (G.S.d.A.)
| | - Girlene Souza de Azevedo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Campina Grande 58406-115, Brazil; (A.M.); (G.S.d.A.)
| | - Paula Pezzuto
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (Á.D.R.); (P.P.); (A.T.); (R.S.A.)
| | - Ohanna Cavalcanti de Lima Bezerra
- Laboratório de Hanseníase, Instituto Oswaldo Cruz Fiocruz, Rio de Janeiro 21040-900, Brazil; (O.C.d.L.B.); (F.S.d.N.M.); (T.A.); (M.O.M.)
| | - Fernanda Saloum de Neves Manta
- Laboratório de Hanseníase, Instituto Oswaldo Cruz Fiocruz, Rio de Janeiro 21040-900, Brazil; (O.C.d.L.B.); (F.S.d.N.M.); (T.A.); (M.O.M.)
| | - Tamiris Azamor
- Laboratório de Hanseníase, Instituto Oswaldo Cruz Fiocruz, Rio de Janeiro 21040-900, Brazil; (O.C.d.L.B.); (F.S.d.N.M.); (T.A.); (M.O.M.)
| | - Bruno Luiz Fonseca Schamber-Reis
- Faculdade de Ciências Médicas de Campina Grande, Núcleo de Genética Médica, Centro Universitário UniFacisa, Campina Grande 58408-326, Brazil;
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (Á.D.R.); (P.P.); (A.T.); (R.S.A.)
| | - Milton Ozório Moraes
- Laboratório de Hanseníase, Instituto Oswaldo Cruz Fiocruz, Rio de Janeiro 21040-900, Brazil; (O.C.d.L.B.); (F.S.d.N.M.); (T.A.); (M.O.M.)
| | - Renato Santana Aguiar
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (Á.D.R.); (P.P.); (A.T.); (R.S.A.)
- Laboratório de Biologia Integrativa, Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA; (F.R.F.); (C.A.S.)
| | - Cynthia Chester Cardoso
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (Á.D.R.); (P.P.); (A.T.); (R.S.A.)
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25
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Bohm EK, Vangorder-Braid JT, Jaeger AS, Moriarty RV, Baczenas JJ, Bennett NC, O’Connor SL, Fritsch MK, Fuhler NA, Noguchi KK, Aliota MT. Zika Virus Infection of Pregnant Ifnar1-/- Mice Triggers Strain-Specific Differences in Fetal Outcomes. J Virol 2021; 95:e0081821. [PMID: 34379510 PMCID: PMC8513483 DOI: 10.1128/jvi.00818-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 01/22/2023] Open
Abstract
Zika virus (ZIKV) is a flavivirus that causes a constellation of adverse fetal outcomes collectively termed congenital Zika syndrome (CZS). However, not all pregnancies exposed to ZIKV result in an infant with apparent defects. During the 2015 to 2016 American outbreak of ZIKV, CZS rates varied by geographic location. The underlying mechanisms responsible for this heterogeneity in outcomes have not been well defined. Therefore, we sought to characterize and compare the pathogenic potential of multiple Asian-/American-lineage ZIKV strains in an established Ifnar1-/- pregnant mouse model. Here, we show significant differences in the rate of fetal demise following maternal inoculation with ZIKV strains from Puerto Rico, Panama, Mexico, Brazil, and Cambodia. Rates of fetal demise broadly correlated with maternal viremia but were independent of fetus and placenta virus titer, indicating that additional underlying factors contribute to fetal outcome. Our results, in concert with those from other studies, suggest that subtle differences in ZIKV strains may have important phenotypic impacts. With ZIKV now endemic in the Americas, greater emphasis needs to be placed on elucidating and understanding the underlying mechanisms that contribute to fetal outcome. IMPORTANCE Zika virus (ZIKV) transmission has been reported in 87 countries and territories around the globe. ZIKV infection during pregnancy is associated with adverse fetal outcomes, including birth defects, microcephaly, neurological complications, and even spontaneous abortion. Rates of adverse fetal outcomes vary between regions, and not every pregnancy exposed to ZIKV results in birth defects. Not much is known about how or if the infecting ZIKV strain is linked to fetal outcomes. Our research provides evidence of phenotypic heterogeneity between Asian-/American-lineage ZIKV strains and provides insight into the underlying causes of adverse fetal outcomes. Understanding ZIKV strain-dependent pathogenic potential during pregnancy and elucidating underlying causes of diverse clinical sequelae observed during human infections is critical to understanding ZIKV on a global scale.
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Affiliation(s)
- Ellie K. Bohm
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Jennifer T. Vangorder-Braid
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Anna S. Jaeger
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Ryan V. Moriarty
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John J. Baczenas
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Natalie C. Bennett
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Shelby L. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael K. Fritsch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole A. Fuhler
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kevin K. Noguchi
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
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Borda V, da Silva Francisco Junior R, Carvalho JB, Morais GL, Duque Rossi Á, Pezzuto P, Azevedo GS, Schamber-Reis BL, Portari EA, Melo A, Moreira MEL, Guida LC, Cunha DP, Gomes L, Vasconcelos ZFM, Faucz FR, Tanuri A, Stratakis CA, Aguiar RS, Cardoso CC, de Vasconcelos ATR. Whole-exome sequencing reveals insights into genetic susceptibility to Congenital Zika Syndrome. PLoS Negl Trop Dis 2021; 15:e0009507. [PMID: 34125832 PMCID: PMC8224898 DOI: 10.1371/journal.pntd.0009507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/24/2021] [Accepted: 05/26/2021] [Indexed: 12/30/2022] Open
Abstract
Congenital Zika Syndrome (CZS) is a critical illness with a wide range of severity caused by Zika virus (ZIKV) infection during pregnancy. Life-threatening neurodevelopmental dysfunctions are among the most common phenotypes observed in affected newborns. Risk factors that contribute to susceptibility and response to ZIKV infection may be related to the virus itself, the environment, and maternal genetic background. Nevertheless, the newborn’s genetic contribution to the critical illness is still not elucidated. Here, we aimed to identify possible genetic variants as well as relevant biological pathways that might be associated with CZS phenotypes. For this purpose, we performed a whole-exome sequencing in 40 children born to women with confirmed exposure to ZIKV during pregnancy. We investigated the occurrence of rare harmful single-nucleotide variants (SNVs) possibly associated with inborn errors in genes ontologically related to CZS phenotypes. Moreover, an exome-wide association analysis was also performed using a case-control design (29 CZS cases and 11 controls), for both common and rare variants. Five out of the 29 CZS patients harbored known pathogenic variants likely to contribute to mild to severe manifestations observed. Approximately, 30% of affected individuals carried at least one pathogenic or likely pathogenic SNV in genes candidates to play a role in CZS. Our common variant association analysis detected a suggestive protective effect of the rs2076469 in DISP3 gene (p-value: 1.39 x 10−5). The IL12RB2 gene (p-value: 2.18x10-11) also showed an unusual distribution of nonsynonymous rare SNVs in control samples. Finally, genes harboring harmful variants are involved in processes related to CZS phenotypes such as neurological development and immunity. Therefore, both rare and common variations may be likely to contribute as the underlying genetic cause of CZS susceptibility. The variations and pathways identified in this study may also have implications for the development of therapeutic strategies in the future. Since the beginning of Zika virus outbreak in Brazil, five years ago, we still don’t understand the genetic factors associated with the small number of babies born with Congenital Zika Syndrome (CZS). Here, we focused on the host genetic susceptibility by studying the whole-exome of the CZS affected (n = 29) and healthy (n = 11) neonates, both born to ZIKV infected women from Brazil. We applied two strategies: 1) Determine whether cases individuals have pathogenic or harmful variants that explain the CZS outcomes (i.e. microcephaly) independently of ZIKV infection or not, 2) Exploring the common and rare variants association with CZS. We found that common and rare variants in genes like DISP3 and IL12RB2 could explain some level of the susceptibility to CZS. Moreover, by considering these and other candidate genes, we observed an over-representation of Gene Ontology terms related to neurological system, metabolism and microtubule-cytoskeleton organization.
