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M Barbi - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of Congenital cmv Infection via dried blood spots
Reviews in Medical Virology, 2006Co-Authors: M Barbi, S Binda, Simona CaroppoAbstract:Cytomegalovirus (CMV) Infection is the most frequent Congenital Infection in humans and can cause permanent damage—particularly neurological—in about 20% of those infected, with or without symptoms at birth. Laboratory diagnosis is essential on account of the relatively non-specific clinical manifestations in symptomatic newborns but also because of the high frequency of asymptomatic cases that are nevertheless at risk of lesions later in life. However, these tests need samples taken within 3 weeks of birth to distinguish Congenital Infection from the more common, but clinically benign, perinatal Infection. Tests for viral DNA have proved a valid means of diagnosing Congenital CMV Infection in neonatal blood dried on paper (DBS) widely used in screening for metabolic and genetic diseases, as an alternative to the conventional urine culture method. The DBS test is simpler, faster and less costly than viral isolation; in addition the samples can be safely stored for long periods, so diagnosis can be made even after several years. The sensitivity and specificity of the DBS test, compared to the reference method, have been reported to range between 71 and 100% and 99 and 100%, respectively, depending on the different studies and diagnostic criteria applied. The most interesting applications reported so far involve retrospective determination of the impact of Congenital CMV in sensorineural deafness, abnormalities of cortical development, neonatal cholestasis and surveys of the prevalence of this Infection in various populations. The test might be useful in the future for neonatal screening with a view to treating neonates and so avoiding the damage this disease can cause. Copyright © 2006 John Wiley & Sons, Ltd.
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multicity italian study of Congenital cytomegalovirus Infection
Pediatric Infectious Disease Journal, 2006Co-Authors: M Barbi, S Binda, Simona Caroppo, Agata Calvario, Cinzia Germinario, A Bozzi, Maria Luisa Tanzi, L Veronesi, I Mura, A PianaAbstract:Background:Cytomegalovirus (CMV) Infection is the most frequent Congenital Infection in humans. Its prevalence and the frequency of disabling sequelae must be assessed in different populations to permit the formulation or assessment of preventive measures.Objectives:To check the prevalence of congen
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a wider role for Congenital cytomegalovirus Infection in sensorineural hearing loss
Pediatric Infectious Disease Journal, 2003Co-Authors: M Barbi, S Binda, Simona Caroppo, Carlo Corbetta, U Ambrosetti, Paola SergiAbstract:Background. Diagnostic problems in identifying Congenital Infection cases in infancy have thus far impaired the assessment of the role of Congenital cytomegalovirus (CMV) Infection in the etiology of sensorineural hearing loss (SNHL). Objective. To estimate the impact of Congenital Infection in children with SNHL by detection of CMV DNA in stored samples of neonatal dried blood (dried blood spots test). Methods. The Guthrie cards of 130 children with hearing loss >40 dB hearing loss were retrieved from the regional screening center. CMV DNA was extracted by thermal shock and amplified by PCR. Results. The percentage of SNHL cases attributable to Congenital CMV Infection was 10% (9 of 87) in infants whose SNHL had been diagnosed in their first 2 months of life and 34.2% (13 of 38) in children with deafness of unidentified cause that was diagnosed in early childhood. In the latter group 42.7% (12 of 28) of the children with a hearing loss of >70 dB were CMV-positive. Conclusions. The results suggest that Congenital CMV Infection has a more relevant role in the etiology of SNHL than previously reported. The data obtained in both groups suggest that 20 to 30% of all deafness cases are caused by CMV. The percent of Congenital CMV cases alone appears to account for all the cases previously attributed to all Congenital Infections. More than 40% of deafness cases with an unknown cause, needing rehabilitation, are caused by Congenital CMV.
