title: Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise.
abstract: BACKGROUND
  The rapid spread of Zika virus in the Americas and current outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses.
  
  
  RESULTS
  We report a case of a 20-year-old pregnant woman who was referred to our service after a large Zika virus outbreak in the city of Salvador, Brazil with an ultrasound examination that showed intrauterine growth retardation of the fetus at the 18th gestational week. Ultrasound examinations in the 2nd and 3rd trimesters demonstrated severe microcephaly, hydranencephaly, intracranial calcifications and destructive lesions of posterior fossa, in addition to hydrothorax, ascites and subcutaneous edema. An induced labor was performed at the 32nd gestational week due to fetal demise and delivered a female fetus. ZIKV-specific real-time polymerase chain reaction amplification products were obtained from extracts of cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid, while extracts of heart, lung, liver, vitreous body of the eye and placenta did not yield detectable products.
  
  
  CONCLUSIONS
  This case report provides evidence that in addition to microcephaly, there may be a link between Zika virus infection and hydrops fetalis and fetal demise. Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes.
authors.affiliation: Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil.|Faculdade de Medicina da Bahia and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
authors.forename: Manoel
authors.initials: M
authors.lastname: Sarno
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil.
authors.forename: Gielson A
authors.initials: GA
authors.lastname: Sacramento
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Khouri
authors.affiliation: Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil.
authors.forename: Mateus S
authors.initials: MS
authors.lastname: do Rosário
authors.affiliation: Faculdade de Medicina da Bahia and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.|Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Federico
authors.initials: F
authors.lastname: Costa
authors.affiliation: Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil.
authors.forename: Gracinda
authors.initials: G
authors.lastname: Archanjo
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil.
authors.forename: Luciane A
authors.initials: LA
authors.lastname: Santos
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil.
authors.forename: Nivison
authors.initials: N
authors.lastname: Nery
authors.affiliation: Department of Pathology and Center of Biodefense and Emerging Infectious Diseases, Institute for Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America.
authors.forename: Nikos
authors.initials: N
authors.lastname: Vasilakis
authors.affiliation: Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil.|Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Albert I
authors.initials: AI
authors.lastname: Ko
authors.affiliation: Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil.|Faculdade de Medicina da Bahia and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
authors.forename: Antonio R P
authors.initials: AR
authors.lastname: de Almeida
mesh_terms: D005260:Female; D006801:Humans; D006832:Hydranencephaly / Q000401:mortality / Q000821:virology*; D015160:Hydrops Fetalis / Q000401:mortality / Q000821:virology*; D011247:Pregnancy; D050497:Stillbirth; D055815:Young Adult; D000071244:Zika Virus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D000071243:Zika Virus Infection / Q000401:mortality / Q000821:virology*