niman Posted April 12, 2016 Report Share Posted April 12, 2016 (edited) CNN describes pregnant case Zika infected in first trimester (12 weeks) whose baby's head circumference was in the 40-50 percentile at week 18 and is below 20th percentile at week 22. A similar reduction in Washington DC ex-Guatemala (from 47th percentile in 16th week to 24th percentile in 20th week) was described as severe brain atrophy by the CDC in MMWR on US pregnant cases. Edited April 12, 2016 by niman Link to comment Share on other sites More sharing options...
niman Posted April 12, 2016 Author Report Share Posted April 12, 2016 When Molina was 18 weeks pregnant, Micaela's head size was almost average -- somewhere between the 40th and 50th percentile compared with other babies, de la Vega says.But today, at 22 weeks, it's below the 20th percentile.http://www.cnn.com/2016/04/12/health/zika-virus-pregnant-ultrasound-microcephaly/index.html?sr=twcnni041216zika-virus-pregnant-ultrasound-microcephaly1008PMVODtopPhoto&linkId=23377174 Link to comment Share on other sites More sharing options...
niman Posted April 12, 2016 Author Report Share Posted April 12, 2016 Zika virus: Will this baby be OK?By Elizabeth Cohen, CNN Updated 5:51 PM ET, Tue April 12, 2016 What is the Zika virus? Zika virus linked to birth defect in newborns Mutant mosquitos to help fight Zika virus Zika virus: Inside the CDC WHO: Zika virus 'spreading explosively' Mosquito-borne virus poses risk to pregnant women Stopping the spread of Zika virus in the U.S. Tourism industry rattled by Zika virus, terrorism Dangers of Zika virus Brazil is taking steps against the Zika virus WHO: Zika virus spreading to almost all the AmericasNow PlayingZika: Will this baby be okay?America's first Zika patient speaks outThe world's deadliest animal is ... ?Living with the Zika virusGrowing concerns as researchers battle Zika virus Family raises two daughters with microcephaly Brazilian lab finds Zika virus in saliva, urine Zika virus tests Catholic beliefs The origin of the Zika virus Officials: U.S. Zika case sexually transmitted What is the Zika virus? Zika virus linked to birth defect in newborns Mutant mosquitos to help fight Zika virus Zika virus: Inside the CDC WHO: Zika virus 'spreading explosively' Mosquito-borne virus poses risk to pregnant women Stopping the spread of Zika virus in the U.S. Tourism industry rattled by Zika virus, terrorism Dangers of Zika virus Brazil is taking steps against the Zika virus WHO: Zika virus spreading to almost all the AmericasZika: Will this baby be okay?America's first Zika patient speaks outThe world's deadliest animal is ... ?Living with the Zika virusGrowing concerns as researchers battle Zika virus Family raises two daughters with microcephaly Brazilian lab finds Zika virus in saliva, urine Zika virus tests Catholic beliefs The origin of the Zika virus Officials: U.S. Zika case sexually transmitted What is the Zika virus? Story highlightsWhen Zulymaris Molina was three months pregnant, she got the Zika virus from a mosquitoZika has been linked to microcephaly, a condition where babies have unusually small heads and underdeveloped brains (CNN)Zulymaris Molina arrives at the high-risk pregnancy clinic in San Juan, Puerto Rico, shortly after dawn, excited to see her baby.Inside the examining room, she raises her shirt so Dr. Alberto de la Vega can put an ultrasound wand on her belly.He heads straight for the baby's brain. Zika virus 'scarier than initially thought'When Molina was three months pregnant, she got the Zika virus from a mosquito. It wasn't a big deal for her -- she just felt sick for a few days.But it could be devastating for her baby. Zika can have an affinity for a fetus's brain tissue, eating away and destroying it.Now five months pregnant, Molina anxiously watches the ultrasound monitor as de la Vega performs his examination on her daughter, whom she's named Micaela."This is a very stressful situation," Molina says. "You don't want to think about it, but you're always reminded of what Zika can do to your baby." Facing Zika fears: Raising kids with microcephalyAs Zika continues to spread, this scene is being repeated over and over again at doctors' offices throughout many parts of the Caribbean and Latin America.More than 950 cases of fetal malformations potentially associated with Zika have been reported worldwide, according to the World Health Organization.And experts say it's only a matter of time before it happens in the continental United States, too.'There's reason to be concerned' De la Vega moves the wand carefully, taking several measurements of Micaela's brain. He carefully calibrates the thickness of her cortex, the brain's outer layer of neurons, and the size of the corpus callosum, the band of nerves that connects the brain's two hemispheres."Her brain anatomy looks normal," de la Vega says. 22 photos: Zika virus outbreak You can feel the tension in the room subside as a huge smile spreads across Molina's face.De la Vega takes a break from measuring the brain and shows Molina 3-D images of her daughter's face and beating heart. They both look perfect."She has my nose!" Molina notices, still smiling.Then he goes back to the brain to take one more measurement. And something in his face tells you it's not quite right.He measures the circumference of Micaela's head."Your baby's head growth is lagging behind," he tells her. "Given the situation, there's reason to be concerned."The "situation" is