Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

doi:10.1056/NEJMoa1601824

Case Reports

. 2016 Jun 2;374(22):2142-51.

doi: 10.1056/NEJMoa1601824. Epub 2016 Mar 30.

Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

Rita W Driggers¹, Cheng-Ying Ho¹, Essi M Korhonen¹, Suvi Kuivanen¹, Anne J Jääskeläinen¹, Teemu Smura¹, Avi Rosenberg¹, D Ashley Hill¹, Roberta L DeBiasi¹, Gilbert Vezina¹, Julia Timofeev¹, Fausto J Rodriguez¹, Lev Levanov¹, Jennifer Razak¹, Preetha Iyengar¹, Andrew Hennenfent¹, Richard Kennedy¹, Robert Lanciotti¹, Adre du Plessis¹, Olli Vapalahti¹

Affiliations

Affiliation

¹ From 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.).

PMID: 27028667
DOI: 10.1056/NEJMoa1601824

Free article

Case Reports

Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

Rita W Driggers et al. N Engl J Med. 2016.

Free article

. 2016 Jun 2;374(22):2142-51.

doi: 10.1056/NEJMoa1601824. Epub 2016 Mar 30.

Authors

Affiliation

¹ From 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.).

PMID: 27028667
DOI: 10.1056/NEJMoa1601824

Abstract

The current outbreak of Zika virus (ZIKV) infection has been associated with an apparent increased risk of congenital microcephaly. We describe a case of a pregnant woman and her fetus infected with ZIKV during the 11th gestational week. The fetal head circumference decreased from the 47th percentile to the 24th percentile between 16 and 20 weeks of gestation. ZIKV RNA was identified in maternal serum at 16 and 21 weeks of gestation. At 19 and 20 weeks of gestation, substantial brain abnormalities were detected on ultrasonography and magnetic resonance imaging (MRI) without the presence of microcephaly or intracranial calcifications. On postmortem analysis of the fetal brain, diffuse cerebral cortical thinning, high ZIKV RNA loads, and viral particles were detected, and ZIKV was subsequently isolated.

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Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

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Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

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