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A Zika virus-associated microcephaly case with background exposure to STORCH agents

Mauro Mitsuru Hanaoka, Alexandre Fligelman Kanas, Carla Torres Braconi, Érica Araújo Mendes, Robert Andreata Santos, Luís Carlos de Souza Ferreira, Marielton dos Passos Cunha, Patrícia Beltrão Braga, João Leonardo Mendonça Dias, Carolina Manganeli Polonio, David Anibal Garrido Andrade, Carla Longo de Freitas, Cristiano Rossato, Wesley Nogueira Brandão, Jean Pierre Schatzmann Peron, Antonio Gomes de Amorim Filho, Joelma Queiroz Andrade, Rossana Pulcineli Vieira Francisco, Fernando Kok, Lisa Suzuki, Claudia da Costa Leite, Leandro Tavares Lucato, Amadou Alpha Sall, Paolo Marinho de Andrade Zanotto
doi: https://doi.org/10.1101/052340
Mauro Mitsuru Hanaoka
1Department of Radiology, Institute of Radiology, Hospital das Clínicas, University of São Paulo, Brazil.
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Alexandre Fligelman Kanas
1Department of Radiology, Institute of Radiology, Hospital das Clínicas, University of São Paulo, Brazil.
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Carla Torres Braconi
4Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Institute of BIomedical Sciences, University of São Paulo, Brazil.
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Érica Araújo Mendes
4Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Institute of BIomedical Sciences, University of São Paulo, Brazil.
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Robert Andreata Santos
9Vaccine Development Laboratory, Department of Microbiology, Institute of BIomedical Sciences, Universidade de São Paulo, Brazil.
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Luís Carlos de Souza Ferreira
9Vaccine Development Laboratory, Department of Microbiology, Institute of BIomedical Sciences, Universidade de São Paulo, Brazil.
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Marielton dos Passos Cunha
4Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Institute of BIomedical Sciences, University of São Paulo, Brazil.
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Patrícia Beltrão Braga
5Stem Cell Laboratory, Surgery Department, Faculdade de Medicina Veterinaria, Universidade de São Paulo, Universidade de São Paulo, Brazil.
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João Leonardo Mendonça Dias
5Stem Cell Laboratory, Surgery Department, Faculdade de Medicina Veterinaria, Universidade de São Paulo, Universidade de São Paulo, Brazil.
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Carolina Manganeli Polonio
6Neuroimmune Interactions Laboratory, Department of Immunology, Instituto de Ciências Biológicas, Universidade de São Paulo, Brazil.
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David Anibal Garrido Andrade
6Neuroimmune Interactions Laboratory, Department of Immunology, Instituto de Ciências Biológicas, Universidade de São Paulo, Brazil.
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Carla Longo de Freitas
6Neuroimmune Interactions Laboratory, Department of Immunology, Instituto de Ciências Biológicas, Universidade de São Paulo, Brazil.
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Cristiano Rossato
6Neuroimmune Interactions Laboratory, Department of Immunology, Instituto de Ciências Biológicas, Universidade de São Paulo, Brazil.
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Wesley Nogueira Brandão
6Neuroimmune Interactions Laboratory, Department of Immunology, Instituto de Ciências Biológicas, Universidade de São Paulo, Brazil.
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Jean Pierre Schatzmann Peron
6Neuroimmune Interactions Laboratory, Department of Immunology, Instituto de Ciências Biológicas, Universidade de São Paulo, Brazil.
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Antonio Gomes de Amorim Filho
7Obstetrics Clinic, Department of Gynecology and Obstetrics, Central Institute, Hospital das Clínicas, Universidade de São Paulo, Brazil.
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Joelma Queiroz Andrade
7Obstetrics Clinic, Department of Gynecology and Obstetrics, Central Institute, Hospital das Clínicas, Universidade de São Paulo, Brazil.
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Rossana Pulcineli Vieira Francisco
7Obstetrics Clinic, Department of Gynecology and Obstetrics, Central Institute, Hospital das Clínicas, Universidade de São Paulo, Brazil.
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Fernando Kok
8Division of Child Neurology, Department of Neurology, Hospital das Clínicas, Universidade de São Paulo, Brazil.
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Lisa Suzuki
3Pediatric Radiology Division, Department of Radiology, Instituto da Crianca, Hospital das Clínicas, University of São Paulo, Brazil.
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Claudia da Costa Leite
2Neuroradiology Division, Department of Radiology, Instituto de Radiologia, Hospital das Clínicas, University of São Paulo, Brazil.
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Leandro Tavares Lucato
2Neuroradiology Division, Department of Radiology, Instituto de Radiologia, Hospital das Clínicas, University of São Paulo, Brazil.
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Amadou Alpha Sall
10Institute Pasteur in Dakar, Dakar 220, Sénégal
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Paolo Marinho de Andrade Zanotto
4Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Institute of BIomedical Sciences, University of São Paulo, Brazil.
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  • For correspondence: pzanotto@usp.br
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Abstract

