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Neuroimaging findings using transfontanellar ultrasound in newborns with microcephaly and Zika virus infection: a comment

We read the publication on “Neuroimaging findings using transfontanellar ultrasound in newborns with microcephaly” with a great interest [1]. Cruz Ximenes et al. concluded that “Neuroimaging patterns by means of transfontanellar ultrasound are accurate and diagnostic investigations of brain pathology in newborns affected by microcephaly and possible intrauterine ZIKV infection” [1]. We agree that the ultrasonography is useful for the identification of the abnormal brain structure in Zika virus syndrome. In tropical South America, the ultrasonography might be useful since the rate of abnormality of the fetus is 8% [2]. Nevertheless, in other areas, many infected infants are asymptomatic and have no brain abnormality [3]. In tropical Asian countries, although the Zika virus is endemic, the neurological disorder in infected infant is extremely rare [4,5]. The ultrasonography examination might give a false negative result. For the case with a positive result, there is a possibility of false positive problem since the imaging technique can detect abnormal structure but it cannot provide a virological confirmation. In addition, the period of performing ultrasonography investigation is an important determinant of results. In a recent report, there is at least 15-week period between maternal infection and appearance of abnormal brain [6].