Manifestaciones oftalmológicas del dengue, el zika y el chikungunya / Ophthalmic manifestations of dengue, zika and chikungunya

Las infecciones por arbovirus constituyen un reto significativo para los sistemas de salud. Cada vez se incrementa el reconocimiento de complicaciones del sistema nervioso central secundarias a ellas, lo que puede ser un dilema para su diagnóstico y tratamiento. Los arbovirus pueden alterar los mecanismos de inmunidad innatos del ojo al dañar las barreras óculo-hemáticas. En esta revisión nos propusimos caracterizar los principales hallazgos oftalmológicos de las enfermedades transmitidas por mosquito, como el dengue, el zika y el chikungunya, y su posible fisiopatología. Se realizó una búsqueda de la literatura sobre el tema en la base de datos de PubMED. En los pacientes con zika y chikungunya se reconocieron frecuentemente la conjuntivitis no purulenta y la queratitis. En los casos de dengue el edema macular y las hemorragias retinianas maculares fueron frecuentes; causaron disminución de la visión y defectos campimétricos; la vasculitis y coriorretinitis periférica podía ser asintomática si la mácula no estaba comprometida. Estuvieron implicados la trombocitopenia y otros procesos fisiopatológicos. En las enfermedades estudiadas se reportaron casos raros con parálisis de nervios oculomotores o neuritis óptica como respuesta autoinmune tardía. Recientemente se reportó el síndrome de zika congénito que incluyó múltiples anomalías del desarrollo. En los neonatos afectados se describió la atrofia macular, así como la pigmentación macular bilateral, la hipoplasia del nervio óptico, la catarata, entre otros. Existen diversas lesiones oculares secundarias a infecciones por dengue, zika y chikungunya que merecen reconocimiento, pues deterioran la función visual temporal o permanentemente(AU)

Arbovirus infections pose a significant challenge to health systems. Awareness of the secondary central nervous system complications caused by these infections is on the increase, which may be a dilemma for their diagnosis and treatment. Arboviruses may alter the innate immunity mechanisms of the eye by damaging blood-retinal barriers. The objective of this review was to characterize the main ophthalmological findings of mosquito-borne diseases, such as dengue, zika and chikungunya, and their possible physiopathology. A bibliographic search about the topic was conducted in the database PubMed. Non-purulent conjunctivitis and keratitis were frequently found in zika and chikungunya patients. Dengue cases often presented macular edema and macular retinal hemorrhage, which caused vision reduction, as well as campimetric defects. Vasculitis and peripheral chorioretinitis could be asymptomatic if the macula was not involved. Thrombocytopenia and other physiopathological processes were also present. Oculomotor nerve palsy and optic neuritis as a late autoimmune response were rarely reported in the diseases studied. Recent reports refer to congenital zika syndrome, which causes multiple developmental abnormalities. Macular atrophy, bilateral macular pigmentation, optic nerve hypoplasia and cataract, among other disorders, were described in affected neonates. A variety of ocular lesions secondary to dengue, zika and chikungunya infection deserve recognition, for they damage visual function either temporarily or permanently(AU)

Análise do conceito síndrome congênita pelo Zika vírus / Analysis of the concept of the Zika Virus congenital syndrome

Resumo O objetivo deste artigo é analisar o conceito de Síndrome Congênita pelo Zika Vírus. Trata-se de uma análise de conceito, baseado em Walker e Avant. Para operacionalização da busca foi realizada uma revisão sistemática. A essência do conceito Síndrome Congênita pelo Zika Vírus é determinada pelos atributos: calcificação intracraniana, ventriculomegalia e volume cerebral diminuído. Para que essa síndrome aconteça faz-se necessário que ocorram os antecedentes: transmissão via transplacentária de mãe infectada pela picada do mosquito Aedes SSP ou por via sexual. Com isso, resultam um conjunto de sinais e sintomas além da microcefalia fetal ou pós-natal, como por exemplo, atraso no desenvolvimento neuropsicomotor, anormalidades auditivas e visuais, desproporção craniofacial, suturas cranianas sobrepostas, osso occipital proeminente, excesso de pele nucal, epilepsia, irritabilidade, discinesia, hipertonia, hipotonia, hemiplegia, hemiparesia, espasticidade, hiperreflexia. O conceito de Síndrome Congênita pelo Zika Vírus é recém conhecido. O que determinará a presença do conjunto de sinais e sintomas pela infecção congênita do Zika vírus é a calcificação intracraniana e volume cerebral diminuído, podendo apresentar microcefalia já ao nascer ou apenas posteriormente.

