#Clinical and x-ray #oral #evaluation in patients with #congenital #Zika Virus (J Appl Oral Sci., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Appl Oral Sci. 2019 May 20;27:e20180276. doi: 10.1590/1678-7757-2018-0276.

Clinical and x-ray oral evaluation in patients with congenital Zika Virus.

Carvalho IF1, Alencar PNB1, Carvalho de Andrade MD1, Silva PGB1, Carvalho EDF1, Araújo LS1, Cavalcante MPM1, Sousa FB1.

Author information: 1 Centro Universitário Christus, Departamento de Odontologia, Fortaleza, Ceará, Brasil.




The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation.


Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student’s t-test and nominal logistic regression were used (p<0.05).


Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010).


The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums.

PMID: 31116278 DOI: 10.1590/1678-7757-2018-0276

Keywords: Zika Virus; Zika Congenital Syndrome; Brazil.



The #challenge of the #laboratory #diagnosis in a confirmed #congenital #Zika virus #syndrome in #utero: A case report (Medicine (Baltimore), abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Medicine (Baltimore). 2019 May;98(20):e15532. doi: 10.1097/MD.0000000000015532.

The challenge of the laboratory diagnosis in a confirmed congenital Zika virus syndrome in utero: A case report.

Sulleiro E1,2, Frick MA1,2, Rodó C1,2, Espasa M1, Thorne C2,3, Espiau M1,2, Martín-Nalda A1,2, Suy A1,2, Giaquinto C2,4, Melendo S1, Rando A1, Alarcón A2,5, Martinón-Torres F2,6, Pumarola T1, Soler-Palacín P1, Soriano-Arandes A1,2.

Author information: 1 Hospital Universitari Vall d’Hebron, Barcelona, Spain. 2 ZIKAction Consortium, European Union’s Horizon 2020 Research and Innovation Programme under Grant Agreement No 734857. 3 University College London, London, United Kingdom. 4 University of Padova, PENTA Foundation, Padova, Italy. 5 Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. 6 Hospital Clínico Universitario, Santiago de Compostela, Spain.




Zika virus (ZIKV) has caused one of the most challenging global infectious epidemics in recent years because of its causal association with severe microcephaly and other congenital malformations. The diagnosis of viral infections usually relies on the detection of virus proteins or genetic material in clinical samples as well as on the infected host immune responses. Serial serologic testing is required for the diagnosis of congenital infection when diagnostic molecular biology is not possible.


A 2-year-old girl, born to a mother with confirmed ZIKV infection during pregnancy, with a confirmed ZIKV infection in utero, showed at birth a severe microcephaly and clinical characteristics of fetal brain disruption sequence compatible with a congenital ZIKV syndrome (CZS).


ZIKV-RNA and ZIKV-IgM serological response performed at birth and during the follow-up time tested always negative. Serial serologic ZIKV-IgG tests were performed to assess the laboratory ZIKV diagnosis, ZIKV-IgG seroreversion was observed at 21 months of age. ZIKV diagnosis of this baby had to be relied on her clinical and radiological characteristics that were compatible with a CZS.


The patient was followed-up as per protocol at approximately 1, 4, 9, 12, 18-21, and 24 months of age. Neurological, radiological, audiological, and ophthalmological assessment were performed during this period of time. Prompt rehabilitation was initiated to prevent potential adverse long-term neurological outcomes.


The growth of this girl showed a great restriction at 24 months of age with a weight of 8.5 kg (-2.5 z-score) and a head circumference of 40.5 cm (-4.8 z-score). She also had a great neurodevelopmental delay at the time of this report.


We presume that as a consequence of prenatal ZIKV infection, the fetal brain and other organs are damaged before birth through direct injury. Following this, active infection ends during intrauterine life, and as a consequence the immune system of the infant is unable to build up a consistent immune response thereafter. Further understanding of the mechanisms taking part in the pathogenesis of ZIKV congenital infection is needed. This finding might change our paradigm regarding serological response in the ZIKV congenital infection.

PMID: 31096455 DOI: 10.1097/MD.0000000000015532

Keywords: Zika Virus; Zika Congenital Syndrome; Microcephaly; Serology.


