Zika clinical updates: implications for pediatrics

Abstract

Purpose of review: Zika virus (ZIKV), a mosquito-borne flavivirus, has gained recognition over the past few years as an important new cause of congenital infection. As a result, it is critical that pediatricians understand its epidemiology, clinical presentation, clinical sequelae, and management.

Recent findings: The recent ZIKV epidemiology, clinical presentation of acute infection in children and complications, perinatal infection, and congenital infection will be summarized in this ZIKV review. This will be followed by a brief summary on ZIKV diagnosis, management, treatment, and prevention.

Summary: The field of clinical research in ZIKV has rapidly evolved over recent months. It is critical that pediatricians continue to stay up-to-date with the continuously evolving understanding of the clinical aspects of ZIKV to ensure optimal identification and management of affected infants and children. Given the recent changes in Centers for Disease Control and Prevention guidelines to limit screening of asymptomatic pregnant women in the United States with possible ZIKV exposure, comprehensive ZIKV clinical knowledge becomes even more crucial.

Figure 1. Clinical Manifestations of Zika virus

Panel A shows a maculopapular rash on the face; Panel B, conjunctival and palpebral erythema; Panel C, retroauricular lymphadenopathy; Panel D, conjunctival injection with prominence of vasculature; Panel E, a rash on the legs, with a lacy reticular pattern; Panel F, a maculopapular rash on the inner arm; Panel G, edema of the foot, which the patient reported was painful; and Panel H, a blanching macular rash on the gravid abdomen. Source: Brasil P, Pereira JP, Jr., Raja Gabaglia C, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro – Preliminary Report. The New England journal of medicine 2016.

Figure 2. Neuroimaging and Classic Sequelae Seen in Congenital ZIKV Syndrome

MRI images of cranial facial disproportion with microcephaly. Diffuse reduction in white matter thickness with corpus callosum not identified. Diffuse pachygyria, more evident in the right parietal lobe. Supratentorial ventricular dilatation. Atrophy of the cerebellar vermix with ample communication of the fourth ventricle with the cisterna magna. Widening of the perivascular spaces of the cerebellar hemispheres, with surrounding gliosis. Panel I, disproportionate microcephaly; Panel J, arthrogryposis at birth; Panel K, redundant scalp; Panel L shows a cortical thumb; Panel M, knee fovea; and Panel N, shows the left infant retina demonstrating optic disc hypoplasia, peripapillary atrophy; macular chorioretinal atrophy with a colobomatous- like aspect with hyperpigmented halo and pigmentary mottling. Source: Brasil P, Pereira JP, Jr., Moreira ME, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro. The New England journal of medicine. 2016;375(24):2321–2334.