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Affiliation(s)
- Victor Borda
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica LNCC/MCTIC Petrópolis, Brazil
| | | | - Joseane B. Carvalho
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica LNCC/MCTIC Petrópolis, Brazil
| | - Guilherme L. Morais
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica LNCC/MCTIC Petrópolis, Brazil
| | - Átila Duque Rossi
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Pezzuto
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Bruno L. Schamber-Reis
- Faculdade de Ciências Médicas de Campina Grande, Núcleo de Genética Médica, Centro Universitário UniFacisa, Campina Grande, Brazil
| | | | - Adriana Melo
- Instituto de Pesquisa Professor Amorim Neto, Campina Grande Brazil
- Faculdade de Ciências Médicas de Campina Grande, Núcleo de Genética Médica, Centro Universitário UniFacisa, Campina Grande, Brazil
| | | | | | | | - Leonardo Gomes
- Instituto Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | | | - Fabio R. Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Renato S. Aguiar
- Departamento de Genética, Ecologia e Evolução Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- * E-mail: (RSA); (CCC); (ATRV)
| | - Cynthia Chester Cardoso
- Laboratório de Virologia Molecular, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (RSA); (CCC); (ATRV)
| | - Ana Tereza Ribeiro de Vasconcelos
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica LNCC/MCTIC Petrópolis, Brazil
- * E-mail: (RSA); (CCC); (ATRV)
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da Costa Faria NR, Chaves-Filho AB, Alcantara LCJ, de Siqueira IC, Calcagno JI, Miyamoto S, de Filippis AMB, Yoshinaga MY. Plasma lipidome profiling of newborns with antenatal exposure to Zika virus. PLoS Negl Trop Dis 2021; 15:e0009388. [PMID: 33930014 PMCID: PMC8115770 DOI: 10.1371/journal.pntd.0009388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/12/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023] Open
Abstract
The 2015–2016 Zika virus (ZIKV) outbreak in Brazil was remarkably linked to the incidence of microcephaly and other deleterious clinical manifestations, including eye abnormalities, in newborns. It is known that ZIKV targets the placenta, triggering an inflammatory profile that may cause placental insufficiency. Transplacental lipid transport is delicately regulated during pregnancy and deficiency on the delivery of lipids such as arachidonic and docosahexaenoic acids may lead to deficits in both brain and retina during fetal development. Here, plasma lipidome profiles of ZIKV exposed microcephalic and normocephalic newborns were compared to non-infected controls. Our results reveal major alterations in circulating lipids from both ZIKV exposed newborns with and without microcephaly relative to controls. In newborns with microcephaly, the plasma concentrations of hydroxyoctadecadienoic acid (HODE), primarily as 13-HODE isomer, derived from linoleic acid were higher as compared to normocephalic ZIKV exposed newborns and controls. Total HODE concentrations were also positively associated with levels of other oxidized lipids and several circulating free fatty acids in newborns, indicating a possible plasma lipidome signature of microcephaly. Moreover, higher concentrations of lysophosphatidylcholine in ZIKV exposed normocephalic newborns relative to controls suggest a potential disruption of polyunsaturated fatty acids transport across the blood-brain barrier of fetuses. The latter data is particularly important given the neurocognitive and neurodevelopmental abnormalities observed in follow-up studies involving children with antenatal ZIKV exposure, but normocephalic at birth. Taken together, our data reveal that plasma lipidome alterations associated with antenatal exposure to ZIKV could contribute to identification and monitoring of the wide spectrum of clinical phenotypes at birth and further, during childhood. Antenatal exposure to Zika virus (ZIKV) is linked to a wide range of clinical presentations at birth, from asymptomatic cases to microcephaly, and other neurocognitive and neurodevelopmental abnormalities manifested in the early childhood. Stratification of these clinical phenotypes in newborns with suspected antenatal ZIKV exposure is challenging, but critical to improve early assessment of rehabilitative interventions. In this study, plasma lipidome profiling of 274 lipid species was performed in both normocephalic and microcephalic newborns with antenatal ZIKV exposure and compared to non-infected controls. Multiple lipid species were independent predictors of antenatal ZIKV exposure. More specifically, microcephaly was strongly associated with an oxidized free fatty acid and ZIKV exposed normocephalic newborns exhibited higher plasma concentrations of lysophosphatidylcholine relative to controls. These findings emphasize the need for studies focused on the role of individual lipids in neuropathogenesis of ZIKV and raise the potential of plasma lipidome profiling for early diagnosis of newborns with suspected antenatal ZIKV exposure. To validate the predictive ability of this approach, prospective studies with a larger cohort of newborns are now required.
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Affiliation(s)
| | | | | | | | - Juan Ignacio Calcagno
- Maternidade Prof. José Maria de Magalhães Netto, State Health Secretary (Salvador), Bahia, Brazil
| | - Sayuri Miyamoto
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | | | - Marcos Yukio Yoshinaga
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
- * E-mail:
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Coutinho CM, Fernandes JDCP, Yamamoto AY, Negrini SFBDM, Negrini BVDM, Teixeira SR, Amaral FR, da Motta MSF, Bárbaro AAT, Aragon DC, Montoya M, Harris E, Duarte G, Mussi-Pinhata MM. Persistence of Anti-ZIKV-IgG over Time Is Not a Useful Congenital Infection Marker in Infants Born to ZIKV-Infected Mothers: The NATZIG Cohort. Viruses 2021; 13:711. [PMID: 33924066 PMCID: PMC8074187 DOI: 10.3390/v13040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/05/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Confirming ZIKV congenital infection is challenging because viral RNA is infrequently detected. We compared the presence of anti-ZIKV-IgM and the persistence of anti-ZIKV-IgG antibodies over 18 months in two cohorts of infants born to ZIKV-infected mothers: Cohort one: 30 infants with typical microcephaly or major brain abnormalities (Congenital Zika Syndrome-CZS); Cohort two: 123 asymptomatic infants. Serum samples obtained within 6 months of age were tested for anti-ZIKV-IgM. Anti-ZIKV-IgG was quantified in sequential samples collected at birth, 3-6 weeks, 3, 6, 12, and 18 months. ZIKV-RNA was never detected postnatally. Anti-ZIKV-IgM antibodies were detected at least once in 15/25 (60.0%; 95%CI: 38.7-78.9) infants with CZS and in 2/115 (1.7%; 95%CI: 0.2-6.1) asymptomatic infants. Although anti-ZIKV-IgG was always positive within 3-6 weeks of age, IgG levels decreased similarly over time in both cohorts. IgG levels decreased similarly in ZIKV-IgM-positive and ZIKV-IgM-negative CZS infants. Differently from other congenital infections, IgM would fail to diagnose 40% of severely symptomatic infants, and the persistence of IgG is not a useful marker for discriminating congenital infection among infants exposed to maternal ZIKV infection.
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Affiliation(s)
- Conrado Milani Coutinho
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil;
| | - Juliana Dias Crivelenti Pereira Fernandes
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Aparecida Yulie Yamamoto
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Silvia Fabiana Biason de Moura Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Bento Vidal de Moura Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Sara Reis Teixeira
- Department of Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil;
| | - Fabiana Rezende Amaral
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Márcia Soares Freitas da Motta
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Adriana Aparecida Tiraboschi Bárbaro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Davi Casale Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
| | - Magelda Montoya
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720-7360, USA; (M.M.); (E.H.)
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720-7360, USA; (M.M.); (E.H.)
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil;
| | - Marisa Márcia Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (J.D.C.P.F.); (A.Y.Y.); (S.F.B.d.M.N.); (B.V.d.M.N.); (F.R.A.); (M.S.F.d.M.); (A.A.T.B.); (D.C.A.)
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Alecrim MDGC, de Amorim MMR, de Araújo TVB, Brasil P, Brickley EB, Castilho MDC, Coelho BP, da Cunha AJLA, Duarte G, Estofolete CF, Gurgel RQ, Herrero-Silva J, Hofer CB, Lopes ASA, Martelli CMT, Melo ASDO, Miranda-Filho DDB, Montarroyos UR, Moreira ME, Mussi-Pinhata MM, de Oliveira CS, Passos SD, Prata-Barbosa A, dos Santos DN, Schuler-Faccini L, da Silva AAM, de Siqueira IC, Sousa PDS, Turchi MD, Ximenes RADA, Zara ALDSA. Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy. Viruses 2021; 13:v13040687. [PMID: 33923434 PMCID: PMC8072625 DOI: 10.3390/v13040687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/31/2022] Open
Abstract
Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.
