In Reply The fact that several babies were born with arthrogryposis after contracting congenital Zika infection was widely reported in the literature1-4 and was the subject of a review by Leyser et al.5 The Letter to the Editor by Leyser and Nascimento in this issue of JAMA Neurology regarding the pathogenesis of the arthrogryposis sheds light on this finding among babies born with Zika virus congenital infection. We agree with Leyser and Nascimento, and have reported the experience of the first 11 infants investigated by our group1 based on their radiological findings and the neuropathological examination of 2 brains. We also believe that motor nerve cell loss in the spinal cord contributes to the occurrence of arthrogryposis. However, only a small segment of the spinal cord was available for examination in 1 case and it could not be properly oriented to evaluate the amount of motor cells. Therefore, although our impression was that there was motor nerve cell loss, we could not confirm that. However, in the comprehensive neuropathological study we performed in 7 additional cases with the analysis of the whole spinal cord, it was evident that the motor nerve cell loss was implicated in the pathogenesis of arthrogryposis.
Melo ASDO, Chimelli L, Tanuri A. Congenital Zika Virus Infection: Beyond Neonatal Microcephaly—Reply. JAMA Neurol. 2017;74(5):610–611. doi:10.1001/jamaneurol.2017.0051
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