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cytomegalovirus dna detection in guthrie cards a powerful tool for diagnosing Congenital Infection
Journal of Clinical Virology, 2000Co-Authors: M Barbi, S Binda, V Primache, Simona Caroppo, P Dido, Paola Guidotti, Carlo Corbetta, Davide MelottiAbstract:Background: A simple and reliable diagnosis of Congenital cytomegalovirus Infection is necessary both for clinical and epidemiological purposes. This could be accomplished through the demonstration of cytomegalovirus (CMV) DNA in blood spots (DBS) on Guthrie cards. Objectives: (1) To assess the sensitivity and specificity of the method (DBS test) in diagnosing Congenital CMV Infection compared with viral isolation and (2) to evaluate the applications of the test to the late diagnosis of Congenital CMV. Study design: The method was tested on the cards of (1) 509 babies examined through viral isolation within their third week of life (72 positive cases) and (2) 191 children studied after 3 weeks of life (25 days to 5 years). Blood was eluted from Guthrie cards and heat extracted. The products of a nested polymerase chain reaction (PCR) amplifying one region in the CMV glycoprotein B (gB) gene were detected by agarose gel electrophoresis. Results: DBS test was positive in all 72 Congenitally infected babies and in four of the 437 negative at cytomegalovirus isolation (sensitivity 100%, specificity 99%). Infection in 16 of the 92 infants with a late viral isolation was demonstrated to be Congenital by the test, which also detected Congenital Infection in 18 of 83 children in whom viral culture was not performed (13 with and five without symptoms). Fifty-six additional control cases tested negative. Conclusions: DBS test is a reliable assay for diagnosing Congenital cytomegalovirus Infection and could be used as an alternative to viral culture. It is able to reveal whether ascertained CMV Infection is Congenital or postnatal at an age when viral isolation is not able to do so. It can assess the role of risky procedures such as transfusion and it can ascertain the etiology of morbid conditions diagnosed late or of controversial origin.
Simona Caroppo - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of Congenital cmv Infection via dried blood spots
Reviews in Medical Virology, 2006Co-Authors: M Barbi, S Binda, Simona CaroppoAbstract:Cytomegalovirus (CMV) Infection is the most frequent Congenital Infection in humans and can cause permanent damage—particularly neurological—in about 20% of those infected, with or without symptoms at birth. Laboratory diagnosis is essential on account of the relatively non-specific clinical manifestations in symptomatic newborns but also because of the high frequency of asymptomatic cases that are nevertheless at risk of lesions later in life. However, these tests need samples taken within 3 weeks of birth to distinguish Congenital Infection from the more common, but clinically benign, perinatal Infection. Tests for viral DNA have proved a valid means of diagnosing Congenital CMV Infection in neonatal blood dried on paper (DBS) widely used in screening for metabolic and genetic diseases, as an alternative to the conventional urine culture method. The DBS test is simpler, faster and less costly than viral isolation; in addition the samples can be safely stored for long periods, so diagnosis can be made even after several years. The sensitivity and specificity of the DBS test, compared to the reference method, have been reported to range between 71 and 100% and 99 and 100%, respectively, depending on the different studies and diagnostic criteria applied. The most interesting applications reported so far involve retrospective determination of the impact of Congenital CMV in sensorineural deafness, abnormalities of cortical development, neonatal cholestasis and surveys of the prevalence of this Infection in various populations. The test might be useful in the future for neonatal screening with a view to treating neonates and so avoiding the damage this disease can cause. Copyright © 2006 John Wiley & Sons, Ltd.
