Late yesterday the NEJM published a correspondence from doctors at Santa Casa de Misericordia and researchers from the University of São Paulo describing a child born last January - without visible neurological defects - but carrying an active Zika infection, who went on to develop severe neurological symptoms by six months of age.
The Zika virus infection continued to be detected in the child's system for two months post delivery. Despite that finding, doctors described him at 54 days of age as having `no obvious illness or evidence of any immunocompromising condition'.
By six months, however, his condition had deteriorated, developing neuropsychomotor developmental delay, global hypertonia, and spastic hemiplegia.
This correspondence raises serious questions for which there are currently few good answers. It is unknown whether this child's neurological damage occurred while still in the womb, or after the child was born.
This also raises concerns that infants - whose brains continue to develop in the months following delivery - might be at risk of neurological damage if infected shortly after birth.
And this also raises questions about the true status of some of the `discarded' cases reported by Brazil's MOH as not meeting the requirement for microcephaly at birth.
Of note, Brazil's MOH doesn't appear to have updated those numbers since late-July.
Two links. First, to the NEJM correspondence, and then a link to the press release from the University of Sao Paulo Scientific Outreach Unit.
Prolonged Shedding of Zika Virus Associated with Congenital Infection
August 24, 2016DOI: 10.1056/NEJMc1607583
To the Editor:
The presence of Zika virus (ZIKV) infection has been associated with microcephaly in multiple studies,1-3 although little is known about ZIKV shedding in congenitally infected infants. We report a case of a newborn who had continued viremia with ZIKV for at least 67 days after birth.
On January 2, 2016, a male child was born with microcephaly in São Paulo, Brazil, at 40 weeks of gestation to a mother who had reported having symptoms associated with ZIKV infection during the 26th week of pregnancy. At birth, the weight was 3095 g, the length 48 cm, and the head circumference 32.5 cm. The neurologic abnormality was not detected during an initial physical examination.
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The case is reported by researchers from the University of São Paulo and the Santa Casa de São Paulo hospital on the website of The New England Journal of Medicine on Wednesday, July 24
Physicians at the Santa Casa de Misericordia and researchers from the Institute of Biomedical Sciences at University of São Paulo describe the case of a baby born with Zika infection in January 2016, who remained infected by the virus even two months and one week after birth.
This is the first reported case of prolonged Zika infection in newborns.
The baby was born with 3 kg, 48 cm in length and the head perimeter of 32.5 cm, slightly smaller than the 33cm recommended by WHO. At first, doctors did not detect signs of any neurological abnormality: the analysis of the cerebrospinal fluid and the exams of the eyes and the ears showed normal results. Images taken by MRI, though, showed a reduced brain parenchyma, foci of calcification in the subcortical area and compensatory dilation of the supraventricular system. These results and the fact that the mother's symptoms of Zika infection appeared in the seventh month of pregnancy - when it is thought that the damage to the fetus is less severe than when the infection occurs earlier in pregnancy - led to a first diagnosis of mild microcephaly.
After 54 days of life, the baby showed no illness or neurological impairment. However, at six months, doctors noticed delayed psychomotor development, with an abnormal increase in the muscle tone and reduced muscle stretchability. Also, spastic hemiplegia (cerebral palsy) was detected. These characteristics imply a more serious condition than diagnosed before.
The baby's father traveled to the Northeast of Brazil and showed symptoms of Zika before his wife. It may indicate that the virus could have been sexually transmitted. Serological tests confirmed the infection in both parents.
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