Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise

Abstract

BackgroundThe rapid spread of Zika virus in the Americas and current outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses.Methodology/Principal FindingsWe report a case of a 20-year-old pregnant woman who was referred to our service after a large Zika virus outbreak in the city of Salvador, Brazil with an ultrasound examination that showed intrauterine growth retardation of the fetus at the 18th gestational week. Ultrasound examinations in the 2nd and 3rd trimesters demonstrated severe microcephaly, hydranencephaly, intracranial calcifications and destructive lesions of posterior fossa, in addition to hydrothorax, ascites and subcutaneous edema. An induced labor was performed at the 32nd gestational week due to fetal demise and delivered a female fetus. ZIKV-specific real-time polymerase chain reaction amplification products were obtained from extracts of cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid, while extracts of heart, lung, liver, vitreous body of the eye and placenta did not yield detectable products.Conclusions/SignificanceThis case report provides evidence that in addition to microcephaly, there may be a link between Zika virus infection and hydrops fetalis and fetal demise. Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes.

Zika virus: what do we know about the viral structure, mechanisms of transmission, and neurological outcomes?

“…Hydranencephaly, intracranial calcifications, destructive lesions of the posterior fossa, hydrothorax, ascites, subcutaneous edema, and arthrogryposis have been described in severe cases (68) (69) . It is important to rule out other infectious agents that are known to induce microcephaly (38) (70) before ascribing it to Zika virus infection.…”

The role of Brazilian National Health Information Systems in assessing the impact of Zika virus outbreak

“…A recent laboratory study showed that ZIKV affects human brain cells, reducing their viability and growth 31 . ZIKV disease has also been associated with other neurological complications, including GBS 15,32 , meningoencephalitis 33 , microcephaly with agyria and hydrocephalus 7 , hydranencephaly, intracranial calcifications 5,7 , and ocular findings such as bilateral macular and perimacular lesions, and optic nerve abnormalities 34 .…”

“…Recent studies have shown that ZIKV infection damages the central nervous system, causing fetal malformations 1 and certain neuropathies such as GuillainBarré Syndrome [2][3][4][5] . The virus's neurotropic behavior and its ability to cross the placental barrier and cause brain damage during fetal development have been demonstrated in laboratory experiments 6,7 .…”

“…Recently, ZIKV infection has also been associated with several neurological complications, including microcephaly 5,7,12 . The virus was first isolated from rhesus monkeys in the Zika Forest of Uganda, Africa, in 1947 13 .…”

Scientometric analysis of research on Zika virus

“…int/mediacentre/news/statements/2016/1st-emergency-com mittee-zika/en/). The ZV has also raised attention to the possible deleterious effects that it may have on foetuses [12]. However, ''there are no licensed medical counter measures (vaccines, therapies or preventive drugs) available for Zika virus infection and disease'' [8].…”