Initial Description of the Presumed Congenital Zika Syndrome

Miranda-Filho, Demócrito de Barros; Martelli, Celina Maria Turchi; Ximenes, Ricardo Arraes de Alencar; Araújo, Thália Velho Barreto de; Rocha, Maria Ângela Wanderley; Ramos, Regina Coeli Ferreira; Dhália, Rafael; França, Rafael Freitas de Oliveira; Marques, Ernesto T. A.; Rodrigues, Laura C.

doi:10.2105/ajph.2016.303115

Cited by 256 publications

(211 citation statements)

References 7 publications

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“…A photograph and cerebral CT image of one of the cases shows features previously described during the current microcephaly epidemic (fi gure). 28 Two cases had only one matched control. The participation rate was 100% for cases and 76% for controls.…”

Section: Resultsmentioning

confidence: 99%

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study

Araújo

Rodrigues

Ximenes

et al. 2016

The Lancet Infectious Diseases

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221

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Section: Resultsmentioning

confidence: 99%

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study

Araújo

Rodrigues

Ximenes

et al. 2016

The Lancet Infectious Diseases

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399

221

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“…The spectrum of disease caused by Zika virus among adults and children is still being investigated and defined, but it is clear in the most recent epidemic in South and Central America, Mexico, and the Caribbean islands that when infection occurs in pregnant women, fetuses appear to be at increased risk for a poor clinical outcome. [2][3][4][5][6][7][8][9] The most significant effect of the Zika virus on the fetus is the occurrence of neuronal necrosis and microcephaly-this has been demonstrated in neuroimaging studies performed both before delivery and following the birth of infected infants. 2,3,7 Pathology studies have been shown to be an important component of the public health investigation of emerging infections, contributing to the understanding of the mechanisms of tissue injury, for example, human immunodeficiency virus, Ebola virus, hantavirus, West Nile virus, and many others.…”

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confidence: 99%

Placental Pathology of Zika Virus: Viral Infection of the Placenta Induces Villous Stromal Macrophage (Hofbauer Cell) Proliferation and Hyperplasia

Rosenberg¹,

Yu²,

Hill³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

155

149

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Context.-The placenta is an important component in understanding the fetal response to intrauterine Zika virus infection, but the pathologic changes in this organ remain largely unknown. Hofbauer cells are fetal-derived macrophages normally present in the chorionic villous stroma. They have been implicated in a variety of physiological and pathologic processes, in particular involving infectious agents.Objectives.-To characterize the fetal and maternal responses and viral localization in the placenta following Zika virus transmission to an 11 weeks' gestation fetus. The clinical course was notable for prolonged viremia in the mother and extensive neuronal necrosis in the fetus. The fetus was delivered at 21 weeks' gestation after pregnancy termination.Design.-The placenta was evaluated by using immunohistochemistry for inflammatory cells (macrophages/ monocytes [Hofbauer cells], B and T lymphocytes) and proliferating cells, and an RNA probe to Zika virus. The fetal brain and the placenta were previously found to be positive for Zika virus RNA by reverse transcriptionpolymerase chain reaction.Results.-The placenta demonstrated prominently enlarged, hydropic chorionic villi with hyperplasia and focal proliferation of Hofbauer cells. The degree of Hofbauer cell hyperplasia gave an exaggerated immature appearance to the villi. No acute or chronic villitis, villous necrosis, remote necroinflammatory abnormalities, chorioamnionitis, funisitis, or hemorrhages were present. An RNA probe to Zika virus was positive in villous stromal cells, presumably Hofbauer cells.Conclusions.-Zika virus placental infection induces proliferation and prominent hyperplasia of Hofbauer cells in the chorionic villi but does not elicit villous necrosis or a maternal or fetal lymphoplasmacellular or acute inflammatory cell reaction.

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“…However, reports of the large numbers of patients attending health units during the outbreak in many Latin American countries, suggest a higher symptomatic proportion. Among cases of neonatal microcephaly, approximately 60-70% of the pregnant women were symptomatic (42) (43) and among the confirmed cases of associated GBS, 88% were symptomatic after infection with ZIKV, reinforcing the need for other seroprevalence studies with larger case by case studies to define the actual symptomatic percentage.…”

Section: Clinical Spectrummentioning

confidence: 99%

One year after the Zika virus outbreak in Brazil: from hypotheses to evidence

Brito

Cordeiro

2016

Rev. Soc. Bras. Med. Trop.

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In the second quarter of 2015, the association between Zika virus infection and neurological symptoms was confirmed in adults. Moreover, in October 2015 a novel suspicion was raised based on clinical and epidemiological observations: that an association between Zika virus infection and neonatal microcephaly may exist. A year after the first reports on Zika virus in Brazil, many hypotheses and much evidence on the patterns of involvement of the disease and its complications have been produced, both in this country and others; other hypotheses still need to be clarified. This review is a synthesis of a new chapter in the history of medicine; it outlines the main results produced.

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Initial Description of the Presumed Congenital Zika Syndrome

Abstract: Affected nations need to prepare to provide complex and costly multidisciplinary care that children diagnosed with this new congenital syndrome will require.

Cited by 256 publications

References 7 publications

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study

Placental Pathology of Zika Virus: Viral Infection of the Placenta Induces Villous Stromal Macrophage (Hofbauer Cell) Proliferation and Hyperplasia

One year after the Zika virus outbreak in Brazil: from hypotheses to evidence

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