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Zika Linked Miscarriage Rotterdam ex-Suriname

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In January 2016, a 31-year-old woman who was 10 weeks pregnant visited an outpatient clinic in Rotterdam, the Netherlands, because of a 2-day history of headache, mild arthralgia in both wrists and the left knee, and a pruritic, macular rash. The symptoms had begun the day after her return from a 3.5-week trip to Suriname, which borders on northern Brazil. During her visit, she had not used malaria chemoprophylaxis or personal protective measures, such as insect repellents.

The patient’s medical history was uneventful, as was her pregnancy. When she was a child, she had received vaccines according to the regular vaccination program in Suriname, where she had lived until her early twenties. She was vaccinated against yellow fever at the age of 5 years.

A physical examination revealed normal vital-sign measurements and an absence of fever. A discrete macular rash was noted on the patient’s trunk and both arms. The joints were not visibly swollen or warm but mildly painful with movement. Blood and urine samples were obtained at regular intervals after the physical examination.

The patient’s symptoms resolved spontaneously after 6 days. On day 14 after the onset of symptoms, ultrasonography performed at a routine prenatal screening visit (estimated gestational age, 11 weeks and 4 days) showed no fetal heartbeat.

One week later, 21 days after the onset of ZIKV-associated disease, amniocentesis was performed, followed by dilation and curettage. Amniotic fluid and fetal and placental tissue were obtained for further laboratory analysis. (A detailed description of the methods is provided in theSupplementary Appendix, available with the full text of this letter at NEJM.org.)

The amniotic fluid and fetal and placental tissue tested positive for ZIKV on semiquantitative real-time reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays and cell-culture isolation; these results were confirmed by means of whole-genome sequencing (GenBank accession number, KU937936)



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