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Affiliation(s)
| | - Melania Maria Ramos de Amorim
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife 50070-902, Brazil
| | | | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
| | | | - Marcia da Costa Castilho
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil; (M.d.G.C.A.); (M.d.C.C.)
| | - Bernadete Perez Coelho
- Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | | | - Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | - Cristina Barroso Hofer
- Departamento de Pediatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-971, Brazil; (A.J.L.A.d.C.); (C.B.H.)
| | | | | | - Adriana Suely de Oliveira Melo
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto Paraibano de Diagnóstico (EMBRION), Campina Grande 58400-506, Brazil
| | | | | | | | - Marisa Marcia Mussi-Pinhata
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | | | | | | | | | - Patrícia da Silva Sousa
- Centro de Referência em Neurodesenvolvimento, Assistência e Reabilitação de Crianças, Secretaria de Saúde do Estado do Maranhão, São Luís 65076-820, Brazil;
| | - Marília Dalva Turchi
- Departamento de Saude Coletiva, Universidade Federal de Goiás, Goiânia 74605-050, Brazil; (M.D.T.); (A.L.d.S.A.Z.)
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife 50100-130, Brazil;
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Recife 50670-901, Brazil
- Correspondence:
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Gordon-Lipkin E, Hoon A, Pardo CA. Prenatal cytomegalovirus, rubella, and Zika virus infections associated with developmental disabilities: past, present, and future. Dev Med Child Neurol 2021; 63:135-143. [PMID: 33084055 PMCID: PMC7785600 DOI: 10.1111/dmcn.14682] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
Prenatal infections have long been recognized as important, preventable causes of developmental disabilities. The list of pathogens that are recognized to have deleterious effects on fetal brain development continues to grow, most recently with the association between Zika virus (ZIKV) and microcephaly. To answer clinical questions in real time about the impact of a novel infection on developmental disabilities, an historical framework is key. The lessons learned from three historically important pathogens: rubella, cytomegalovirus, and ZIKV, and how these lessons are useful to approach emerging congenital infections are discussed in this review. Congenital infections are preventable causes of developmental disabilities and several public health approaches may be used to prevent prenatal infection. When they cannot be prevented, the sequelae of prenatal infection may be treatable. WHAT THIS PAPER ADDS: The list of prenatal infections associated with developmental disabilities continues to increase. Lessons learned from rubella, cytomegalovirus, and Zika virus have implications for new pathogens. Severity of illness in the mother does not correlate with severity of sequelae in the infant.
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Affiliation(s)
- Eliza Gordon-Lipkin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander Hoon
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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Freitas DA, Souza-Santos R, Carvalho LMA, Barros WB, Neves LM, Brasil P, Wakimoto MD. Congenital Zika syndrome: A systematic review. PLoS One 2020; 15:e0242367. [PMID: 33320867 PMCID: PMC7737899 DOI: 10.1371/journal.pone.0242367] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The signs and symptoms of Zika virus infection are usually mild and self-limited. However, the disease has been linked to neurological complications such as Guillain-Barré syndrome and peripheral nerve involvement, and also to abortion and fetal deaths due to vertical transmission, resulting in various congenital malformations in newborns, including microcephaly. This review aimed to describe the o signs and symptoms that characterize the congenital Zika syndrome. METHODS AND FINDINGS A systematic review was performed with a protocol and described according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search strategy yielded 2,048 studies. After the exclusion of duplicates and application of inclusion criteria, 46 studies were included. The main signs and symptoms associated with the congenital Zika syndrome were microcephaly, parenchymal or cerebellar calcifications, ventriculomegaly, central nervous system hypoplasia or atrophy, arthrogryposis, ocular findings in the posterior and anterior segments, abnormal visual function and low birthweight for gestational age. CONCLUSIONS Zika virus infection during pregnancy can cause a series of changes in the growth and development of children, while impacting the healthcare system due to the severity of cases. Our findings outline the disease profile in newborns and infants and may contribute to the development and updating of more specific clinical protocols.
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Affiliation(s)
- Danielle A. Freitas
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Reinaldo Souza-Santos
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Liege M. A. Carvalho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Wagner B. Barros
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Luiza M. Neves
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Patrícia Brasil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Mayumi D. Wakimoto
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Blackmon K, Waechter R, Landon B, Noël T, Macpherson C, Donald T, Cudjoe N, Evans R, Burgen KS, Jayatilake P, Oyegunle V, Pedraza O, Abdel Baki S, Thesen T, Dlugos D, Chari G, Patel AA, Grossi-Soyster EN, Krystosik AR, LaBeaud AD. Epilepsy surveillance in normocephalic children with and without prenatal Zika virus exposure. PLoS Negl Trop Dis 2020; 14:e0008874. [PMID: 33253174 PMCID: PMC7728266 DOI: 10.1371/journal.pntd.0008874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/10/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Children with Congenital Zika Syndrome and microcephaly are at high risk for epilepsy; however, the risk is unclear in normocephalic children with prenatal Zika virus (ZIKV) exposure [Exposed Children (EC)]. In this prospective cohort study, we performed epilepsy screening in normocephalic EC alongside a parallel group of normocephalic unexposed children [Unexposed Children (UC)]. We compared the incidence rate of epilepsy among EC and UC at one year of life to global incidence rates. Pregnant women were recruited from public health centers during the ZIKV outbreak in Grenada, West Indies and assessed for prior ZIKV infection using a plasmonic-gold platform that measures IgG antibodies in serum. Normocephalic children born to mothers with positive ZIKV results during pregnancy were classified as EC and those born to mothers with negative ZIKV results during and after pregnancy were classified as UC. Epilepsy screening procedures included a pediatric epilepsy screening questionnaire and video electroencephalography (vEEG). vEEG was collected using a multi-channel microEEG® system for a minimum of 20 minutes along with video recording of participant behavior time-locked to the EEG. vEEGs were interpreted independently by two pediatric epileptologists, who were blinded to ZIKV status, via telemedicine platform. Positive screening cases were referred to a local pediatrician for an epilepsy diagnostic evaluation. Epilepsy screens were positive in 2/71 EC (IR: 0.028; 95% CI: 0.003-0.098) and 0/71 UC. In both epilepsy-positive cases, questionnaire responses and interictal vEEGs were consistent with focal, rather than generalized, seizures. Both children met criteria for a clinical diagnosis of epilepsy and good seizure control was achieved with carbamazepine. Our results indicate that epilepsy rates are modestly elevated in EC. Given our small sample size, results should be considered preliminary. They support the use of epilepsy screening procedures in larger epidemiological studies of children with congenital ZIKV exposure, even in the absence of microcephaly, and provide guidance for conducting epilepsy surveillance in resource limited settings.
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Affiliation(s)
- Karen Blackmon
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- * E-mail:
| | - Randall Waechter
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Barbara Landon
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Trevor Noël
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Calum Macpherson
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | | | - Nikita Cudjoe
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Kemi S. Burgen
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Piumi Jayatilake
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Vivian Oyegunle
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Otto Pedraza
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
| | - Samah Abdel Baki
- Biosignal Group Inc., Boston, Massachusetts, United States of America
| | - Thomas Thesen
- New York University School of Medicine, Department of Neurology, New York, New York, United States of America
- Department of Biomedical Sciences, University of Houston College of Medicine, USA
| | - Dennis Dlugos
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Geetha Chari
- SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Archana A. Patel
- Boston Children’s Hospital, Department of Neurology, Boston, Massachusetts, United States of America
| | - Elysse N. Grossi-Soyster
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - Amy R. Krystosik
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - A. Desiree LaBeaud
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
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Martinez SS, Pardo‐Hernandez H, Palacios C. Feeding modifications and additional primary caregiver support for infants exposed to Zika virus or diagnosed with congenital Zika syndrome: a rapid review of the evidence. Trop Med Int Health 2020; 25:1353-1361. [PMID: 32881216 PMCID: PMC7756506 DOI: 10.1111/tmi.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Infants exposed to Zika virus (ZIKV) or diagnosed with congenital Zika syndrome (CZVS) may present dysphagia, regurgitation and other feeding difficulties. They may require special feeding practices to minimise the risk of mortality, morbidity and developmental problems. Improving knowledge, skills and behaviours of caregivers may preserve health, maximise development and promote quality of life among affected infants. We reviewed intervention studies of modified feeding practices and additional primary caregiver support to improve outcomes among infants 0 to 12 months of age exposed to ZIKV or diagnosed with CZVS. METHODS Rapid review and meta-analysis. We searched PubMed/MEDLINE and contacted experts. The search is current to 18 July 2020. We planned a meta-analysis using fixed-effect models; if unfeasible, we intended to summarise studies narratively. We planned to assess risk of bias of included studies and quality of evidence using Cochrane guidance. RESULTS We identified 42 records for title and abstract screening; 14 were eligible for full-text assessment. Among these, no intervention studies were found. Eight observational studies reported on the nutritional status, feeding practices and outcomes among infants affected by ZIKV or diagnosed with CZVS. They are presented and discussed to provide a basis for future research. CONCLUSIONS While no intervention studies were found, evidence from eight observational studies highlights the need for early nutrition interventions and caregiver support among infants affected by ZIKV or diagnosed with CZSV. More research is needed to assess whether modifications of feeding practices and provision of additional primary caregiver support will impact outcomes of interest.
