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Volume 23, Number 6—June 2017

Dispatch

Severe Neurologic Disorders in 2 Fetuses with Zika Virus Infection, Colombia

Jorge Acosta-ReyesComments to Author , 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
Author affiliations: Universidad del Norte, Barranquilla, Colombia (J. Acosta-Reyes, E. Navarro, M.J. Herrera, H. Baquero); Secretaría de Salud de Barranquilla, Barranquilla (E. Goenaga); Instituto Nacional de Salud, Bogotá, Colombia (M.L. Ospina, E. Parra, M. Mercado, P. Chaparro, M. Beltrán, M.L. Gunturiz, L. Pardo); Clínica Colsanitas, Clínica Reina Sofía, Bogotá (C. Valencia, S. Huertas, J. Rodríguez, G. Ruiz); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (D. Valencia, S.C. Tinker, C.A. Moore); Emory University School of Medicine, Atlanta (L.B. Haddad).

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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.

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