Table. Summary of 2 case reports involving fetuses examined after pregnancy termination who had severe neurologic defects attributed to maternal Zika virus infection, Colombia*.
| Characteristics |
Case 1 |
Case 2 |
|---|---|---|
| Pregnancy history | ||
| Maternal age, y | 24 | 15 |
| Municipality of residence | Barranquilla, Colombia | Bogotá, Colombia; recent travel to area with circulating Zika virus |
| Gestational age at maternal infection, wks | 5–6 | 16–20 |
| Maternal symptoms | Fever; generalized rash for 2 d; edema and joint pain for 2 wks | Generalized rash for 2 d and myalgia |
| Prior pregnancy complications | Previous pregnancy complicated by Potter syndrome ending in stillbirth 2 mo before current pregnancy | None; one previous live birth |
| Plurality | Singleton | Singleton |
| Ultrasound findings | 8 wks: no notable abnormalities; 12 wks: no notable abnormalities; 15 wks: absence of cranial vault with brain tissue loss including absence of cerebral hemispheres (exencephaly–anencephaly sequence) | 26 wks: abnormal clefts in cerebral hemispheres of the brain (schizencephaly) with open lip; 26 wks (4 d later): large regions of parietal and temporal brain parenchyma loss |
| Samples obtained | Amniotic fluid from amniocentesis (17 wks); cord blood from amniocentesis (17 wks); tissue samples of fetal organs (placenta, liver, kidney, spleen, cord, eyes, brain tissue, spinal cord) | Amniotic fluid from amniocentesis (27 wks); cord blood from amniocentesis (27 wks); tissue samples of fetal organs (placenta, liver, kidney, spleen, cord, eyes, brain tissue, spinal cord) |
| Pregnancy outcome |
Elective termination at 20 wks |
Elective termination at 27 wks |
| Macroscopic and histopathologic examination | ||
| CNS | Anencephaly, without associated malformations; absence of cerebral hemispheres and cerebellum; rudimentary central trunk; absence of bones of the upper calvaria, with purplish brown irregular tissue attached to the base corresponding to residual nerve tissue; recent bleeding in tissues of the cortex and brain stem; decreased neuroblast density compatible with neuronal migration arrest and glial leptomeningeal heterotopy | Almost complete absence of periventricular germinal matrix of CNS tissue, with replacement by reactive glia; decreased pattern of maturation/migration of cerebral cortex with edema and congestion; neuropil disruption with microcalcification in the spinal cord, with reactive gliosis and loss of the ascending and descending tracts of the spinal cord, with congestion; peripheral nerve ganglion of the sympathetic chain with Wallerian degeneration and reactive proliferation of sustentacular cells, satellitosis, and neuronophagia of ganglion cells, and neuronal degeneration |
| Eye | Neuroepithelium of the retina without disruptive changes or microcalcifications | Neuroepithelium of the retina not identified |
| Spleen | Congestion; adequate development of white and red pulp | Complete autolysis |
| Chorionic villi | Immature chorionic villi with enlarged irregular contours without inflammatory infiltrate and partial obliteration of fetal vessels | Heterogeneous pattern of accelerated maturation of the chorionic villi, with some chorionic villi enlarged with irregular surroundings with irregular growth pattern |
| Umbilical cord | Unremarkable | Single umbilical artery |
| Placenta | Slight increase in perivillous fibrin deposits; chronic lymphocytic deciduitis | Increase in perivillous fibrin deposits |
| Kidney | Unremarkable | Unremarkable |
| Liver | Unremarkable | Unremarkable |
| Thymus | Not reported | Unremarkable |
| Lung |
Not reported |
Unremarkable |
| RT-PCR results for Zika virus in fetal tissues | ||
| Brain | Positive | Positive |
| Brain stem | Positive | Not reported |
| Spinal cord | Positive | Not reported |
| Eye | Positive | Negative |
| Spleen | Positive | Positive |
| Kidney | Positive | Positive |
| Liver | Positive | Positive |
| Thymus | Not reported | Positive |
| Lung | Not reported | Positive |
| Myocardium | Not reported | Positive |
| Bone marrow | Not reported | Positive |
| Peripheral nerve | Not reported | Positive |
| Umbilical cord | Positive | Positive |
| Placenta | Positive | Negative |
*CNS, central nervous system; RT-PCR, reverse transcription PCR.