Zika Virus Infection, Pregnancy and Microcephaly

Dear Editor,

The publication by Duarte et al[1] on “Zika Virus Infection in Pregnant Women and Microcephaly” is very interesting. Duarte et al[1] mentioned that “If there are no complications (meningoencephalitis or Guillain-Barré syndrome), further examination is unnecessary to assess systemic impairment” and “Anti-inflammatory drugs should be avoided until the diagnosis of dengue is discarded.” We would like to discuss on these two interesting points. First, there is no doubt regarding the fact that most cases of Zika virus infection are asymptomatic.[2] However, this does not mean that the asymptomatic Zika virus infection does not present any hidden abnormalities. In a recent publication, it was clearly shown that there are many cases with congenital Zika virus syndrome that present no microcephaly but many abnormalities in the brain-from-brain imaging evaluation.[3] If we overlooked the complete clinical assessment of the asymptomatic cases, we might miss many hidden problems that can result in future unwanted events. Focusing on the recommendation to avoid anti-inflammatory drugs, there is no contraindication to the use of anti-inflammatory drug in the patients with dengue,[4] and there is also no evidence that the use of anti-inflammatory drugs provides any clinical advantage in cases of Zika virus infection.

• References

• 1 Duarte G, Moron AF, Timerman A. , et al. Zika virus infection in pregnant women and microcephaly. Rev Bras Ginecol Obstet 2017; 39 (05) 235-248 . Doi: 10.1055/s-0037-1603450
• 2 Wiwanitkit S, Wiwanitkit V. Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: Don't miss it!. Asian Pac J Trop Med 2016; 9 (05) 513 . Doi: 10.1016/j.apjtm.2016.03.036
• 3 Aragao MFVV, Holanda AC, Brainer-Lima AM. , et al. Nonmicrocephalic infants with congenital zika syndrome suspected only after neuroimaging evaluation compared with those with microcephaly at birth and postnatally: how large is the zika virus “iceberg”?. AJNR Am J Neuroradiol 2017; 38 (07) 1427-1434 . Doi: 10.3174/ajnr.A5216
• 4 Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther 2010; 8 (07) 841-845 . Doi: 10.1586/eri.10.53