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multicity italian study of Congenital cytomegalovirus Infection
Pediatric Infectious Disease Journal, 2006Co-Authors: M Barbi, S Binda, Simona Caroppo, Agata Calvario, Cinzia Germinario, A Bozzi, Maria Luisa Tanzi, L Veronesi, I Mura, A PianaAbstract:Background:Cytomegalovirus (CMV) Infection is the most frequent Congenital Infection in humans. Its prevalence and the frequency of disabling sequelae must be assessed in different populations to permit the formulation or assessment of preventive measures.Objectives:To check the prevalence of congen
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a wider role for Congenital cytomegalovirus Infection in sensorineural hearing loss
Pediatric Infectious Disease Journal, 2003Co-Authors: M Barbi, S Binda, Simona Caroppo, Carlo Corbetta, U Ambrosetti, Paola SergiAbstract:Background. Diagnostic problems in identifying Congenital Infection cases in infancy have thus far impaired the assessment of the role of Congenital cytomegalovirus (CMV) Infection in the etiology of sensorineural hearing loss (SNHL). Objective. To estimate the impact of Congenital Infection in children with SNHL by detection of CMV DNA in stored samples of neonatal dried blood (dried blood spots test). Methods. The Guthrie cards of 130 children with hearing loss >40 dB hearing loss were retrieved from the regional screening center. CMV DNA was extracted by thermal shock and amplified by PCR. Results. The percentage of SNHL cases attributable to Congenital CMV Infection was 10% (9 of 87) in infants whose SNHL had been diagnosed in their first 2 months of life and 34.2% (13 of 38) in children with deafness of unidentified cause that was diagnosed in early childhood. In the latter group 42.7% (12 of 28) of the children with a hearing loss of >70 dB were CMV-positive. Conclusions. The results suggest that Congenital CMV Infection has a more relevant role in the etiology of SNHL than previously reported. The data obtained in both groups suggest that 20 to 30% of all deafness cases are caused by CMV. The percent of Congenital CMV cases alone appears to account for all the cases previously attributed to all Congenital Infections. More than 40% of deafness cases with an unknown cause, needing rehabilitation, are caused by Congenital CMV.
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cytomegalovirus dna detection in guthrie cards a powerful tool for diagnosing Congenital Infection
Journal of Clinical Virology, 2000Co-Authors: M Barbi, S Binda, V Primache, Simona Caroppo, P Dido, Paola Guidotti, Carlo Corbetta, Davide MelottiAbstract:Background: A simple and reliable diagnosis of Congenital cytomegalovirus Infection is necessary both for clinical and epidemiological purposes. This could be accomplished through the demonstration of cytomegalovirus (CMV) DNA in blood spots (DBS) on Guthrie cards. Objectives: (1) To assess the sensitivity and specificity of the method (DBS test) in diagnosing Congenital CMV Infection compared with viral isolation and (2) to evaluate the applications of the test to the late diagnosis of Congenital CMV. Study design: The method was tested on the cards of (1) 509 babies examined through viral isolation within their third week of life (72 positive cases) and (2) 191 children studied after 3 weeks of life (25 days to 5 years). Blood was eluted from Guthrie cards and heat extracted. The products of a nested polymerase chain reaction (PCR) amplifying one region in the CMV glycoprotein B (gB) gene were detected by agarose gel electrophoresis. Results: DBS test was positive in all 72 Congenitally infected babies and in four of the 437 negative at cytomegalovirus isolation (sensitivity 100%, specificity 99%). Infection in 16 of the 92 infants with a late viral isolation was demonstrated to be Congenital by the test, which also detected Congenital Infection in 18 of 83 children in whom viral culture was not performed (13 with and five without symptoms). Fifty-six additional control cases tested negative. Conclusions: DBS test is a reliable assay for diagnosing Congenital cytomegalovirus Infection and could be used as an alternative to viral culture. It is able to reveal whether ascertained CMV Infection is Congenital or postnatal at an age when viral isolation is not able to do so. It can assess the role of risky procedures such as transfusion and it can ascertain the etiology of morbid conditions diagnosed late or of controversial origin.
Rubens Belfort - One of the best experts on this subject based on the ideXlab platform.
