No abstract

Zika virus (ZIKV) is a flavivirus with teratogenic effects on the fetal brain, but the spectrum of brain injury is unknown, particularly when ultrasound imaging is normal. In a pregnant pigtail macaque (Macaca nemestrina) model, we demonstrate that ZIKV injury to the fetal brain was significant even in the absence of microcephaly and is clinically challenging to detect. A common and subtle injury pattern was identified including: 1) periventricular T2-hyperintense foci and loss of fetal non-cortical brain volume, 2) injury to the ependymal epithelium with underlying gliosis, and 3) loss of late fetal neuronal progenitor cells in the subventricular zone (temporal cortex) and subgranular zone (dentate gyrus, hippocampus) with dysmorphic granule neuron patterning. Attenuation of fetal neurogenic output demonstrates potentially significant teratogenic effects of congenital ZIKV infection even without microcephaly. All children exposed to ZIKV in utero should be followed long-term for neurocognitive deficits, regardless of head size at birth.