Extension of TORCH spectrum in ophthalmology: congenital Zika, case report
Keywords:
Zika Virus Infection, Optic Nerve, /abnormalities, Microcephaly, Macula LuteaAbstract
Background: Zika is a flavivirus that can be transmitted transplacentally. Eye abnormalities have been reported in 70% of Zika cases, and 41.7% of them can occur in the absence of microcephaly. The most common ocular abnormalities are macular atrophy, optic atrophy and chorioretinal coloboma. The objective was to report the case of eye disorders associated with Zika, acquired transplacentally, despite negative results for TORCH, and serology and PCR analyses for Zika.
Clinical case: 9-month-old female patient, born in Chiapas, Mexico, brought to an ophthalmologic evaluation because she did not follow objects. As family background patient’s mother had Zika, confirmed serologically at 9 weeks gestation. Physical examination revealed microcephaly, redundant skin on neck, joint stiffness and delayed psychomotor development. Ophthalmological examination revealed in right eye atrophy of the optic nerve, and left eye with exotropia, macular scar and optic nerve aplasia. TORCH profile and serology and PCR for Zika were negative.
Conclusions: Despite the negative serology for Zika, given the history of pregnancy and the pre and post-natal clinical manifestations, diagnosis of embryopathy secondary to Zika infection with optic nerve aplasia, chorioretinal atrophy, macular scar, microcephaly and global neurodevelopmental delay was made.
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Gubler DJ, Vasilakis N, Musso D. History and Emergence of Zika Virus. J Infect Dis. 2017;216:S860‑7.
Yepez JB, Murati FA, Pettito M, Peñaranda CF, De Yepez J, Maestre G, et al. Ophthalmic manifestations of congenital Zika syndrome in Colombia and Venezuela. JAMA Ophthalmol. 2017;135(5):440‑5.
Rafael J, Dias DO, Ventura CV, Freitas BDP, Ventura LO, Bravo-Filho V, et al. Ocular abnormalities in congenital Zika syndrome: are the ophthalmoscopic findings “the top of the iceberg”? Prog Retin Eye Res. 2018. https://doi.org/10.1016/j.preteyeres.2018.04.004
Robbiani DF, Bozzacco L, Keeffe JR, Khouri R, Olsen PC, Gazumyan A, et al. Recurrent Potent Human Neutralizing Antibodies to Zika Virus in Brazil and Mexico. Cell. 2017;169(4):597-609.e11. doi: http://dx.doi.org/10.1016/j.cell.2017.04.024
Montoya M, Collins M, Dejnirattisai W, Katzelnick LC, Puerta-Guardo H, Jadi R, et al. Longitudinal analysis of antibody cross-neutralization following Zika virus and dengue virus infection in Asia and the Americas. J Infect Dis. 2018;218(4):536‑45.
Parke DW, Almeida DRP, Albini TA, Ventura CV, Berrocal AM, Mittra RA. Serologically Confirmed Zika-Related Unilateral Acute Maculopathy in an Adult. Ophthalmology. 2016;123(11):2432‑3.
Oehler E, Watrin L, Larre P, Leparc-Goffart I, Lastere S, Valour F, et al. Zika Virus Infection Complicated by Guillain-Barre Syndrome--Case Report, French Polynesia, December 2013. Euro Surveill. 2014;19(9):20720.
Hennessey M, Fischer M, Staples J. Zika Virus Spreads to New Areas - Region of the Americas, May 2015-January 2016. MMWR Morb Mortal Wkly Rep. 2016;65(3):55-8.
De Paula Freitas B, De Oliveira Dias JR, Prazeres J, Sacramento GA, Ko AI, Maia M, et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol. 2016;134(5):529‑35.
Vissoci JRN, Lein A, Staton C, Rocha TAH, Silva NC da, de Sousa Queiroz RC, et al. Zika virus infection and microcephaly: Evidence regarding geospatial associations. PLoS Negl Trop Dis. 2018;12(4):1‑16.
Ventura CV, Ventura LO. Ophthalmologic Manifestations Associated With Zika Virus Infection. Pediatrics. 2018;141(Suppl 2):S161‑6.
Organización Mundial de la Salud. Perímetro cefálico para la edad. OMS; 2014. Disponible en http://www.who.int/childgrowth/standards/second_set/chts_hcfa_ninas_z/es/
Kikuti M, Cardoso CW, Prates APB, Paploski IAD, Kitron U, Reis MG, et al. Congenital brain abnormalities during a Zika virus epidemic in Salvador, Brazil, april 2015 to july 2016. Eurosurveillance. 2018;23(45):1‑10.
Guevara JG, Agarwal-Sinha S. Ocular abnormalities in congenital Zika syndrome: A case report, and review of the literature. J Med Case Rep. 2018;12(1):1‑5.
Kiroglu Y, Calli C, Karabulut N, Cagatay O. Intracranial calcifications on computed tomography: pictorial essay. Diagn Interv Radiol. 2010;16(4):263-9.
Mehrjardi MZ. Is Zika virus an emerging TORCH agent? An invited commentary. Virol Res Treat. 2017;8:1‑3.
De Paula Freitas B, Zin A, Ko A, Maia M, Ventura CV, Belfort R. Anterior-Segment Ocular Findings and Microphthalmia in Congenital Zika Syndrome. Ophthalmology. 2017;124(12):1876‑8.
De Paula Freitas B, Ko AI, Khouri R, Mayoral M, Henriques DF, Maia M, et al. Glaucoma and Congenital Zika Syndrome. Ophthalmology. 2017;124(3):407‑8.
Ventura CV, Ventura LO, Bravo-Filho V, Martins TT, Berrocal AM, Gois AL, et al. Optical coherence tomography of retinal lesions in infants with congenital Zika syndrome. JAMA Ophthalmol. 2016;134(12):1420‑7.
De Miranda 2nd HA, Costa MC, Frazão MAM, Simão N, Franchischini S, Moshfeghi DM. Expanded Spectrum of Congenital Ocular Findings in Microcephaly with Presumed Zika Infection. Ophthalmology. 2016;123(8):1788‑94. doi: http://dx.doi.org/10.1016/j.ophtha.2016.05.001
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