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BibMe Free Bibliography & Citation Maker - MLA, APA, Chicago, Harvard.Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study. Maria de Fatima Vasco Aragao, neuroradiologist and professor of radiology. Vanessa van der Linden, paediatric neurologist. Alessandra Mertens Brainer- Lima, neuroradiologist and professor of radiology. Regina Ramos Coeli, paediatric infectologist and professor. Maria Angela Rocha, infectologist. Paula Sobral da Silva, paediatric neurologist. Maria Durce Costa Gomes de Carvalho, paediatric neurologist. Ana van der Linden, paediatric neurologist. Arthur Cesario de Holanda, medical student. Marcelo Moraes Valenca, neurosurgeon and full professor of neurology and neurosurgery. Centro Diagnostico Multimagem, Rua Frei Matias Tevis, 1. Ilha do Leite Recife Pernambuco 5. Brazil; Medical School, Mauricio de Nassau University, Recife, Pernambuco, Brazil. Association for Assistance of Disabled Children, Recife, Brazil; Bar. The other 1. 7 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for Ig. M antibodies to the virus—the test was not yet available on a routine basis. Of the 2. 3 children, 1. CT, seven underwent both CT and MRI, and one underwent MRI. Of the 2. 2 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 2. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (8. Shop 486 NorthStar products at Northern Tool + Equipment. 20161101 100501 v7.0 Guidance on statutory notifications ASC IH PDC PA Reg Persons Registration under the Health and Social Care Act 2008 Statutory notifications. The Case IH Patriot® Series sprayers provide consistent, accurate application across every piece of ground, all season, every season.
Malformations were symmetrical in 7. Conclusion Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem. Introduction. Since October 2. Pernambuco,1 a Brazilian state with nine million inhabitants. Several possible explanations for this phenomenon have been proposed, including an association with the current rise in Zika virus infections observed since March 2. The putative association between Zika virus infection in mothers during pregnancy and microcephalic offspring is based on epidemiological and laboratory evidence. These include the temporal association between the Zika virus epidemic and concomitant increase in the number of babies born with microcephaly. Zika virus genome (using reverse transcription- polymerase chain reaction assay) in amniotic fluid samples from two pregnant women with microcephalic fetuses. Zika virus genome in the blood and tissue samples of a newborn baby with microcephaly who died five minutes after birth. Zika virus neurotropism in experimental animals. Zika virus can cause death of neural cells. Zika virus infection compared with those without. Zika virus is transmitted through the bite of an infected arthropod. The virus has been isolated from several species of mosquitoes: Aedes africanus, Aedes luteocephalus, and Aedes aegypti. The last of these is also known to transmit other diseases, such as dengue and yellow fever, which are endemic infections, and Chikungunya, which has also emerged recently. Zika virus epidemics have been described in several countries, especially in the most densely populated cities of tropical and subtropical regions. Although Zika virus was first described in 1. Zika virus infection and microcephaly was confirmed until November 2. Brazil (table 1. Of these, Zika virus infection has been diagnosed in 5. Brazilian Ministry of Health’s protocol. In Pernambuco, the state with most notifications (n=1. Zika virus related infection. Fig 1 Map of Brazil showing cities with notified cases of microcephaly in Brazil up to 1. February 2. 01. 6. Adapted from Brazilian Ministry of Health. Even though microcephaly is the principal characteristic of a severe congenital infection during the early stages of pregnancy, to the best of our knowledge, the radiological features of children with presumed Zika virus related congenital infection or microcephaly have not been well characterised. A case series from Brazil described the computed tomography (CT) and transfontanellar cranial ultrasound characteristics of Zika virus related microcephaly, but the images were not shown. The features on magnetic resonance imaging (MRI) have not been described in children born with microcephaly. We describe the brain imaging (CT and MRI) features as well as principal clinical findings of children with microcephaly and presumed congenital infection related to the Zika virus during the epidemic in Pernambuco, Brazil. Patient involvement. No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for design or implementation of the study. No patients were asked to advise on interpretation or writing up of results. There are no plans to disseminate the results of the research to study participants or the relevant patient community. Methods. This is a retrospective report of a case series of 2. Zika virus related congenital infection during the Brazilian epidemic, 2. Since October 2. 01. Pernambuco report all infants born in the state with suspected microcephaly on a government website (cievs. In the initial stages of the epidemic, microcephaly was defined as a head circumference of 3. On 2 December 2. 01. Fenton curve. According to the Brazilian Ministry of Health’s protocol, all infants born with suspected microcephaly in Pernambuco should be referred to one of two paediatric infectious disease departments and to one of four rehabilitation centres. The Association for Assistance of Disabled Children (AACD) is one of the rehabilitation centres. All investigations described in this report were conducted as part of the routine clinical evaluation of these children as established by clinical protocols defined by the Brazilian Ministry of Health and the health secretary of Pernambuco state,1 and the differential diagnosis was based on clinical presentation, personal and family history, laboratory test results, and radiological findings. Parents or guardians gave consent before the procedures. In AACD, all children are initially examined by a neurologist or physician specialising in physical medicine and rehabilitation, and, as needed, an ophthalmologist, orthopaedic consultant, and a multidisciplinary team of rehabilitation specialists. All children undergo a CT brain scan without contrast. Some also undergo MRI of the brain, based on the results of the clinical evaluation, mainly the presence of refractory seizures or suspicion of hydrocephalus and arthrogryposis. We used a standard form to collect personal and clinical data. Mothers gave information on illness during pregnancy compatible with Zika virus infection (eg, maculopapular rash, fever, headache, myalgia, arthralgia, and conjunctivitis), with or without serological confirmation, as well as any neurological dysfunction or craniofacial disproportion in the newborn. The main agents of congenital infections that cause brain calcifications and microcephaly (cytomegalovirus, toxoplasmosis, rubella, and syphilis) were investigated with paired serology (Ig. M and Ig. G antibodies to Zika virus) of both mother and newborn. If Ig. G antibodies to cytomegalovirus were present in both, polymerase chain reaction was conducted on urine samples. We excluded from the study those children with known causes of microcephaly other than Zika virus. Cerebrospinal fluid samples from six children were tested by Ig. M antibody capture enzyme- linked immunosorbent assay (the new specific test for Zika virus), following the protocol of the Centers for Disease Control and Prevention. Genetic testing is not included in the Brazilian government’s protocol, and differential diagnosis is performed based on family history and imaging findings, as is done with all metabolic diseases. Other causes of microcephaly, such as prenatal and perinatal complications and exposure to licit and illicit drugs, toxic substances, and ionising radiation were excluded in the children. Children included in this report had microcephaly or craniofacial disproportion (diagnosed by ultrasound examination during pregnancy or at birth), or both; brain imaging suggestive of congenital infection; and negative test results for other known infectious causes of microcephaly (eg, toxoplasmosis, cytomegalovirus, rubella, syphilis, and HIV). CT and MRI scans. According to the protocol of the Brazilian government, all children with microcephaly undergo non- contrast brain CT after clinical examination. MRI is not included in the protocol, but it is performed when available, based on clinical indication. The evaluation of the images was exclusively qualitative. All CT scanning was performed using a multislice CT scanner without contrast, and all MRI was performed using a 1. T MRI scanner. Only in one child was MRI done with contrast. The conventional MRI sequences available for analysis were T1 weighted imaging, T2 weighted imaging, susceptibility magnetic weighted imaging or T2* gradient echo, and diffusion weighted imaging. Site buyinderalrxus. Real content coming soon. |