Table 2.
Results of Histopathology, Immunohistochemistry (IHC) and Real Time PCR (RT-qPCR) in the 12 fatal cases of ZIKV infection.
| Case | Category | Gestational Age | Lifetime | Material | Results | ||
|---|---|---|---|---|---|---|---|
| Histopathology | IHC | RT-qPCR | |||||
| 1 | Fetus (Miscarriage) | 8 weeks | NA | Fetus | Fetal tissue inside the yolk sac with necrotic lesions, but no observed inflammatory reaction | Pos | NR |
| Placenta | Membrane and deciduous with necrosis, neutrophils and mononuclear cells. Areas with hyaline, mononuclear infiltrate, calcification foci, and abundant fibrinoid material | Pos | NR | ||||
| 2 | Stillbirth | 34 weeks (preterm) | NA | Brain | Tissue edema, vasocongestion in meninges. Nervous tissue with vascular proliferation, necrosis or apoptosis, gliosis, calcification multiple, edema. There are few neurons | Pos | Pos |
| Liver | Autolysis | Pos | Pos | ||||
| Kidney | Vasocongestion. Renal tubes with autolysis | Pos | Pos | ||||
| Lung | Lung immaturity, presence of keratinized cells in alveolar spaces with amniotic fluid, and other areas with atelectasis; vessels with thickened walls | Pos | Pos | ||||
| 3 | Stillbirth | 40 weeks (At term) | NA | Brain | Edema and diffuse vasocongestion, neuronal apoptosis | Pos | NR |
| Liver | Intense sinusoidal vasocongestion, macrovacuolar steatosis, little inflammatory infiltration of macrophages and plasma cells in portal tract. | Pos | NR | ||||
| Spleen | Vasocongestion | Neg | NR | ||||
| Heart | No changes | Neg | NR | ||||
| Kidney | Intense vasocongestion | Pos | NR | ||||
| Lung | Vasocongestion, presence of amniotic fluid and meconium in alveoli, bronchi, and bronchioles, suggestive of fetal distress | Neg | NR | ||||
| Placenta | Membranes preserved with multiple foci of calcification, fibrin, and vasocongestion | Neg | NR | ||||
| 4 | Newborn | Unknown | 2 h | Brain | Structure preserved but with edema and vasocongestion. | Pos | Neg |
| Liver | Intense vasocongestion and focal erythropoiesis. Focal microvacuolar steatosis in some hepatocytes. No portal inflammatory reaction | Pos | Pos | ||||
| Kidney | Diffuse vasocongestion and renal pelvis bleeding | Pos | Neg | ||||
| Lung | Structure preserved with few areas of alveolar bleeding and vasocongestion | Neg | Neg | ||||
| 5 | Newborn | 40 weeks (At term) | 6 h | Brain | Edema, vasocongestion, degenerative neural lesions (vacuolization of nucleus) | Pos | Pos |
| Liver | Subcapsular bleeding, hepatocyte edema, macro and microvacuolar steatosis, inflammatory infiltrate in portal area and sinusoids | Neg | Neg | ||||
| Kidney | Glomerular immaturity, hemorrhagic foci and vasocongestion | Neg | Neg | ||||
| Lung | Interstitial pneumonia, alveolar bleeding and intense vasocongestion; hemorrhagic pleuritis | Neg | Neg | ||||
| 6 | Newborn | Unknown | 14 h | Brain | Necrosis, calcification, gliosis, edema, neuroapoptosis and intense vasocongestion in the cortical layer; perivascular lymphocytic infiltrate; dilatation of ventricles (ventriculomegaly) | Pos | Pos |
| Liver | Hepatocytes with discreet and sparse macrovesicular steatosis. Sinusoidal intense vasocongestion. No portal inflammatory reaction | Neg | Neg | ||||
| Kidney | Vasocongestion | Neg | Neg | ||||
| Lung | Edema, alveoli bleeding, and vasocongestion | Pos | Neg | ||||
