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Case Report

Discordant Clinical Outcomes in a Monozygotic Dichorionic-Diamniotic Twin Pregnancy with Probable Zika Virus Exposure. Case Report

by
Marcela Mercado
1,
Marcela Daza
2,*,
Cynthia A. Moore
3,
Diana Valencia
3,
Angelica Rico
1,
Diego A. Álvarez-Diaz
1,
Aaron C. Brault
4,
Kelly Fitzpatrick
4 and
Sarah B. Mulkey
5,6
1
Division of Research in Public Health, National Institute of Health of Colombia, Bogota 110311, Colombia
2
Vysnova Partners, Bethesda, MD 20785, USA
3
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Division of Birth Defects and Infant Disorders, Atlanta, GA 30333, USA
4
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Ft Collins, CO 80521, USA
5
Prenatal Pediatrics Institute, Children’s National Hospital, Washington, DC 20310, USA
6
Departments of Pediatrics and Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2020, 5(4), 188; https://doi.org/10.3390/tropicalmed5040188
Received: 26 November 2020 / Revised: 11 December 2020 / Accepted: 15 December 2020 / Published: 19 December 2020
(This article belongs to the Special Issue Zika in Infants and Children)
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Abstract

Prenatal exposure to Zika virus (ZIKV) is associated with congenital anomalies of the brain and the eye and neurodevelopmental sequelae. The spectrum of disease outcomes may relate to timing of infection as well as genetic and environmental factors. Congenital infections occurring in twin pregnancies can inform the clinical spectrum of these conditions and provide unique information regarding timing of infection and in utero environment with disease pathophysiology. Herein, we report a monozygotic dichorionic-diamniotic twin pregnancy with probable prenatal ZIKV exposure identified through the Colombian ZIKV disease surveillance system. Multidisciplinary clinical evaluations were provided to the twins during their first three years of life through a national program for children with in utero ZIKV exposure. Laboratory evidence of congenital infection as well as microcephaly, brain, eye, and neurodevelopmental compromise related to prenatal ZIKV infection were identified in only one infant of the twin pregnancy. This is the first report of monozygotic twins discordant for Zika-associated birth defects. The evaluation of the pathophysiology of discordance in disease outcome for congenital infections in twin pregnancies may lead to a better understanding of potential complex environmental and genetic interactions between the mother, her offspring, and an infectious exposure. View Full-Text
Keywords: Zika virus; twins; brain anomalies; congenital infection; microcephaly; pregnancy Zika virus; twins; brain anomalies; congenital infection; microcephaly; pregnancy
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MDPI and ACS Style

Mercado, M.; Daza, M.; Moore, C.A.; Valencia, D.; Rico, A.; Álvarez-Diaz, D.A.; Brault, A.C.; Fitzpatrick, K.; Mulkey, S.B. Discordant Clinical Outcomes in a Monozygotic Dichorionic-Diamniotic Twin Pregnancy with Probable Zika Virus Exposure. Case Report. Trop. Med. Infect. Dis. 2020, 5, 188. https://doi.org/10.3390/tropicalmed5040188

AMA Style

Mercado M, Daza M, Moore CA, Valencia D, Rico A, Álvarez-Diaz DA, Brault AC, Fitzpatrick K, Mulkey SB. Discordant Clinical Outcomes in a Monozygotic Dichorionic-Diamniotic Twin Pregnancy with Probable Zika Virus Exposure. Case Report. Tropical Medicine and Infectious Disease. 2020; 5(4):188. https://doi.org/10.3390/tropicalmed5040188

Chicago/Turabian Style

Mercado, Marcela, Marcela Daza, Cynthia A. Moore, Diana Valencia, Angelica Rico, Diego A. Álvarez-Diaz, Aaron C. Brault, Kelly Fitzpatrick, and Sarah B. Mulkey. 2020. "Discordant Clinical Outcomes in a Monozygotic Dichorionic-Diamniotic Twin Pregnancy with Probable Zika Virus Exposure. Case Report" Tropical Medicine and Infectious Disease 5, no. 4: 188. https://doi.org/10.3390/tropicalmed5040188

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