[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]
JAMA Pediatr. 2018 Nov 26. doi: 10.1001/jamapediatrics.2018.4138. [Epub ahead of print]
Sequential Neuroimaging of the Fetus and Newborn With In Utero Zika Virus Exposure.
Mulkey SB1,2,3, Bulas DI4, Vezina G4, Fourzali Y5, Morales A5, Arroyave-Wessel M1, Swisher CB1, Cristante C1, Russo SM1, Encinales L6, Pacheco N7, Kousa YA8, Lanciotti RS9, Cure C10, DeBiasi RL2,11,12, du Plessis AJ1,2,3.
Author information: 1 Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, DC. 2 Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC. 3 Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC. 4 Division of Radiology, Children’s National Health System, Washington, DC. 5 Sabbag Radiologos, Barranquilla, Colombia. 6 Allied Research Society, Miami, Florida. 7 Bacteriologa, Bio-Nep, Barranquilla, Colombia. 8 Division of Neurology, Children’s National Health System, Washington, DC. 9 Arbovirus Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado. 10 BIOMELAB, Barranquilla, Colombia. 11 Division of Infectious Diseases, Children’s National Health System, Washington, DC. 12 Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC.
The evolution of fetal brain injury by Zika virus (ZIKV) infection is not well described.
To perform longitudinal neuroimaging of fetuses and infants exposed to in utero maternal ZIKV infection using concomitant magnetic resonance imaging (MRI) and ultrasonography (US), as well as to determine the duration of viremia in pregnant women with ZIKV infection and whether the duration of viremia correlated with fetal and/or infant brain abnormalities.
DESIGN, SETTING, AND PARTICIPANTS:
A cohort of 82 pregnant women with clinical criteria for probable ZIKV infection in Barranquilla, Colombia, and Washington, DC, were enrolled from June 15, 2016, through June 27, 2017, with Colombian women identified by community recruitment and physician referral and travel-related cases of American women recruited from a Congenital Zika Program.
INTERVENTIONS AND EXPOSURES:
Women received 1 or more MRI and US examinations during the second and/or third trimesters. Postnatally, infants underwent brain MRI and cranial US. Blood samples were tested for ZIKV.
MAIN OUTCOMES AND MEASURES:
The neuroimaging studies were evaluated for brain injury and cerebral biometry.
Of the 82 women, 80 were from Colombia and 2 were from the United States. In 3 of 82 cases (4%), fetal MRI demonstrated abnormalities consistent with congenital ZIKV infection. Two cases had heterotopias and malformations in cortical development and 1 case had a parietal encephalocele, Chiari II malformation, and microcephaly. In 1 case, US results remained normal despite fetal abnormalities detected on MRI. Prolonged maternal polymerase chain reaction positivity was present in 1 case. Of the remaining 79 cases with normal results of prenatal imaging, postnatal brain MRI was acquired in 53 infants and demonstrated mild abnormalities in 7 (13%). Fifty-seven infants underwent postnatal cranial US, which detected changes of lenticulostriate vasculopathy, choroid plexus cysts, germinolytic/subependymal cysts, and/or calcification in 21 infants (37%).
CONCLUSIONS AND RELEVANCE:
In a cohort of pregnant women with ZIKV infection, prenatal US examination appeared to detect all but 1 abnormal fetal case. Postnatal neuroimaging in infants who had normal prenatal imaging revealed new mild abnormalities. For most patients, prenatal and postnatal US may identify ZIKV-related brain injury.
PMID: 30476967 DOI: 10.1001/jamapediatrics.2018.4138
Keywords: Zika Virus; Zika Congenital Infection; Neurology.