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Affiliation(s)
| | | | - Cristina Palacios
- Department of Dietetics and NutritionFlorida International UniversityMiamiFLUSA
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N. Costa MC, Cardim LL, Teixeira MG, Barreto ML, de Carvalho-Sauer RDCO, R. Barreto F, Itaparica Carvalho MS, Oliveira WK, França GVA, Carmo EH, Andrade RFS, Rodrigues MS, Veiga RV, Oliveira JF, Fernandes QHRF, Costa LC, Coelho GE, Paixao ES. Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †. Viruses 2020; 12:v12111228. [PMID: 33138282 PMCID: PMC7692842 DOI: 10.3390/v12111228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child's health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child-maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015-2017. METHODS Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. RESULTS The microcephaly/CZS case fatality rate was 10% (95% CI 9.2-10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63-2.83), and very low birth weight (OR = 3.77; 95% CI 2.20-6.46); late preterm births (OR = 1.65; 95% CI 1.21-2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46-8.02) and 5th minutes (OR = 4.13; 95% CI 2.78-6.13), among others. CONCLUSIONS A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.
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Affiliation(s)
- Maria Conceição N. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Luciana Lobato Cardim
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Maria Gloria Teixeira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Mauricio L. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Rita de Cassia Oliveira de Carvalho-Sauer
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
- East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus, Bahia ZC 44570-550, Brazil
| | - Florisneide R. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Martha Suely Itaparica Carvalho
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Municipal Health Secretariat of Salvador, Bahia ZC 40010-010, Brazil
| | - Wanderson K. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Technical Directorate of Education and Research, Ministry of Defense Hospital das Armed Forces, Brasília ZC 70675-731, Brazil
| | - Giovanny V. A. França
- Secretariat of Health Surveillance, Ministry of Health, Brasilia ZC 70070-040, Brazil;
| | - Eduardo Hage Carmo
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Roberto F. S. Andrade
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Physics Institute, Federal University of Bahia, Salvador, Bahia ZC 40210-340, Brazil
| | - Moreno S. Rodrigues
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Rafael V. Veiga
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Juliane F. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | | | - Larissa C. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Giovanini E. Coelho
- Department of Communicable Diseases and Environmental Determinants of Health, Neglected, Tropical and Vector-Borne Diseases, Pan-American Health Organization/World Health Organization, Washington, WA 20037, USA;
| | - Enny S. Paixao
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Correspondence:
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Wessel AW, Kose N, Bombardi RG, Roy V, Chantima W, Mongkolsapaya J, Edeling MA, Nelson CA, Bosch I, Alter G, Screaton GR, Fremont DH, Crowe JE, Diamond MS. Antibodies targeting epitopes on the cell-surface form of NS1 protect against Zika virus infection during pregnancy. Nat Commun 2020; 11:5278. [PMID: 33077712 PMCID: PMC7572419 DOI: 10.1038/s41467-020-19096-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/29/2020] [Indexed: 12/18/2022] Open
Abstract
There are no licensed therapeutics or vaccines available against Zika virus (ZIKV) to counteract its potential for congenital disease. Antibody-based countermeasures targeting the ZIKV envelope protein have been hampered by concerns for cross-reactive responses that induce antibody-dependent enhancement (ADE) of heterologous flavivirus infection. Nonstructural protein 1 (NS1) is a membrane-associated and secreted glycoprotein that functions in flavivirus replication and immune evasion but is absent from the virion. Although some studies suggest that antibodies against ZIKV NS1 are protective, their activity during congenital infection is unknown. Here we develop mouse and human anti-NS1 monoclonal antibodies that protect against ZIKV in both non-pregnant and pregnant mice. Avidity of antibody binding to cell-surface NS1 along with Fc effector functions engagement correlate with protection in vivo. Protective mAbs map to exposed epitopes in the wing domain and loop face of the β-platform. Anti-NS1 antibodies provide an alternative strategy for protection against congenital ZIKV infection without causing ADE.
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Affiliation(s)
- Alex W Wessel
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Nurgun Kose
- Departments of Pediatrics, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Robin G Bombardi
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Vicky Roy
- Ragon Institute of MGH, MIT, and Harvard University, Cambridge, MA, 02139, USA
| | - Warangkana Chantima
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Juthathip Mongkolsapaya
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
- Dengue Hemorrhagic Fever Unit, Faculty of Medicine, Office for Research and Development, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Melissa A Edeling
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Christopher A Nelson
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Irene Bosch
- E25Bio, Inc., The Engine of MIT, Cambridge, MA, 02139, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard University, Cambridge, MA, 02139, USA
| | - Gavin R Screaton
- Nuffield Department of Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - David H Fremont
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, 63110, USA
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - James E Crowe
- Departments of Pediatrics, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Michael S Diamond
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO, 63110, USA.
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.
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Carroll C, Booth A, Campbell F, Relton C. What are the implications of Zika Virus for infant feeding? A synthesis of qualitative evidence concerning Congenital Zika Syndrome (CZS) and comparable conditions. PLoS Negl Trop Dis 2020; 14:e0008731. [PMID: 33085668 PMCID: PMC7605709 DOI: 10.1371/journal.pntd.0008731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/02/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
If a mother contracts the Zika Virus before or during pregnancy, then there is a risk of the child developing Congenital Zika Syndrome (CZS). An infant can then experience problems feeding due to the specific physical and developmental consequences of Congenital Zika Syndrome (CZS), such as microcephaly, dysphagia and an increased likelihood of choking. This qualitative evidence synthesis accesses direct and indirect evidence to inform WHO infant feeding guidelines. We conducted a qualitative evidence synthesis of the values and preferences of relevant stakeholders (e.g. pregnant women, mothers, family members and health practitioners) concerning infant (0-2 years) feeding in the presence of: 1) CZS (the'direct evidence'); 2) severe disability and nonprogressive, chronic encephalopathies ('indirect evidence'), which present with similar problems. Authors' findings were extracted, synthesised using thematic synthesis techniques, and confidence in the findings were assessed using GRADE-CERQual. Six CZS-specific studies (all from Brazil) were included in the direct evidence, with a further eight indirect studies reporting feeding difficulties in infants with severe disability and nonprogressive, chronic encephalopathies. Included studies highlighted: breast-feeding represented the preference for all mothers in the studies in both reviews, and the inability to do so affected bonding between parents and child, and generated fear and anxiety relating to feeding choices, especially around the risks of choking and swallowing; the perception that health professionals were often unable to offer appropriate advice; the potential value of training; and a strong desire to achieve individual maternal autonomy in infant feeding decisions. Confidence in most findings ranged from low to moderate. The evidence base has limitations, but consistently reported that parents of children with feeding difficulties due to Congenital Zika Syndrome, or similar, need information, advice and counselling, and substantial emotional support. Parents perceive that these needs are often neither recognised nor satisfied; optimal feeding and support strategies for this population have not yet been identified.
