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 OutcomeMaternal Signs/Symptoms of Zika Virus Infection During PregnancyZika Virus and Other Testing: Type of Specimens and Testing MethodResults of Histopathologic Evaluation, Autopsy, and Imaging StudiesExamination Findings
Case series; Rio Grande do Norte state, Brazil18Live-born at 38 wk gestation, died within 20 h of birthFever and rash during first trimesterZika virus testing: brain tissue sample RT-PCR positive in both infants and IHC positive in 1 infantHistopathologic findings from infant specimens
  • Parenchymal calcification

  • Microglial nodules

  • Gliosis

• Congenital microcephaly
Live-born at 36 wk gestation, died within 20 h of birthFever and rash during first trimesterInfant specimens negative for dengue virus• Cell degeneration and necrosis• Congenital microcephaly
Pregnancy loss at 13 wk gestationFever and rash during first trimesterZika virus testing: products of conception RT-PCR positive in both fetuses and chorionic villi IHC positive in 1 product of conceptionHistopathologic findings from products of conception
  • Heterogeneous chorionic villi with calcification

  • Fibrosis

  • Perivillous fibrin deposition

• Not reported
Pregnancy loss at 11 wk gestationFever and rash during first trimesterMaternal TORCH serology and HIV testing negative; fetal specimens negative for dengue virus• Patchy intervillositis and focal villitis• Not reported
Case series; Paraiba state, Brazil17, 20Live-born at 40 wk gestationFever, myalgia, and rash at 18 wk gestationZika virus testing: amniotic fluid RT-PCR positiveFetal 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 ageFever, myalgia, and rash at 10 wk gestationZika virus testing: amniotic fluid RT-PCR positive.Fetal ultrasounds performed at 22, 25, and 29 wk gestation• Microphthalmia
Maternal TORCH serology, HIV, parvovirus B19, dengue virus, and chikungunya virus test results were negative
  • Microcephaly

  • Asymmetric cerebral hemispheres

  • 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

  • Cataracts

  • Severe arthrogryposis of all extremities

Case report; Rio Grande de Norte state, Brazil19Termination at 32 wk gestationHigh fever, severe myalgia and headache, and rash at 13 wk gestationZika virus testing: brain tissue sample RT-PCR positiveFetal 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 infl ammation

Case report; Salvador, Brazil21Fetal death at 32 wk gestation, induced deliveryAsymptomaticZika virus testing: extracts of the cerebral cortex, medulla oblongata, CSF, and amniotic fluid RT-PCR positiveFetal ltrasounds performed at 14, 18, 26, and 30 wk gestation• Congenital microcephaly
Maternal HIV, HTLV, hepatitis C, rubella, T gondii, and CMV testing negative
  • Fetal weight 3 SDs less than the mean for gestational age

  • Microcephaly

  • Hydranencephaly

  • Intracranial calcifications

  • Destructive lesions of the posterior fossa

  • Hydrops fetalis (hydrothorax, ascites, subcutaneous edema)

• Arthrogryposis
Case series; Zika virus–affected areas22Spontaneous pregnancy loss at 8 wk gestationFever, rash, arthralgia, myalgia, and malaise during travel at 5 wk gestationZika virus testing: products of conception RT-PCR positive and IHC positive
Maternal Zika virus serology testing confirmed recent infection
Elective termination at ∼20 wk gestationFever, eye pain, myalgia, and rash after travel at 11–12 wk gestationZika virus testing: amniotic fluid RT-PCR positiveFetal 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 gestationFever, rash, arthralgia, and headache while residing in Brazil at 7–8 wk gestationZika virus testing: placenta RTPCR positive and IHC positivePostnatal 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.