that Zika has been linked to microcephaly, a condition where babies have unusually small heads and underdeveloped brains. A baby with microcephaly.When Molina was 18 weeks pregnant, Micaela's head size was almost average -- somewhere between the 40th and 50th percentile compared with other babies, de la Vega says.But today, at 22 weeks, it's below the 20th percentile.This might just be a fluke, he explains to Molina. Babies' heads grow at unsteady rates, and she might speed up soon. Plus, because of Micaela's position, it was hard to measure her head. He repeats that it's reassuring that the structures inside Micaela's brain look normal. Stopping Zika: Should U.S. hand out condoms at airports?He asks Molina to come back in two weeks for another ultrasound. That will help him know if today's number was a one-off or a sign of brain damage.Tough decisionsIt doesn't matter to Molina what they find in two weeks. She's already decided she'll keep her baby, no matter what.She knows that it will be more difficult to care for Micaela if she has severe brain defects, but Molina knows about hard work. Her income as a university admissions officer supports herself, her 2-year-old son and her mother, who live together in an apartment in public housing. Molina carrying her son, Marco.Raised Catholic and now a practicing Pentecostalist, Molina says her religious beliefs will not allow her, under any circumstances, to terminate the pregnancy.Other women in her situation have made different choices.On March 30, the day before Molina had her most recent ultrasound, the New England Journal of Medicine published a report about a woman with Zika in Washington who chose to terminate her pregnancy because the fetus had severe brain defects.So far, there have been 32 pregnant women in the United States who've had Zika, according to the Centers for Disease Control and Prevention. Map: Tracking Zika virusThese women were not bitten by mosquitoes at home. They contracted Zika by traveling to an area where the virus is spreading or by having sex with a man who had traveled, according to Tom Skinner, a CDC spokesman.Zika virus 'scarier than initially thought'But in the coming months, as the weather gets warmer, experts anticipate that mosquitoes will start biting pregnant women in the continental United States, too."It's not a matter of whether Zika will come here, but when," said Dr. Jose Cordero, a professor of public health at the University of Georgia and the former director of the CDC's National Center on Birth Defects and Developmental Disabilities.This means mothers here will have to make decisions like the one Molina has made. Zika: Another puzzle piece leads to more questionsAbortion decisions are never easy, but with Zika, there's an added element of difficulty: The brain damage caused by the virus doesn't seem to show up until relatively late in the pregnancy, when it's more complicated, medically and emotionally, to end a pregnancy.With the patient in Washington, her baby's brain defects didn't appear until 19 weeks, nearly halfway through the pregnancy. The parents decided to terminate two weeks later."This was a very difficult decision for them to make," said the woman's obstetrician, Dr. Rita Driggers, an associate professor of gynecology and obstetrics at Hopkins.Join the conversationSee the latest news and share your comments with CNN Health on Facebook andTwitter.With another patient, also reported in the New England Journal of Medicine, the defects didn't show up until even later -- 29 weeks. That mother also chose to terminate her pregnancy.Molina's next ultrasound is April 13. She awaits it with some anxiety."But I am feeling very positive," she says. "I know everything will be OK."Debra Goldschmidt and John Bonifield also contributed to this report. Link to comment Share on other sites More sharing options...
niman Posted April 12, 2016 Author Report Share Posted April 12, 2016 In our study, a review of three sequential ultrasonographic images between 16 and 20 weeks showed a decrease in the fetal head circumferences from the 47th percentile to the 24th percentile, which suggests a reduction in the rate of brain growth during that period (Fig. S3 in the Supplementary Appendix). We suspect these reductions in brain growth would have eventually met the criteria for microcephaly.http://recombinomics.co/topic/944-nejm-case-report-on-mmwr-patient-b-zika-termination/ Link to comment Share on other sites More sharing options...
niman Posted April 12, 2016 Author Report Share Posted April 12, 2016 Patient B. In January 2016, a pregnant woman in her 30s underwent laboratory testing for Zika virus infection. She reported a history of travel to a Zika-affected area at approximately 11–12 weeks’ gestation. One day after returning from travel, she developed fever, eye pain, and myalgia. The next day, she developed a rash. Serologic testing confirmed recent Zika virus infection. At approximately 20 weeks’ gestation, she underwent a fetal ultrasound that suggested absence of the corpus callosum, ventriculomegaly, and brain atrophy; subsequent fetal magnetic resonance imaging demonstrated severe brain atrophy. Amniocentesis was performed, and Zika virus RNA was detected by RT-PCR testing. After discussion with her health care providers, the patient elected to terminate her pregnancy.http://www.cdc.gov/mmwr/volumes/65/wr/mm6508e1.htm?s_cid=mm6508e1_w Link to comment Share on other sites More sharing options...