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ocular findings in infants with microcephaly associated with presumed zika virus Congenital Infection in salvador brazil
JAMA Ophthalmology, 2016Co-Authors: De Oliveira Dias, Juliana Prazeres, Gielson Almeida Sacramento, Albert Icksang Ko, Maurício Maia, Rubens BelfortAbstract:IMPORTANCE The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV. OBJECTIVE To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV Infection in Salvador, Bahia, Brazil. DESIGN, SETTING, AND PARTICIPANTS Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of 32 cm) with a presumed diagnosis of Congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015. INTERVENTIONS All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations. MAIN OUTCOMES AND MEASURES Ocular abnormalities associated with ZIKV. RESULTS Twenty-three of 29 mothers (79.3%) reported suspected ZIKV Infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9% CONCLUSIONS AND RELEVANCE Congenital Infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.
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Ocular findings in infants with microcephaly associated with presumed zika virus Congenital Infection in Salvador, Brazil
JAMA Ophthalmology, 2016Co-Authors: Bruno De Paula Freitas, Juliana Prazeres, Gielson Almeida Sacramento, Albert Icksang Ko, Maurício Maia, João Rafael De Oliveira Dias, Rubens BelfortAbstract:Importance The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV. Objective To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV Infection in Salvador, Bahia, Brazil. Design, Setting, and Participants Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of ≤32 cm) with a presumed diagnosis of Congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015. Interventions All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations. Main Outcomes and Measures Ocular abnormalities associated with ZIKV. Results Twenty-three of 29 mothers (79.3%) reported suspected ZIKV Infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%). Conclusions and Relevance Congenital Infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.
S Binda - One of the best experts on this subject based on the ideXlab platform.
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diagnosis of Congenital cmv Infection via dried blood spots
Reviews in Medical Virology, 2006Co-Authors: M Barbi, S Binda, Simona CaroppoAbstract:Cytomegalovirus (CMV) Infection is the most frequent Congenital Infection in humans and can cause permanent damage—particularly neurological—in about 20% of those infected, with or without symptoms at birth. Laboratory diagnosis is essential on account of the relatively non-specific clinical manifestations in symptomatic newborns but also because of the high frequency of asymptomatic cases that are nevertheless at risk of lesions later in life. However, these tests need samples taken within 3 weeks of birth to distinguish Congenital Infection from the more common, but clinically benign, perinatal Infection. Tests for viral DNA have proved a valid means of diagnosing Congenital CMV Infection in neonatal blood dried on paper (DBS) widely used in screening for metabolic and genetic diseases, as an alternative to the conventional urine culture method. The DBS test is simpler, faster and less costly than viral isolation; in addition the samples can be safely stored for long periods, so diagnosis can be made even after several years. The sensitivity and specificity of the DBS test, compared to the reference method, have been reported to range between 71 and 100% and 99 and 100%, respectively, depending on the different studies and diagnostic criteria applied. The most interesting applications reported so far involve retrospective determination of the impact of Congenital CMV in sensorineural deafness, abnormalities of cortical development, neonatal cholestasis and surveys of the prevalence of this Infection in various populations. The test might be useful in the future for neonatal screening with a view to treating neonates and so avoiding the damage this disease can cause. Copyright © 2006 John Wiley & Sons, Ltd.
