Screening Criteria for Ophthalmic Manifestations of Congenital Zika Virus Infection

Screening Criteria for Ophthalmic Manifestations of Congenital Zika Virus Infection

Author Zin, Andrea A. Google Scholar
Tsui, Irena Google Scholar
Rossetto, Julia Autor UNIFESP Google Scholar
Vasconcelos, Zilton Google Scholar
Adachi, Kristina Google Scholar
Valderramos, Stephanie Google Scholar
Halai, Umme-Aiman Google Scholar
da Silva Pone, Marcos Vinicius Google Scholar
Pone, Sheila Moura Google Scholar
Barros Silveira Filho, Joel Carlos Google Scholar
Aibe, Mitsue S. Google Scholar
da Costa, Ana Carolina C. Google Scholar
Zin, Olivia A. Google Scholar
Belfort, Rubens, Jr. Autor UNIFESP Google Scholar
Brasil, Patricia Google Scholar
Nielsen-Saines, Karin Google Scholar
Lopes Moreira, Maria Elisabeth Google Scholar
Abstract IMPORTANCE Current guidelines recommend screening eye examinations for infants with microcephaly or laboratory-confirmed Zika virus infection but not for all infants potentially exposed to Zika virus in utero. OBJECTIVE To evaluate eye findings in a cohort of infants whose mothers had polymerase chain reaction-confirmed Zika virus infection during pregnancy. DESIGN, SETTING, AND PARTICIPANTS In this descriptive case series performed from January 2 through October 30, 2016, infants were examined from birth to 1 year of age by a multidisciplinary medical team, including a pediatric ophthalmologist, from Fernandes Figueira Institute, a Ministry of Health referral center for high-risk pregnancies and infectious diseases in children in Rio de Janeiro, Brazil. PARTICIPANTS Mother-infant pairs from Rio de Janeiro, Brazil, who presented with suspected Zika virus infection during pregnancy were referred to our institution and had serum, urine, amniotic fluid, or placenta samples tested by real-time polymerase chain reaction for Zika virus. MAIN OUTCOMES AND MEASURES Description of eye findings, presence of microcephaly or other central nervous system abnormalities, and timing of infection in infants with confirmed Zika virus during pregnancy. Eye abnormalities were correlated with central nervous system findings, microcephaly, and the timing of maternal infection. RESULTS Of the 112 with polymerase chain reaction-confirmed Zika virus infection in maternal specimens, 24 infants (21.4%) examined had eye abnormalities (median age at first eye examination, 31 days

range, 0-305 days). Ten infants (41.7%) with eye abnormalities did not have microcephaly, and 8 (33.3%) did not have any central nervous system findings. Fourteen infants with eye abnormalities (58.3%) were born to women infected in the first trimester, 8 (33.3%) in the second trimester, and 2 (8.3%) in the third trimester. Optic nerve and retinal abnormalities were the most frequent findings. Eye abnormalities were statistically associated with microcephaly (odds ratio [OR], 19.1

95% CI, 6.0-61.0), other central nervous system abnormalities (OR, 4.3

95% CI, 1.6-11.2), arthrogryposis (OR, 29.0

95% CI, 3.3-255.8), and maternal trimester of infection (first trimester OR, 5.1

95% CI, 1.9-13.2

second trimester OR, 0.5

95% CI, 0.2-1.2

and third trimester OR, 0.3

95% CI, 0.1-1.2). CONCLUSIONS AND RELEVANCE Eye abnormalitiesmay be the only initial finding in congenital Zika virus infection. All infants with potential maternal Zika virus exposure at any time during pregnancy should undergo screening eye examinations regardless of the presence or absence of central nervous system abnormalities.
Language English
Sponsor Brazilian National Council for Scientific and Technological Development (CNPq)
National Institute of Allergy and Infectious Diseases (NIAID )
National Eye Institute (NEI)
Research to Prevent Blindness grant
Thrasher Research Fund
Grant number CNPq: 441098/2016-9
NEI: R21EY028318-01
Thrasher Research Fund: 20164370
Date 2017
Published in Jama Pediatrics. Chicago, v. 171, n. 9, p. 847-854, 2017.
ISSN 2168-6203 (Sherpa/Romeo, impact factor)
Publisher Amer Medical Assoc
Extent 847-854
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000410140700011

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