Experience in diagnosing congenital Zika syndrome in Brazilian children born to asymptomatic mothers.

INTRODUCTION: Typical symptoms of primary Zika virus infection are not specific and share similarities with other arbovirus infections such as dengue fever and chikungunya. As acute infection can be asymptomatic in up to 73% of cases, infants with microcephaly represent a diagnostic challenge for pediatricians. We describe the frequency of congenital Zika syndrome (CZS) in Brazilian children born to asymptomatic pregnant mothers and its differential diagnosis. METHODS: This longitudinal, observational study was conducted on children with suspected CZS whose mothers did not report rash during pregnancy, referred to the reference hospital in a metropolitan area of ​ Rio de Janeiro, Brazil. The diagnosis of suspected CZS was based on Brazilian Ministry of Health protocol. RESULTS: Forty-three (17%) of 246 referred children were born to mothers without rash history during pregnancy. Thirteen (30%) of 43 children met the Brazilian Ministry of Health criteria for CZS, all with microcephaly (two post-natal). The other children included 11 cases with post-natal microcephaly due to hypoxic-ischemic encephalopathy (6), non-progressive encephalopathy of unknown etiology (2), microcephaly under investigation (2) and congenital toxoplasmosis (1); 17 children were misdiagnosed with microcephaly and progressed with normal head circumference during the follow-up period; one child was included because of epidemiological link and one was loss to follow-up. All children who underwent laboratory investigation for ZIKV infection during neonatal period had negative RT-qPCR tests. CONCLUSION: We emphasize the increasing importance of CZS in differential diagnosis of microcephaly at birth or post-natal period. Detailed clinical investigation assisted by neuroimaging tests may clarify the diagnosis of CZS when laboratory tests are not available during the acute phase of the disease.

Radiological aspects in computed tomography as determinants in the diagnosis of pulmonary tuberculosis in immunocompetent infants.

OBJECTIVE: To describe the chest computed tomography (CT) findings in immunocompetent children under 36 months of age with pulmonary tuberculosis. MATERIALS AND METHODS: This was a descriptive case series conducted in the city of Rio de Janeiro, Brazil, between January 2004 and July 2013, involving 20 young children who underwent CT after undergoing chest X-rays that did not provide a definitive diagnosis. RESULTS: All of the participants had lymph node enlargement and consolidations. In 15 cases (75%), the consolidations were accompanied by atelectasis. Pulmonary cavitation was seen in 10 cases (50%), and cavitation within consolidations was seen in 7 (35%). The areas of cavitation and parenchymal destruction were not seen on conventional chest X-rays. CONCLUSION: The radiological presentation of pulmonary tuberculosis in young children differs from that described in older children and adults. CT is an effective method for the early diagnosis of pulmonary tuberculosis in immunocompetent infants, allowing the rapid institution of specific treatment, which is crucial for halting disease progression, as well as for preventing local and systemic complications.

OBJETIVO: Descrever achados radiológicos na tomografia computadorizada (TC) de tórax de crianças imunocompetentes menores de 36 meses com tuberculose pulmonar. MATERIAIS E MÉTODOS: Esta série de casos foi desenvolvida na cidade do Rio de Janeiro, no período de janeiro de 2004 a julho de 2013, onde 20 pacientes foram submetidos a TC após a realização de radiografias de tórax que não definiram o diagnóstico. RESULTADOS: Todos os participantes tiveram linfonodomegalias e consolidações. Em 15 casos (75%) as consolidações tiveram atelectasia associada. Escavações pulmonares ocorreram em 10 casos (50%), havendo consolidações em 7 (35%). Áreas de escavação e destruição parenquimatosa em fase inicial não foram observadas nas radiografias simples. CONCLUSÃO: A apresentação radiológica de tuberculose pulmonar em lactentes não foi a mesma descrita em crianças maiores e adultos. A TC é um método aplicável para o diagnóstico precoce de tuberculose pulmonar em lactentes imunocompetentes, permitindo a rápida instituição de tratamento específico, que é crucial para interromper a progressão da doença e prevenir suas complicações locais e sistêmicas.