To the Editor We read with interest the elegant and well-illustrated article by de Paula Freitas et al1 on ocular changes in newborns with microcephaly and presumed congenital Zika virus (ZIKV) infection in Brazil. Despite all global concern on this emerging disease, the dimension of the ZIKV epidemic in our country is still largely unknown, with the vast majority of cases being presumed on unspecific clinical symptoms.1 There is recent anecdotal neuropathological and molecular data implicating ZIKV in the pathogenesis of microcephaly in a few cases.2 We question whether other causes have been ruled out sufficiently, particularly toxoplasmosis, syphilis, and infections by members of the Herpesviridae family such as herpes simplex virus and cytomegalovirus. We wonder whether enough attention is being devoted to ruling out these entities, recognizing their high prevalence and morbidity in Brazil, and noting that they are all amenable to treatment, in contrast to ZIKV.
Vasconcelos-Santos DV, Andrade GMQ, Caiaffa WT. Zika Virus, Microcephaly, and Ocular Findings. JAMA Ophthalmol. 2016;134(8):946. doi:10.1001/jamaophthalmol.2016.1313