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dc.contributor.authorde Oliveira Melo, Adriana Suely
dc.contributor.authorAguiar, Renato Santana
dc.contributor.authorRamos Amorim, Melania Maria
dc.contributor.authorArruda, Monica B.
dc.contributor.authorMelo, Fabiana de Oliveira
dc.contributor.authorClementino Ribeiro, Suelem Tais
dc.contributor.authorMedeiros Batista, Alba Gean
dc.contributor.authorFerreira, Thales
dc.contributor.authordos Santos, Mayra Pereira
dc.contributor.authorSampaio, Virginia Vilar
dc.contributor.authorMartins Moura, Sarah Rogeria
dc.contributor.authorRabello, Luciana Portela
dc.contributor.authorGonzaga, Clarissa Emanuelle
dc.contributor.authorMalinger, Gustavo
dc.contributor.authorXimenes, Renato
dc.contributor.authorOliveira-Szejnfeld, Patricia Soares de [UNIFESP]
dc.contributor.authorTovar-Moll, Fernanda
dc.contributor.authorChimelli, Leila
dc.contributor.authorSilveira, Paola Paz
dc.contributor.authorDelvechio, Rodrigo
dc.contributor.authorHiga, Luiza
dc.contributor.authorCampanati, Loraine
dc.contributor.authorNogueira, Rita M. R.
dc.contributor.authorBispo Filippis, Ana Maria
dc.contributor.authorSzejnfeld, Jacob [UNIFESP]
dc.contributor.authorVoloch, Carolina Moreira
dc.contributor.authorFerreira, Orlando C., Jr.
dc.contributor.authorBrindeiro, Rodrigo M.
dc.contributor.authorTanuri, Amilcar
dc.identifier.citationJama Neurology. Chicago, v. 73, n. 12, p. 1407-1416, 2016.
dc.description.abstractIMPORTANCE Recent studies have reported an increase in the number of fetuses and neonates with microcephaly whose mothers were infected with the Zika virus (ZIKV) during pregnancy. To our knowledge, most reports to date have focused on select aspects of the maternal or fetal infection and fetal effects. OBJECTIVE To describe the prenatal evolution and perinatal outcomes of 11 neonates who had developmental abnormalities and neurological damage associated with ZIKV infection in Brazil. DESIGN, SETTING, AND PARTICIPANTS We observed 11 infants with congenital ZIKV infection from gestation to 6 monthus in the state of Paraba, Brazil. Ten of 11 women included in this study presented with symptoms of ZIKV infection during the first half of pregnancy, and all 11 had laboratory evidence of the infection in several tissues by serology or polymerase chain reaction. Brain damage was confirmed through intrauterine ultrasonography and was complemented by magnetic resonance imaging. Histopathological analysis was performed on the placenta and brain tissue from infants who died. The ZIKV genome was investigated in several tissues and sequenced for further phylogenetic analysis. MAIN OUTCOMES AND MEASURES Description of the major lesions caused by ZIKV congenital infection. RESULTS Of the 11 infants, 7 (63.6%) were female, and the median (SD) maternal age at delivery was 25 (6) years. Three of 11 neonates died, giving a perinatal mortality rate of 27.3%. The median (SD) cephalic perimeter at birth was 31 (3) cm, a value lower than the limit to consider a microcephaly case. In all patients, neurological impairments were identified, including microcephaly, a reduction in cerebral volume, ventriculomegaly, cerebellar hypoplasia, lissencephaly with hydrocephalus, and fetal akinesia deformation sequence (ie, arthrogryposis). Results of limited testing for other causes of microcephaly, such as genetic disorders and viral and bacterial infections, were negative, and the ZIKV genome was found in both maternal and neonatal tissues (eg, amniotic fluid, cord blood, placenta, and brain). Phylogenetic analyses showed an intrahost virus variation with some polymorphisms in envelope genes associated with different tissues. CONCLUSIONS AND RELEVANCE Combined findings from clinical, laboratory, imaging, and pathological examinations provided a more complete picture of the severe damage and developmental abnormalities caused by ZIKV infection than has been previously reported. The term congenital Zika syndrome is preferable to refer to these cases, as microcephaly is just one of the clinical signs of this congenital malformation disorder.en
dc.description.sponsorshipConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)
dc.description.sponsorshipCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
dc.description.sponsorshipPrefeitura Municipal de Campina Grande
dc.publisherAmer Medical Assoc
dc.relation.ispartofJama Neurology
dc.rightsAcesso aberto
dc.titleCongenital Zika Virus Infection Beyond Neonatal Microcephalyen
dc.description.affiliationInst Pesquisa Prof Amorim Neto IPESQ, Campina Grande, Paraiba, Brazil
dc.description.affiliationInst Saude Elpidio de Almeida, Campina Grande, Paraiba, Brazil
dc.description.affiliationFac Ciencias Med Campina Grande, Campina Grande, Paraiba, Brazil
dc.description.affiliationHosp Municipal Pedro I, Campina Grande, Paraiba, Brazil
dc.description.affiliationUniv Fed Rio de Janeiro, Inst Biol, Dept Genet, Rio De Janeiro, Brazil
dc.description.affiliationUniv Fed Campina Grande, Campina Grande, Paraiba, Brazil
dc.description.affiliationTel Aviv Univ, Div Ultrasound Obstet & Gynecol, Lis Matern Hosp, Tel Aviv Sourasky Med Ctr,Sackler Fac Med, Tel Aviv, Israel
dc.description.affiliationFundacao Med Fetal Latino Amer, Sao Paulo, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Fundacao Inst Pesquisa & Ensino Diagnost Imagem, Sao Paulo, Brazil
dc.description.affiliationUniv Fed Rio de Janeiro, Inst Ciencias Biomed, Rio De Janeiro, Brazil
dc.description.affiliationInst DOr Pesquisa & Ensino, Rio De Janeiro, Brazil
dc.description.affiliationInst Estadual Cerebro Paulo Niemeyer, Lab Neuropatol, Rio De Janeiro, Brazil
dc.description.affiliationFundacao Oswaldo Cruz, Inst Oswaldo Cruz, Lab Flavivirus, Rio De Janeiro, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Dept Diagnost Imagem, Sao Paulo, Brazil
dc.description.affiliationUnifespFundação Instituto de Pesquisa e Ensino de Diagnostico por Imagem, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.affiliationUnifespDepartamento de Diagnóstico por Imagem, Universidade Federal de São Paulo, São Paulo, Brazil
dc.description.sourceWeb of Science
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