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Ultraschall in Med 2016; 37 been described in 2 neonates in 2014; one of them was asymptomatic whereas the other developed a mild transient disease with fever and rash [31]. If ZIKV can be transmitted vertically, then the involvement of the central nervous system should not come as a complete surprise; the tropism of Zika for CNS had already been described in the first reports of Dick [3, 32], and experimental intracerebral inoculation of ZIKV in newborn mice resulted in replication of the virus in neurons and astroglial cells and eventually in their destruction, possibly though an immunological mechanism (at least partially) [33]. Although it is still not precisely known how ZIKV infection can damage the fetal brain, the paradigm of skin cells shows that the virus can infect immature dendritic cells (among others) and induce the formation of autophagosomes [34]. A more direct proof of causal relationship was provided in a recent autopsy report of a fetus with microcephaly and calcifications, in which Zika particles and RNA in were found in its brain, but no other organs [35]. However, confirmatory examinations are not the rule in ZIKV-attributed microcephaly and there are still publications highlighting the potential role of confounders (see at the end of this document).

A mild pathogen turned ugly: Zika virus and the case with microcephaly