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      Toxoplasmosis cerebral congénita e infección por el virus del Zika y del chikunguña: reporte de un caso Translated title: Congenital cerebral toxoplasmosis, Zika and chikungunya virus infections: A case report

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          Abstract

          Resumen En este artículo se describe el caso clínico de una mujer colombiana del sur del país con diagnóstico de infección intrauterina por Toxoplasma gondii y por los virus del chikungunya y del Zika. La mujer acudió al control prenatal en el segundo trimestre de su embarazo e informó que durante el primer trimestre había presentado síntomas indicativos de infección por el virus del Zika. Mediante reacción en cadena de la polimerasa (PCR) en líquido amniótico, se demostró infección por Toxoplasma gondii así como por los virus del chikungunya y del Zika. En las imágenes diagnósticas se observaron malformaciones del sistema nervioso central en el feto. A las 29 semanas de gestación se dio por terminado el embarazo mediante procedimiento médico.

          Translated abstract

          Abstract We report a case of intrauterine infection by Toxoplasma gondii, Chikungunya and Zika viruses in a Colombian woman from the southern part of the country. The patient attended prenatal care in the second trimester of her pregnancy and she informed that in the first trimester she had presented with clinical symptoms compatible with Zika virus infection. Amniotic fluid PCR assays showed infection by T. gondii, chikungunya and Zika viruses. Diagnostic imaging showed fetal malformation of the central nervous system. At 29 weeks of gestation, pregnancy was terminated medically.

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          Most cited references 34

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          Chikungunya: a re-emerging virus.

          In the past decade, chikungunya--a virus transmitted by Aedes spp mosquitoes--has re-emerged in Africa, southern and southeastern Asia, and the Indian Ocean Islands as the cause of large outbreaks of human disease. The disease is characterised by fever, headache, myalgia, rash, and both acute and persistent arthralgia. The disease can cause severe morbidity and, since 2005, fatality. The virus is endemic to tropical regions, but the spread of Aedes albopictus into Europe and the Americas coupled with high viraemia in infected travellers returning from endemic areas increases the risk that this virus could establish itself in new endemic regions. This Seminar focuses on the re-emergence of this disease, the clinical manifestations, pathogenesis of virus-induced arthralgia, diagnostic techniques, and various treatment modalities. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study

            Objective To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic. Design Retrospective study with a case series. Setting Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil. Participants 23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic. Main outcome measures Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans. Results Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus—the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. 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 (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases. 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.
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              Congenital cerebral malformations and dysfunction in fetuses and newborns following the 2013 to 2014 Zika virus epidemic in French Polynesia.

              We detected an unusual increase in congenital cerebral malformations and dysfunction in fetuses and newborns in French Polynesia, following an epidemic of Zika virus (ZIKV), from October 2013 to March 2014. A retrospective review identified 19 cases, including eight with major brain lesions and severe microcephaly, six with severe cerebral lesions without microcephaly and five with brainstem dysfunction without visible malformations. Imaging revealed profound neurological lesions (septal and callosal disruption, ventriculomegaly, abnormal neuronal migration, cerebellar hypoplasia, occipital pseudocysts, brain calcifications). Amniotic fluid was drawn from seven cases at gestation weeks 20 to 29. ZIKV RNA was detected by RT-PCR and infectious ZIKV isolates were obtained in four of five microcephalic, but not in two non-microcephalic cases with severe brain lesions. Medical termination of pregnancy was performed in eleven cases; two cases with brainstem dysfunction died in the first months of life; six cases are alive, with severe neurological impairment. The results show that four of seven tested fetuses with major neurological injuries were infected with ZIKV in utero. For other non-microcephalic, congenital abnormalities we were not able to prove or exclude ZIKV infection retrospectively. The unusual occurrence of brain malformations or dysfunction without microcephaly following a ZIKV outbreak needs further studies.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                bio
                Biomédica
                Biomédica
                Instituto Nacional de Salud (Bogotá, Cundinamarca, Colombia )
                0120-4157
                June 2018
                : 38
                : 2
                : 144-152
                Affiliations
                Bogotá Arauca orgnameUniversidad Nacional de Colombia orgdiv1Dirección General Colombia
                Bogotá Arauca orgnameUniversidad Nacional de Colombia orgdiv1Dirección de Vigilancia y Análisis de Riesgo en Salud Pública orgdiv2Equipo Maternidad Segura Colombia
                Bogotá Arauca orgnameUniversidad Nacional de Colombia orgdiv1Dirección de Redes en Salud Pública orgdiv2Grupo de Parasitología Colombia
                Bogotá Arauca orgnameUniversidad Nacional de Colombia orgdiv1Dirección de Investigación en Salud Pública Colombia
                Bogotá Arauca orgnameUniversidad Nacional de Colombia orgdiv1Dirección de Investigación en Salud Pública orgdiv2Equipo Banco de Proyectos Colombia
                Article
                S0120-41572018000200144
                10.7705/biomedica.v38i0.3652

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 49, Pages: 9
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