Abstract The scope of this article is to analyze the concept of the Zika Virus Congenital Syndrome. It is a conceptual analysis, based on Walker and Avant. In order to operationalize the search, a systematic review was conducted. The essence of the concept of the Zika Virus Congenital Syndrome is determined by the following attributes: intracranial calcification, ventriculomegaly, and diminished brain volume. For this syndrome to occur, it is necessary to have the following antecedents: transplacental transmission of a mother infected by the bite of the Aedes SSP mosquito or by sexual contact. Accordingly, this entails a set of signs and symptoms that go beyond fetal or postnatal microcephaly, such as, for example, delayed neuropsychomotor development, auditory and visual abnormalities, craniofacial disproportion, overlapping cranial sutures, prominent occipital bone, excess nuchal skin, epilepsy, irritability, dyskinesia, hypertonia, hypotonia, hemiplegia, hemiparesis, spasticity and hyperreflexia. The concept of the Zika Virus Congenital Syndrome is newly acknowledged. The presence of the set of signs and symptoms by the Zika Virus Congenital Syndrome is determined by intracranial calcification and decreased brain volume, and the baby may present microcephaly at birth or subsequently.

Family fortresses in Zika Congenital Syndrome according to Betty Neuman / Fortalezas familiares en el Síndrome Congénita del Zika a la luz de Betty Neuman / Fortalezas familiares na Síndrome Congênita do Zika à luz de Betty Neuman

ABSTRACT Objectives: to identify elements that contribute to strengthen the family system of children with Zika virus congenital syndrome according to Betty Neuman's theory. Methods: qualitative research, carried out in the outpatient service of a public hospital in the city of Recife, Brazil, with 13 mothers, by semi-structured interviews. The IRAMUTEQ software was used for data analysis and the interpretation was carried out according to Betty Neuman's Systems Model Theory. Results: the dendrogram originated five categories, which we named: Family Routine, Health Service Assistance, Changes in Lifestyle, Support Network, and Social Repercussions of Care for the the Family Context. Final considerations: nursing actions based on Betty Neuman's theory provide subsidies for the recognition of elements that strengthen the defense lines of the family system. These resources can be explored, aiming to maintaining the well-being and balance in the context of the family system.

RESUMEN Objetivos: identificar los elementos que contribuyen al fortalecimiento del sistema familiar del niño con el síndrome congénita del virus del Zika bajo la teoría de Betty Neuman. Métodos: investigación cualitativa, realizada con 13 madres en el ambulatorio de un hospital público de Recife, y en la que se utilizó entrevista semiestructurada. El software IRAMUTEQ se utilizó en el análisis de datos, y la Teoría del Modelo de Sistemas de Betty Neuman en su interpretación. Resultados: el dendograma generó cinco clases intituladas: Rutina Familiar, Atención del Servicio de Salud, Cambios en el Estilo de Vida, Red de Apoyo y Repercusiones Sociales del Cuidado en el Contexto Familiar. Consideraciones finales: las acciones de enfermería con base en la teoría de Betty Neuman promueven subsidios para reconocer elementos que fortalecen las líneas de defensa del sistema familiar. Se pueden explorar estos recursos con el fin de mantener el bienestar y el equilibrio en el contexto del sistema familiar.

