Description of atypical pattern in twins with presumed congenital Zika and without microcephaly - Case Report

Authors

  • Ana Carolina Peixoto e Lucena Fontes English
  • Italla Maria Pinheiro Bezerra English
  • Luiz Carlos de Abreu English

DOI:

https://doi.org/10.7322/jhgd.152196

Keywords:

pregnancy, Zika virus, ophthalmology, vision disorders

Abstract

Introduction: Zika virus (ZIKV) infection was a public health emergency of Brazilian national interest until May 2017, due to the sudden increase in newborns with microcephaly and other neurological alterations during the epidemic started in Brazil in November 2015. The manifestations of Intrauterine infections by ZIKV are more severe when they occur in the first and second trimesters of gestation, especially in the first trimester. In this situation, early diagnosis of visual problems is essential for patients to progress in the neurological and motor fields, and there are complications such as refractive errors (myopia, astigmatism and hyperopia), strabismus and hypoactomy. The absence of microcephaly in infants exposed to the zika virus is not indicative of changes in ophthalmology, and it is essential that the ophthalmologist perform the investigations that are relevant to the clinical case. Any and all eye lesions and their consequences are serious. The earlier the diagnosis, the sooner the child can undergo an intervention to enable vision. Objective: To analyze atypical pattern in twins with presumed congenital zika and without microcephaly.

Methods: This is a case report, developed in the city of Serra Talhada, in the state of Pernambuco, Northeast Brazil.

Report: Case of twins whose mother was exposed to zika virus in the second trimester of gestation (eleventh week). The children were born prematurely and without microcephaly. One of the twins had hydrocephalus requiring surgery. The same child was taken for ophthalmologic examination because of convergent strabismus; and hypocortical optic nerve and chorioretinal scar were found in the macular region in both eyes similar to the lesions described by zika virus. A similar scenario, but with less visual impairment was identified in the second twin. Skull tomography demonstrated bilateral calcification foci in the cerebral hemispheres.

Conclusion: There was presence of convergent deviation and nystagmus to lateroversions. In the funduscopy, the optic nerve was pale and with cicatricial chorioretinal lesion with well delimited edges in the macular area of both eyes.

Author Biographies

  • Ana Carolina Peixoto e Lucena Fontes, English

     Laboratório de Delineamento de Estudos e Escrita Científica

  • Italla Maria Pinheiro Bezerra, English

     Laboratório de Delineamento de Estudos e Escrita Científica

  • Luiz Carlos de Abreu, English

     Laboratório de Delineamento de Estudos e Escrita Científica

References

1. MacNamara FN. Zika virus: a report on three cases of human infection during na epidemic of jaundice in Nigeria. Trans R Soc Trop Med Hyg. 1954;48(2):139-45. DOI: https://dx.doi.org/10.1016/0035-9203(54)90006-1

2. Fagbami AH. Zika virus infections in Nigeria: virological and seroepidemiological investigations in Oyo State. J Hyg (Lond). 1979;83(2):213-9.

3. Olson JG, Ksiazek TG, Suhandiman, Triwibowo. Zika virus, a cause of fever in Central Java, Indonesia. Trans R Soc Trop Med Hyg. 1981;75(3):389-93. DOI: https://dx.doi.org/10.1016/0035-9203(81)90100-0

4. Simpson DIH. Zika virus infection in man. Trans R Soc Trop Med Hyg.1964;58(4):335-8. DOI: https://dx.doi.org/10.1016/0035-9203(64)90200-7

5. Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika virus. N Engl J Med. 2016;374:1552-63. DOI: https://dx.doi.org/10.1056/NEJMra1602113

6. Cardoso CW, Paploski IA, Kikuti M, Rodrigues MS, Silva MM, Campos GS, et al. Outbreak of Exanthematous Illness Associated with Zika, Chikungunya, and Dengue Viruses, Salvador, Brazil. Emerg Infect Dis. 2015;21(12):2274-6. DOI: https://dx.doi.org/10.3201/eid2112.151167

7. Centers of Disease Control and Prevention (CDC). Symptons, diagnosis & treatment. [cited 2018 Jan 28] Available from: https://www.cdc.gov/zika/symptoms/index.html.

