Volume 24, Number 8—August 2018
CME ACTIVITY - Synopsis
Unilateral Phrenic Nerve Palsy in Infants with Congenital Zika Syndrome
Nipunie S. Rajapakse
, Kevin Ellsworth, Rachael M. Liesman, Mai Lan Ho, Nancy Henry, Elitza S. Theel, Adam Wallace, Ana Catarina Ishigami Alvino, Luisa Medeiros de Mello, and Jucille Meneses
, Kevin Ellsworth, Rachael M. Liesman, Mai Lan Ho, Nancy Henry, Elitza S. Theel, Adam Wallace, Ana Catarina Ishigami Alvino, Luisa Medeiros de Mello, and Jucille Meneses
Table
Summary of maternal and infant characteristics in 4 cases of congenital Zika syndrome in infants who had unilateral elevation of the diaphragm*
| Characteristics | Patient 1 | Patient 2 | Patient 3 | Patient 4 |
|---|---|---|---|---|
| Maternal characteristics | ||||
| Maternal age, y | 27 | 21 | 17 | 21 |
| Prenatal care | Yes | Yes | Yes | Yes |
| Zika virus symptoms, trimester | 1st | 1st | 1st | 1st |
| Fever | + | – | + | – |
| Rash | + | + | – | + |
| Arthralgia | + | – | – | – |
| Abnormal fetal ultrasound, trimester |
3rd |
3rd |
2nd |
3rd |
| Infant characteristics | ||||
| Delivery type | Cesarean | Cesarean | Vaginal | Cesarean |
| Sex | F | F | F | F |
| Gestational age, wk | 38 | 40 | 39 | 41 |
| Birthweight, g | 2,020 | 2,025 | 2,565 | 2,075 |
| Length, cm | 40 | 42 | 46 | 41 |
| HC at birth, cm | 27.5 | 28.5 | 28 | 28 |
| z-score | −4.3 | −4.3 | −4.2 | −4.9 |
| Arthrogryposis | Hips, knees, ankles, elbows | Hips, ankles, wrists | Hips, ankles, wrists | Hips, ankles, wrists |
| Talipes equinovarus | + | + | + | + |
| Head imaging findings | V, C, H | V | V, C, H | V, C |
| Elevated right hemidiaphragm | + | + | + | + |
| Cause of death | Respiratory failure | Respiratory failure | Respiratory failure | Respiratory failure |
| Day of life |
13 |
10 |
86 |
4 |
| Maternal testing for Zika virus | ||||
| RT-PCR | ||||
| Amniotic fluid | NA | NA | + | NA |
| Serum | NA | NA | – | – |
| IgM, serum |
– |
NA |
– |
– |
| Infant testing | ||||
| RT-PCR for Zika virus | ||||
| Serum | – | – | – | – |
| CSF | NA | – | – | + |
| Urine | – | NA | NA | NA |
| Placenta | – | NA | NA | NA |
| Zika virus IgM | ||||
| Serum | + | + | + | + |
| CSF |
NA |
+ |
+ |
+ |
| PRNT titer | ||||
| Zika virus | >1:1,280 | 180† | 897† | 270† |
| DENV-1 | 1:10 | <20 | <20 | <20 |
| DENV-2 | <1:10 | <20 | <20 | <20 |
*C, calcifications; CSF, cerebrospinal fluid; DENV, dengue virus; H, cerebral hypoplasia; HC, head circumference; NA, not available; PRNT, plaque reduction neutralization test; RT-PCR, reverse transcription PCR; V, ventriculomegaly; +, positive finding/test result; –, negative finding/test result.
†Indicates 50% plaque reduction neutralization test titer.
Page created: July 11, 2018
Page updated: July 11, 2018
Page reviewed: July 11, 2018
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