A Novel Radiologic Finding to Predict Ophthalmic Abnormalities in Children With Congenital Zika Syndrome
Virginia Vilar Sampaio1,2,3, Adriana S O Melo2, Anne L Coleman1,3
1Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
Insights
Infratentorial abnormalities in infants with congenital Zika syndrome (CZS) significantly predict vision-threatening ophthalmic abnormalities. Early ophthalmologic exams are crucial for all neonates exposed to Zika virus (ZIKV) during pregnancy.
Area of Science:
- Neurology
- Ophthalmology
- Infectious Diseases
Background:
- The Zika virus (ZIKV) epidemic caused severe health issues in Brazil.
- Congenital Zika syndrome (CZS) presents with various developmental challenges.
- The association between specific radiologic findings and ophthalmic defects in CZS requires further investigation.
Purpose of the Study:
- To determine if infratentorial abnormalities in CZS predict sight-threatening ophthalmic defects.
- To explore correlations between ophthalmic abnormalities, head circumference (HC), and gestational age at ZIKV infection.
Main Methods:
- A cross-sectional study of 75 infants with confirmed ZIKV infection during pregnancy or CZS features.
- Data collected from March 2016 to December 2018 in Paraíba, Brazil.
- Evaluation included radiologic findings, ophthalmic examinations, head circumference, and gestational age.
Main Results:
- All 75 infants had brain calcifications; 71% had microcephaly.
- Infratentorial abnormalities were present in 22.7% of infants.
- Infants with infratentorial abnormalities showed a significantly higher prevalence of ophthalmic abnormalities (94%) compared to those without (28%).
Conclusions:
- Infratentorial abnormalities are a strong predictor of ophthalmic abnormalities in CZS.
- Ophthalmic abnormalities were more strongly associated with infratentorial findings than microcephaly.
- Routine ophthalmologic examinations are recommended for all neonates with maternal ZIKV exposure.
Background:
The Zika virus (ZIKV) epidemic had devastating consequences in Brazil. We investigated whether a radiologic finding (ie, infratentorial abnormalities) was associated with sight-threatening defects in children born with congenital Zika syndrome (CZS). We also investigated whether ophthalmic abnormalities correlated with head circumference (HC) and gestational age of infection.
Methods:
Cross-sectional evaluation based upon a previous cohort from March 2016 to December 2018, in Paraíba, Brazil. The study population was comprised of children born to mothers with laboratory-confirmed ZIKV infection during pregnancy (ZIKV reverse transcriptase polymerase chain reaction [RT-PCR]+) and children born with clinical and radiologic features of CZS.
Results:
A total of 75 infants had complete data. All 75 had brain calcifications. Microcephaly was present in 53 (71%) of them. Infratentorial abnormalities were present in 17 infants (22.7%). Ophthalmic abnormalities were seen in 16 of the 17 children (94%) with infratentorial abnormalities, while 28% of children without infratentorial abnormalities had ophthalmic findings (odds ratio [OR]: 42.0; 95% confidence interval [CI]: 5.1-342.9). Similar associations were observed when macular chorioretinal atrophy and optic nerve abnormalities were analyzed individually (OR: 23.7; 95% CI: 6.0-93.3 and OR: 11.5; 95% CI: 3.3-40.0, respectively). Infratentorial abnormalities were more frequently associated with ophthalmic abnormalities (94%) than microcephaly (43.4%) (P < .001). Mean HC was statistically different between groups with and without ophthalmic abnormalities (P = .01). A statistically significant difference in gestational age between both groups was not noted (P = .12).
Conclusions:
In children with CZS, the presence of infratentorial abnormalities is a significant predictor of ophthalmic abnormalities. All neonates whose mothers had ZIKV exposure during pregnancy should have an ophthalmologic examination.
