sharon sanders
Editor-in-Chief & President
CORRESPONDENCE
[h=1]Computed Tomographic Findings in Microcephaly Associated with Zika Virus[/h] April 6, 2016DOI: 10.1056/NEJMc1603617
snip
Intrauterine ZIKV infection appears to be associated with severe brain anomalies, including calcifications, cortical hypogyration, ventriculomegaly, and white-matter abnormalities, although we cannot determine with certainty when ZIKV infection may have occurred during fetal development in these 23 infants. Our findings are nonspecific and may be seen in other congenital viral infections. The global presence of cortical hypogyration and white-matter hypomyelination or dysmyelination in all the infants and cerebellar hypoplasia in the majority of them suggest that ZIKV is associated with a disruption in brain development rather than destruction of brain. The neuronal and glial proliferation as well as neuronal migration appear to be affected. The mothers of the microcephalic infants in our study population had symptoms (e.g., low-grade fever and cutaneous rash) that were compatible with ZIKV infection during the first or second trimester of pregnancy, similar to the findings in other studies.4 Tang et al. found that ZIKV directly infects human cortical neural progenitor cells with high efficiency, resulting in stunted growth of this cell population and transcriptional dysregulation.5 This observation supports the type of disruptive, anomalous brain development that we found in these infants.
Adriano N. Hazin, M.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Andrea Poretti, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD
aporett1@jhmi.edu
Danielle Di Cavalcanti Souza Cruz, M.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Marli Tenorio, Ph.D.
Research Center Aggeu Magalh?es, Recife, Brazil
Ana van der Linden, M.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Lindomar Jose Pena, M.D.
Carlos Brito, M.D., Ph.D.
Laura H. Vega Gil, Ph.D.
Research Center Aggeu Magalh?es, Recife, Brazil
Dem?crito de Barros Miranda-Filho, Ph.D.
Oswaldo Cruz University Hospital, Recife, Brazil
Ernesto Torres de Azevedo Marques, M.D., Ph.D.
Celina M. Turchi Martelli, M.D., Ph.D.
Research Center Aggeu Magalh?es, Recife, Brazil
Jo?o G. Bezerra Alves, M.D., Ph.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Thierry A. Huisman, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD
for the Microcephaly Epidemic Research Group
http://www.nejm.org/doi/full/10.1056/NEJMc1603617
[h=1]Computed Tomographic Findings in Microcephaly Associated with Zika Virus[/h] April 6, 2016DOI: 10.1056/NEJMc1603617
snip
Intrauterine ZIKV infection appears to be associated with severe brain anomalies, including calcifications, cortical hypogyration, ventriculomegaly, and white-matter abnormalities, although we cannot determine with certainty when ZIKV infection may have occurred during fetal development in these 23 infants. Our findings are nonspecific and may be seen in other congenital viral infections. The global presence of cortical hypogyration and white-matter hypomyelination or dysmyelination in all the infants and cerebellar hypoplasia in the majority of them suggest that ZIKV is associated with a disruption in brain development rather than destruction of brain. The neuronal and glial proliferation as well as neuronal migration appear to be affected. The mothers of the microcephalic infants in our study population had symptoms (e.g., low-grade fever and cutaneous rash) that were compatible with ZIKV infection during the first or second trimester of pregnancy, similar to the findings in other studies.4 Tang et al. found that ZIKV directly infects human cortical neural progenitor cells with high efficiency, resulting in stunted growth of this cell population and transcriptional dysregulation.5 This observation supports the type of disruptive, anomalous brain development that we found in these infants.
Adriano N. Hazin, M.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Andrea Poretti, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD
aporett1@jhmi.edu
Danielle Di Cavalcanti Souza Cruz, M.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Marli Tenorio, Ph.D.
Research Center Aggeu Magalh?es, Recife, Brazil
Ana van der Linden, M.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Lindomar Jose Pena, M.D.
Carlos Brito, M.D., Ph.D.
Laura H. Vega Gil, Ph.D.
Research Center Aggeu Magalh?es, Recife, Brazil
Dem?crito de Barros Miranda-Filho, Ph.D.
Oswaldo Cruz University Hospital, Recife, Brazil
Ernesto Torres de Azevedo Marques, M.D., Ph.D.
Celina M. Turchi Martelli, M.D., Ph.D.
Research Center Aggeu Magalh?es, Recife, Brazil
Jo?o G. Bezerra Alves, M.D., Ph.D.
Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
Thierry A. Huisman, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD
for the Microcephaly Epidemic Research Group
http://www.nejm.org/doi/full/10.1056/NEJMc1603617