niman Posted April 13, 2016 Author Report Share Posted April 13, 2016 (edited) Note that on video at the 1 min 46 sec mark the baby's head circumference of 17.80 cm is displayed. Also note that the graph displayed at the 2 min 2 sec mark there are three data points (on a background of normal curves) showing a reading higher than the 50th percentile (looks like 60-70th at week 14) followed by a reading below the 50th percentile at week 18 (40-45th percentile), followed by the 20th percentile at week 22.Note also that the date of the sonogram is March 31, indicating that the week 24 follow-up visit should be this week, Edited April 13, 2016 by niman Link to comment Share on other sites More sharing options...
niman Posted April 13, 2016 Author Report Share Posted April 13, 2016 Puerto Rico confirms 1st Zika case in pregnant womanPublished February 04, 2016EFEPuerto Rico on Thursday confirmed its first case of the Zika virus in a pregnant woman.The virus is spreading rapidly through the Americas and, although it is not overly dangerous for most of the public, it has been linked to congenital deformations in newborns."The woman is currently in the first trimester ... and has been informed about the possible risk of the virus for her pregnancy. She's been evaluated by her doctor and has asked that her privacy be respected," said Puerto Rican Health Secretary Ana Rius on Thursday.Rius said that the woman was between 25 and 35 years old but provided no further details about her, adding that three Zika cases were confirmed over the past week, bringing to 19 the number of people known to have been infected on the island, although health authorities say that often the symptoms go unnoticed.Fifty-eight percent of the people confirmed to have the virus on the island, Rius said, are women.Since the first case was detected in Puerto Rico, the tourist and health sectors, in particular, have taken measures to eliminate the mosquitoes that spread it at government facilities.The Aedes aegypti mosquito transmits Zika, the same insect that carries dengue fever and Chikungunya.Rius also said that between Jan. 24-30, 1,657 cases of flu and 70 hospitalizations for it were reported."The region ... with the highest rate (of flu) is that of Ponce. We continue to urge people to get vaccinated," state epidemiologist Brenda Rivera Garcia said. EFEhttp://latino.foxnews.com/latino/health/2016/02/04/puerto-rico-confirms-1st-zika-case-in-pregnant-woman/ Link to comment Share on other sites More sharing options...
niman Posted April 13, 2016 Author Report Share Posted April 13, 2016 http://www.cdc.gov/mmwr/volumes/65/wr/mm6506e2er.htm?s_cid=mm6506e2.htm_w Case B. On January 22, 2016, RT-PCR–confirmed Zika virus disease was diagnosed in a woman in her first trimester of pregnancy; she had sought care because of a 2-day history of nonfebrile eye, body, and joint pain; petechial rash; conjunctivitis; and nausea. Her obstetrician provided counseling regarding risks to her fetus and recommended clinical follow-up, according to CDC interim guidelines (4). Link to comment Share on other sites More sharing options...
niman Posted April 13, 2016 Author Report Share Posted April 13, 2016 ‘I’m going to have the baby’The new mystery disease has infected Zulmarys Molina Paredes, 29. She’s one of the five pregnant women with a confirmed Zika diagnosis. But at 16 weeks in her pregnancy, an ultrasound shows her baby developing normally.Molina and her 2-year-old son, Marco, live in Humacao in a peach-colored public housing project with her mother, aunt and brother. She is the sole breadwinner. She thinks she became infected at the private university where she works as an admissions officer, during tours of the campus. The campus has an artificial lake surrounded by trees full of mosquitoes.Health/Science alertsBreaking news on health, science and the environment.Sign upHer headaches began Feb. 5. The following Monday, she looked in the mirror and was stunned.“I was starting to put on my makeup and realized I was covered in a rash,” she said. “I got really scared.”The emergency room doctor sent Molina’s blood to be tested. Nine days later, she was told her test was positive for Zika. But the doctor also said scientists didn’t know how often women with Zika infections have babies with birth defects such as microcephaly, where they are born with abnormally small heads.Given the uncertainty, she is choosing to believe — and to pray — that everything will be fine. An amniocentesis is scheduled for next week. More ultrasounds will follow.“I don’t care what happens. I’m going to have the baby,” Molina said. “I have faith that she’s going to be fine.” Her due date is Aug. 6. She will name her daughter Michaela.https://www.washingtonpost.com/national/health-science/zika-is-expected-to-infect-1-in-5-puerto-ricans-raising-threat-to-rest-of-us/2016/02/29/c1288e30-db62-11e5-891a-4ed04f4213e8_story.html Link to comment Share on other sites More sharing options...
niman Posted May 13, 2016 Author Report Share Posted May 13, 2016 (edited) It is unclear if the case described above is the same as the first Zika confirmed microcephaly case in Puerto Rico. Edited May 13, 2016 by niman Link to comment Share on other sites More sharing options...
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