#Zika virus #outbreak in 19 #English- and #Dutch-speaking #Caribbean #countries and territories, 2015-2016 (Rev Panam Salud Publica, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Rev Panam Salud Publica. 2018 Sep 7;42:e120. doi: 10.26633/RPSP.2018.120. eCollection 2018.

Zika virus outbreak in 19 English- and Dutch-speaking Caribbean countries and territories, 2015-2016.

Francis L1, Hunte SA2, Valadere AM3, Polson-Edwards K1, Asin-Oostburg V1, Hospedales CJ1.

Author information: 1 Division of Surveillance, Disease Prevention and Control, Communicable Diseases and Emergency Response Department, Caribbean Public Health Agency, Port-of-Spain, Trinidad. 2 Division of Policy, Planning and Research, Caribbean Public Health Agency, Port-of-Spain, Trinidad. 3 Division of Surveillance, Disease Prevention and Control, Laboratory Services and Networks Department, Caribbean Public Health Agency, Port-of-Spain, Trinidad.


Abstract in English, Portuguese, Spanish

Surveillance for Zika virus was enhanced in the English- and Dutch-speaking Caribbean following emergence of the virus in Brazil in May 2015. The first autochthonous case of Zika in the Caribbean was reported by Suriname in November 2015, and the virus subsequently spread rapidly throughout the region. Caribbean Public Health Agency (CARPHA) member states (CMS) reported clinically suspected cases of Zika and submitted serum specimens to the agency for laboratory investigation. A patient was considered a confirmed case if Zika virus was detected by real-time reverse transcription-polymerase chain reaction (RT-PCR) assay or serological test. Due to the documented link between 1) Zika virus and congenital syndrome, and 2) Zika virus and Guillain-Barré syndrome (GBS), data on both of these disease outcomes were extracted from country and regional reports. This special report describes the epidemiology of laboratory-confirmed Zika cases reported to CARPHA, including links with both congenital syndrome and GBS, for 19 English- and Dutch-speaking Caribbean countries during the epidemic period (1 October 2015-29 December 2016).

KEYWORDS: Caribbean region; Communicable diseases; Zika virus; emerging; epidemics

PMID: 31093148 PMCID: PMC6386109 DOI: 10.26633/RPSP.2018.120

Keywords: Zika Virus; Zika Congenital Syndrome; GBS; Caribbean.


Reporting of #birth #defects from the #Zika #outbreak in #Colombia, 2015-2017 (Rev Panam Salud Publica, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Rev Panam Salud Publica. 2019 May 3;43:e38. doi: 10.26633/RPSP.2019.38. eCollection 2019.

[Reporting of birth defects from the Zika outbreak in Colombia, 2015-2017]

Notificação de defeitos congênitos associados ao surto de vírus zika na Colômbia, 2015-2017].

[Article in Spanish]

Mendivelso Duarte FO1, Robayo García A2, Rodríguez Bedoya M3, Suárez Rángel G2.

Author information: 1 Centro de Medicina Basada en la Evidencia Keralty Centro de Medicina Basada en la Evidencia Keralty Bogotá Colombia Centro de Medicina Basada en la Evidencia Keralty, Bogotá, Colombia. 2 Programa de Entrenamiento en Epidemiología de Campo (FETP) del Instituto Nacional de Salud de Colombia Programa de Entrenamiento en Epidemiología de Campo (FETP) del Instituto Nacional de Salud de Colombia Colombia Colombia Programa de Entrenamiento en Epidemiología de Campo (FETP) del Instituto Nacional de Salud de Colombia, Colombia. 3 Fundación Universitaria Sanitas Fundación Universitaria Sanitas Bogotá Colombia Fundación Universitaria Sanitas, Bogotá, Colombia.


Abstract in English, Portuguese


The Zika outbreak affected several tropical countries in 2015 and 2016, requiring the creation of intensified surveillance strategies for microcephaly and other neurological syndromes. The effect of the Zika outbreak on the reporting of birth defects in Colombia was evaluated from the perspective of the national surveillance system.


National reporting of newborns with different birth defects was analyzed; variations in reporting attributed to the epidemic were determined through difference in differences (DID), a semiparametric model.


