Characteristics of Dysphagia in Infants with Microcephaly Caused by Congenital Zika Virus Infection, Brazil, 2015.

Mariana C Leal,Adriana C.G Borges,Coeli R Ximenes,Thiago P Bezerra,Catharina X Moura,Laura C Rodrigues,Margarida M.C Antunes,Kátia G Brandt,Luciana De Valois,Vanessa Van Der Linden

doi:10.3201/eid2308.170354

Abstract

We summarize the characteristics of dysphagia in 9 infants in Brazil with microcephaly caused by congenital Zika virus infection. The Schedule for Oral Motor Assessment, fiberoptic endoscopic evaluation of swallowing, and the videofluoroscopic swallowing study were used as noninstrumental and instrumental assessments. All infants had a degree of neurologic damage and showed abnormalities in the oral phase. Of the 9 infants, 8 lacked oral and upper respiratory tract sensitivity, leading to delays in initiation of the pharyngeal phase of swallowing. Those delays, combined with marked oral dysfunction, increased the risk for aspiration of food, particularly liquid foods. Dysphagia resulting from congenital Zika virus syndrome microcephaly can develop in infants >3 months of age and is severe.

Highlights

The identification of a congenital Zika syndrome (CZS) during the November 2015 microcephaly epidemic in Brazil raised many questions [1]
Feeding problems in persons with neurologic diseases are mainly explained by brain damage leading to lack of swallowing coordination; abnormalities of posture; and abnormalities of digestive tract motility, such as gastroparesis and gastroesophageal reflux [9]. These problems may be the cause of dysphagia seen in infants with CZS, we suggest that CZS-associated dysphagia might be caused by anomalies of orofacial anatomy, oral and upper respiratory tract sensitivity, and changes in the motor function of the upper digestive tube caused primarily or secondarily by direct action of the virus
The study was conducted in 3 tertiary care institutions in Recife, Pernambuco State, Brazil: 1) Associação de Assistência à Criança Deficiente, the reference center for disabled children, where the infants with dysphagia were followed up by a neurologist and speech pathologist; 2) the Pediatric Otolaryngology and Pediatric Gastroenterology Outpatient Unit at the Hospital das Clínicas da Universidade Federal de Pernambuco, where infants received a complete dysphagia assessment, including fiberoptic endoscopic evaluation of swallowing (FEES); and 3) the Division of Radiology at Real Hospital Português, where infants underwent the videofluoroscopic swallowing study (VFSS)

Summary

Introduction

The identification of a congenital Zika syndrome (CZS) during the November 2015 microcephaly epidemic in Brazil raised many questions [1]. Feeding problems in persons with neurologic diseases are mainly explained by brain damage leading to lack of swallowing coordination; abnormalities of posture; and abnormalities of digestive tract motility, such as gastroparesis and gastroesophageal reflux [9] These problems may be the cause of dysphagia seen in infants with CZS, we suggest that CZS-associated dysphagia might be caused by anomalies of orofacial anatomy, oral and upper respiratory tract sensitivity, and changes in the motor function of the upper digestive tube caused primarily or secondarily by direct action of the virus. We undertook instrumental evaluation of dysphagia in children with CZS with the objective of describing the characteristics of this condition

Methods

Results

Conclusion