RESUMO Objetivos: identificar elementos que contribuem para fortalecer o sistema familiar da criança com síndrome congênita do Zika vírus à luz da teoria de Betty Neuman. Métodos: pesquisa qualitativa, realizada no ambulatório de um hospital público do Recife, com 13 mães, por meio de entrevista semiestruturada. Para a análise dos dados foi utilizado o software IRAMUTEQ e interpretação à luz da Teoria do Modelo de Sistemas de Betty Neuman. Resultados: o dendograma deu origem a cinco classes nomeadas: Rotina Familiar, Assistência do Serviço de Saúde, Mudanças no Estilo de Vida, Rede de Apoio e Repercussões Sociais do Cuidado para o Contexto Familiar. Considerações finais: ações de enfermagem fundamentadas na teoria de Betty Neuman fornecem subsídios para o reconhecimento de elementos que fortalecem as linhas de defesa do sistema familiar. Esses recursos podem ser explorados, com vistas à manutenção do bem-estar e o equilíbrio no contexto do sistema familiar.

Clinical and x-ray oral evaluation in patients with congenital Zika Virus

Abstract Objective: The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation. Methodology: Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student's t-test and nominal logistic regression were used (p<0.05). Results: Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010). Conclusions: The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums.

Análise da evolução do neurodesenvolvimento de crianças assintomáticas ao nascimento expostas verticalmente ao Zika Vírus / Analysis of the neurodevelopmental evolution of asymptomatic children vertically exposed to Zika Virus at birth

Introdução: A exposição vertical ao vírus Zika tem sido responsável por grandes danos neurológicos a crianças. Dentre a população com ausência de sintomas da Síndrome de Zika Congênita, ainda persistem dúvidas quanto ao potencial dano neurológico causado pela exposição, necessitando maior investigação a respeito do neurodesenvolvimento desses pacientes. Objetivo: Avaliar a evolução do neurodesenvolvimento dos recém-nascidos assintomáticos ao nascimento expostos verticalmente ao ZIKV, durante os dois primeiros anos de vida. Método: Foi realizado um estudo de série de casos de filhos de mães com infecção confirmada pelo ZIKV durante a gestação. Por meio dos prontuários e questionários, observou-se um conjunto de variáveis sociodemográficas do período pré-natal, pós-natal e do seguimento de crianças assintomáticas ao nascimento e expostas verticalmente ao ZIKV. O neurodesenvolvimento foi avaliado a partir da escala de Bayley III em duas avaliações, entre os seis meses e dois anos de vida das crianças. Diante do resultado do escore composto no Bayley III foi realizado análise estatística das variáveis selecionadas correlacionando as crianças com ou sem alteração na última avaliação do Bayley III. Resultados: Foi possível verificar uma piora do neurodesenvolvimento dessa população, principalmente na área da linguagem, durante os dois primeiros anos de vida. Houve uma relação estatisticamente significativa da alteração do neurodesenvolvimento com a variação do perímetro cefálico. Não foi possível identificar correlação entre outras variáveis analisadas com o atraso no neurodesenvolvimento. Discussão/Conclusão: O ZIKV afeta as células progenitoras neurais e pode causar comprometimento cerebral em diversas fases do neurodesenvolvimento. Este trabalho evidenciou uma piora do neurodesenvolvimento nos primeiros dois anos de vida e também uma relação entre a variação do perímetro cefálico com essas alterações. Portanto, faz-se necessária a continuidade da investigação nessas crianças, com o intuito de definir melhor a fisiopatologia da doença e traçar novas estratégias e terapias para reabilitação desses pacientes.

