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Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities
Open accessAbstract
Summ a r yThe 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.Z ika virus (ZIKV), a mosquito-borne flavivirus and member of the Flaviviridae family, was originally isolated from a sentinel primate in Uganda in 1947. 1 ZIKV was associated with mild febrile disease and maculopapular rash in tropical Africa and some areas of Southeast Asia.Since 2007, ZIKV has caused several outbreaks outside its former distribution area in islands of the Pacific: in 2007 on Yap island in Micronesia, in 2013 and 2014 in French Polynesia, and in 2015 in South America, where ZIKV had not been identified previously.[2][3][4][5] There are separate African and Asian lineages of the virus, 6 and the latter strains have caused the outbreaks in the Pacific and the Americas.7 As in the transmission of dengue and chikungunya viruses, the main transmission cycle of ZIKV occurs between urban aedes mosquitoes and humans.One striking feature of the current ZIKV outbreak is the apparent increased risk of intrauterine or perinatal transmission of the virus as well as the marked increase in the number of newborns with microcephaly reported in Brazil.[8][9][10][11][12][13][14][15][16][17] A recent prospective study showed fetal ultrasonographic abnormalities in 12 of 42 women (29%) with ZIKV infection during pregnancy; 7 of the 42 fetuses (17%) that were studied had microcephaly, cerebral atrophy, or brain calcifications.11 Because of the association between ZIKV infection and microcephaly and other neurologic disorders, the World Health Organization has declared the ZIKV epidemic a public health emergency of international concern.13 Early in this particular outbreak, investigations into the viral pathogenesis, vertical transmission rates, potential viral cofactors, and sensitivity and specificity of diagnostic testing have presented more questions than answers.Nevertheless, the Centers for Disease Control and Prevention (CDC) has issued a travel advisory The authors' full names, academic degrees, and affiliations are listed in the Appendix.
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“Notably, this rapid period of fetal brain growth and maturation is sensitive to hostile intra-uterine conditions, such as prenatal malnutrition [123], infection [124], drugs [125], and stress [126].”
From Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy (2024) · cites this paper as [124]
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Hubert, M., Jeannin, P., Burlaud‐Gaillard, J., Roingeard, P., Antoine Gessain, A., Ceccaldi, P., & Vidy, A. (2020) · Frontiers in Microbiology · doi:10.3389/fmicb.2020.524678 · Cited by 7
Astrocyte Control of Zika Infection Is Independent of Interferon Type I and Type III Expression
Das, M., Smith, M., Furihata, T., Sarker, S., O’Shea, R. D., & Helbig, K. J. (2022) · Biology · doi:10.3390/biology11010143 · Cited by 7
Drugs to limit Zika virus infection and implication for maternal-fetal health
Kumar, A., Kumar, D., Jose, J., Giri, R., & Mysorekar, I. U. (2022) · Frontiers in Virology · doi:10.3389/fviro.2022.928599 · Cited by 7
Monodelphis domestica as a Fetal Intra-Cerebral Inoculation Model for Zika Virus Pathogenesis
Thomas, J., Garcia, J., Terry, M., Lozano, I., Mahaney, S. M., Quintanilla, O., Carlo-Silva, D., Morales, M., & VandeBerg, J. L. (2023) · Pathogens · doi:10.3390/pathogens12050733 · Cited by 7
Lesteberg, K. E., Fader, D. S., & Beckham, J. D. (2020) · The Journal of Immunology · doi:10.4049/jimmunol.2000882 · Cited by 7
Editorial brain malformation surveillance in the Zika era
Trevathan, E. (2016) · Birth Defects Research Part A Clinical and Molecular Teratology · doi:10.1002/bdra.23582 · Cited by 7
Congenital Zika syndrome and neuroimaging findings
Ribeiro, B. N. D. F. (2018) · Radiologia Brasileira · doi:10.1590/0100-3984.2018.51.2e2 · Cited by 7
Cheng, M., Yang, Y.-X., Liu, Z., Wen, D., Yang, P., Huang, X., Dong, H.-L., Xu, Y., Li, X., Deng, Y., et al. (2022) · Journal of Virology · doi:10.1128/jvi.00879-22 · Cited by 6
The Zika virus: an opportunity to revisit reproductive health needs and disparities
Stein, R. A., Grayon, A. R., Katz, A. A., & Chervenak, F. A. (2022) · GERMS · doi:10.18683/germs.2022.1357 · Cited by 6
