By Gary M. White, MD
Zika fever (ZF) or Zika disease is a viral illness caused by the Zika virus. The infection is transmitted by the Aedes aegypti mosquito. Maternal infection with the Zika virus can predispose to the development of microcephaly. If possible, pregnant women or women who will be trying to get pregnant in the near future should avoid travel to places endemic for Zika fever.
- All three viral diseases, Zika, Dengue and Chikunga fever, are transmitted by the Aedes aegypti mosquito.
- Approximately only 1 in 5 people infected with the Zika virus become symptomatic.
- Animals do not seem to be affected.
- The Zika virus is a flavivirus related to yellow fever, dengue, West Nile, and Japanese encephalitis viruses.
- The Zika virus was discovered in 1947 in Uganda's Zika forest, but the first notable outbreak didn’t occur until 2007 in Micronesia.
- More widespread outbreaks initially occurred in Africa, Southeast Asia, and the Pacific Islands.
- ZF has now spread to the US, most commonly areas of Florida and Texas.
Complications of Zika Virus Infection
- Microcephaly in the fetus/newborn and other CNS abnormalities (e.g. seizure, spasticity). The risk is highest if infection is during the first trimester.
Modes of transmission
- Mosquito bite (Aedes aegypti)
- Vertical transmission (transplacental, amniotic fluid)
- Sexual Transmission, both male to female and female to male
- Blood donation
The incubation period is 3-12 days. The majority of patients are asymptomatic. Typical symptoms of ZF include a maculopapular rash, pruritus, joint pain, and red eyes. Fever does occur, but is less common. Other symptoms include muscle pain, headache, pain behind the eyes, and vomiting. The rash has been described as maculopapular, but others say it is more typically comprised of many red papules [JAMA Derm 2016;152;691].
In 119 cases of confirmed zika virus infection [Dermatology News, May 2016, p. 4], the following were found during the first 4 days: rash (97%), itching (79%), prostration (73%), headache (66%), arthralgias (63%), myalgia (61%), and fever (36%).
See this CDC webpage for diagnostic tests. PCR (both serum and urine samples) should be submitted.
According to the CDC website:
- No specific antiviral treatment is available.
- Treatment of symptoms may include rest, fluids, antipyretics, and analgesics.
- Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided until dengue can be ruled out to reduce the risk of hemorrhage.
If you are traveling to an endemic area, take precautions to avoid mosquito bites, especially if you are pregnant. Typical precautions include using insect repellants such as DEET (safe for pregnant women according to the CDC), wearing long pants and sleeves, and staying indoors behind screens. Pregnant woman should not have unprotected sex with those who have recently traveled to Zika-endemic areas.
The non-descript maculopapular rash of Zika Fever. Emerg Infect Dis. 2011 May; 17(5): 880–882
West J Emerg Med. 2016 May; 17(3): 238–244
The non-descript maculopapular rash of Zika Fever. Blog Agusto Aves
Injected conjunctive or "red eyes" from Tuasade
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