Clinical Features and Neurodevelopmental Outcomes for Infants with Perinatal Vertical Transmission of Zika Virus, Colombia

Abstract

T he emergence of Zika virus (ZIKV) in the Americas has coincided with an abnormal increase in prenatal and neonatal documented cases of microcephaly and other anomalies of the central nervous system (1) These alterations of the brain, along with animal models of vertical transmission of ZIKV, a single-stranded RNA fl avivirus, are evidence of the neurotropic nature of the virus (2-4).Vertical transmission and infection of the fetus during all 3 trimesters of pregnancy with ZIKV has been extensively reported, but little is known about perinatal transmission; only a few cases have been reported (5-8). We report 3 cases of perinatal ZIKV infection during the epidemic of Zika in Colombia and data on the neurodevelopmental outcome at 18 months of age (corrected). The StudyThe Institutional Review Board and Ethics Committee of the Universidad Industrial de Santander approved this study. Formal written consent was obtained from participating women.Case-patient 1 was a 26-year-old pregnant woman in labor who was admitted to the Hospital Universitario de Santander on August 7, 2015, after she reported fever, exanthema (maculopapular rash on the torso), and osteoid-muscular pains (Figure). Her initial hemogram showed mild thrombocytopenia (112,000 platelets/µL; reference range 150,000-400,000 platelets/µL). Test results for syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, varicella zoster virus, and parvovirus B19 during hospitalization were negative, as was a test result for dengue virus (DENV) IgM.A boy was born vaginally at 37 weeks of gestation. Apgar scores were normal. Anthropometric measurements yielded a birthweight of 3.03 kg (32nd percentile), a head circumference (HC) of 32 cm (6th percentile), and a length of 54 cm (99th percentile). Results of a physical examination were unremarkable. The infant was admitted for observation, and cord blood samples were sent to the Instituto Nacional de Salud (INS) for additional testing by reverse transcription PCR (RT-PCR) for DENV and chikungunya virus. On the second day of life, the infant had a distal macular-papular rash with hyperalgesia and mild edema of the hands and feet; a test result for DENV IgM was negative. Hyperthermia developed on the sixth day, and generalized exanthema developed on the seventh day.Because of persistent fever, we initiated a sepsis work-up. Results for initial complete blood count/ differential count, erythrocyte sedimentation rate, blood culture, urine culture, and C-reactive protein were within reference ranges. Fever and exanthema