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Affiliation(s)
- Christopher Carroll
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Andrew Booth
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Fiona Campbell
- Health Economics & Decision Science Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Clare Relton
- Senior Lecturer in Clinical Trials, Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
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Smythe T, Matos M, Reis J, Duttine A, Ferrite S, Kuper H. Mothers as facilitators for a parent group intervention for children with Congenital Zika Syndrome: Qualitative findings from a feasibility study in Brazil. PLoS One 2020; 15:e0238850. [PMID: 32913354 PMCID: PMC7482954 DOI: 10.1371/journal.pone.0238850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Zika virus outbreak in Brazil (2015-2016) affected thousands of children who were born with Congenital Zika Syndrome (CZS). Families play an important role in their care of children with complex needs, yet their knowledge, experience and skills are rarely harnessed in existing interventions to best support these families. OBJECTIVE This study explores the use of mothers as facilitators for a community-based group intervention for children with CZS and their caregivers in Brazil. METHODS Four facilitators were trained to deliver the 10-week intervention called "Juntos". Two were mothers of a child with CZS ("expert mothers") and two were therapists (speech therapist and physiotherapist). The intervention was delivered to three groups, generally including 8-10 caregivers. Two researchers, who were psychologists, observed the groups and held focus group discussions at the end of each session. They undertook semi-structured interviews post intervention with a purposive sample of caregivers, and with the facilitators. Observation notes were collated and summarised. Transcripts were transcribed and thematically analysed using five elements to assess feasibility: acceptability, demand, implementation, practicality and adaptation. RESULTS The use of expert mothers as facilitators was considered to be acceptable and there was demand for their role. Their experiential knowledge was viewed as important for sharing and learning, and supporting and encouraging the group. The intervention was delivered with fidelity by the expert mothers. The practicality of the intervention was facilitated by holding the group sessions in the community, providing transport costs to facilitators and participants, paying expert mothers and therapist facilitators equally and supporting the expert mothers through a mentorship programme. Equal payment with the therapist enabled the expert mothers to better facilitate the groups, through increased confidence in the value of their role. Adaptation of the intervention included development of video resources and mentoring guidelines. CONCLUSION The use of expert mothers as facilitators of caregiver groups provides a unique approach to harness the knowledge, experience, and skills of families to provide care, and is likely to be feasible in similar contexts.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Monica Matos
- Collective Health Institute, Universidade Federal da Bahia, Salvador, Brazil
| | - Julia Reis
- Department of Child Psychology, Rehabilitation Institute of Bahia, Salvador, Brazil
| | - Antony Duttine
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Federal University of Bahia, Salvador, Brazil
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
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Amaral MS, Goulart E, Caires-Júnior LC, Morales-Vicente DA, Soares-Schanoski A, Gomes RP, Olberg GGDO, Astray RM, Kalil JE, Zatz M, Verjovski-Almeida S. Differential gene expression elicited by ZIKV infection in trophoblasts from congenital Zika syndrome discordant twins. PLoS Negl Trop Dis 2020; 14:e0008424. [PMID: 32745093 PMCID: PMC7425990 DOI: 10.1371/journal.pntd.0008424] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/13/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
Zika virus (ZIKV) causes congenital Zika syndrome (CZS), which is characterized by fetal demise, microcephaly and other abnormalities. ZIKV in the pregnant woman circulation must cross the placental barrier that includes fetal endothelial cells and trophoblasts, in order to reach the fetus. CZS occurs in ~1-40% of cases of pregnant women infected by ZIKV, suggesting that mothers' infection by ZIKV during pregnancy is not deterministic for CZS phenotype in the fetus. Therefore, other susceptibility factors might be involved, including the host genetic background. We have previously shown that in three pairs of dizygotic twins discordant for CZS, neural progenitor cells (NPCs) from the CZS-affected twins presented differential in vitro ZIKV susceptibility compared with NPCs from the non-affected. Here, we analyzed human-induced-pluripotent-stem-cell-derived (hiPSC-derived) trophoblasts from these twins and compared by RNA-Seq the trophoblasts from CZS-affected and non-affected twins. Following in vitro exposure to a Brazilian ZIKV strain (ZIKVBR), trophoblasts from CZS-affected twins were significantly more susceptible to ZIKVBR infection when compared with trophoblasts from the non-affected. Transcriptome profiling revealed no differences in gene expression levels of ZIKV candidate attachment factors, IFN receptors and IFN in the trophoblasts, either before or after ZIKVBR infection. Most importantly, ZIKVBR infection caused, only in the trophoblasts from CZS-affected twins, the downregulation of genes related to extracellular matrix organization and to leukocyte activation, which are important for trophoblast adhesion and immune response activation. In addition, only trophoblasts from non-affected twins secreted significantly increased amounts of chemokines RANTES/CCL5 and IP10 after infection with ZIKVBR. Overall, our results showed that trophoblasts from non-affected twins have the ability to more efficiently activate genes that are known to play important roles in cell adhesion and in triggering the immune response to ZIKV infection in the placenta, and this may contribute to predict protection from ZIKV dissemination into fetuses' tissues.
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Affiliation(s)
| | - Ernesto Goulart
- Departmento de Genética e Biologia Evolutiva, Centro de Pesquisas sobre o Genoma Humano e Células Tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Carlos Caires-Júnior
- Departmento de Genética e Biologia Evolutiva, Centro de Pesquisas sobre o Genoma Humano e Células Tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - David Abraham Morales-Vicente
- Laboratório de Parasitologia, Instituto Butantan, São Paulo, Brazil
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Jorge E. Kalil
- Laboratório de Imunologia, Faculdade de Medicina e Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Departmento de Genética e Biologia Evolutiva, Centro de Pesquisas sobre o Genoma Humano e Células Tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Sergio Verjovski-Almeida
- Laboratório de Parasitologia, Instituto Butantan, São Paulo, Brazil
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
- * E-mail:
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Galang RR, Avila GA, Valencia D, Daza M, Tong VT, Bermúdez AJ, Gilboa SM, Rico A, Cates J, Pacheco O, Winfield CM, Prieto F, Honein MA, Cortés LJ, Moore CA, Ospina ML. Etiology of Microcephaly and Central Nervous System Defects during the Zika Epidemic in Colombia. J Pediatr 2020; 222:112-119.e3. [PMID: 32417080 PMCID: PMC7321917 DOI: 10.1016/j.jpeds.2020.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/06/2020] [Accepted: 02/12/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To estimate the prevalence of microcephaly and central nervous system (CNS) defects during the Zika virus (ZIKV) epidemic in Colombia and proportion attributable to congenital ZIKV infection. STUDY DESIGN Clinical and laboratory data for cases of microcephaly and/or CNS defects reported to national surveillance between 2015 and 2017 were reviewed and classified by a panel of clinical subject matter experts. Maternal and fetal/infant biologic specimens were tested for congenital infection and chromosomal abnormalities. Infants/fetuses with microcephaly and/or CNS defects (cases) were classified into broad etiologic categories (teratogenic, genetic, multifactorial, and unknown). Cases classified as potentially attributable to congenital ZIKV infection were stratified by strength of evidence for ZIKV etiology (strong, moderate, or limited) using a novel strategy considering birth defects unique or specific to ZIKV or other infections and laboratory evidence. RESULTS Among 858 reported cases with sufficient information supporting a diagnosis of microcephaly or CNS defects, 503 were classified as potentially attributable to congenital ZIKV infection. Of these, the strength of evidence was considered strong in 124 (24.7%) cases; moderate in 232 (46.1%) cases; and limited in 147 (29.2%). Of the remaining, 355 (41.4%) were attributed to etiologies other than ZIKV infection (syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes 1 and herpes 2 viruses only, n = 32 [3.7%]; genetic, n = 16 [1.9%]; multifactorial, n = 42 [4.9%]; unknown, n = 265 [30.9%]). CONCLUSIONS Fifty-eight percent of cases of microcephaly and/or CNS defects were potentially attributable to congenital ZIKV infection; however, the strength of evidence varied considerably. This surveillance protocol might serve as a model approach for investigation and etiologic classification of complex congenital conditions.
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Affiliation(s)
- Romeo R Galang
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Greace Alejandra Avila
- Dirección de Vigilancia y Análisis de Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Distrito Capital, Colombia
| | - Diana Valencia
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marcela Daza
- Vysnova Partners, Research Division, Bethesda, MD, United States
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Antonio José Bermúdez
- Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Distrito Capital, Colombia
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Angélica Rico
- Dirección de Redes en Salud Pública, Instituto Nacional de Salud, Bogotá, Distrito Capital, Colombia
| | - Jordan Cates
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Oscar Pacheco
- Dirección de Vigilancia y Análisis de Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Distrito Capital, Colombia
| | - Christina M Winfield
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Franklyn Prieto
- Dirección de Vigilancia y Análisis de Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Distrito Capital, Colombia
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Liliana J Cortés
- Dirección de Vigilancia y Análisis de Riesgo en Salud Pública, Instituto Nacional de Salud, Bogotá, Distrito Capital, Colombia
| | - Cynthia A Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Martha L Ospina
- Dirección General, Instituto Nacional de Salud, Bogotá, Distrito Capital, Colombia
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40
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Flanagan M, Hughes H, Forman EB, O'Rourke D, Paturi B, Curley A, Knowles SJ, De Gascun C, Sweetman D. Diagnostic Limitations in Congenital Zika Virus Infection. Ir Med J 2020; 113:101. [PMID: 32816436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This is the first documented case of an infant with congenital Zika virus infection (ZVI) born in Ireland. A term infant was delivered with an antenatal diagnosis of severe microcephaly. First trimester bloods confirmed maternal ZVI and although the infant did not have Zika virus RNA or Zika-specific IgM in her blood or urine, she had multiple clinical features of congenital ZVI and Zika virus RNA was present in the placenta.
