From the perception of a cluster of cases of children with microcephaly to congenital Zika syndrome in Brazil: the lessons we have learned and the challenges that lie ahead of us

Abstract

A little more than a year ago, physicians and researchers from the northeastern region of Brazil raised the hypothesis of an association between microcephaly cases in newborns and a possible Zika virus infection in their mothers during pregnancy. Common phenotypic features called the attention of the discerning eyes of geneticists, already used to this type of observation [1]. In those cases, records of exanthematous disease during pregnancy were found in the anamnesis. Moreover, radiology images revealed findings that although resembled some other TORCH, they had their particularities in common. Initially, a recurrent pattern in computerized tomography of the skulls was described, which led physicians to classify the set of findings as the emergence of a new disease [2].

For professionals who were experiencing this reality in the Northeast, there was no doubt that the puzzle was being solved. Chronology, clinical history and findings, all of these suggested that the exanthematous disease reported by those women during pregnancy was related to the microcephaly of their babies [3]. Although there was a strong distrust concerning causal relationship and at that time no scientific basis to corroborate the hypothesis, for many physicians Zika virus was underestimated, an apparently self-limited disease with discrete symptoms that people often overlooked.