Congenital Zika Virus Infection with Normal Neurodevelopmental Outcome, Brazil

Abstract

We describe a case of a 20-month-old girl with probable congenital Zika virus infection and normal neurodevelopment, despite microcephaly and abnormal neuroimaging. This case raises questions about early prognostic markers and draws attention to the need for investigation in suspected Zika cases, even if the child’s early neurodevelopment is normal.

The neurodevelopmental spectrum of congenital Zika infection: a scoping review

“…2,17 Data from 11 papers showed that 348 out of 406 mothers (85.7%) were reported to have had symptoms during pregnancy suggestive of ZIKV infection, even though the mother's rash illness was not considered an obligatory criterion for CZS diagnosis in all of them; in five studies, all the children were born to symptomatic mothers. 2,4,6,13,16 Regarding the trimester of the symptoms, nine out of 10 studies reported this, emphasizing that, among the symptomatic mothers of the children reported in those studies, the symptoms occurred mainly in the first trimester of pregnancy (249 out of 335, 74.3%).…”

“…6,12,15 The 13 studies included an overall sample of 433 children, but 55 of them were included in two papers with different approaches concerning neurodevelopmental evaluation. 2,13 The sample size of each study ranged from one 4,6 to 82 children 2 and 50.1% were males; one paper did not report this information. 7 The mean age at the last follow-up evaluation was 18.5 months, ranging from 12 to 24 months.…”

“…Most used a combination of epidemiological, neuroradiological, and laboratory criteria. The most mentioned criteria were the neuroimaging typical features, described in nine 2,4,[6][7][8][12][13][14]16 out of the 13 studies. The presence of a rash illness suggestive of a ZIKV infection during pregnancy was considered an obligatory inclusion criteria in five papers 2,4,6,13,16 and the presence of congenital microcephaly in eight studies.…”

“…The most mentioned criteria were the neuroimaging typical features, described in nine 2,4,[6][7][8][12][13][14]16 out of the 13 studies. The presence of a rash illness suggestive of a ZIKV infection during pregnancy was considered an obligatory inclusion criteria in five papers 2,4,6,13,16 and the presence of congenital microcephaly in eight studies. 4,6,8,11,13,14,17,18 Regarding laboratory criteria, serology results were considered in six studies (positive IgM, 4,14,17 positive IgG, 8 or not specified 16,18 ) and molecular confirmation through polymerase chain reaction in only three studies.…”

“…The initial description included the following features: severe microcephaly and partly collapsed skull; typical neuroimaging features, including cerebral atrophy and subcortical calcifications; ocular abnormalities, with macular scarring and focal pigmentary retinal mottling; arthrogryposis; and early severe hypertonia. 1 It soon became clear that the clinical and neuroradiological features were present in a spectrum of severity, which included cases with unusual features, ranging from severely affected, 2 to milder 3 and asymptomatic 4 children. In addition, some cases of apparently typically developing children with a history of confirmed or probable intrauterine ZIKV exposure were reported to have neurodevelopmental disturbances, 5 as observed by follow-up evaluations.…”