We present a case of microcephaly associated with Zika virus (ZIKV) in a chronological, multimodal imaging approach, illustrating the hallmarks of this disease on intrauterine morphological ultrasound, transfontanelar ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). We also determined the serological e immunological status of the mother and newborn. Noticeably, there was evidence for maternal infection by ZIKV, cytomegalovirus (CMV), herpes simplex virus (HSV), dengue virus (DENV) and Toxoplasma gondii, which indicates a possible role of previous exposures to STORCH agents and possibly comorbidities in the severe fetal congenital manifestation.

Author Summary Zika virus (ZIKV) is an emerging mosquito-borne arbovirus causing dengue-like symptoms. In humans the illness is characterized by malaise and cutaneous rash and absent or short-termed fever. Recently, the Brazilian Ministry of Health reported an outbreak of microcephaly in Brazil as a delayed effect of the 2014-2015 outbreak of ZIKV in the Northeast of Brazil. A 20-fold increase in the notifications of newborns with microcephaly was documented during the second semester of 2015. This increase was almost immediately found to be associated with ZIKV infections, both in Brazil and, retrospectively, in French Polynesia. Herein we report a case of microcephaly associated with ZIKV and we also present evidence of other maternal infections. Our results indicated that, both mother and microcephaly infant had immunologic status compatible with previous exposure (in the mother) by STORCH agents. These indicate a possible role of previous exposures and possibly comorbidities in the severe fetal congenital manifestation. □

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Posted May 10, 2016.
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A Zika virus-associated microcephaly case with background exposure to STORCH agents
Mauro Mitsuru Hanaoka, Alexandre Fligelman Kanas, Carla Torres Braconi, Érica Araújo Mendes, Robert Andreata Santos, Luís Carlos de Souza Ferreira, Marielton dos Passos Cunha, Patrícia Beltrão Braga, João Leonardo Mendonça Dias, Carolina Manganeli Polonio, David Anibal Garrido Andrade, Carla Longo de Freitas, Cristiano Rossato, Wesley Nogueira Brandão, Jean Pierre Schatzmann Peron, Antonio Gomes de Amorim Filho, Joelma Queiroz Andrade, Rossana Pulcineli Vieira Francisco, Fernando Kok, Lisa Suzuki, Claudia da Costa Leite, Leandro Tavares Lucato, Amadou Alpha Sall, Paolo Marinho de Andrade Zanotto
bioRxiv 052340; doi: https://doi.org/10.1101/052340
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A Zika virus-associated microcephaly case with background exposure to STORCH agents
Mauro Mitsuru Hanaoka, Alexandre Fligelman Kanas, Carla Torres Braconi, Érica Araújo Mendes, Robert Andreata Santos, Luís Carlos de Souza Ferreira, Marielton dos Passos Cunha, Patrícia Beltrão Braga, João Leonardo Mendonça Dias, Carolina Manganeli Polonio, David Anibal Garrido Andrade, Carla Longo de Freitas, Cristiano Rossato, Wesley Nogueira Brandão, Jean Pierre Schatzmann Peron, Antonio Gomes de Amorim Filho, Joelma Queiroz Andrade, Rossana Pulcineli Vieira Francisco, Fernando Kok, Lisa Suzuki, Claudia da Costa Leite, Leandro Tavares Lucato, Amadou Alpha Sall, Paolo Marinho de Andrade Zanotto
bioRxiv 052340; doi: https://doi.org/10.1101/052340

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