Two Infants with Presumed Congenital Zika Syndrome, Brownsville, Texas, USA, 2016-2017

Abstract

Since 2007, Zika virus has spread through the Pacific Islands and the Americas. Beginning in 2016, women in Brownsville, Texas, USA, were identified as possibly being exposed to Zika virus during pregnancy. We identified 18 pregnant women during 2016-2017 who had supportive serologic or molecular test results indicating Zika virus or flavivirus infection. Two infants were evaluated for congenital Zika syndrome after identification of prenatal microcephaly. Despite standard of care testing of mothers and neonates, comparative results were unreliable for mothers and infants, which highlights the need for clinical and epidemiologic evidence for an accurate diagnosis. A high index of suspicion for congenital Zika syndrome for at-risk populations is useful because of current limitations of testing.

Keywords: Brownsville; Mexico; Texas; United States; Zika virus; congenital Zika syndrome; flavivirus; infants; microcephaly; newborns; pregnancy; southern Texas; viruses.

Figure 1

Term male infant (case-patient 1) with presumed congenital Zika syndrome, Brownsville, Texas, USA, 2016–2017. A) Microcephaly on the day of birth. Head circumference was 29 cm, which is 2.63 SDs below the mean value for term male newborns. Craniofacial abnormalities present are mild narrow and laterally depressed frontal bone and mild retrognathia. B) Generalized pustular melanosis rash. C) Prenatal transvaginal ultrasonographic (midsagittal plane) image at 37.2 weeks’ gestation, showing calcifications at the gray matter–white matter junction. Head circumference was 251 mm. D) Sagittal T2 magnetic resonance image on day of life 1, showing severe microcephaly, frontal lobe polymicrogyria, and hypoplastic corpus callosum. E) Axial T2 magnetic resonance image on day of life 1, showing severely hypoplastic cerebral hemispheres and corpus callosum. Symmetric frontal lobe polymicrogyria and simplified gyral pattern in the occipital and temporal lobes are present. F) Axial computed tomography image on day of life 3, showing small bilateral brain hemispheres and hypogyration of the cerebral cortex. Areas of punctate calcification located at the subcortical and gray matter–white matter junctions of the frontal, parietal, and occipital lobes are present. A, anterior; AFL, anterior left; FPL, posterior left; HAR, anterior right; L, left; LHA, left anterior; P, posterior; PHR, posterior right; R, right; RFP, right posterior.

Figure 2

Term female infant (case-patient 2) with presumed congenital Zika syndrome, Brownsville, Texas, USA, 2016–2017. A) Microcephaly on the day of birth. Head circumference was 26.5 cm, which is 6.23 SDs below the mean value for term females. Craniofacial disproportion with narrow and laterally depressed frontal bone is seen. Upper wrist contractures are present, more apparent on the right, with ulnar deviation. B) Redundant scalp skin with multiple rugae. C) Transabdominal ultrasonography image of the axial transthalamic plane at 37 weeks’ gestation, showing coarse bilateral calcifications in the thalami. D) Transvaginal ultrasonography image of the coronal section at 37 weeks’ gestation, showing coarse calcifications in the thalami. E) Sagittal T2 turbo spin echo magnetic resonance image on day of birth, showing microcephaly, dysgenesis of the corpus callosum, and a small bilateral choroid plexus cyst. F) Axial T2 turbo spin echo magnetic resonance image on day of birth, showing microcephaly with enlarged extra-axial spaces and a smooth gyral pattern. Large bilateral posterior parietal and occipital lobe parenchymal cysts are present. AFL, anterior left; FLP, left posterior; HRA, right anterior; LHA, left anterior; PHR, posterior right; R, right; RFP, right posterior.