Differential diagnosis of congenital infections and arthrogryposis should include congenital Zika virus, according to a study.
“The Zika virus can cause, in addition to neurological disorders, severe orthopedic deformity and difficult treatment,” Epitácio Leite Rolim Filho, PhD, associate professor at the Federal University of Pernambuco, told Orthopedics Today. “Moreover, these deformities may deteriorate the prognosis of walking and activities of daily life for these patients.”
Filho and his colleagues reviewed the medical records of seven children who had arthrogryposis and a diagnosis of congenital infection, which was presumably caused by the Zika virus. All patients underwent neurological and orthopedic examinations, as well as radiography, brain CT or brain MRI without contrast, high-definition ultrasonography of joints, nerve conduction studies and needle electromyography. Four of the patients underwent MRI of the spine, researchers noted. Main outcome measures included main clinical, radiological and electromyographic findings and the correlation between clinical and primary neurological abnormalities.
Results showed all seven children had brain images characteristic of congenital infection and arthrogryposis, with two children testing positive for immunoglobulin M to Zika virus in the cerebrospinal fluid. Researchers found arthrogryposis present in the arms and legs of six children and in the legs of one child. According to findings on hip radiographs, all patients had bilateral dislocation and 43% had subluxation of the knee associated with genu valgus. Of these, 29% were bilateral.
Although there was no evidence of abnormalities with high-definition ultrasonography of the joints, needle electromyography showed moderate signs of remodeling of the motor units and a reduced recruitment pattern. Results showed malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter, reduction in brain volume, ventriculomegaly and hypoplasia of the brainstem and cerebellum in all brain CTs and MRIs. Researchers observed apparent thinning of the spinal cord and reduced ventral roots among the four patients who underwent MRI of the spine.
“My biggest surprise was that the displacement of the hips considered these cases as a teratological dislocation, but this group of patients was able to reduce hip dislocation after anesthesia without the need to open the hip joint,” Filho said.
More research needed
Filho and his colleagues are conducting histochemical studies of affected muscles with the aim to publish their results with an increased number of patients and longer follow-up.
“I believe there is still much to discover about this virus Zika action in the musculoskeletal system,” Filho said. “I emphasize that the deformities were found resulting from central nervous system involvement and not by direct action of the virus in the joint, [which means] the virus does not cause change by direct action in the joints.” – by Casey Tingle
- Van der Linden V, et al. BMJ. 2016;doi:10.1136/bmj.i3899.
- For more information:
- Epitácio Leite Rolim Filho, PhD, can be reached at the Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife – PE, 50670-901, Brazil; email: email@example.com.
Disclosure: Filho reports no relevant financial disclosures.