Congenital Zika Virus Infection

Melo, Adriana Suely de Oliveira; Aguiar, Renato Santana; Amorim, Melania Maria Ramos; Arruda, Mónica; Melo, Fabiana de Oliveira; Ribeiro, Suelem Taís Clementino; Batista, Alba Gean Medeiros; Ferreira, Thales A.; Santos, Mayra Pereira dos; Sampaio, Virgínia Vilar; Moura, Sarah Rogéria Martins; Rabello, Luciana Portela; Gonzaga, Clarissa Emanuelle; Malinger, G.; Ximenes, R.; Oliveira-Szejnfeld, Patricia Soares de; Tovar‐Moll, Fernanda; Chimelli, Leila; Silveira, Paola Paz; Delvechio, Rodrigo; Higa, Luiza M.; Campanati, Loraine; Nogueira, Rita Maria Ribeiro; Filippis, Ana María Bispo de; Szejnfeld, Jacob; Voloch, Carolina M.; Ferreira, Orlando C.; Brindeiro, Rodrigo M.; Tanuri, Amílcar

doi:10.1001/jamaneurol.2017.0051

Cited by 140 publications

(6 citation statements)

References 36 publications

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“…This lack of reported testing could have been due to short-term delays in obtaining testing and test results; a critical issue is ensuring that pediatric clinicians are aware of maternal Zika virus exposure or testing results and thus can readily identify infants who should be tested. More research is needed to define optimal testing strategies for identifying congenitally infected infants; some infants with evidence of congenital Zika virus infection prenatally and evidence of Zika virus in fetal tissue have negative results on cord blood samples by both PCR and IgM …”

Section: Discussionmentioning

confidence: 99%

“…For example, case reports have highlighted the potential for underlying brain abnormalities such as ventriculomegaly among normocephalic infants with prenatal Zika virus exposure. More complete clinical evaluation of infants including neuroimaging and audiological, ophthalmological, neurological, and developmental assessments will be needed to fully describe the extent of brain abnormalities and other adverse outcomes in affected fetuses or infants …”

Section: Discussionmentioning

confidence: 99%

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Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy

Honein

Dawson

Petersen

et al. 2017

JAMA

718

435

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; for the US Zika Pregnancy Registry Collaboration IMPORTANCE Understanding the risk of birth defects associated with Zika virus infection during pregnancy may help guide communication, prevention, and planning efforts. In the absence of Zika virus, microcephaly occurs in approximately 7 per 10 000 live births. OBJECTIVE To estimate the preliminary proportion of fetuses or infants with birth defects after maternal Zika virus infection by trimester of infection and maternal symptoms. DESIGN, SETTING, AND PARTICIPANTS Completed pregnancies with maternal, fetal, or infant laboratory evidence of possible recent Zika virus infection and outcomes reported in the continental United States and Hawaii from January 15 to September 22, 2016, in the US Zika Pregnancy Registry, a collaboration between the CDC and state and local health departments. EXPOSURES Laboratory evidence of possible recent Zika virus infection in a maternal, placental, fetal, or infant sample. MAIN OUTCOMES AND MEASURES Birth defects potentially Zika associated: brain abnormalities with or without microcephaly, neural tube defects and other early brain malformations, eye abnormalities, and other central nervous system consequences. RESULTS Among 442 completed pregnancies in women (median age, 28 years; range, 15-50 years) with laboratory evidence of possible recent Zika virus infection, birth defects potentially related to Zika virus were identified in 26 (6%; 95% CI, 4%-8%) fetuses or infants. There were 21 infants with birth defects among 395 live births and 5 fetuses with birth defects among 47 pregnancy losses. Birth defects were reported for 16 of 271 (6%; 95% CI, 4%-9%) pregnant asymptomatic women and 10 of 167 (6%; 95% CI, 3%-11%) symptomatic pregnant women. Of the 26 affected fetuses or infants, 4 had microcephaly and no reported neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had brain abnormalities without microcephaly; reported brain abnormalities included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities. Infants with microcephaly (18/442) represent 4% of completed pregnancies. Birth defects were reported in 9 of 85 (11%; 95% CI, 6%-19%) completed pregnancies with maternal symptoms or exposure exclusively in the first trimester (or first trimester and periconceptional period), with no reports of birth defects among fetuses or infants with prenatal exposure to Zika virus infection only in the second or third trimesters. CONCLUSIONS AND RELEVANCE Among pregnant women in the United States with completed pregnancies and laboratory evidence of possible recent Zika infection, 6% of fetuses or infants had evidence of Zika-associated birth defects, primarily brain abnormalities and microcephaly, whereas among women with first-trimester Zika infection, 11% of fetuses or infants had evidence of Zika-associated birth defects. These findings support the importance of screening pregnant women for Zika virus exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy

Honein

Dawson

Petersen

et al. 2017

JAMA

718

435

View full text Add to dashboard Cite

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“…Almost 70 years after its initial discovery, Zika virus (ZIKV) captured international attention when its devastating effects to the developing human brain became recognized during a pandemic outbreak of congenital microcephaly. Since late 2015, large regions of South and Central America and the Caribbean were affected by the neurologic phenotype of the congenital ZIKV syndrome and the associated brain imaging findings of neuronal migration abnormalities, callosal and cerebellar malformation, and ventriculomegaly . The international medical community had to quickly develop an understanding of the infection and provide recommendations for evaluation of exposed and infected pregnant women and their infants …”

Section: Introductionmentioning

confidence: 99%

Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure

et al. 2019

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IMPORTANCE The evolution of fetal brain injury by Zika virus (ZIKV) infection is not well described. OBJECTIVES To perform longitudinal neuroimaging of fetuses and infants exposed to in utero maternal ZIKV infection using concomitant magnetic resonance imaging (MRI) and ultrasonography (US), as well as to determine the duration of viremia in pregnant women with ZIKV infection and whether the duration of viremia correlated with fetal and/or infant brain abnormalities. DESIGN, SETTING, AND PARTICIPANTS A cohort of 82 pregnant women with clinical criteria for probable ZIKV infection in Barranquilla, Colombia, and Washington, DC, were enrolled from June 15, 2016, through June 27, 2017, with Colombian women identified by community recruitment and physician referral and travel-related cases of American women recruited from a Congenital Zika Program. INTERVENTIONS AND EXPOSURES Women received 1 or more MRI and US examinations during the second and/or third trimesters. Postnatally, infants underwent brain MRI and cranial US. Blood samples were tested for ZIKV. MAIN OUTCOMES AND MEASURES The neuroimaging studies were evaluated for brain injury and cerebral biometry. RESULTS Of the 82 women, 80 were from Colombia and 2 were from the United States. In 3 of 82 cases (4%), fetal MRI demonstrated abnormalities consistent with congenital ZIKV infection. Two cases had heterotopias and malformations in cortical development and 1 case had a parietal encephalocele, Chiari II malformation, and microcephaly. In 1 case, US results remained normal despite fetal abnormalities detected on MRI. Prolonged maternal polymerase chain reaction positivity was present in 1 case. Of the remaining 79 cases with normal results of prenatal imaging, postnatal brain MRI was acquired in 53 infants and demonstrated mild abnormalities in 7 (13%). Fifty-seven infants underwent postnatal cranial US, which detected changes of lenticulostriate vasculopathy, choroid plexus cysts, germinolytic/subependymal cysts, and/or calcification in 21 infants (37%). CONCLUSIONS AND RELEVANCE In a cohort of pregnant women with ZIKV infection, prenatal US examination appeared to detect all but 1 abnormal fetal case. Postnatal neuroimaging in infants who had normal prenatal imaging revealed new mild abnormalities. For most patients, prenatal and postnatal US may identify ZIKV-related brain injury.

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“…4 The fetal consequences were further defined as Congenital Zika Syndrome (CZS), which includes a spectrum of congenital defects (not only microcephaly). 5 These conditions are similar of those caused by "TORCH" pathogens. The TORCH acronym stands for: Toxoplasma gondii infection, Other (Treponema pallidum, Listeria monocytogenes, parvovirus B-19, and human immunodeficiency virus (HIV), amongst others), Rubella, Cytomegalovirus (CMV), and Herpesviruses (HSV) 1 and 2.…”

Section: Introductionmentioning

confidence: 79%

Characterization of Placental Infection by Zika Virus in Humans: A Review of the Literature

Venceslau

Guida

Amaral

et al. 2020

Rev Bras Ginecol Obstet

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Objective The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection. Data sources We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions. Selection of studies The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts) Data collection We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis. Data synthesis The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts. Conclusion Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.

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Congenital Zika Virus Infection

Abstract: Hematoma size in deep intracerebral hemorrhage and its correlation with dot-like hemosiderin spots on gradient echo T2*-weighted MRI.

Cited by 140 publications

References 36 publications

Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy

Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy

Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure

Characterization of Placental Infection by Zika Virus in Humans: A Review of the Literature

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