A two-year-old Afro-Caribbean female presented with microcephaly during a ZIKV outbreak in Grenada, West Indies. Her mother was recruited from a public health center as part of a larger study investigating the impact of in utero Zika virus exposure on neurodevelopment. The mother provided written informed consent to support her child's participation in the study and also consented to publication of this case study.
The mother had serum drawn at 24 (+-2) weeks gestation. Prenatal serology was positive for flavivirus and negative for alphavirus infection using IgM antibody captured enzyme-linked immunosorbent assay (MAC-ELISA). A plasmonic-gold (pGOLD) platform (Nirmidas Biotech, Palo Alto, CA) for measuring IgG against ZIKV and dengue virus (DENV) antigens was used to distinguish these possible flaviviral infections, with IgG avidity used to determine the timing of exposure. The pGOLD IgG immunoassay has demonstrated sensitivity and specificity to ZIKV greater than 90% and 98%, respectively, in the convalescent phase. Maternal pGOLD IgG immunoassay results were positive for ZIKV and DENV antibodies. IgG avidity testing showed ZIKV exposure within the prior 6 months and more remote DENV infection (i.e., prior to pregnancy). The infant had serum drawn at 2 months of age. Results from the pGOLD IgG immunoassay were positive for ZIKV and negative for DENV.
The mother was 30 years of age at the time of delivery. Her pregnancy was uncomplicated, with no reported alcohol, drug, or tobacco use. The patient was born full-term via normal vaginal delivery. Meconium aspiration was noted and resuscitative assistance was provided. One-minute APGAR score was 2, 5-minute score was 3, and 10-minute score was 8. Facial dysmorphism was observed. Head circumference was 30 cm at birth (z = -3.5). Reflex testing was performed at 2 months of age with grasping, sucking, and plantar reflexes present and Moro and Galant reflexes absent.