Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities
Rita W Driggers1, Cheng-Ying Ho1, Essi M Korhonen1
1From the Department of Gynecology and Obstetrics, Division of Maternal Fetal Medicine (R.W.D., J.T.), and the Department of Pathology (F.J.R.), Johns Hopkins University School of Medicine, Baltimore; the Division of Maternal Fetal Medicine, Sibley Memorial Hospital (R.W.D., J.T., J.R.), the Division of Pathology and Center for Genetic Medicine Research (C.-Y.H., A.R., D.A.H.), Division of Pediatric Infectious Diseases (R.L.D.), Department of Diagnostic Radiology and Imaging (G.V.), and the Fetal Medicine Institute, Division of Fetal and Transitional Medicine (A.P.), Children's National Health System, the Departments of Integrative Systems Biology (C.-Y.H., D.A.H.), Pediatrics and Microbiology, Immunology and Tropical Medicine (R.L.D.B.), and Radiology and Pediatrics (G.V.), George Washington University School of Medicine and Health Sciences, the Center for Policy, Planning and Evaluation (P.I.) and Centers for Disease Control and Prevention (CDC)-Council of State and Territorial Epidemiologists (CSTE) Applied Epidemiology Fellowship (A.H.), District of Columbia Department of Health, and One Medical Group (R.K.) - all in Washington, DC; the Departments of Virology (E.M.K., S.K., T.S., L.L., O.V.) and Veterinary Biosciences (E.M.K., O.V.), University of Helsinki, and the Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital (A.J.J., O.V.), Helsinki; and the Arboviral Diseases Branch, Division of Vector-Borne Diseases, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta (R.L.).
Zika virus (ZIKV) infection in early pregnancy can cause severe fetal brain abnormalities, even without microcephaly. Postmortem analysis confirmed ZIKV presence and brain damage in a fetus infected during the first trimester.
Area of Science:
- Neurology
- Virology
- Obstetrics & Gynecology
Background:
- The Zika virus (ZIKV) outbreak has been linked to congenital microcephaly.
- Early gestational ZIKV infection poses risks to fetal development.
Observation:
- A pregnant woman was infected with ZIKV during the 11th gestational week.
- Fetal head circumference decreased significantly between 16 and 20 weeks.
- ZIKV RNA was detected in maternal serum.
Findings:
- Substantial fetal brain abnormalities were identified via ultrasonography and MRI by 19-20 weeks.
- Postmortem analysis revealed diffuse cerebral cortical thinning and high ZIKV RNA loads.
- ZIKV viral particles were detected, and the virus was isolated from the fetal brain.
Implications:
- ZIKV infection during early pregnancy can lead to severe, non-microcephalic brain malformations.
- This case highlights the importance of monitoring fetal brain development after maternal ZIKV exposure.
- Further research is needed to understand the full spectrum of ZIKV-related congenital abnormalities.
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