The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly.

Mariana C Leal,Ana Elizabeth S C Vilela,Marli T Cordeiro,Ricardo Ximenes,Karen Pena De Souza Cavalcanti,Mirella Rodrigues,Vanessa Van Der Linden,Thiago Pinto Bezerra,Danielle Seabra Ramos,Elizabeth B Brickley,Rebeka Jacques De F Maciel,Mariana Lira,Silvio S Caldas,Demócrito Miranda-Filho

doi:10.3390/v13010062

Abstract

Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two reference centers for otorhinolaryngological care of patients with congenital Zika syndrome. Out of 92 children with confirmed ZRM, 57 were evaluated by nasopharyngoscopy after presenting with upper respiratory obstruction symptoms. In this study, 31 of the 57 (54%) children with ZRM who were evaluated had obstructive AH. Thirteen children with obstructive AH were submitted to surgery, which resulted in the complete resolution of symptoms for 11, partial resolution in 1, and no improvement in 1. No evidence of direct involvement by Zika virus (ZIKV) infection in the adenoid tissues was demonstrated by histology or immunohistochemistry. Our results suggest that there is a high prevalence and early presentation of AH in children with ZRM, with consequent upper airway obstruction causing upper airway obstructive disorder, secretory otitis media, and dysphagia.

Highlights

In late 2015, Brazil experienced a dramatic increase in microcephaly cases, which were subsequently attributed to intrauterine infection by Zika virus (ZIKV) [1,2,3,4,5,6] Much has been written about congenital ZIKV infection since ; the full spectrum of congenital Zika syndrome (CZS) is not yet known
The study sample included children with congenital ZIKV infection confirmed through laboratory testing of cerebrospinal fluid by a positive Zika virus-specific immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA) performed on cerebrospinal fluid [18,19]
We observed obstructive adenoid hypertrophy (AH) in more than half of children with Zika-related microcephaly (ZRM) in this study. These data reveal the importance of evaluating the upper airway obstruction symptoms in children with ZRM, even in the first years of life

Summary

Introduction

In late 2015, Brazil experienced a dramatic increase in microcephaly cases, which were subsequently attributed to intrauterine infection by Zika virus (ZIKV) [1,2,3,4,5,6] Much has been written about congenital ZIKV infection since ; the full spectrum of congenital Zika syndrome (CZS) is not yet known. As part of a prospective cohort of children with CZS in Recife, Pernambuco, Brazil, this study aims to investigate adenoid hypertrophy (AH) as a cause of upper respiratory obstruction in children with Zika-related microcephaly (ZRM) in the first three years of life. Resulting from alterations in the normal growth of lymphoid tissue, hypertrophy of the pharyngeal tonsils, better known as adenoids, can present with a range of symptoms including nasal obstruction, mouth breathing, craniofacial alterations, dysphagia, conductive hearing losses related to secretory otitis media, and snoring during sleep. AH may result in obstructive sleep apnea (OSA) with severe systemic consequences, such as cardiovascular morbidity, metabolic disorders, and nocturnal enuresis [13,14,15,16,17]

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