• Vanessa van der Linden, André Pessoa, William Dobyns, A James Barkovich, Hélio van der Linden Júnior, Epitacio Leite Rolim Filho, Erlane Marques Ribeiro, Mariana de Carvalho Leal, Pablo Picasso de Araújo Coimbra, Aragão Maria de Fátima Viana Vasco MF, Islane Verçosa, Camila Ventura, Regina Coeli Ramos, Danielle Di Cavalcanti Sousa Cruz, Marli Tenório Cordeiro, Vivian Maria Ribeiro Mota, Mary Dott, Christina Hillard, and Cynthia A Moore.
• MMWR Morb. Mortal. Wkly. Rep. 2016 Dec 2; 65 (47): 1343-1348.

AbstractCongenital Zika virus infection can cause microcephaly and severe brain abnormalities (1). Congenital Zika syndrome comprises a spectrum of clinical features (2); however, as is the case with most newly recognized teratogens, the earliest documented clinical presentation is expected to be the most severe. Initial descriptions of the effects of in utero Zika virus infection centered prominently on the finding of congenital microcephaly (3). To assess the possibility of clinical presentations that do not include congenital microcephaly, a retrospective assessment of 13 infants from the Brazilian states of Pernambuco and Ceará with normal head size at birth and laboratory evidence of congenital Zika virus infection was conducted. All infants had brain abnormalities on neuroimaging consistent with congenital Zika syndrome, including decreased brain volume, ventriculomegaly, subcortical calcifications, and cortical malformations. The earliest evaluation occurred on the second day of life. Among all infants, head growth was documented to have decelerated as early as 5 months of age, and 11 infants had microcephaly. These findings provide evidence that among infants with prenatal exposure to Zika virus, the absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities. These findings support the recommendation for comprehensive medical and developmental follow-up of infants exposed to Zika virus prenatally. Early neuroimaging might identify brain abnormalities related to congenital Zika infection even among infants with a normal head circumference (4).

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