Estudo sobre zika revela lesões oculares graves em bebês
Um ano e meio após o início da emergência sanitária internacional de microcefalia relacionada à infecção congênita do vírus zika, um novo estudo coordenado por especialistas do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/Fiocruz) apontou que anormalidades oculares podem ser o único achado inicial dos bebês cujas mães foram infectadas durante a gravidez.
De acordo com os pesquisadores, a descoberta sugere a necessidade de se repensar os critérios de avaliação na triagem neonatal, para incluir o exame de fundo de olho de todos os bebês com potencial exposição materna ao vírus. Publicado na renomada revista americana The Journal of the American Medical Association (Jama) o artigo é fruto de uma parceria da Fiocruz, por meio do IFF e do Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz), com a Universidade da Califórnia e a Universidade Federal de São Paulo (Unifesp).
O trabalho envolveu a maior série de casos confirmados de exposição à zika com dados coletados sistematicamente. “Conseguimos fazer um estudo descritivo das anormalidades oculares, correlacionando-as com achados do sistema nervoso central, ocorrência de microcefalia e o momento da infecção materna a partir de uma coorte robusta, envolvendo bebês cujas mães tiveram resultado laboratorial positivo para a infecção na gestação”, destacou a oftalmologista pediátrica do IFF e autora do artigo, Andrea Zin. Além de Andrea, participaram do estudo outros seis pesquisadores do Instituto: Maria Elisabeth Moreira, Zilton Vasconcelos, Marcos Vinicius Pone, Sheila Pone, Mitsue Aibe e Ana Carolina da Costa.
Das 112 crianças acompanhadas do nascimento até os seis meses de vida, 46 não tinham diagnóstico de microcefalia. No entanto, dez delas apresentaram anormalidades oculares ao exame de fundo de olho. O número representa 42% das crianças com algum tipo de lesão oftalmológica, sendo questões referentes ao nervo óptico e a retina os achados mais frequentes. O estudo também revelou que a maioria das gestantes foi infectada ainda no primeiro trimestre (58%). Em 33%, a infecção aconteceu no segundo trimestre e, em 8%, no final da gestação, já no terceiro trimestre.
As diretrizes atuais recomendam exames oculares em bebês com microcefalia, mas não inclui todas crianças potencialmente expostas ao vírus zika no útero. “Encontramos lesões significativas em crianças que não apresentavam microcefalia. Trata-se de alterações graves e quanto mais precoce for o diagnóstico, mais cedo a criança pode ser submetida a uma intervenção para habilitação da visão. Com esses achados, ressaltamos a necessidade de repensar os critérios de avaliação, de forma a incluir o exame de fundo de olho na triagem neonatal de todos os bebês com potencial exposição materna ao vírus”, destacou Andrea Zin.
Os achados, ilustrados no artigo do Jama, foram registrados por meio da RetCam, câmera fotográfica especial adquirida pela Fiocruz no final do ano passado. O investimento foi fundamental para possibilitar o estudo e sua publicação. “Através deste equipamento, que fotografa em 360º o fundo de olho, conseguimos documentar as alterações com grande riqueza de detalhes, possibilitando a comparação de exames subsequentes. Com isso, foi possível não só refinar a capacidade de diagnóstico, como também tornar mais acessível a troca de informações entre especialistas”, finalizou a pesquisadora.
Por Aline Câmera (IFF/Fiocruz)
Fonte: AFN
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