Descrição de padrão atípico de gemelares com Zika congênita presumida e sem microcefalia - Relato de Caso
DOI:
https://doi.org/10.7322/jhgd.152196Palavras-chave:
gravidez, Zika Vírus, oftalmologia, transtornos de visãoResumo
Introdução: A infecção pelo Zika vírus (VZIK) foi emergência em saúde pública de interesse nacional brasileiro até maio de 2017, devido ao súbito aumento de nascidos com microcefalia e outras alterações neurológicas durante a epidemia iniciada no Brasil em novembro de 2015. As manifestações da infecção intrauterina pelo VZIK são mais graves quando ocorrem no primeiro e segundo trimestres de gestação, principalmente no primeiro trimestre. Nesta situação, o diagnóstico precoce dos problemas visuais é imprescindível para que os pacientes apresentem avanços nos campos neurológicos e até motores, sendo que há complicações como erros refrativos (miopia, astigmatismo e hipermetropia), estrabismo e hipoacomodação. A ausência de microcefalia em lactentes expostos ao Zika vírus não é indicativo de alterações ofatalmológicas, sendo imprescindível ap médico oftalmologista realizar as investigações spertinentes ao caso clínico. Toda e qualquer lesão ocular e em seus anexos são graves. Quanto mais precoce for o diagnóstico, mais cedo a criança pode ser submetida a uma intervenção para habilitação da visão.
Objetivo: Analisar padrão atípico de gemelares com Zika congênita presumida e sem microcefalia.
Método: Trata-se de um relato de caso, desenvolvido na cidade de Serra Talhada, interior do estado de Pernambuco, Nordeste Brasileiro.
Relato: Caso de gemelares cuja mãe foi exposta ao Zika vírus no segundo trimestre de gestação (décima primeira semana). As crianças nasceram prematuras e sem microcefalia. Um dos gemelares apresentou hidrocefalia com necessidade de intervenção cirúrgica. A mesma criança foi levada para exame oftalmológico por possuir estrabismo convergente e foi encontrado nervo óptico hipocorado e cicatriz coriorretiniana em região macular em ambos os olhos semelhantes às lesões descritas pelo Zika vírus. Quadro similar, mas com menor comprometimento visual foi identificado no segundo gemelar. A tomografia de crânio demonstrou focos de calcificação nos hemisférios cerebrais bilateralmente.
Conclusão: Houve presença de desvio convergente e nistagmo às lateroversões. Na fundoscopia, o nervo óptico apresentou-se hipocorado e com lesão coriorretiniana cicatricial com bordos bem delimitados em área macular de ambos os olhos.
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Referências
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2. Fagbami AH. Zika virus infections in Nigeria: virological and seroepidemiological investigations in Oyo State. J Hyg (Lond). 1979;83(2):213-9.
3. Olson JG, Ksiazek TG, Suhandiman, Triwibowo. Zika virus, a cause of fever in Central Java, Indonesia. Trans R Soc Trop Med Hyg. 1981;75(3):389-93. DOI: https://dx.doi.org/10.1016/0035-9203(81)90100-0
4. Simpson DIH. Zika virus infection in man. Trans R Soc Trop Med Hyg.1964;58(4):335-8. DOI: https://dx.doi.org/10.1016/0035-9203(64)90200-7
5. Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika virus. N Engl J Med. 2016;374:1552-63. DOI: https://dx.doi.org/10.1056/NEJMra1602113
6. Cardoso CW, Paploski IA, Kikuti M, Rodrigues MS, Silva MM, Campos GS, et al. Outbreak of Exanthematous Illness Associated with Zika, Chikungunya, and Dengue Viruses, Salvador, Brazil. Emerg Infect Dis. 2015;21(12):2274-6. DOI: https://dx.doi.org/10.3201/eid2112.151167
7. Centers of Disease Control and Prevention (CDC). Symptons, diagnosis & treatment. [cited 2018 Jan 28] Available from: https://www.cdc.gov/zika/symptoms/index.html.
8. Chan JF, Choi GK, Yip CC, Cheng VC, Yuen KY. Zika fever and congenital Zika syndrome: An unexpected emerging arboviral disease. J Infect. 2016;72(5):507-24. DOI: https://dx.doi.org/10.1016/j.jinf.2016.02.011
9. Chouin-Carneiro T, Vega-Rua A, Vazeille M, Yebakima A, Girod R, Goindin D, et al. Differential Susceptibilities of Aedes aegypti and Aedes albopictus from the Americas to Zika Virus. PLoS Negl Trop Dis. 2016;10(3):e0004543. DOI: https://dx.doi.org/10.1371/journal.pntd.0004543
10. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009;360(24):2536-43. DOI: https://dx.doi.org/10.1056/NEJMoa0805715
11. Brasil P, Pereira Jr JP, Moreira ME, Nogueira RMR, Damasceno L, Wakimoto M, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro. N Engl J Med. 2016;375(24):2321-34. DOI: https://dx.doi.org/10.1056/NEJMoa1602412
12. Gulland A. Men and women should practise safe sex for six months to avoid Zika, says WHO. BMJ. 2016;354:i4897. DOI: https://dx.doi.org/10.1136/bmj.i4897
13. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis. 2015;21(2):359-61. DOI: https://dx.doi.org/10.3201/eid2102.141363
14. Oster AM, Brooks JT, Stryker JE, Kachur RE, Mead P, Pesik NT, et al. Interim guidelines for prevention of sexual transmission of Zika virus-United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(5):120-1. DOI: http://dx.doi.org/10.15585/mmwr.mm6505e1
15. Mansuy JM, Dutertre M, Mengelle C, Fourcade C, Marchou B, Delobel P, et al. Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen? Lancet Infect Dis. 2016;16(4):405. DOI: https://dx.doi.org/10.1016/S1473-3099(16)00138-9
16. Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill. 2014;19(14):20761.
17. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill. 2014;19(13):20751.
18. Zanluca C, Melo VC, Mosimann AL, Santos GI, Santos CN, Luz K. First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz. 2015;110(4):569-72. DOI: https://dx.doi.org/10.1590/0074-02760150192
19. Campos GS, Bandeira AC, Sardi SI. Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis. 2015;21(10):1885-6. DOI: https://dx.doi.org/10.3201/eid2110.150847
20. Dick GWA, Kitchen SF, Haddow AJ. Zika virus (I). Isolations and serological specificity. Trans R Soc Trop Med Hyg. 1952;46(5):509-20. DOI: https://dx.doi.org/10.1016/0035-9203(52)90042-4
21. Darko R, Mashburn JL. Zika Virus Disease: case report and review of literature. Pediatr Emerg Care. 2016;32(10):705-9. DOI: https://dx.doi.org/10.1097/PEC.0000000000000932
22. Musso D. Zika Virus Transmission from French Polynesia to Brazil. Emerg Infect Dis. 2015;21(10):1887. DOI: https://dx.doi.org/10.3201/eid2110.151125
23. Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DD, Cavalcanti DP, Pessoa A, et al. Possible Association Between Zika Virus Infection and Microcephaly-Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(3):59-62. DOI: https://dx.doi.org/10.15585/mmwr.mm6503e2
24. European Centre for Disease Prevention and Control (ECDPC). Microcephaly in Brazil potentially linked to the Zika virus epidemic. [cited 2016 Jan 26] Available from: http://ecdc.europa.eu/en/publications/Publications/zika-microcephaly-Brazil-rapid-risk-assessment-Nov-2015.pdf.
25. Centers for Disease Control and Prevention (CDC). Concludes Zika causes Microcephaly and Other Birth Defects. [cited 2018 Jan 31] Available from: http://www.cdc.gov/media/releases/2016/s0413-zikamicrocephaly.
html
26. World Health Organization (WHO). Zika Virus, microcephaly, and Guillain Barré Syndrome. World Health Organization, 2016.
27. Santos JLG, Lima MVM, Leitão FNC, Costa VDE, Macedo Jr H, Muniz PT. Zika virus and measures of legal interventions in public health. J Hum Growth Dev. 2016;26(3):393-7. DOI: http://dx.doi.org/10.7322/jhgd.122919
28. Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, et al. Zika virus associated with microcephaly. N Engl J Med. 2016;374(10):951-8. DOI: http://dx.doi.org/10.1056/NEJMoa1600651
29. Miranda-Filho DB, Martelli CM, Ximenes RA, Araújo TV, Rocha MA, Ramos RC, et al. Initial description of the presumed congenital Zika Syndrome. Am J Public Health. 2016;106(4):598-600. DOI: http://dx.doi.org/10.2105/AJPH.2016.303115
30. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus and birth defects-reviewing the evidence for causality. N Engl J Med. 2016;374(20):1981-7. DOI: http://dx.doi.org/10.1056/NEJMsr1604338
31. Ventura CV, Maia M, Dias N, Ventura LO, Belfort Jr R. Zika: neurological and ocular findings in infant without microcephaly. Lancet. 2016; 387(10037):2502. DOI: https://dx.doi.org/10.1016/S0140-6736(16)30776-0
32. França GVA, Schuler-Faccini L, Oliveira WK, Henriques CM, Carmo EH, Pedi VD, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016;388(10047):891-7. DOI: https://dx.doi.org/10.1016/S0140-6736(16)30902-3
33. van der Linden V, Pessoa A, Dobyns W, Barkovich AJ, Linden Júnior H, Rolim Filho EL, et al. Description of 13 Infants Born During October 2015-January 2016 With Congenital Zika Vírus Infection Without Microcephaly at Birth- Brazil. MMWR Morb Mortal Wkly Rep. 2016;65(47):1343-8. DOI: http://dx.doi.org/10.15585/mmwr.mm6547e2
34. Zin AA, Tsui I, Rossetto J, Vasconcelos Z, Adachi K, Valderramos S, et al. Screening Criteria for Ophthalmic Manifestations of Congenital Zika Virus Infection. JAMA Pediatr. 2017;171(9):847-54. DOI: http://dx.doi.org/10.1001/jamapediatrics.2017.1474
35. Levine D, Jani JC, Castro-Aragon I, Cannie M. How Does imaging of congenital Zika compare with imaging of other TORCH infections? Radiology. 2017;285(3):744-61. DOI: http://dx.doi.org/10.1148/radiol.2017171238
36. Moore CA, Staples JE, Dobyns WB, Pessoa A, Ventura CV, Fonseca EB, et al. Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians. JAMA Pediatr. 2017;171(3):288-95. DOI: http://dx.doi.org/10.1001/jamapediatrics.2016.3982
37. Ventura CV, Maia M, Bravo-Filho V, Góis AL, Belfort Jr R. Zika virus in Brazil and macular atrophy in a child with microcephaly. Lancet. 2016;387(10015):228. DOI: https://doi.org/10.1016/S0140-6736(16)00006-4
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