During the period of study, 18,234 cases of birth defects were reported in Colombia. The majority were congenital malformations (91.9%), and 82.3% was confirmed by clinical diagnosis or epidemiological link. In the case of microcephaly, eight new cases per epidemiological week were reported (coefficient of case reporting [D] = 8.8; P = 0.000) and 32 cases from other congenital anatomical malformations (D = 32.0; P = 0.000). The absolute value of the difference in differences estimator attributed to the Zika outbreak increased weekly case reporting of microcephaly (DID = |-5.0|; P = 0.008) and congenital malformations (DID = |-12.0|; P = 0.111).


The Zika outbreak increased reporting of newborns with microcephaly, but caused no significant variation in reporting of other malformations and functional birth defects of sensory or metabolic origin in the surveillance system.

KEYWORDS: Colombia; Zika virus; congenital abnormalities; health surveillance; public health

PMID: 31093262 PMCID: PMC6499088 DOI: 10.26633/RPSP.2019.38

Keywords: Zika Virus; Zika Congenital Syndrome; Microcephaly; Colombia.


#Maternal #infection with #Zika virus and #prevalence of #congenital disorders in #infants: systematic review and meta-analysis (Can J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Can J Public Health. 2019 May 10. doi: 10.17269/s41997-019-00215-2. [Epub ahead of print]

Maternal infection with Zika virus and prevalence of congenital disorders in infants: systematic review and meta-analysis.

Nithiyanantham SF1, Badawi A2,3.

Author information: 1 Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada. 2 Public Health Risk Sciences Division, Public Health Agency of Canada, 180 Queen Street West, Rm 8-15, Toronto, ON, M5V 3L7, Canada. alaa.badawi@canada.ca. 3 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. alaa.badawi@canada.ca.




Zika virus (ZIKV) infection is a vector-borne disease that can be transmitted sexually and vertically. The vertical transmission of the virus may lead to congenital Zika syndrome in infants. The aim of this study is to conduct a systematic review and meta-analysis of published reports documenting the prevalence of congenital Zika-related disorders in infants of mothers infected with ZIKV during pregnancy.


We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of print, Embase, Embase Classic and Web of Science databases to identify human studies reporting prevalence of congenital disorders in infants of ZIKV-infected mothers.


We identified 25 reports selected for inclusion in the current study (n = 4683 subjects). The majority of the studies were from South American high-risk countries. Only one third of the identified studies were conducted in the United States. Clinical maternal symptoms included maculopapular rash (76.9%), arthralgia (46.4%), fever (45.5%) and headache (31.8%) with myalgia and conjunctivitis only presented in 25% of the cases. The most prevalent congenital disorder in the newborns was brain calcifications (42.6; 95% CI, 30.8-54.4), followed by ventriculomegaly (21.8; 95% CI, 15.2-28.4), joint abnormalities (13.2; 95% CI, 9.4-18.2), ocular abnormalities (4.2; 95% CI, 1.0-7.5) and microcephaly (3.9; 95% CI, 2.4-5.4).


The current study highlights the high prevalence of a range of congenital disorders in newborns of mothers infected with ZIKV. It warrants developing studies to further clarify the mechanisms by which each of these disorders occurs in response to the viral infection during pregnancy and its vertical transmission to the infants.

KEYWORDS: Brain calcification; Congenital disease; Microcephaly; Systematic review; Zika virus

PMID: 31077071 DOI: 10.17269/s41997-019-00215-2

Keywords: Zika Virus; Pregnancy; Zika Congenital Syndrome.


