Representative histopathological changes and positive immunostaining in central nervous tissue of ZIKV-positive microcephaly cases by ZIKV. (A,B) Cellular disorganization in the cortical layer and positive immunostaining (arrow) for ZIKV antigen in neurons (Case 4) (IHC, SAAP, 400×). (C) Foci of dystrophic calcification in parenchyma with degenerative necrotic lesion (Case 6) (HE, 400×). (D) Gliosis in parenchyma with degenerative necrotic lesion (Case 6) (HE, 400×). (E,F) Positive immunostaining for ZIKV in neurons and astrocytes with perivascular inflammatory infiltrate (Case 6) (IHC, SAAP, 400×). (G) Significant vascular proliferation, edema and vessel congestion (arrows) (Case 11) (HE, 100×). (H) Pyramidal neurons of the cerebral cortex with neuronophagy, satelitosis, and gliosis (circles) (Case 11) (HE, 400×).