Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

Rita W. Driggers(Sibley Memorial Hospital), Cheng‐Ying Ho(Johns Hopkins Medicine), Essi M. Korhonen(Johns Hopkins Medicine), Suvi Kuivanen(Johns Hopkins Medicine), Anne J. Jääskeläinen(Johns Hopkins Medicine), Teemu Smura(Johns Hopkins University), Avi Z. Rosenberg(Johns Hopkins Medicine), David A. Hill(Johns Hopkins Medicine), Roberta L. DeBiasi(Johns Hopkins University), Gilbert Vézina(Pediatrics and Genetics), Julia Timofeev(Sibley Memorial Hospital), Fausto J. Rodríguez(Johns Hopkins Medicine), Lev Levanov(Johns Hopkins University), Jennifer Razak(Johns Hopkins Medicine), Preetha Iyengar(George Washington University), Andrew K. Hennenfent(Johns Hopkins University), Richard D. Kennedy(District of Columbia Department of Health), Robert S. Lanciotti(Johns Hopkins University), Adré du Plessis(Johns Hopkins University), Olli Vapalahti(Helsinki University Hospital)
New England Journal of Medicine
March 30, 2016
10.1056/nejmoa1601824
Cited by 857Open Access
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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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