Volume 23, Number 6—June 2017
Dispatch
Severe Neurologic Disorders in 2 Fetuses with Zika Virus Infection, Colombia
Jorge Acosta-Reyes
, Edgar Navarro, Maria José Herrera, Eloina Goenaga, Martha L. Ospina, Edgar Parra, Marcela Mercado, Pablo Chaparro, Mauricio Beltran, Maria Luz Gunturiz, Lissethe Pardo, Catalina Valencia, Sandra Huertas, Jorge Rodríguez, Germán Ruiz, Diana Valencia, Lisa B. Haddad, Sarah C. Tinker, Cynthia A. Moore, and Hernando Baquero
, Edgar Navarro, Maria José Herrera, Eloina Goenaga, Martha L. Ospina, Edgar Parra, Marcela Mercado, Pablo Chaparro, Mauricio Beltran, Maria Luz Gunturiz, Lissethe Pardo, Catalina Valencia, Sandra Huertas, Jorge Rodríguez, Germán Ruiz, Diana Valencia, Lisa B. Haddad, Sarah C. Tinker, Cynthia A. Moore, and Hernando Baquero
Table
Summary of 2 case reports involving fetuses examined after pregnancy termination who had severe neurologic defects attributed to maternal Zika virus infection, Colombia*
| Characteristics |
Case 1 |
Case 2 |
|---|---|---|
| Pregnancy history | ||
| Maternal age, y | 24 | 15 |
| Municipality of residence | Barranquilla, Colombia | Bogotá, Colombia; recent travel to area with circulating Zika virus |
| Gestational age at maternal infection, wks | 5–6 | 16–20 |
| Maternal symptoms | Fever; generalized rash for 2 d; edema and joint pain for 2 wks | Generalized rash for 2 d and myalgia |
| Prior pregnancy complications | Previous pregnancy complicated by Potter syndrome ending in stillbirth 2 mo before current pregnancy | None; one previous live birth |
| Plurality | Singleton | Singleton |
| Ultrasound findings | 8 wks: no notable abnormalities; 12 wks: no notable abnormalities; 15 wks: absence of cranial vault with brain tissue loss including absence of cerebral hemispheres (exencephaly–anencephaly sequence) | 26 wks: abnormal clefts in cerebral hemispheres of the brain (schizencephaly) with open lip; 26 wks (4 d later): large regions of parietal and temporal brain parenchyma loss |
| Samples obtained | Amniotic fluid from amniocentesis (17 wks); cord blood from amniocentesis (17 wks); tissue samples of fetal organs (placenta, liver, kidney, spleen, cord, eyes, brain tissue, spinal cord) | Amniotic fluid from amniocentesis (27 wks); cord blood from amniocentesis (27 wks); tissue samples of fetal organs (placenta, liver, kidney, spleen, cord, eyes, brain tissue, spinal cord) |
| Pregnancy outcome |
Elective termination at 20 wks |
Elective termination at 27 wks |
| Macroscopic and histopathologic examination | ||
| CNS | Anencephaly, without associated malformations; absence of cerebral hemispheres and cerebellum; rudimentary central trunk; absence of bones of the upper calvaria, with purplish brown irregular tissue attached to the base corresponding to residual nerve tissue; recent bleeding in tissues of the cortex and brain stem; decreased neuroblast density compatible with neuronal migration arrest and glial leptomeningeal heterotopy | Almost complete absence of periventricular germinal matrix of CNS tissue, with replacement by reactive glia; decreased pattern of maturation/migration of cerebral cortex with edema and congestion; neuropil disruption with microcalcification in the spinal cord, with reactive gliosis and loss of the ascending and descending tracts of the spinal cord, with congestion; peripheral nerve ganglion of the sympathetic chain with Wallerian degeneration and reactive proliferation of sustentacular cells, satellitosis, and neuronophagia of ganglion cells, and neuronal degeneration |
| Eye | Neuroepithelium of the retina without disruptive changes or microcalcifications | Neuroepithelium of the retina not identified |
| Spleen | Congestion; adequate development of white and red pulp | Complete autolysis |
| Chorionic villi | Immature chorionic villi with enlarged irregular contours without inflammatory infiltrate and partial obliteration of fetal vessels | Heterogeneous pattern of accelerated maturation of the chorionic villi, with some chorionic villi enlarged with irregular surroundings with irregular growth pattern |
| Umbilical cord | Unremarkable | Single umbilical artery |
| Placenta | Slight increase in perivillous fibrin deposits; chronic lymphocytic deciduitis | Increase in perivillous fibrin deposits |
| Kidney | Unremarkable | Unremarkable |
| Liver | Unremarkable | Unremarkable |
| Thymus | Not reported | Unremarkable |
| Lung |
Not reported |
Unremarkable |
| RT-PCR results for Zika virus in fetal tissues | ||
| Brain | Positive | Positive |
| Brain stem | Positive | Not reported |
| Spinal cord | Positive | Not reported |
| Eye | Positive | Negative |
| Spleen | Positive | Positive |
| Kidney | Positive | Positive |
| Liver | Positive | Positive |
| Thymus | Not reported | Positive |
| Lung | Not reported | Positive |
| Myocardium | Not reported | Positive |
| Bone marrow | Not reported | Positive |
| Peripheral nerve | Not reported | Positive |
| Umbilical cord | Positive | Positive |
| Placenta | Positive | Negative |
*CNS, central nervous system; RT-PCR, reverse transcription PCR.
Page created: May 16, 2017
Page updated: May 16, 2017
Page reviewed: May 16, 2017
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