Wilken, L., Rimmelzwaan, G. F., & Elbahesh, H. (2024) · Journal of Virology · doi:10.1128/jvi.00618-24 · Cited by 6
Zika Virus Disease for the Neurointensivist
Pastula, D. M., Durrant, J. C., Smith, D., Beckham, J. D., & Tyler, K. L. (2016) · Neurocritical Care · doi:10.1007/s12028-016-0333-z · Cited by 6
Persistent maternal Zika viremia: a marker of fetal infection
Schaub, B., Monthieux, A., Najioullah, F., Adenet, C., MULLER, F. M., & Césaire, R. (2016) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.17210 · Cited by 6
New Insights into the Natural History of Congenital Zika Virus Syndrome
Frutos, M. G. L., Ochoa, J. H., Barbás, M. G., Lucchini, H. D., Moya, M. M., & Malinger, G. (2017) · Fetal Diagnosis and Therapy · doi:10.1159/000479866 · Cited by 6
Pereira, L. R., Alves, R. P. D. S., Sales, N. S., Andreata‐Santos, R., Venceslau-Carvalho, A. A., Pereira, S. S., de Castro‐Amarante, M. F., Rodrigues‐Jesus, M. J., Favaro, M. T. D. P., Chura‐Chambi, R. M., et al. (2020) · Frontiers in Medical Technology · doi:10.3389/fmedt.2020.604160 · Cited by 6
CARE guidelines for case reports: explanation and elaboration document. Translation into Russian
Barber, M. S., Aronson, J. K., von Schoen-Angerer, T., Riley, D. S., Tugwell, P., Kiene, H., Helfand, M., Altman, D. G., Sox, H. C., Werthmann, P. G., et al. (2022) · Digital Diagnostics · doi:10.17816/dd105291 · Cited by 6
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Epidemiological surveillance of main vector borne arboviral diseases in Brazil: a brief review
Maniero, V. C., Fares, R. D., Lamas, C. D. C., & Cardozo, S. V. (2021) · Brazilian Journal of Veterinary Medicine/Revista Brasileira de Medicina Veterinária · doi:10.29374/2527-2179.bjvm001420 · Cited by 6
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Li, X., Shopit, A., & Wang, J. (2022) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2022/7264649 · Cited by 6
The value of case reports in diagnostic radiography
Elliott, J. E. G. (2023) · Radiography · doi:10.1016/j.radi.2023.01.028 · Cited by 6
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Faluyi, U., Obadare, O., Sangem, A., Onuegbu, C. A., & Medavarapu, S. (2016) · American Scientific Research Journal for Engineering, Technology, and Sciences · Cited by 6
Zika virus infection: Clinical overview with a summary of Japanese cases
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The Impact of African and Brazilian Zika virus isolates on neuroprogenitorsPreprint
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Mishra, I., Gupta, K., Mishra, R., Chaudhary, K., & Sharma, V. (2023) · Current Pharmaceutical Biotechnology · doi:10.2174/0113892010273024230925075231 · Cited by 5
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Duy, P. Q., Mehta, N. H., & Kahle, K. T. (2023) · Cerebral Cortex · doi:10.1093/cercor/bhad432 · Cited by 5
Metadata
- Authors
- Driggers, R. W., Ho, C.-Y., Korhonen, E. M., Kuivanen, S., Jääskeläinen, A. J., Smura, T., Rosenberg, A., Hill, D. A., DeBiasi, R. L., Vezina, G., Timofeev, J., Rodriguez, F. J., Levanov, L., Razak, J., Iyengar, P., Hennenfent, A., Kennedy, R., Lanciotti, R., du Plessis, A., & Vapalahti, O.
- Affiliations
- Children's National (US)
- Centers for Disease Control and Prevention (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2016-06-02
- Volume
- 374
- Issue
- 22
- Pages
- 2142-2151
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2333018296
- Cited by
- 831
- References
- 21
- Citations by year
- 2026: 13 · 2025: 22 · 2024: 29 · 2023: 29 · 2022: 43 · 2021: 56 · 2020: 79 · 2019: 95 · 2018: 119 · 2017: 195 · 2016: 150
- FWCI
- 184.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Vectors
- Keywords
- Zika virus infection, congenital Zika syndrome, microcephaly, maternal viremia, fetal brain anomalies, intrauterine transmission, perinatal transmission, fetal head circumference, flavivirus, Zika virus outbreak, pregnancy complications, fetal brain MRI
- MeSH terms
- Zika Virus Infection, Zika Virus, Adult, Brain, Disease Outbreaks, Female, Fetus, Humans, Magnetic Resonance Imaging, Microcephaly, Pregnancy, Pregnancy Complications, Infectious, Viremia, Ultrasonography, Prenatal
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