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Updated: Jun 29 2018

Zika Virus

  • Snapshot
    • A 30-year-old G1P0 woman delivers a baby with microcephaly at 38 weeks via normal spontaneous vaginal delivery. During her first trimester, she went on a trip to Puerto Rico in December of 2015 and had multiple mosquito bites there. A week after this trip, she had a low-grade fever, itchy maculopapular rash, and conjunctivitis that resolved within 10 days. She had not gone consistently to her prenatal appointments. On physical exam, the baby has congenital microcephaly. A serum sample from the baby is collected.
  • 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 and depending on time of infection, fetuses may have microcephaly, intracranial calcifications, and cerebral malformation
  • Presentation
    • Symptoms
      • Zika virus infection
        • may have a pruritic rash
        • miscarriage
        • arthralgia
        • headache
        • hematospermia (in 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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