title: Congenital cerebral malformations and dysfunction in fetuses and newborns following the 2013 to 2014 Zika virus epidemic in French Polynesia.
abstract: We detected an unusual increase in congenital cerebral malformations and dysfunction in fetuses and newborns in French Polynesia, following an epidemic of Zika virus (ZIKV), from October 2013 to March 2014. A retrospective review identified 19 cases, including eight with major brain lesions and severe microcephaly, six with severe cerebral lesions without microcephaly and five with brainstem dysfunction without visible malformations. Imaging revealed profound neurological lesions (septal and callosal disruption, ventriculomegaly, abnormal neuronal migration, cerebellar hypoplasia, occipital pseudocysts, brain calcifications). Amniotic fluid was drawn from seven cases at gestation weeks 20 to 29. ZIKV RNA was detected by RT-PCR and infectious ZIKV isolates were obtained in four of five microcephalic, but not in two non-microcephalic cases with severe brain lesions. Medical termination of pregnancy was performed in eleven cases; two cases with brainstem dysfunction died in the first months of life; six cases are alive, with severe neurological impairment. The results show that four of seven tested fetuses with major neurological injuries were infected with ZIKV in utero. For other non-microcephalic, congenital abnormalities we were not able to prove or exclude ZIKV infection retrospectively. The unusual occurrence of brain malformations or dysfunction without microcephaly following a ZIKV outbreak needs further studies.
authors.affiliation: Service de réanimation néonatale, Centre Hospitalier de Polynésie Française (CHPF), Pirae, Polynésie Française.
authors.forename: Marianne
authors.initials: M
authors.lastname: Besnard
authors.forename: Dominique
authors.initials: D
authors.lastname: Eyrolle-Guignot
authors.forename: Prisca
authors.initials: P
authors.lastname: Guillemette-Artur
authors.forename: Stéphane
authors.initials: S
authors.lastname: Lastère
authors.forename: Frédérique
authors.initials: F
authors.lastname: Bost-Bezeaud
authors.forename: Ludivine
authors.initials: L
authors.lastname: Marcelis
authors.forename: Véronique
authors.initials: V
authors.lastname: Abadie
authors.forename: Catherine
authors.initials: C
authors.lastname: Garel
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Moutard
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Jouannic
authors.forename: Flore
authors.initials: F
authors.lastname: Rozenberg
authors.forename: Isabelle
authors.initials: I
authors.lastname: Leparc-Goffart
authors.forename: Henri-Pierre
authors.initials: HP
authors.lastname: Mallet
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000821:virology*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D058872:Epidemics; D005260:Female; D005333:Fetus / Q000002:abnormalities* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008831:Microcephaly / Q000150:complications / Q000175:diagnosis*; D011114:Polynesia / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D012367:RNA, Viral / Q000235:genetics; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed; D000071244:Zika Virus / Q000302:isolation & purification*; D000071243:Zika Virus Infection / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology
chemical_list: D012367:RNA, Viral
keywords: French Polynesia; Zika virus; cerebral malformation or dysfunction; epidemic; foetus; newborn