Updated: 6/29/2018

Zika Virus Infection

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Snapshot
  • A 26-year-old man presents to his primary care physician for weakness in his legs. He had recently spent spring break in the Caribbean exploring jungles and caves and had multiple bug bites from this trip. He recalls a febrile illness with an itchy rash and conjunctivitis that occured shortly after this trip. A few days ago he experienced bilateral weakness in his extremities with occasional foot drop and difficulty walking. He reports no difficulty breathing. On physical exam, he has no fever and no rash. His lower extremities have depressed bilateral deep tendon reflexes and 3/5 in strength. His sensation is intact. He is admitted for monitoring and treatment for this complication of a viral illness.
Introduction
  • Classification
    • Zika virus
      • an enveloped positive-sense, single-stranded RNA flavivirus
    • transmission
      • Aedes mosquitoes
      • can be vertically and sexually transmitted
  • Epidemiology
    • incidence
      • more common in tropical and subtropical climates
      • Central and South America
      • the Caribbean
    • risk factors
      • mosquito exposure
      • travel to endemic areas
      • sexual exposure to others who have traveled to endemic areas
  • Pathogenesis
    • the Zika virus replicates in skin cells (e.g., keratinocytes and fibroblasts), which undergo cell death
    • the virus spreads via blood and induces an innate immune response
      • may potentially penetrate through the placental barrier, leading to teratogenicity
  • Associated conditions
    • microcephaly
    • Guillain-Barré syndrome
  • Prognosis
    • most infections are asymptomatic
    • if symptomatic, the disease will occur 3-12 days after exposure
      • typically, the disease is self-limited
    • if vertically transmitted, fetuses often have microcephaly, intracranial calcifications, and cerebral malformation
Presentation
  • Symptoms
    • Zika virus infection
      • may have a pruritic rash
      • miscarriage
      • arthralgia
      • headache
      • hematospermia (males)
  • Physical exam
    • Zika virus infection
      • conjunctival injection
      • low-grade fever
      • macular or papular rash
    • vertically transmitted to fetus
      • congenital microcephaly
      • intracranial calcifications
      • ocular lesions
Studies
  • Labs
    • serum or urine Zika virus immunoglobulin M (IgM)
      • often the initial test
      • screen in pregnant women with risk factors during the first and second trimester
    • serum or urine reverse-transcriptase polymerase chain reaction (RT-PCR)
      • confirmatory testing if IgM is positive
  • Making the diagnosis
    • based on clinical presentation and laboratory studies
Differential
  • Dengue fever
    • distinguishing factor
      • often presents with signs of hemorrhage and without conjunctivitis
Treatment
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • hydration
        • pain control
        • anti-pyretic medications
Complications
  • Permanent neurologic damage
  • Guillain-Barré syndrome

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