Introduction: Vertical exposure to Zika virus has been responsible for major neurological damage to children. Among the population with no symptoms of Congenital Zika Syndrome, there are still doubts about the potential neurological damage caused by Zika virus exposure during pregnancy, requiring further investigation regarding the neurodevelopment of these patients. Objective: To evaluate the neurodevelopmental evolution of the asymptomatic newborns exposed vertically to ZIKV during the first 2 years of life. Method: A case series study was carried out of children of mothers with ZIKV-confirmed infection during pregnancy. A set of sociodemographic variables of the pre and postnatal period and the follow up of children exposed vertically to the ZIKV who were asymptomatic at birth were observed in the patients' and questionnaires. Neurodevelopment was evaluated using Bayley III in two different occasions in children between the ages of 6 months and 2 years. was used to evaluate the factors related to the difference in Bayley's results. A statistical analysis of the selected variables was performed correlating the children with or without alteration in the last evaluation of Bayley III. Results: It was possible to verify a neurodevelopmental decay in this population, especially in the area of language, during the first 2 years of life. There was a statistically significant relationship between head circumference variation with neurodevelopmental worsening. It was not possible to identify a correlation between other variables analyzed with the delay in neurodevelopment. Discussion / Conclusion: ZIKV affects neural progenitor cells and can cause brain damage in various stages of neurodevelopment. Discussion / Conclusion: ZIKV affects neural progenitor cells and can cause brain damage in various stages of neurodevelopment. This work evidences a worsening of neurodevelopment in the first 2 years of life, as well as a relationship between the variation of head circumference and these alterations. Therefore, it is necessary to continue the investigation in these children, in order to better define the pathophysiology of the disease and to outline new strategies and effective therapies for these patients.

Neurological manifestations of Chikungunya and Zika infections / Manifestações neurológicas das infecções pelos vírus Zika e Chikungunya

ABSTRACT The epidemics of Chikungunya virus (CHIKV) and Zika virus (ZIKV) infections have been considered the most important epidemiological occurrences in the Americas. The clinical picture of CHIKV infection is characterized by high fever, exanthema, myalgia, headaches, and arthralgia. Besides the typical clinical picture of CHIKV, atypical manifestations of neurological complications have been reported: meningo-encephalitis, meningoencephalo-myeloradiculitis, myeloradiculitis, myelitis, myeloneuropathy, Guillain-Barré syndrome and others. The diagnosis is based on clinical, epidemiological, and laboratory criteria. The most common symptoms of ZIKV infection are skin rash (mostly maculopapular), fever, arthralgia, myalgia, headache, and conjunctivitis. Some epidemics that have recently occurred in French Polynesia and Brazil, reported the most severe conditions, with involvement of the nervous system (Guillain-Barré syndrome, transverse myelitis, microcephaly and meningitis). The treatment for ZIKV and CHIKV infections are symptomatic and the management for neurological complications depends on the type of affliction. Intravenous immunoglobulin, plasmapheresis, and corticosteroid pulse therapy are options.

RESUMO As epidemias provocadas pelo vírus Chikungunya (CHIK) e Zika vírus (ZIKV) têm sido consideradas as ocorrências epidemiológicas mais importantes da América. O quadro clínico da infecção por CHIK caracteriza-se por febre alta, exantema, mialgia, cefaléia e artralgia. Além do quadro clínico típico, manifestações atípicas como complicações neurológicas foram relatadas: meningo-encefalite, mielorradiculopatia, mielorradiculite, mielite, mieloneuropatia, síndrome de Guillain-Barre (GBS), entre outras. O diagnóstico é baseado em critérios clínicos, epidemiológicos e laboratoriais. Em relação aos sinais e sintomas da infecção pelo ZIKV, erupção cutânea (principalmente maculopapular), febre, artralgia, mialgia, cefaléia e conjuntivite são os mais comuns. Algumas epidemias que ocorreram recentemente na Polinésia Francesa e Brasil relataram condições mais severas, com envolvimento do sistema nervoso (GBS, mielite transversa, microcefalia e meningite). O tratamento para ZIKV e CHIK é sintomático, e o manejo das complicações neurológicas dependerá do tipo da afecção. Imunoglobulina venosa, plasmaférese, e pulsoterapia com corticosteróides são opções.