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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.