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Affiliation(s)
- M Flanagan
- Neonatology Department, National Maternity Hospital, Holles St, Dublin
| | - H Hughes
- Fetal Medicine Department, National Maternity Hospital, Holles St, Dublin
| | - E B Forman
- Neurology and Neurophysiology Department, Children's University Hospital, Temple Street, Dublin
| | - D O'Rourke
- Neurology and Neurophysiology Department, Children's University Hospital, Temple Street, Dublin
| | - B Paturi
- Neonatology Department, National Maternity Hospital, Holles St, Dublin
| | - A Curley
- Neonatology Department, National Maternity Hospital, Holles St, Dublin
| | - S J Knowles
- Microbiology Department, National Maternity Hospital, Holles St, Dublin
| | - C De Gascun
- Virology Department, National Viral Reference Laboratory, University College Dublin
| | - D Sweetman
- Neonatology Department, National Maternity Hospital, Holles St, Dublin
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Aguiar RS, Pohl F, Morais GL, Nogueira FCS, Carvalho JB, Guida L, Arge LWP, Melo A, Moreira MEL, Cunha DP, Gomes L, Portari EA, Velasquez E, Melani RD, Pezzuto P, de Castro FL, Geddes VEV, Gerber AL, Azevedo GS, Schamber-Reis BL, Gonçalves AL, Junqueira-de-Azevedo I, Nishiyama MY, Ho PL, Schanoski AS, Schuch V, Tanuri A, Chimelli L, Vasconcelos ZFM, Domont GB, Vasconcelos ATR, Nakaya HI. Molecular alterations in the extracellular matrix in the brains of newborns with congenital Zika syndrome. Sci Signal 2020; 13:eaay6736. [PMID: 32518143 DOI: 10.1126/scisignal.aay6736] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Zika virus (ZIKV) infection during pregnancy can cause a set of severe abnormalities in the fetus known as congenital Zika syndrome (CZS). Experiments with animal models and in vitro systems have substantially contributed to our understanding of the pathophysiology of ZIKV infection. Here, to investigate the molecular basis of CZS in humans, we used a systems biology approach to integrate transcriptomic, proteomic, and genomic data from the postmortem brains of neonates with CZS. We observed that collagens were greatly reduced in expression in CZS brains at both the RNA and protein levels and that neonates with CZS had several single-nucleotide polymorphisms in collagen-encoding genes that are associated with osteogenesis imperfecta and arthrogryposis. These findings were validated by immunohistochemistry and comparative analysis of collagen abundance in ZIKV-infected and uninfected samples. In addition, we showed a ZIKV-dependent increase in the expression of cell adhesion factors that are essential for neurite outgrowth and axon guidance, findings that are consistent with the neuronal migration defects observed in CZS. Together, these findings provide insights into the underlying molecular alterations in the ZIKV-infected brain and reveal host genes associated with CZS susceptibility.
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Affiliation(s)
- Renato S Aguiar
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fabio Pohl
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Guilherme L Morais
- National Laboratory of Scientific Computation, LNCC/MCTI, Petrópolis, Brazil
| | - Fabio C S Nogueira
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Proteomics, LADETEC, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joseane B Carvalho
- National Laboratory of Scientific Computation, LNCC/MCTI, Petrópolis, Brazil
| | - Letícia Guida
- Fernandes Figueira Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Luis W P Arge
- National Laboratory of Scientific Computation, LNCC/MCTI, Petrópolis, Brazil
| | - Adriana Melo
- Instituto de Pesquisa Professor Amorim Neto, Campina Grande, Paraíba, Brazil
| | | | - Daniela P Cunha
- Fernandes Figueira Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Leonardo Gomes
- Fernandes Figueira Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | - Erika Velasquez
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael D Melani
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Pezzuto
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda L de Castro
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Victor E V Geddes
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandra L Gerber
- National Laboratory of Scientific Computation, LNCC/MCTI, Petrópolis, Brazil
| | - Girlene S Azevedo
- Instituto de Pesquisa Professor Amorim Neto, Campina Grande, Paraíba, Brazil
| | - Bruno L Schamber-Reis
- Faculdade de Ciências Médicas de Campina Grande, Núcleo de Genética Médica, Centro Universitário UniFacisa, Campina Grande, Paraíba, Brazil
| | - Alessandro L Gonçalves
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Milton Y Nishiyama
- Special Laboratory for Applied Toxinology, Butantan Institute, São Paulo, Brazil
| | - Paulo L Ho
- Bacteriology Laboratory, Butantan Institute, São Paulo, Brazil
| | | | - Viviane Schuch
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Amilcar Tanuri
- Departamento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leila Chimelli
- Laboratório de Neuropatologia, Instituto Estadual do Cérebro, Rio de Janeiro, Brazil.
| | | | - Gilberto B Domont
- Proteomics Unit, Department of Biochemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Ana T R Vasconcelos
- National Laboratory of Scientific Computation, LNCC/MCTI, Petrópolis, Brazil.
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
- Scientific Platform Pasteur-USP, São Paulo, Brazil
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Duttine A, Smythe T, Ribiero Calheiro de Sá M, Ferrite S, Zuurmond M, Moreira ME, Collins A, Milner K, Kuper H. Congenital Zika Syndrome-Assessing the Need for a Family Support Programme in Brazil. Int J Environ Res Public Health 2020; 17:ijerph17103559. [PMID: 32438700 PMCID: PMC7277658 DOI: 10.3390/ijerph17103559] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
The Zika outbreak in Brazil caused congenital impairments and developmental delays, or Congenital Zika Syndrome (CZS). We sought to ascertain whether a family support programme was needed and, if so, could be adapted from the Getting to Know Cerebral Palsy programme (GTKCP) designed for children with cerebral palsy (CP). We conducted a systematic review of the needs of families of children with CZS or CP in low- and middle-income countries and reviewed the findings of the Social and Economic Impact of Zika study. We undertook a scoping visit to three facilities offering services to children with CZS in Brazil to understand potential utility and adaptability of GTKCP. The literature review showed that caregivers of children with CZS experience challenges in mental health, healthcare access, and quality of life, consistent with the CP literature. The scoping visits demonstrated that most support provided to families was medically orientated and while informal support networks were established, these lacked structure. Caregivers and practitioners expressed an eagerness for more structure community-based family support programmes. A support programme for families of children with CZS in Brazil appeared relevant and needed, and may fill an important gap in the Zika response.
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Affiliation(s)
- Antony Duttine
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
- Correspondence:
| | - Tracey Smythe
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Míriam Ribiero Calheiro de Sá
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador 40110-902, Brazil;
| | - Maria Zuurmond
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Maria Elisabeth Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Anna Collins
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Kate Milner
- Murdoch Children’s Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia;
| | - Hannah Kuper
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
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Walker CL, Ehinger N, Mason B, Oler E, Little MTE, Ohuma EO, Papageorghiou AT, Nayeri U, Curry C, Adams Waldorf KM. Ultrasound prediction of Zika virus-associated congenital injury using the profile of fetal growth. PLoS One 2020; 15:e0233023. [PMID: 32401826 PMCID: PMC7219748 DOI: 10.1371/journal.pone.0233023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022] Open
Abstract
Zika virus (ZIKV) is a mosquito-transmitted flavivirus, recently linked to microcephaly and central nervous system anomalies following infection in pregnancy. Striking findings of disproportionate growth with a smaller than expected head relative to body length have been observed more commonly among fetuses with exposure to ZIKV in utero compared to pregnancies without ZIKV infection regardless of other signs of congenital infection including microcephaly. This study's objective was to determine the diagnostic accuracy of femur-sparing profile of intrauterine growth restriction for the identification of ZIKV-associated congenital injuries on postnatal testing. A retrospective cohort study of pregnant women with possible or confirmed ZIKV infection between January 1, 2016 and December 31, 2017 were included. Subjects were excluded if no prenatal ultrasound was available. A femur-sparing profile of growth restriction determined using INTERGROWTH-21st sonographic standard for head circumference to femur length (HC: FL). Congenital injuries were determined postnatally by imaging, comprehensive eye exam and standard newborn hearing screen. A total of 111 pregnant women diagnosed with ZIKV infection underwent fetal ultrasound and 95 neonates had complete postnatal evaluation. Prenatal microcephaly was detected in 5% of fetuses (6/111). Postnatal testing detected ZIKV-associated congenital injuries in 25% of neonates (24/95). A HC: FL Z-score ≤ -1.3 had a 52% specificity (95% CI 41-63%), 82% negative predictive value (NPV, 95% CI 73-88%) for the detection of ZIKV-associated congenital injuries in the neonatal period. A more stringent threshold with a Z-score ≤ -2 was associated with a 90% specificity (95% CI 81-95%), 81% NPV (95% CI 77-85%). Excluding cases of fetal microcephaly, HC: FL (Z-score ≤ -2) demonstrated a similar specificity (89%, 95% CI 81-95%) with superior NPV (87%, 95% CI 84-90%). The sonographic recognition of a normally proportioned fetus may be useful prenatally to exclude a wider spectrum of ZIKV-associated congenital injuries detected postnatally.