8. Chan JF, Choi GK, Yip CC, Cheng VC, Yuen KY. Zika fever and congenital Zika syndrome: An unexpected emerging arboviral disease. J Infect. 2016;72(5):507-24. DOI: https://dx.doi.org/10.1016/j.jinf.2016.02.011

9. Chouin-Carneiro T, Vega-Rua A, Vazeille M, Yebakima A, Girod R, Goindin D, et al. Differential Susceptibilities of Aedes aegypti and Aedes albopictus from the Americas to Zika Virus. PLoS Negl Trop Dis. 2016;10(3):e0004543. DOI: https://dx.doi.org/10.1371/journal.pntd.0004543

10. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009;360(24):2536-43. DOI: https://dx.doi.org/10.1056/NEJMoa0805715

11. Brasil P, Pereira Jr JP, Moreira ME, Nogueira RMR, Damasceno L, Wakimoto M, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro. N Engl J Med. 2016;375(24):2321-34. DOI: https://dx.doi.org/10.1056/NEJMoa1602412

12. Gulland A. Men and women should practise safe sex for six months to avoid Zika, says WHO. BMJ. 2016;354:i4897. DOI: https://dx.doi.org/10.1136/bmj.i4897

13. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis. 2015;21(2):359-61. DOI: https://dx.doi.org/10.3201/eid2102.141363

14. Oster AM, Brooks JT, Stryker JE, Kachur RE, Mead P, Pesik NT, et al. Interim guidelines for prevention of sexual transmission of Zika virus-United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(5):120-1. DOI: http://dx.doi.org/10.15585/mmwr.mm6505e1

15. Mansuy JM, Dutertre M, Mengelle C, Fourcade C, Marchou B, Delobel P, et al. Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen? Lancet Infect Dis. 2016;16(4):405. DOI: https://dx.doi.org/10.1016/S1473-3099(16)00138-9

16. Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill. 2014;19(14):20761.

17. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill. 2014;19(13):20751.

18. Zanluca C, Melo VC, Mosimann AL, Santos GI, Santos CN, Luz K. First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz. 2015;110(4):569-72. DOI: https://dx.doi.org/10.1590/0074-02760150192

19. Campos GS, Bandeira AC, Sardi SI. Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis. 2015;21(10):1885-6. DOI: https://dx.doi.org/10.3201/eid2110.150847

20. Dick GWA, Kitchen SF, Haddow AJ. Zika virus (I). Isolations and serological specificity. Trans R Soc Trop Med Hyg. 1952;46(5):509-20. DOI: https://dx.doi.org/10.1016/0035-9203(52)90042-4

21. Darko R, Mashburn JL. Zika Virus Disease: case report and review of literature. Pediatr Emerg Care. 2016;32(10):705-9. DOI: https://dx.doi.org/10.1097/PEC.0000000000000932

22. Musso D. Zika Virus Transmission from French Polynesia to Brazil. Emerg Infect Dis. 2015;21(10):1887. DOI: https://dx.doi.org/10.3201/eid2110.151125

23. Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DD, Cavalcanti DP, Pessoa A, et al. Possible Association Between Zika Virus Infection and Microcephaly-Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(3):59-62. DOI: https://dx.doi.org/10.15585/mmwr.mm6503e2

24. European Centre for Disease Prevention and Control (ECDPC). Microcephaly in Brazil potentially linked to the Zika virus epidemic. [cited 2016 Jan 26] Available from: http://ecdc.europa.eu/en/publications/Publications/zika-microcephaly-Brazil-rapid-risk-assessment-Nov-2015.pdf.

25. Centers for Disease Control and Prevention (CDC). Concludes Zika causes Microcephaly and Other Birth Defects. [cited 2018 Jan 31] Available from: http://www.cdc.gov/media/releases/2016/s0413-zikamicrocephaly.
html

26. World Health Organization (WHO). Zika Virus, microcephaly, and Guillain Barré Syndrome. World Health Organization, 2016.

