Zika virus has received significant media attention in the US due to its recent link with teratogenicity. But Zika is also associated with critical and life-threatening complications, including death. Differentiating it from other Flavivirus diseases such as Dengue or Chikungunya can be challenging.

Diagnosis

• Clinical -- low-grade fever, maculopapular pruritic rash, arthralgias (small joints of hands and feet), non-purulent conjunctivitis [1,4]
• Serum RT-PCR
• Dengue --high fever, severe myalgias, no conjunctivitis, cytopenia common [2,4]
  • Dengue is a hemorrhagic fever, Zika and Chikungunya are not.
• Chikungunya -- high fever, severe polyarthralgias, no conjunctivitis, no hemorrhage [2,4]

Complications

• Guillian-Barre Syndrome (GBS) [1,3]
  • Responsible for majority of Zika deaths worldwide
  • Estimated at 1 in 4000 cases of Zika in French Polynesian study [3]
  • WHO estimates up to 4M cases in the Americas this year (~1k cases GBS)
• Immune Thrombocytopenic Pupura (ITP) [2]
  • Thrombocytopenia leading to bleeding. Responsible for lone US death and deaths in Columbia
• Meningoencephalitis, transverse myelitis, fetal microcephaly [2]

References

1. Petersen LR, Jamieson DJ, Powers AM, Honein MA. Zika Virus. N Engl J Med. 2016 Apr 21;374(16):1552-63. doi: 10.1056/NEJMra1602113. Epub 2016 Mar 30. Review. PubMed PMID: 27028561.

2. LaBeaud, AD. Zika virus infection: An overview. uptodate.com. Accessed 5/10/2016.

3. Cao-Lormeau VM, et al. Guillain-Barr Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016 Apr 9;387(10027):1531-9. doi: 10.1016/S0140-6736(16)00562-6. Epub 2016 Mar 2. PubMed PMID: 26948433.

4. Centers for Disease Control and Prevention. Zika virus - What clinicians need to know? Clinician Outreach and Communication Activity (COCA) Call, January 26, 2016. Available at: http://emergency.cdc.gov/coca/ppt/2016/01_26_16_zika.pdf. Accessed May 10, 2016.

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