Fig. 21.1
Wide-angle fundus image (Retcam, Clarity Medical Systems, Pleasanton, CA, USA) of the right eye of an infant with a well-defined macular chorioretinal atrophic lesion associated with macular pigment mottling
Fig. 21.2
Wide-angle fundus image (Retcam, Clarity Medical Systems, Pleasanton, CA, USA) of the left right eye of an infant with a chorioretinal scar and perilesional pigmentary mottling in the macular region
According to the studies conducted so far, chorioretinal atrophy and focal pigment mottling occurred predominantly in the posterior pole, especially the macular area [21–23]. It was also observed that some chorioretinal lesions had an excavated appearance (colobomatous-like) [23]. No signs of active uveitis or vasculitis were observed. Most mothers who reported symptoms had them predominantly in the first trimester of pregnancy, and no expectant mother had conjunctivitis [21–23].
The current data suggested that even asymptomatic or oligosymptomatic pregnant patients presumably infected with ZIKV might have children with CZS manifestations such as ophthalmologic lesions. Another important consideration is whether children without microcephaly born from mothers infected during pregnancy develop ocular lesions as a spectrum of CZS and if these patients need to be screened in areas with ongoing ZIKV transmission.
21.2 Recommendations
Screening approaches are essential for pregnant women who reside in regions where the ZIKV is present and include PCR, serology tests, and ultrasound and amniocentesis in some patients.
Pregnant women who live in areas of ongoing ZIKV transmission and women who traveled to these areas who present with a dengue-like illness (rash, fever, myalgias, and arthralgias) should undergo an RT-PCR test on serum collected within 7 days of symptom onset. Viremia decreases over time and a negative RT-PCR result from serum collected 5–7 days after symptom onset does not exclude the ZIKV infection. Pregnant women who live in risk areas for the ZIKV infection and do not report symptoms can undergo a ZIKV IgM test during prenatal care. If negative, repeat testing can be considered during the second trimester. The CDC recommends that men who live in or travel to an area with active Zika virus transmission and who have a pregnant partner should use condoms every time they have sex or not have sex for the duration of the pregnancy [27].
IgM antibodies to the ZIKV, dengue viruses, and other flaviviruses have strong cross-reactivity. More accurate IgM and IgG assays are essential to stratify the risk in women of childbearing age and facilitate targeted prenatal screening. This is even more important where abortion for this situation is legal.
Infants that abnormalities are consistent with Congenital Zika Syndrome or laboratory evidence of Zika virus infection of mothers presumably infected with the ZIKV during pregnancy should undergo at least one ocular examination that includes an a complete ophthalmological evaluation, including the anterior and posterior segment assessment and indirect ophthalmoscopy under pharmacologic mydriasis. Anterior segment changes should be described, and optic nerve, retinal, and choroidal abnormalities should be registered with a wide-field digital imaging system. Children who have macular lesions and a high probability of low vision should be referred to a specialist. The current data suggested that even asymptomatic or oligosymptomatic pregnant patients presumably infected with the ZIKV might have microcephalic newborns with retinal and optic disc lesions. It is unknown whether the ZIKV congenital infection might cause future ocular abnormalities.
Due to the difficulties in controlling the mosquito vector, the development of a vaccine against ZIKV seems to be essential for long-term control of new cases. In addition, for those existing cases of CZS, more information is needed in order to fully understand their needs and manage their disabilities.
Core Messages
Zika virus congenital infection may cause microcephaly and ocular abnormalities in 29-45% of newborns. Majority of lesions are bilateral and may affect the macula. Early diagnosis and visual as well as cognitive rehabilitation are necessary.
The best prevention is the control of the biologic vector Aedes aegypti and to avoid pregnant in endemic areas. The use of insect repellents is high recommended in such situations and adults that had the diagnosis of Zika infection should avoid sexual reaction or use condom for 3-6 months. Care must be take in blood tranfusion from endemic areas.
References
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Foy BD, Kobylinski KC, Chilson Foy JL et al (2011) Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 17:880–882CrossRefPubMedPubMedCentral
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