27. Santos JLG, Lima MVM, Leitão FNC, Costa VDE, Macedo Jr H, Muniz PT. Zika virus and measures of legal interventions in public health. J Hum Growth Dev. 2016;26(3):393-7. DOI: http://dx.doi.org/10.7322/jhgd.122919

28. Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, et al. Zika virus associated with microcephaly. N Engl J Med. 2016;374(10):951-8. DOI: http://dx.doi.org/10.1056/NEJMoa1600651

29. Miranda-Filho DB, Martelli CM, Ximenes RA, Araújo TV, Rocha MA, Ramos RC, et al. Initial description of the presumed congenital Zika Syndrome. Am J Public Health. 2016;106(4):598-600. DOI: http://dx.doi.org/10.2105/AJPH.2016.303115

30. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus and birth defects-reviewing the evidence for causality. N Engl J Med. 2016;374(20):1981-7. DOI: http://dx.doi.org/10.1056/NEJMsr1604338

31. Ventura CV, Maia M, Dias N, Ventura LO, Belfort Jr R. Zika: neurological and ocular findings in infant without microcephaly. Lancet. 2016; 387(10037):2502. DOI: https://dx.doi.org/10.1016/S0140-6736(16)30776-0

32. França GVA, Schuler-Faccini L, Oliveira WK, Henriques CM, Carmo EH, Pedi VD, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016;388(10047):891-7. DOI: https://dx.doi.org/10.1016/S0140-6736(16)30902-3

33. van der Linden V, Pessoa A, Dobyns W, Barkovich AJ, Linden Júnior H, Rolim Filho EL, et al. Description of 13 Infants Born During October 2015-January 2016 With Congenital Zika Vírus Infection Without Microcephaly at Birth- Brazil. MMWR Morb Mortal Wkly Rep. 2016;65(47):1343-8. DOI: http://dx.doi.org/10.15585/mmwr.mm6547e2

34. Zin AA, Tsui I, Rossetto J, Vasconcelos Z, Adachi K, Valderramos S, et al. Screening Criteria for Ophthalmic Manifestations of Congenital Zika Virus Infection. JAMA Pediatr. 2017;171(9):847-54. DOI: http://dx.doi.org/10.1001/jamapediatrics.2017.1474

35. Levine D, Jani JC, Castro-Aragon I, Cannie M. How Does imaging of congenital Zika compare with imaging of other TORCH infections? Radiology. 2017;285(3):744-61. DOI: http://dx.doi.org/10.1148/radiol.2017171238

36. Moore CA, Staples JE, Dobyns WB, Pessoa A, Ventura CV, Fonseca EB, et al. Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians. JAMA Pediatr. 2017;171(3):288-95. DOI: http://dx.doi.org/10.1001/jamapediatrics.2016.3982

37. Ventura CV, Maia M, Bravo-Filho V, Góis AL, Belfort Jr R. Zika virus in Brazil and macular atrophy in a child with microcephaly. Lancet. 2016;387(10015):228. DOI: https://doi.org/10.1016/S0140-6736(16)00006-4

38. Freitas BP, Dias JRO, Prazeres J, Sacramento GA, Ko AI, Maia M, et al. Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol. 2016. DOI: https://doi.org/10.1001/jamaophthalmol.2016.0267

39. Ventura CV, Maia M, Ventura BV, van der Linden V, Araújo EB, Ramos RC, et al. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol. 2016;79(1):1-3. DOI: http://dx.doi.org/10.5935/0004-2749.20160002

40. Yepez JB, Murati FA, Pettito M, Peñaranda CF, Yepez J, Maestre G, et al. Ophthalmic manifestations of congenital Zika Syndrome in Colombia and Venezuela. JAMA Ophthalmol. 2017;135(5):440-5. DOI: http://dx.doi.org/10.1001/jamaophthalmol.2017.0561

