Gert van der Hoek
In Memoriam - Editor, Senior Moderator
07 January 2016
Zika virus (ZIKV), a mosquito-borne Flavivirus, was first reported in human beings in 1952.1 Before April, 2015, no case had been reported in Brazil. However, between April and November, 2015, 18 of the 27 Brazilian states reported ZIKV autochthonous cases.2
After ZIKV emerged in Brazil, a 20-fold annual increase of microcephaly cases was observed.3 In 2015, there has been 1248 new suspected cases, a prevalence of 99?7 per 100 000 livebirths.3, 4 The Brazilian Ministry of Health confirmed the relation between ZIKV and microcephaly,4 and WHO issued an epidemiological alert about the association of ZIKV infection with congenital malformations and neurological syndromes.5
Here we report ophthalmic findings in three children with microcephaly born after the ZIKV outbreak in Brazil. These infants (see appendix for details) had cerebral calcifications detected by CT scans and presumable intrauterus ZIKV infection. One of the mothers reported rash and arthralgia in the first trimester. Toxoplasmosis, rubella, cytomegalovirus, herpes simplex, syphillis, and HIV were ruled out in all cases (mothers and infants), fulfilling the Ministry of Health's criteria for ZIKV vertical infection.
Mothers and infants underwent ocular examination that included biomicroscopy and fundus examination. The mothers had no ocular lesions. The three infants had unilateral ocular findings involving solely the macular region. All three infants presented with gross macular pigment mottling and foveal reflex loss. A well defined macular neuroretinal atrophy was detected in one child (figure). To our knowledge, this is the first report of ocular findings in infants with microcephaly born after the ZIKV outbreak. All three children had fundoscopic alterations in the macular region.
Although ZIKV infection was not tested by real-time PCR, cases fulfil criteria for ZIKV vertical infection. Further studies are being conducted in a larger group of infants to assess the ocular manifestations of ZIKV vertical infection.
Severe macular neuroretinal atrophy in an infant with microcephaly
Zika virus (ZIKV), a mosquito-borne Flavivirus, was first reported in human beings in 1952.1 Before April, 2015, no case had been reported in Brazil. However, between April and November, 2015, 18 of the 27 Brazilian states reported ZIKV autochthonous cases.2
After ZIKV emerged in Brazil, a 20-fold annual increase of microcephaly cases was observed.3 In 2015, there has been 1248 new suspected cases, a prevalence of 99?7 per 100 000 livebirths.3, 4 The Brazilian Ministry of Health confirmed the relation between ZIKV and microcephaly,4 and WHO issued an epidemiological alert about the association of ZIKV infection with congenital malformations and neurological syndromes.5
Here we report ophthalmic findings in three children with microcephaly born after the ZIKV outbreak in Brazil. These infants (see appendix for details) had cerebral calcifications detected by CT scans and presumable intrauterus ZIKV infection. One of the mothers reported rash and arthralgia in the first trimester. Toxoplasmosis, rubella, cytomegalovirus, herpes simplex, syphillis, and HIV were ruled out in all cases (mothers and infants), fulfilling the Ministry of Health's criteria for ZIKV vertical infection.
Mothers and infants underwent ocular examination that included biomicroscopy and fundus examination. The mothers had no ocular lesions. The three infants had unilateral ocular findings involving solely the macular region. All three infants presented with gross macular pigment mottling and foveal reflex loss. A well defined macular neuroretinal atrophy was detected in one child (figure). To our knowledge, this is the first report of ocular findings in infants with microcephaly born after the ZIKV outbreak. All three children had fundoscopic alterations in the macular region.
Although ZIKV infection was not tested by real-time PCR, cases fulfil criteria for ZIKV vertical infection. Further studies are being conducted in a larger group of infants to assess the ocular manifestations of ZIKV vertical infection.
Severe macular neuroretinal atrophy in an infant with microcephaly