Cross- #Protection of #Dengue Virus #Infection against #Congenital #Zika #Syndrome, Northeastern #Brazil (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 8—August 2019 / Research

Cross-Protection of Dengue Virus Infection against Congenital Zika Syndrome, Northeastern Brazil

Celia Pedroso1, Carlo Fischer1, Marie Feldmann1, Manoel Sarno, Estela Luz, Andrés Moreira-Soto, Renata Cabral, Eduardo Martins Netto, Carlos Brites, Beate M. Kümmerer, and Jan Felix Drexler

Author affiliations: Universidade Federal de Bahia, Salvador, Brazil (C. Pedroso, M. Sarno, E. Luz, R. Cabral, E. Martins Netto, C. Brites); Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humbolt-Universität zu Berlin and Berlin Institute of Health, Institute of Virology, Berlin, Germany (C. Fischer, A. Moreira-Soto, J.F. Drexler); University of Bonn Medical Centre, Bonn, Germany (M. Feldmann, B.M. Kümmerer); German Centre for Infection Research (B.M. Kümmerer, J.F. Drexler)



The Zika virus outbreak in Latin America resulted in congenital malformations, called congenital Zika syndrome (CZS). For unknown reasons, CZS incidence was highest in northeastern Brazil; one potential explanation is that dengue virus (DENV)–mediated immune enhancement may promote CZS development. In contrast, our analyses of historical DENV genomic data refuted the hypothesis that unique genome signatures for northeastern Brazil explain the uneven dispersion of CZS cases. To confirm our findings, we performed serotype-specific DENV neutralization tests in a case–control framework in northeastern Brazil among 29 Zika virus–seropositive mothers of neonates with CZS and 108 Zika virus–seropositive control mothers. Neutralization titers did not differ significantly between groups. In contrast, DENV seroprevalence and median number of neutralized serotypes were significantly lower among the mothers of neonates with CZS. Supported by model analyses, our results suggest that exposure to multitypic DENV infection may protect from, rather than enhance, development of CZS.

Keywords: Flavivirus; Dengue Fever; Zika Virus; A.D.E.; Congenital Zika Syndrome; Pregnancy; Brazil; Seroprevalence.


#Congenital #Zika Syndrome: The Main Cause of #Death and Correspondence Between #Brain #CT and Postmortem #Histological Section Findings From the Same Individuals (Top Magn Reson Imaging, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Top Magn Reson Imaging. 2019 Feb;28(1):29-33. doi: 10.1097/RMR.0000000000000194.

Congenital Zika Syndrome: The Main Cause of Death and Correspondence Between Brain CT and Postmortem Histological Section Findings From the Same Individuals.

de Fatima Viana Vasco Aragão M1,2, van der Linden V3, Petribu NC3, Valenca MM4, Parizel PM5,6, de Mello RJV4.

Author information: 1 Multimagem, Recife, Brazil. 2 Catholic University of Pernambuco, Recife, Brazil. 3 Barão de Lucena Hospital, Recife, Brazil. 4 Federal University of Pernambuco, Recife, Brazil. 5 Royal Perth Hospital (RPH), Perth, WA, Australia. 6 University of Western Australia (UWA) Medical School, Perth, WA, Australia.



In the present case series, the cause of death of infants diagnosed with congenital Zika syndrome (CZS) was lung disease (pneumonia and sepsis with massive pulmonary aspiration), probably secondary to dysphagia and reflux. The main findings in infants with a confirmed diagnosis of CZS who died were as follows: (1) calcification and hypoplasia of the lentiform nuclei, hypoplasia of the caudate nuclei, and calcification at the cortical-subcortical junction was noted in all cases (100%) and calcification of the caudate nuclei was noted in 66.7% of cases; (2) calcification in the brainstem and along the lateral wall of the lateral ventricles was noted in only the case with arthrogryposis (33.3%); and (3) lesions in the posterior fossa (hypoplasia of the brainstem and cerebellum) were noted in two cases (66.7%), including the case with arthrogryposis. The findings concerning calcifications and brain malformations obtained from non-contrast computed tomography (CT) demonstrated good agreement with findings obtained from the postmortem pathological analysis; however, CT failed to detect discontinuity of the pia mater with heterotopia, invasion of the cerebral tissue into the subarachnoid space, and discontinuity of the ependyma in the lateral ventricles with gliosis; this last feature was only imaged in the most severe case of extreme microcephaly with a simplified gyral pattern. Only histopathology showed grouped calcifications associated with scattered calcifications suggestive of the neuron morphology.

PMID: 30817678 DOI: 10.1097/RMR.0000000000000194 [Indexed for MEDLINE]

Keywords: Congenital Zika Syndrome; Zika Virus; Microcephaly; Histopathology; Neurology; Neuroimaging.