Zika vírus em gestantes atendidas no ambulatório especializado (GestaZika) durante epidemia em Dourados, Mato Grosso do Sul

Abstract

The World Health Organization has classified Zika as a public health problem of global importance, as the Zika virus entering Brazil has changed its epidemiological pattern, spreading to various states and other countries of the Americas. Associated with this spread was a new presentation of the disease, Congenital Zika Syndrome. To describe the clinical manifestations and fetal repercussions of Zika disease, pregnant and puerperal women referred to the specialized ambulatory from the University Hospital of the Federal University of Grande Dourados with suspected infection were included using three categories: 1) Pregnant women with clinical condition of cutaneous exanthema started in the last seven days before consultation, accompanied or not with other symptoms; 2) Pregnant women who during pregnancy presented suspected ultrasound alteration of Congenital Zika Syndrome; 3) Puerperal women whose newborns were framed as a suspected or confirmed case of Congenital Zika Syndrome. Clinical and socioeconomic questionnaires were applied and tests were performed for the differential diagnosis of arboviruses and TORCH group diseases (toxoplasmosis, syphilis, rubella, cytomegalovirus, and herpes). From March 2016 to March 2018, 51 women were initially included, 42 pregnant women with exanthema, five pregnant women with ultrasound alteration, three puerperant women with newborns suspected of Congenital Zika Syndrome and one patient with Cytomegalovirus, who was excluded after diagnosis. Of these 50 women who remained in the study, 44 (88%) women from Dourados and six (12%) from Grande Dourados, only one case was not classified as indigenous. There was no social or age concentration with age ranging from 15 to 37 years (average = 27.6 years, standard deviation of 5.2 years), with the largest number of patients between 30 to 34 years (34%). The exanthema was present in 88% of the cases, 40.9% of which were located in the torso, 34.1% in the upper limbs and spread throughout the body in 72.7% of the patients. Regarding the other symptoms, pruritus was the most frequent, being reported in 58% of women, followed by headache (40%) and fever (38%) which had an average duration of 2.3 days. Other symptoms were less observed, such as myalgias (34%), prostration (28%), retroocular pain (26%), fatigue (24%), conjunctival hyperemia (22%) and joint pain in 20%. Symptoms such as nausea, vomiting, diarrhea or abdominal pain have rarely been described. As for the laboratory diagnosis, of the 50 women evaluated, only ten patients were positive for Zika virus, of these, nine by molecular detection of the viral genome and one by detection of IgM antibodies. There was no coinfection for arboviruses or other TORCH group diseases. Four patients were diagnosed positive for Dengue virus, none for Chikungunya virus and one patient for human immunodeficiency virus. Among these ten women positive for the Zika virus, regardless of the gestational trimester in which exposure occurred, only three pregnancies had fetal repercussions and were classified as Congenital Zika Syndrome. Four other pregnant women negative for Zika virus were also classified as confirmed cases of congenital infection, but without etiological identification. Several changes have been described, during pregnancy the most frequent was cerebral ventriculomegaly and at birth was microcephaly. The symptomatology observed in pregnant women was mild, however it was possible to observe severe results, including neonatal death, microcephaly and other serious brain changes in the conceptus. Microcephaly and other birth changes are common in Congenital Zika Syndrome, however, longitudinal follow-up of exposed children is necessary to determine if there are other consequences of the infection during childhood, and further studies are needed.