Characteristics of Dysphagia in Infants with Microcephaly Caused by Congenital Zika Virus Infection, Brazil, 2015

Abstract

We summarize the characteristics of dysphagia in 9 infants in Brazil with microcephaly caused by congenital Zika virus infection. The Schedule for Oral Motor Assessment, fiberoptic endoscopic evaluation of swallowing, and the videofluoroscopic swallowing study were used as noninstrumental and instrumental assessments. All infants had a degree of neurologic damage and showed abnormalities in the oral phase. Of the 9 infants, 8 lacked oral and upper respiratory tract sensitivity, leading to delays in initiation of the pharyngeal phase of swallowing. Those delays, combined with marked oral dysfunction, increased the risk for aspiration of food, particularly liquid foods. Dysphagia resulting from congenital Zika virus syndrome microcephaly can develop in infants >3 months of age and is severe.

Keywords: Brazil; Zika virus infection; aspiration risk; congenital Zika syndrome; congenital infection; dysphagia; esophageal phase; infants; microcephaly; neurologic disease; oral motor dysfunction; oral phase; pharyngeal phase; swallowing; vector-borne infections; viruses.

Figure 1

Computed tomography radiographs of the brains of 2 infants with dysphagia and microcephaly caused by congenital Zika virus infection, Brazil, 2015. A–D) Images for patient 4 show malformation of cortical development, ventriculomegaly (long arrows), and calcifications in cortical and subcortical white matter in transition between cortex and white matter (short arrows). E–H) Images for patient 6 show no malformation of cortical development or ventriculomegaly, but calcifications are visible in the cortical area (arrows).

Figure 2

Instrumental evaluation of an infant with dysphagia and microcephaly caused by congenital Zika virus infection, Brazil, 2015. A) Videofluoroscopic swallowing study image showing a lateral view of the infant with premature spillage of liquid food (with added contrast) in the pharynx before triggering of the swallowing reflex. B) Image of the fiberoptic endoscopic evaluation of a delay in initiation of swallowing; thickened, dyed liquid is visible on the supraglottis. C) Silent aspiration, as indicated by a Rosenbek score of 8.