Microcephalic children due congenital Zika virus syndrome (CZS) present neurological symptoms already well described. However, several other alterations can also be observed. Here, we aimed to evaluate the immune system of microcephaly CZS children. We showed that these patients have enlarged thymus, spleen and cervical lymph nodes, analysed by ultrasound and compared to the reference values for healthy children. In the periphery, they have an increase in eosinophil count and morphological alterations as hypersegmented neutrophils and atypical lymphocytes, even in the absence of urinary tract infections, parasitological infections or other current symptomatic infections. Microcephalic children due CZS also have high levels of IFN-γ, IL-2, IL-4, IL-5 and type I IFNs, compared to healthy controls. In addition, this population showed a deficient cellular immune memory as demonstrated by the low reactivity to the tuberculin skin test even though they had been vaccinated with BCG less than 2 years before the challenge with the PPD. Together, our data demonstrate for the first time that CZS can cause alterations in primary and secondary lymphoid organs and also alters the morphology and functionality of the immune system cells, which broadens the spectrum of CZS symptoms. This knowledge may assist the development of specific therapeutic and more efficient vaccination schemes for this population of patients.

先天性寨卡病毒综合征 (CZS) 导致的小头儿童呈现出已经充分描述的神经系统症状。然而，也可以观察到其他一些变化。在这里，我们旨在评估小头畸形 CZS 儿童的免疫系统。我们发现这些患者的胸腺、脾脏和颈部淋巴结肿大，通过超声分析并与健康儿童的参考值进行比较。在外周，即使没有尿路感染、寄生虫感染或其他当前的症状性感染，它们的嗜酸性粒细胞计数和形态学改变也会增加，如过度分节的中性粒细胞和非典型淋巴细胞。与健康对照组相比，CZS 导致的小头畸形儿童也具有高水平的 IFN-γ、IL-2、IL-4、IL-5 和 I 型 IFN。此外，该人群表现出细胞免疫记忆缺陷，这可以通过对结核菌素皮肤试验的低反应性来证明，即使他们在 PPD 挑战前不到 2 年就接种了 BCG 疫苗。总之，我们的数据首次证明 CZS 可以引起初级和次级淋巴器官的改变，还可以改变免疫系统细胞的形态和功能，从而拓宽了 CZS 症状的范围。这些知识可能有助于为这群患者开发特定的治疗和更有效的疫苗接种计划。我们的数据首次表明，CZS 可引起初级和次级淋巴器官的改变，并改变免疫系统细胞的形态和功能，从而拓宽了 CZS 症状的范围。这些知识可能有助于为这群患者开发特定的治疗和更有效的疫苗接种计划。我们的数据首次表明，CZS 可引起初级和次级淋巴器官的改变，并改变免疫系统细胞的形态和功能，从而拓宽了 CZS 症状的范围。这些知识可能有助于为这群患者开发特定的治疗和更有效的疫苗接种计划。