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S
imões
R
et
al
.
112
R
ev
A
ssoc
M
ed
B
ras
2016; 62(2):108-115
Recommendation
The magnitude of the risk that infection with Zika virus
occurred during pregnancy will result in birth defects re-
mains unknown to date. The studies reported (case re-
ports) presented significant methodological problems re-
garding selection of the pregnant women, definition of
the outcome (microcephaly) and definition of exposure
(lack of adequate serologic tests because of the similari-
ty between the Dengue virus and Zika virus, and identi-
fication of the genome virus by RT-PCR hindered by the
short period in which the virus is present in the blood or
other tissues). Thus, further evidence arising from pro-
spective epidemiological studies is needed to establish a
causal link between Zika virus infection and congenital
malformations in the central nervous system.
2. W
hat
is
the
association
between
zika
virus
and
guillain
-
barré
syndrome
? I
s
it
different
during
pregnancy
? C
an
it
affect
the
fetus
?
Guillain-Barré syndrome
(GBS) is a neurological disease
that consists of an acute autoimmune inflammatory de-
myelinating polyneuropathy, whose basic pathophysiolog-
ical process is not completely known. This is the leading
cause of widespread flaccid paralysis in the world with an
annual incidence of 1 to 4 cases per 100,000 inhabitants.
19
(
D
)
It typically appears in two to three weeks after nonspecif-
ic viral infection. The occurrence of neurological syndromes
after infectious processes by dengue virus and chikungu-
nya is described since the late 1960s, and with Zika virus
infection since 2007, especially after the outbreaks in Mi-
cronesia and in French Polynesia.
2
(
C
)
In the primary databases consulted, there is only one
case report occurred in French Polynesia in which GBS
was diagnosed in a patient infected with Zika virus. The
report showed the first case of GBS manifested seven days
after febrile illness characterized as Zika virus infection
based on serological results.
20
(
C
)
The association between Zika virus infection and
Guillain-Barré syndrome still needs confirmation through
analytical studies. One factor that hinders greater under-
standing about this association in Brazil is the lack of ep-
idemiological data specific for this syndrome.
Recommendation
Investigations regarding an association between Zika vi-
rus infection and Guillain-Barré syndrome are still ongo-
ing in the affected countries.
3. W
hat
are
the
symptoms
in
pregnant
women with
suspected
Z
ika
virus
infection
?
A
re
they
different
than
in
the
general
population
?
It is estimated that 80% of people infected by Zika virus
do not develop clinical manifestations as seen from epi-
demiological studies. However, when there is clinical man-
ifestation, the main associated signs and symptoms are
usually: sudden fever (sometimes absent); pruritic mac-
ulopapular rashes that can affect the face, trunk, limbs,
palms and soles; non-purulent conjunctivitis; fatigue and
myalgia; and joint pain in the extremities (wrist/ankle),
often associated with edema. Other unspecific manifes-
tations that may be reported are headache, retro-orbital
and abdominal pain, diarrhea, vomiting, constipation
and cough.
3,4,21-24
(
C
) No sign is pathognomonic of infec-
tion with Zika virus.
Studies specifically evaluating the population of
pregnant women infected by Zika virus are rare in the
literature. However, a case series conducted in Brazil re-
vealed that 72.4% (n=21) of the women experienced rash;
44.8% (n=13) had fever; 37.9% (n=11) had arthralgia; with
headache in 17.2%, and pruritus in 13.8%. All pregnant
women denied ophthalmologic manifestations.
23
(
C
) In
this study, other causes for the symptoms were exclud-
ed such as infection with cytomegalovirus, rubella, her-
pes virus, syphilis, toxoplasmosis and HIV. However, the
major problem in this assessment would be the sample,
which was made for convenience of women who showed
signs and symptoms suggestive of infection Zika virus.
Another point of great limitation for the interpretation
of these results is the lack of statistical analysis, which
would make it impossible to claim that the percentag-
es or findings are exclusive to this population or if they
can be extrapolated to all presumed infections with Zika
virus.
23
(
C
)
Recommendation
To date, there is no full recognition of the clinical mani-
festations of infection caused by Zika virus in specific
populations, such as pregnant women, since information
derive from isolated case reports or series of cases in ep-
idemic situations.
When present, the signs and symptoms are charac-
terized by intermittent fever, non-purulent conjunctival
hyperemia, pruritic maculopapular rash, arthralgia, my-
algia and headache.