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multicity italian study of Congenital cytomegalovirus Infection
Pediatric Infectious Disease Journal, 2006Co-Authors: M Barbi, S Binda, Simona Caroppo, Agata Calvario, Cinzia Germinario, A Bozzi, Maria Luisa Tanzi, L Veronesi, I Mura, A PianaAbstract:Background:Cytomegalovirus (CMV) Infection is the most frequent Congenital Infection in humans. Its prevalence and the frequency of disabling sequelae must be assessed in different populations to permit the formulation or assessment of preventive measures.Objectives:To check the prevalence of congen
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a wider role for Congenital cytomegalovirus Infection in sensorineural hearing loss
Pediatric Infectious Disease Journal, 2003Co-Authors: M Barbi, S Binda, Simona Caroppo, Carlo Corbetta, U Ambrosetti, Paola SergiAbstract:Background. Diagnostic problems in identifying Congenital Infection cases in infancy have thus far impaired the assessment of the role of Congenital cytomegalovirus (CMV) Infection in the etiology of sensorineural hearing loss (SNHL). Objective. To estimate the impact of Congenital Infection in children with SNHL by detection of CMV DNA in stored samples of neonatal dried blood (dried blood spots test). Methods. The Guthrie cards of 130 children with hearing loss >40 dB hearing loss were retrieved from the regional screening center. CMV DNA was extracted by thermal shock and amplified by PCR. Results. The percentage of SNHL cases attributable to Congenital CMV Infection was 10% (9 of 87) in infants whose SNHL had been diagnosed in their first 2 months of life and 34.2% (13 of 38) in children with deafness of unidentified cause that was diagnosed in early childhood. In the latter group 42.7% (12 of 28) of the children with a hearing loss of >70 dB were CMV-positive. Conclusions. The results suggest that Congenital CMV Infection has a more relevant role in the etiology of SNHL than previously reported. The data obtained in both groups suggest that 20 to 30% of all deafness cases are caused by CMV. The percent of Congenital CMV cases alone appears to account for all the cases previously attributed to all Congenital Infections. More than 40% of deafness cases with an unknown cause, needing rehabilitation, are caused by Congenital CMV.
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cytomegalovirus dna detection in guthrie cards a powerful tool for diagnosing Congenital Infection
Journal of Clinical Virology, 2000Co-Authors: M Barbi, S Binda, V Primache, Simona Caroppo, P Dido, Paola Guidotti, Carlo Corbetta, Davide MelottiAbstract:Background: A simple and reliable diagnosis of Congenital cytomegalovirus Infection is necessary both for clinical and epidemiological purposes. This could be accomplished through the demonstration of cytomegalovirus (CMV) DNA in blood spots (DBS) on Guthrie cards. Objectives: (1) To assess the sensitivity and specificity of the method (DBS test) in diagnosing Congenital CMV Infection compared with viral isolation and (2) to evaluate the applications of the test to the late diagnosis of Congenital CMV. Study design: The method was tested on the cards of (1) 509 babies examined through viral isolation within their third week of life (72 positive cases) and (2) 191 children studied after 3 weeks of life (25 days to 5 years). Blood was eluted from Guthrie cards and heat extracted. The products of a nested polymerase chain reaction (PCR) amplifying one region in the CMV glycoprotein B (gB) gene were detected by agarose gel electrophoresis. Results: DBS test was positive in all 72 Congenitally infected babies and in four of the 437 negative at cytomegalovirus isolation (sensitivity 100%, specificity 99%). Infection in 16 of the 92 infants with a late viral isolation was demonstrated to be Congenital by the test, which also detected Congenital Infection in 18 of 83 children in whom viral culture was not performed (13 with and five without symptoms). Fifty-six additional control cases tested negative. Conclusions: DBS test is a reliable assay for diagnosing Congenital cytomegalovirus Infection and could be used as an alternative to viral culture. It is able to reveal whether ascertained CMV Infection is Congenital or postnatal at an age when viral isolation is not able to do so. It can assess the role of risky procedures such as transfusion and it can ascertain the etiology of morbid conditions diagnosed late or of controversial origin.
Maurício Maia - One of the best experts on this subject based on the ideXlab platform.