| 7 | Newborn | Unknown | 1 day | Brain | Meningeal thickening with vascularization intense, hyperemia, edema, lymphocytic inflammatory infiltrate; nervous tissue with edema, perivascular lymphocytic infiltrate, vasocongestion intense, and neuronal necrosis | Pos | Pos |
| Liver | Erythropoiesis and sinusoidal congestion | Neg | Pos | ||||
| Spleen | Vasocongestion | Neg | Pos | ||||
| Heart | No changes | Neg | Pos | ||||
| Kidney | Diffuse vascular congestion | Neg | Pos | ||||
| Lung | Vasocongestion, alveolar collapse; Bronchi and interstitial septa with lymphocytic infiltrate | Neg | Pos | ||||
| 8 | Newborn | Unknown | 2 days | Placenta | No changes. Maturity corresponding to 3rd trimester of pregnancy | Neg | NR |
| Umbilical cord | Normal aspect | Neg | NR | ||||
| Brain | Edema, vasocongestion and vascular proliferation, neuronal necrosis, focal depopulation, and calcifications | Pos | Neg | ||||
| Liver | Vasocongestion, hepatic steatosis macro and microvacuolar, erythropoiesis foci; inflammatory reaction in portal tract | Pos | Neg | ||||
| Spleen | Vasocongestion | Pos | Neg | ||||
| Heart | Muscle fibers with vacuolated aspect | Pos | Neg | ||||
| Kidney | Vasocongestion intense, predominantly in medullar area | Pos | Neg | ||||
| Lung | Vasocongestion, alveoli containing granular and acidophilus material, and desquamated epithelial cells, suggesting amniotic fluid aspiration and fetal distress | Pos | Neg | ||||
| 9 | Newborn | 28 weeks (preterm) | 1 day | Brain | Multiple calcifications in cortical layer. Edema, necrosis, vascular proliferation, gliosis foci, neuronal depopulation, and residual neurons with necrosis. | Pos | Pos |
| Liver | Focal erythropoiesis; partial autolysis of hepatocytes | Pos | Neg | ||||
| Spleen | Autolysis | Neg | Neg | ||||
| Kidney | No changes | Pos | Pos | ||||
| Lung | Large areas collapsed with acidophilus material brown-dark color, suggesting amniotic fluid and meconium aspiration and fetal distress | Neg | Pos | ||||
| 10 | Newborn | 29 weeks (preterm) | 5 min | Blood | NA | NA | Neg |
| CSF | NA | NA | Pos | ||||
| Urine | NA | NA | Neg | ||||
| Brain | NR | NR | Pos | ||||
| Liver | NR | NR | Neg | ||||
| Spleen | NR | NR | Neg | ||||
| Thymus | NR | NR | Neg | ||||
| Heart | NR | NR | Pos | ||||
| Kidney | NR | NR | Pos | ||||
| Lung | NR | NR | Pos | ||||
| 11 | Newborn | 36 weeks (preterm) | 1 day | Brain | Meningeal thickening with abundant vascularization, vasocongestion, mononuclear infiltrate, edema. Cortical with neuronal depopulation, disorganization, neuronal satelitosis, focal gliosis, vascular proliferation, hyperemia, and intense edema | Pos | Pos |
| Liver | Sinusoidal congestion and edema of hepatocytes | Pos | Pos | ||||
| Spleen | Vasocongestion | Neg | Pos | ||||
| Heart | No changes | Pos | Pos | ||||
| Kidney | Vasocongestion | Pos | Pos | ||||
| Lung | Vasocongestion | Neg | Pos | ||||
| 12 | Newborn | At term | 1 day | Serum | NA | NA | Pos |
| Placenta | Membranes preserved. Chorionic villi vascularized with calcification foci | Pos | Pos | ||||
NA: not applicable; IHC: Immunohistochemistry; RT-qPCR: reverse transcription real-time polymerase chain reaction; NR: sample not obtained; CSF: cerebrospinal fluid; Pos: Positive; Neg: Negative.