First Neonatal Demise with Travel-Associated Zika Virus Infection in the United States of America

Abstract

Zika virus is increasingly recognized as a fetal pathogen worldwide. We describe the first case of neonatal demise with travel-associated Zika virus infection in the United States of America, including a novel prenatal ultrasound finding. A young Latina presented to our health care system in Southeast Texas for prenatal care at 23 weeks of gestation. Fetal Dandy–Walker malformation, asymmetric cerebral ventriculomegaly, single umbilical artery, hypoechoic fetal knee, dorsal foot edema, and mild polyhydramnios were noted upon initial screening prenatal sonography at 26 weeks. A growth-restricted, microcephalic, and arthrogrypotic infant was delivered alive at 36 weeks but died within an hour despite resuscitation. The neonatal karyotype was normal. Flavivirus IgM antibodies were identified in the serum of the puerpera, once she disclosed that she had traveled from El Salvador to Texas in the early second trimester. Zika virus was identified in the umbilical cord and neonatal brain. Fetal arthritis may precede congenital arthrogryposis in cases of Zika virus infection and may be detectable by prenatal sonography. Physician and health care system vigilance is required to optimally address the significant and enduring Zika virus global health threat.

Keywords

Zika virus - prenatal ultrasound - fetal arthritis - Dandy–Walker malformation - single umbilical artery - congenital Zika virus syndrome - neonatal demise - prolonged maternal Zika virus seropositivity - perinatal universal precautions

• References

• 1 Frieden TR, Schuchat A, Petersen LR. Zika virus 6 months later. JAMA 2016; 316 (14) 1443-1444
• 2 Centers for Disease Control and Prevention. Pregnant women with any laboratory evidence of possible Zika virus infection in the United States and territories (2016). Available at: http://www.cdc.gov/zika/geo/pregwomen-uscases.html . Accessed February 16, 2017
• 3 Centers for Disease Control and Prevention. Zika virus case counts in the US. Available at: http://www.cdc.gov/zika/geo/united-states.html . Accessed February 16, 2017
• 4 Johansson MA, Mier-y-Teran-Romero L, Reefhuis J, Gilboa SM, Hills SL. Zika and the risk of microcephaly. N Engl J Med 2016; 375 (01) 1-4
• 5 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
• 6 Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Ultrasound screening for fetal microcephaly following Zika virus exposure. Am J Obstet Gynecol 2016; 214 (06) B2-B4
• 7 Gelber SE, Grünebaum A, Chervenak FA. Prenatal screening for microcephaly: an update after three decades. J Perinat Med 2017; 45 (02) 167-170
• 8 Platt L, Malinger G. International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) outreach webinar: Congenital Zika virus syndrome—how to improve your diagnostic capabilities [video webinar]. Available at: https://www.youtube.com/watch?v=N1wsPypw6ho&feature=youtu.be . Accessed May 20, 2016
• 9 Texas Department of State Health Services. Infant death in Texas linked to Zika, news release, August 9, 2016. Available at: http://www.dshs.texas.gov/news/releases/2016/20160809.aspx . Accessed February 16, 2017
• 10 Soares de Oliveira-Szejnfeld P, Levine D, Melo AS. , et al. Congenital brain abnormalities and Zika virus: what the radiologist can expect to see prenatally and postnatally. Radiology 2016; 281 (01) 203-218
• 11 Moore CA, Staples JE, Dobyns WB. , et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr 2017; 171 (03) 288-295
• 12 van der Eijk AA, van Genderen PJ, Verdijk RM. , et al. Miscarriage associated with Zika virus infection. N Engl J Med 2016; 375 (10) 1002-1004
• 13 Driggers RW, Ho CY, Korhonen EM. , et al. Zika virus infection with prolonged maternal viremia and fetal brain abnormalities. N Engl J Med 2016; 374 (22) 2142-2151