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risk factors associated with the ophthalmoscopic findings identified in infants with presumed zika virus Congenital Infection
JAMA Ophthalmology, 2016Co-Authors: Camila V Ventura, Maurício Maia, Simone Travassos, Thayze T Martins, Felipe Patriota, Marcos Eugenio Nunes, Cristiana Agra, Virginia Laura Lucas Torres, Vanessa Van Der Linden, Regina Coeli Ferreira RamosAbstract:Importance The Zika virus (ZIKV) might cause microcephaly and ophthalmoscopic findings in infants of mothers infected during pregnancy. Objective To assess and identify possible risk factors for ophthalmoscopic findings in infants born with microcephaly and a presumed clinical diagnosis of ZIKV intrauterine Infection. Design, Setting, and Participants We conducted a cross-sectional study at the Altino Ventura Foundation in Recife, Brazil, that included 40 infants with microcephaly born in Pernambuco state, Brazil, between May and December 2015. Toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus were ruled out in all of them. Testing of cerebrospinal fluid for ZIKV using IgM antibody-capture enzyme-linked immunosorbent assay was performed in 24 of 40 infants (60.0%). The infants and mothers underwent ocular examinations. The infants were divided into 2 groups, those with and without ophthalmoscopic alterations, for comparison. Main Outcomes and Measures Identification of risk factors for ophthalmoscopic findings in infants born with microcephaly and ZIKV intrauterine Infection. Results Among the 40 infants, the mean (SD) age was 2.2 (1.2) months (range, 0.1-7.3 months). Of the 24 infants tested, 100% had positive results for ZIKV Infection: 14 of 22 infants (63.6%) from the group with ophthalmoscopic findings and 10 of 18 infants (55.6%) from the group without ophthalmoscopic findings. The major symptoms reported in both groups were rash by 26 mothers (65.0%), fever by 9 mothers (22.5%), headache by 9 mothers (22.5%), and arthralgia by 8 mothers (20.0%). No mothers reported conjunctivitis or other ocular symptoms during pregnancy or presented signs of uveitis at the time of examination. Thirty-seven eyes (46.3%) of 22 infants (55.0%) had ophthalmoscopic alterations. Ten mothers (71.4%) of infants with ocular findings reported symptoms during the first trimester (frequency, 0.48; 95% CI, 0.02-0.67; P = .04). A difference was also observed between the groups of infants with and without ocular findings regarding the cephalic perimeter: mean (SD) of 28.8 (1.7) and 30.3 (1.5), respectively (frequency, −1.50; 95% CI, −2.56 to −0.51; P = .004). Conclusions and Relevance Ocular involvement in infants with presumed ZIKV Congenital Infection were more often seen in infants with smaller cephalic diameter at birth and in infants whose mothers reported symptoms during the first trimester.
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ocular findings in infants with microcephaly associated with presumed zika virus Congenital Infection in salvador brazil
JAMA Ophthalmology, 2016Co-Authors: De Oliveira Dias, Juliana Prazeres, Gielson Almeida Sacramento, Albert Icksang Ko, Maurício Maia, Rubens BelfortAbstract:IMPORTANCE The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV. OBJECTIVE To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV Infection in Salvador, Bahia, Brazil. DESIGN, SETTING, AND PARTICIPANTS Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of 32 cm) with a presumed diagnosis of Congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015. INTERVENTIONS All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations. MAIN OUTCOMES AND MEASURES Ocular abnormalities associated with ZIKV. RESULTS Twenty-three of 29 mothers (79.3%) reported suspected ZIKV Infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9% CONCLUSIONS AND RELEVANCE Congenital Infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.
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Ocular findings in infants with microcephaly associated with presumed zika virus Congenital Infection in Salvador, Brazil
JAMA Ophthalmology, 2016Co-Authors: Bruno De Paula Freitas, Juliana Prazeres, Gielson Almeida Sacramento, Albert Icksang Ko, Maurício Maia, João Rafael De Oliveira Dias, Rubens BelfortAbstract:Importance The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV. Objective To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV Infection in Salvador, Bahia, Brazil. Design, Setting, and Participants Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of ≤32 cm) with a presumed diagnosis of Congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015. Interventions All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations. Main Outcomes and Measures Ocular abnormalities associated with ZIKV. Results Twenty-three of 29 mothers (79.3%) reported suspected ZIKV Infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%). Conclusions and Relevance Congenital Infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.