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Affiliation(s)
- Christie L. Walker
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Noah Ehinger
- Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Brittney Mason
- Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Elizabeth Oler
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | | | - Eric O. Ohuma
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Unzila Nayeri
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Christine Curry
- Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Kristina M. Adams Waldorf
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Sahlgrenska Academy, University of Gothenburg, Gothenburg University, Gothenburg, Sweden
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Ventura LO, Travassos S, Ventura Filho MC, Marinho P, Lawrence L, Wilson ME, Carreiro N, Xavier V, Gois AL, Ventura CV. Congenital Zika Syndrome: Surgical and Visual Outcomes After Surgery for Infantile Strabismus. J Pediatr Ophthalmol Strabismus 2020; 57:169-175. [PMID: 32453850 DOI: 10.3928/01913913-20200331-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/17/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the surgical and functional outcomes in children with congenital Zika syndrome who underwent strabismus surgery. METHODS This prospective case series included children with congenital Zika syndrome who presented with horizontal infantile strabismus and underwent strabismus surgery. Ocular motility and visual fields were assessed preoperatively and postoperatively. Visual fields were considered normal if they exceeded 70 degrees in the temporal meridian. Postoperatively, parents and caregivers answered a questionnaire that assessed their child's behavioral improvements. A final ocular alignment within ±10 prism diopters (PD) and expansion of the visual fields were considered satisfactory motor surgical results at 6 months postoperatively. RESULTS Five children (3 girls [60%]) with congenital Zika syndrome (age: 36.4 ± 0.9 months) were included in this study. All children (100%) presented with moderate to severe visual impairment and 4 (80%) presented with funduscopic abnormalities. Preoperatively, 4 children (80%) had infantile esotropia (mean preoperative angle of deviation: 41.3 ± 6.3 PD) and 1 (20%) had infantile exotropia measuring 65 PD. The postoperative outcomes demonstrated ocular alignment in 4 children (80%) at the 6-month follow-up visit. Expansion of the temporal visual field was observed in 7 eyes (70%) of 4 children (80%). Four caregivers (80%) reported behavioral improvement in daily activities, and all caregivers (100%) reported improved peripheral target detection and socialization skills. CONCLUSIONS Strabismus surgery can be an effective procedure for treating horizontal strabismus in children with congenital Zika syndrome because it can improve ocular alignment, expand the visual field, and improve the child's social, functional, and behavioral skills. [J Pediatr Ophthalmol Strabismus. 2020;57(3):169-175.].
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45
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Wheeler AC, Toth D, Ridenour T, Lima Nóbrega L, Borba Firmino R, Marques da Silva C, Carvalho P, Marques D, Okoniewski K, Ventura LO, Bailey DB, Ventura CV. Developmental Outcomes Among Young Children With Congenital Zika Syndrome in Brazil. JAMA Netw Open 2020; 3:e204096. [PMID: 32369180 PMCID: PMC7201309 DOI: 10.1001/jamanetworkopen.2020.4096] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Although birth defects in children with congenital Zika syndrome (CZS) are expected to result in significant intellectual disabilities, the extent of delay and profiles of development have yet to be fully described. OBJECTIVES To describe the neurodevelopmental profiles of children with CZS and to test whether prenatal and postpartum characteristics were associated with the severity of developmental delays. DESIGN, SETTING, AND PARTICIPANTS This is a case series of the trajectories of developmental, behavioral, and medical needs of 121 young children with CZS who were assessed at a specialized rehabilitation center in Recife, Brazil, beginning in January 2018 as part of 5-year longitudinal study. Children were included if they had serologic confirmation of Zika virus and met clinical criteria accompanied by parental report of suspected exposure to Zika virus during pregnancy. EXPOSURES Prenatal Zika virus exposure. MAIN OUTCOMES AND MEASURES The Brazilian version of the Bayley Scales of Infant and Toddler Development, Third Edition, was administered by trained assessors as part of an initial comprehensive assessment battery. Caregiver interviews and medical record reviews were conducted to gather basic demographic information and medical comorbidities. Linear regression was used to identify potential factors for development. RESULTS The sample included 121 young children (mean [SD] age, 31.2 [1.9] months; 61 [50.4%] girls). At age approximately 2.5 years, nearly all children in this sample demonstrated profound developmental delays across all domains of functioning, with a mean (SD) developmental age equivalent to approximately 2 to 4 months (eg, cognitive domain, 2.24 [3.09] months; fine motor subscale, 2.15 [2.93] months; expressive language subscale, 2.30 [2.52] months). A relative strength was found in receptive language, with scores on this scale significantly higher than most other domains (eg, cognition: t = 3.73; P < .001; fine motor: t = 6.99; P < .001). Head circumference at birth was the single strongest factor associated with outcomes across all developmental domains (eg, cognitive: β = 1.41; SE, 0.67; P = .04; fine motor: β = 1.36; SE, 0.49; P = .007). CONCLUSIONS AND RELEVANCE The findings of this study provide important information regarding the severity of disability that these children and their families will experience. The findings also establish an initial point from which to monitor developmental trajectories, medical comorbidities (eg, seizures), effectiveness of interventions, and cumulative consequences on families.
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Affiliation(s)
- Anne C. Wheeler
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Danielle Toth
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Ty Ridenour
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Lucélia Lima Nóbrega
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Raíne Borba Firmino
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | | | - Pollyanna Carvalho
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Douglas Marques
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Katherine Okoniewski
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Liana O. Ventura
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
| | - Donald B. Bailey
- Center for Newborn Screening, Ethics, and Disability Studies, Research Triangle Institute International, Research Triangle Park, North Carolina
| | - Camila V. Ventura
- Rehabilitation Center Menina dos Olhos, Altino Ventura Foundation, Recife, Brazil
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Tsui I, Neves LM, Adachi K, Gaw SL, Pereira JP, Brasil P, Nielsen-Saines K, Moreira MEL, Zin AA. Overlapping Spectrum of Retinochoroidal Scarring in Congenital Zika Virus and Toxoplasmosis Infections. Ophthalmic Surg Lasers Imaging Retina 2020; 50:779-784. [PMID: 31877223 DOI: 10.3928/23258160-20191119-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Antenatal Zika virus (ZIKV) or toxoplasmosis infections may present with isolated eye abnormalities with absence of other apparent birth defects. The purpose of this article is to discuss the overlapping spectrum of clinical presentation and retinochoroidal scarring in congenital ZIKV and toxoplasmosis infections. PATIENTS AND METHODS Prenatal ultrasound abnormalities seen from antenatal ZIKV and toxoplasmosis infections overlap and may include intracranial calcifications, microcephaly, and intrauterine growth restriction. The clinical spectrum of both infections in less severely affected infants and children may include nonspecific neurological impairment such as developmental delay and seizures. RESULTS Inherent limitations in serological testing pose additional barriers in establishing a diagnosis. Retinal pigment epithelium (RPE) mottling in ZIKV infection can occur in isolation or adjacent to retinochoroidal atrophy. In contrast, RPE mottling outside of the borders of retinochoroidal atrophy is not typically seen in toxoplasmosis. To date, postnatal reactivation of congenital eye lesions as seen in toxoplasmosis have not been reported with ZIKV infection. CONCLUSIONS As children infected with congenital ZIKV grow older, subclinical eye abnormalities may be indistinguishable from toxoplasmosis. Brazil has had high prevalence of both diseases with long-term information available on toxoplasmosis only. Surveillance guidelines for asymptomatic eye abnormalities will likely evolve. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:779-784.].