41. Jin HD, Demmler-Harrison GJ, Coats DK, Paysse EA, Bhatt A, Edmond JC, et al. Long-term visual and ocular sequelae in patients with congenital cytomegalovirus infection. Pediatr Infect Dis J. 2017;36(9):877-82. DOI: http://dx.doi.org/10.1097/INF.0000000000001599

42. Maenz M, Schlüter D, Liesenfeld O, Schares G, Gross U, Pleyer U. Ocular toxoplasmosis past, present and new aspects of an old disease. Prog Retin Eye Res. 2014;39:77-106. DOI: http://dx.doi.org/10.1016/j.preteyeres.2013.12.005

43. Linden VV, Linden Junior HV, Leal MC, Rolim Filho EL, Linden AV, Aragão MFVV, et al. Discordant clinical outcomes of congenital Zika virus infection in twin pregnancies. Arq Neuropsiquiatr. 2017;75(6):381-6. DOI: http://dx.doi.org/10.1590/0004-282X20170066

44. Alves LV, Cruz DDCS, van der Linden AMC, Falbo AR, Mello MJG, Paredes CE, et al. Epileptic seizures in children with congenital Zika virus Syndrome. Rev Bras Saude Mater Infant. 2016;16(Suppl 1):S27-31. DOI: http://dx.doi.org/10.1590/1806-9304201600s100003

45. Jucá E, Pessoa A, Ribeiro E, Menezes R, Kerbage S, Lopes T, et al. Hydrocephalus associated to congenital Zika Syndrome: does shunting improve clinical features? Childs Nerv Syst. 2018;34(1):101-6. DOI: http://dx.doi.org/10.1007/s00381-017-3636-2

46. Oliveira-Szejnfeld PS, Levine D, Melo AS, Amorim MM, Batista AG, Chimelli L, et al. Congenital brain abnormalities and Zika Virus: what the radiologist can expect to see prenatally and postnatally. Radiology. 2016;281(1):203-18. DOI: https://dx.doi.org/10.1148/radiol.2016161584

47. Prata ARS, Pedroso D, Menezes G, Drezett J, Torres JHR, Bomfim JRA, et al. Juridical perspectives of interruption of pregnancy with zika virus infection regarding medical, emotional and social consequences. J Hum Growth Dev. 2018;28(1):77-81. DOI: https://doi.org/10.7322/jhgd.143875

48. Machado LDS, Ramos JLS, Machado MFAS, Antão JYFL, Santos SB, Bezerra IMP, et al. Participatory process of health promotion at school. J Hum Growth Dev. 2015;25(3):357-63. DOI: http://dx.doi.org/10.7322/jhgd.106014

49. Bezerra HMC, Machado MFAS, Antão JYFL, Mello CMB, Abreu LC, Garcia TTB, et al. Community health agent and the interface with the educational actions. Int Arch Med. 2015;8(153):1-10. DOI: http://dx.doi.org/10.3823/1752

50. Bezerra IMP, Sorpreso ICE. Concepts and movements in health promotion to guide educational practices. J Hum Growth Dev. 2016;26:(1):11-20. DOI: https://doi.org/10.7322/jhgd.113709

51. Schram PCF. Zika virus and public health. J Hum Growth Dev. 2016;26(1): 7-8. DOI: http://dx.doi.org/10.7322/jhgd.114415

52. Caires-Junior LC, Goulart E, Melo US, Araujo BHS, Alvizi L, Soares-Schanoski A, et al. Discordant congenital Zyka syndrome twins show differential in vitro viral susceptibility of neural progenitor cells. Nature Communications. 2018;475(9):1-11. DOI: http://dx.doi.org/10.1038/s41467-017-02790-9

53. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Protocolo de vigilância e resposta à ocorrência de microcefalia e/ou alterações do sistema nervoso central (SNC). Brasília: Ministério da Saúde, 2016.

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2018-11-28

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Vol. 28 No. 3 (2018)

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