TABLE 1

Reports of Laboratory-Confirmed Congenital Zika Virus Infection Cases and Their Clinical Findings, Brazil and the United States, 2015–2016

Report Type, Location of ExposureBirth Status and Infant OutcomeZika Virus and Other Testing: Type of Specimens and Testing MethodMaternal Signs/Symptoms of Zika Virus Infection During PregnancyResults of Histopathologic Evaluation, Autopsy, and Imaging StudiesExamination Findings
Case series; Rio Grande do Norte state, Brazil18Live-born at 38 wk gestationZika virus testing: brain tissue sample RT-PCR positive in both infants and IHC positive in 1 infantFever and rash during first trimesterHistopathologic findings from infant specimens• Congenital microcephaly
Died within 20 h of birth • Parenchymal calcification
Live-born at 36 wk gestationInfant specimens negative for dengue virus Fever and rash during first trimester • Microglial nodules• Congenital microcephaly
Died within 20 h of birth • Gliosis
 • Cell degeneration and necrosis
Pregnancy loss at 13 wk gestationZika virus testing: products of conception RT-PCR positive in both fetuses and chorionic villi IHC positive in 1 product of conceptionFever and rash during first trimesterHistopathologic findings from products of conception• Not reported
Pregnancy loss at 11 wk gestationMaternal TORCH serology and HIV testing negative; fetal specimens negative for dengue virus Fever and rash during first trimester • Heterogeneous chorionic villi with calcification• Not reported
 • Fibrosis
 • Perivillous fibrin deposition
 • Patchy intervillositis and focal villitis
Case series; Paraiba state, Brazil17,20Live-born at 40 wk gestationZika virus testing: amniotic fluid RT-PCR positiveFever, myalgia, and rash at 18 wk gestationFetal ultrasounds performed at 21, 27, 30, and 40 wk gestation• Congenital microcephaly, OFC of 30 cm
Maternal TORCH serology, HIV, parvovirus B19, dengue virus, and chikungunya virus testing were negative • Microcephaly
 • Asymmetric cerebral hemispheres
 • Moderate ventriculomegaly
 • Brain atrophy with a hypoplastic cerebellum
 • Brain calcifications: frontal lobes, caudate nucleus, lentostriatal vessels, and cerebellum
 • Agenesis of the cerebellar vermis
 • Dysgenesis of the corpus callosum
 • Enlarged cisterna magna
Live-born at unknown gestational ageZika virus testing: amniotic fluid RT-PCR positive. Maternal TORCH serology, HIV, parvovirus B19, dengue virus, and chikungunya virus test results were negativeFever, myalgia, and rash at 10 wk gestationFetal ultrasounds performed at 22, 25, and 29 wk gestation• Microphthalmia
 • Microcephaly• Cataracts
 • Asymmetric cerebral hemispheres• Severe arthrogryposis of all extremities
 • Severe unilateral ventriculomegaly
 • Brain calcifications: periventricular
 • Agenesis of the corpus callosum and thalamus
 • Hypoplasia of the cerebellar vermis
 • Enlargement of the posterior fossa
 • Bilateral cataracts and intraocular calcifications
Case report; Rio Grande de Norte state, Brazil19Termination at 32 wk gestationZika virus testing: brain tissue sample RT-PCR positiveHigh fever, severe myalgia and headache, and rash at 13 wk gestationFetal ultrasound performed at 32 wk gestation• Congenital microcephaly, 4 SDs below the mean for gender and gestational age
Autopsy samples negative for dengue, yellow fever, West Nile, tick-borne encephalitis, chikungunya, LCMV, CMV, rubella, varicella zoster, HSV, parvovirus B19, enteroviruses, and Toxoplasma gondii • Intrauterine growth retardation
 • Placental calcifications
 • Microcephaly (<2nd percentile)
 • Moderate ventriculomegaly
 • Transcerebellar diameter <2nd percentile
 • Intracerebral calcifications
Autopsy results
 • Almost complete agyria
 • Hydrocephalus
 • Multifocal dystrophic calcifications in the cortex and subcortical white matter
 • Cortical displacement
 • Mild focal inflammation
Case report; Salvador, Brazil21Fetal death at 32 wk gestationZika virus testing: extracts of the cerebral cortex, medulla oblongata, CSF, and amniotic fluid RT-PCR positiveAsymptomaticFetal ultrasounds performed at 14, 18, 26, and 30 wk gestation• Congenital microcephaly
Induced deliveryMaternal HIV, HTLV, hepatitis C, rubella, T gondii, and CMV testing negative • Fetal weight 3 SDs less than the mean for gestational age• Arthrogryposis
 • Microcephaly
 • Hydranencephaly
 • Intracranial calcifications
 • Destructive lesions of the posterior fossa
 • Hydrops fetalis (hydrothorax, ascites, subcutaneous edema)
Case series; Zika virus–affected areas22Spontaneous pregnancy loss at 8 wk gestationZika virus testing: products of conception RT-PCR positive and IHC positiveFever, rash, arthralgia, myalgia, and malaise during travel at 5 wk gestation
Maternal Zika virus serology testing confirmed recent infection
Elective termination at ∼20 wk gestationZika virus testing: amniotic fluid RT-PCR positiveFever, eye pain, myalgia, and rash after travel at 11–12 wk gestationFetal ultrasound performed at 20 wk gestation
Maternal Zika virus serology testing confirmed recent infection • Absence of the corpus callosum
 • Ventriculomegaly
 • Brain atrophy
Fetal MRI
 • Severe brain atrophy
Live-born at 39 wk gestationZika virus testing: placenta RT-PCR positive and IHC positiveFever, rash, arthralgia, and headache while residing in Brazil at 7–8 wk gestationPostnatal computed tomography scan• Congenital microcephaly, OFC of 27 cm
Maternal Zika virus serology testing confirmed recent infection • Multiple scattered and periventricular brain calcifications• Hypertonia
• Dysphagia
• Seizures
• Pale optic nerve
• Mild macular chorioretinitis
  • CMV, cytomegalovirus; CSF, cerebrospinal fluid; IHC, immunohistochemistry; HSV, herpes simplex virus; HTLV, human T-cell lymphotropic virus; LCMV, lymphocytic choriomeningitis; OFC, occipitofrontal circumference; TORCH, Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex, and syphilis.