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Radaelli G, Lahorgue Nunes M, Bernardi Soder R, de Oliveira JM, Thays Konat Bruzzo F, Kalil Neto F, Leal-Conceição E, Wetters Portuguez M, Costa da Costa J. Review of neuroimaging findings in congenital Zika virus syndrome and its relation to the time of infection. Neuroradiol J 2020; 33:152-157. [PMID: 31896285 PMCID: PMC7140307 DOI: 10.1177/1971400919896264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many original articles and case series have been published emphasizing the neuroimaging findings of congenital Zika virus (ZIKV) infection. The majority of these studies do not follow a neuroradiological methodology to describe malformations and brain abnormalities resulting from ZIKV infection. The cause-and-effect correlation between the gestational period of maternal infection and the severity of encephalic changes at birth has rarely been reported. A systematic literature review was conducted on the neuroimaging findings in children affected with microcephaly due to ZIKV. METHODS PubMed, Cochrane Library and Web of Science were searched for full-text articles published up to July 2019. Duplicate entries were removed. Two independent reviewers performed a quality assessment of all the studies included. RESULTS A total of 2214 publications were identified. Of these 2170 were excluded by analysis of titles and abstracts, resulting in the inclusion of only eight articles. Chi-square and Fisher's exact tests were performed with a 95% confidence interval to verify the statistically significant differences in the neuroradiological findings between the cases of ZIKV infection in the first or second trimester of gestation. The studies published so far have described image abnormalities at random, without utilizing any pre-established neuroradiological criteria, and imaging modalities with different sensitivity and accuracy have been used, which jeopardizes a reliable and adequate statistical analysis. CONCLUSIONS Neuroimaging abnormalities are much more prevalent and severe when the infection by ZIKV is contracted in the first or second trimester of pregnancy.
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Affiliation(s)
- Graciane Radaelli
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Magda Lahorgue Nunes
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
- CNPq, Brazil
- School of Medicine, Pontifical Catholic
University of Rio Grande do Sul, Brazil
| | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
- School of Medicine, Pontifical Catholic
University of Rio Grande do Sul, Brazil
| | - Júlia Monteiro de Oliveira
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
| | | | - Felipe Kalil Neto
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Eduardo Leal-Conceição
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - Mirna Wetters Portuguez
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
- School of Medicine, Pontifical Catholic
University of Rio Grande do Sul, Brazil
| | - Jaderson Costa da Costa
- Brain Institute of Rio Grande do Sul
(BraIns), Pontifical Catholic University of Rio Grande do Sul, Brazil
- CNPq, Brazil
- School of Medicine, Pontifical Catholic
University of Rio Grande do Sul, Brazil
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Barros Faiçal AV, de Oliveira JMGC, Andrade NC, Lucena R, Acosta AX, de Siqueira IC. Socioemotional Status of Children With Uterine Exposure to the Zika Virus. Pediatr Neurol 2020; 103:86-88. [PMID: 31735568 DOI: 10.1016/j.pediatrneurol.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Nara C Andrade
- Departamento de Psicologia, Universidade Católica de Salvador, Salvador, BA, Brazil
| | - Rita Lucena
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
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49
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Barbeito-Andrés J, Pezzuto P, Higa LM, Dias AA, Vasconcelos JM, Santos TMP, Ferreira JCCG, Ferreira RO, Dutra FF, Rossi AD, Barbosa RV, Amorim CKN, De Souza MPC, Chimelli L, Aguiar RS, Gonzalez PN, Lara FA, Castro MC, Molnár Z, Lopes RT, Bozza MT, Vianez JLSG, Barbeito CG, Cuervo P, Bellio M, Tanuri A, Garcez PP. Congenital Zika syndrome is associated with maternal protein malnutrition. Sci Adv 2020; 6:eaaw6284. [PMID: 31950075 PMCID: PMC6954064 DOI: 10.1126/sciadv.aaw6284] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/22/2019] [Indexed: 05/09/2023]
Abstract
Zika virus (ZIKV) infection during pregnancy is associated with a spectrum of developmental impairments known as congenital Zika syndrome (CZS). The prevalence of this syndrome varies across ZIKV endemic regions, suggesting that its occurrence could depend on cofactors. Here, we evaluate the relevance of protein malnutrition for the emergence of CZS. Epidemiological data from the ZIKV outbreak in the Americas suggest a relationship between undernutrition and cases of microcephaly. To experimentally examine this relationship, we use immunocompetent pregnant mice, which were subjected to protein malnutrition and infected with a Brazilian ZIKV strain. We found that the combination of protein restriction and ZIKV infection leads to severe alterations of placental structure and embryonic body growth, with offspring displaying a reduction in neurogenesis and postnatal brain size. RNA-seq analysis reveals gene expression deregulation required for brain development in infected low-protein progeny. These results suggest that maternal protein malnutrition increases susceptibility to CZS.
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Affiliation(s)
- J. Barbeito-Andrés
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute for Studies in Neuroscience and Complex Systems (ENyS) CONICET, Buenos Aires, Argentina
| | - P. Pezzuto
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L. M. Higa
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. A. Dias
- Microbiology Institute Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J. M. Vasconcelos
- Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - T. M. P. Santos
- Nuclear Instrumentation Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J. C. C. G. Ferreira
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R. O. Ferreira
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - F. F. Dutra
- Microbiology Institute Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. D. Rossi
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R. V. Barbosa
- CENABIO (National Center of Structural Biology and Bioimaging), Rio de Janeiro, Brazil
| | - C. K. N. Amorim
- Technological Innovations Centre, Evandro Chagas Institute, Ananindeua, Brazil
| | - M. P. C. De Souza
- Technological Innovations Centre, Evandro Chagas Institute, Ananindeua, Brazil
| | - L. Chimelli
- State Institute of Brain Paulo Niemeyer, Rio de Janeiro, Brazil
| | - R. S. Aguiar
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - P. N. Gonzalez
- Institute for Studies in Neuroscience and Complex Systems (ENyS) CONICET, Buenos Aires, Argentina
| | - F. A. Lara
- Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - M. C. Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Z. Molnár
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - R. T. Lopes
- Nuclear Instrumentation Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M. T. Bozza
- Microbiology Institute Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J. L. S. G. Vianez
- Technological Innovations Centre, Evandro Chagas Institute, Ananindeua, Brazil
| | - C. G. Barbeito
- Faculty of Veterinary Sciences, National University of La Plata, Buenos Aires, Argentina
| | - P. Cuervo
- Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - M. Bellio
- Microbiology Institute Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A. Tanuri
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - P. P. Garcez
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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50
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Pando-Cifuentes A, Cortés-González V, Berrones-Medina D, Villanueva-Mendoza C. [Extension of TORCH spectrum in ophthalmology: congenital Zika, case report]. Rev Med Inst Mex Seguro Soc 2019; 57:395-399. [PMID: 33001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Zika is a flavivirus that can be transmitted transplacentally. Eye abnormalities have been reported in 70% of Zika cases, and 41.7% of them can occur in the absence of microcephaly. The most common ocular abnormalities are macular atrophy, optic atrophy and chorioretinal coloboma. The objective was to report the case of eye disorders associated with Zika, acquired transplacentally, despite negative results for TORCH, and serology and PCR analyses for Zika. CLINICAL CASE 9-month-old female patient, born in Chiapas, Mexico, brought to an ophthalmologic evaluation because she did not follow objects. As family background patient's mother had Zika, confirmed serologically at 9 weeks gestation. Physical examination revealed microcephaly, redundant skin on neck, joint stiffness and delayed psychomotor development. Ophthalmological examination revealed in right eye atrophy of the optic nerve, and left eye with exotropia, macular scar and optic nerve aplasia. TORCH profile and serology and PCR for Zika were negative. CONCLUSIONS Despite the negative serology for Zika, given the history of pregnancy and the pre and post-natal clinical manifestations, diagnosis of embryopathy secondary to Zika infection with optic nerve aplasia, chorioretinal atrophy, macular scar, microcephaly and global neurodevelopmental delay was made.
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Affiliation(s)
| | | | - David Berrones-Medina
- Asociación para Evitar la Ceguera en México, Servicio de Retina, Ciudad de México, México
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