Investigators in Brazil discovered associations, particularly in brain calcification, between arthrogryposis, congenital infection and Zika virus in newborns, according to recently published study findings.
“Brain impairment in the presence of microcephaly is the main characteristic of a congenital Zika virus syndrome,” Vanessa van der Linden, MD, a pediatric neurologist at the Association for Assistance of Disabled Children in Recife, Brazil, and colleagues wrote. “However, little is still known about this condition and its clinical spectrum, which also concerns newborns with a normal head circumference. Two studies have described the association between arthrogryposis and microcephaly in newborns presumed to have congenital Zika virus infection.”
van der Linden and colleagues conducted an observational, retrospective case series study that included seven children with dual diagnoses of arthrogryposis and congenital infection believed to be linked to Zika virus during the microcephaly epidemic in Brazil. The researchers examined radiological and electromyographic brain and joint images of all patients, along with main clinical outcomes.
All the patients tested negative for the other primary causes of microcephaly and presented with calcification in the brain. Evidence from MRI and the electromyographic imaging suggested lower motor neurone involvement. In addition, characteristics of Zika were present in the cerebrospinal fluid of two children, and spinal MRIs indicated thinning of the cord and reduced ventral roots in four children.
The researchers recommended further research with larger cohorts to examine the neurological abnormalities found in arthrogryposis, including histopathology from tissue or autopsy samples of stillborn babies with microcephaly.
“In our case series, the arthrogryposis did not result from abnormalities of the joints themselves but was likely to be of neurogenic origin,” the researchers wrote. “On the basis of our neurophysiological observations and the literature, we suggest two possible mechanisms: tropism for the neurones or neural progenitor cells, with involvement of peripheral motor neurons and central motor neurones; or a relation with vascular disorders.
“Congenital Zika syndrome should be added to the differential diagnosis of congenital infections and arthrogryposis.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.