Zika Virus Associated with Microcephaly

TLDR

A widespread Zika virus epidemic in 2015 across South and Central America and the Caribbean raised concerns about a heightened incidence of microcephaly in fetuses of infected mothers. We describe the case of an expectant mother who experienced a febrile rash illness in the first trimester while residing in Brazil. After the mother requested termination, a fetal autopsy was performed. Ultrasonography at 29 weeks revealed microcephaly with calcifications, and autopsy confirmed micrencephaly with agyria, hydrocephalus, and dystrophic calcifications; ZIKV was detected in fetal brain tissue by RT‑PCR and electron microscopy, and its complete genome was recovered.

Abstract

A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 in South and Central America and the Caribbean. A major concern associated with this infection is the apparent increased incidence of microcephaly in fetuses born to mothers infected with ZIKV. In this report, we describe the case of an expectant mother who had a febrile illness with rash at the end of the first trimester of pregnancy while she was living in Brazil. Ultrasonography performed at 29 weeks of gestation revealed microcephaly with calcifications in the fetal brain and placenta. After the mother requested termination of the pregnancy, a fetal autopsy was performed. Micrencephaly (an abnormally small brain) was observed, with almost complete agyria, hydrocephalus, and multifocal dystrophic calcifications in the cortex and subcortical white matter, with associated cortical displacement and mild focal inflammation. ZIKV was found in the fetal brain tissue on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay, with consistent findings on electron microscopy. The complete genome of ZIKV was recovered from the fetal brain.