Infectious Disease 2016: Zika

Dr. Theodore Rosen

Zika virus: what is relevant for dermatologists?

Zika virus disease is a disease caused by Zika virus that is spread to people primarily through the bite of an infected Aedes species mosquito. The most common symptoms of Zika are fever, rash, joint and muscle pain, headache and conjunctivitis. The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. Once a person has been infected, he or she is likely to be protected from future infections. The virus was first discovered in 1947 and is named after the Zika forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. A stream of recent case report studies as well as a small number of case control and cohort studies initially suggested an association between Zika and both microcephaly and Guillain-Barré syndrome.

In May 2015, the Pan American Health Organization issued an alert regarding the first confirmed Zika virus infection in Brazil and on February 1, 2016, the World Health Organization declared Zika virus a public health emergency of international concern. In April, 2016, the CDC concluded that Zika virus is, indeed, a teratogen, associated with microcephaly, intracranial calcification in the newborn, and other neonatal brain abnormalities. Cases have now been widely reported throughout Central and South America and the Caribbean. Puerto Rico has been especially hard hit, with nearly 700 confirmed cases to date, including 8 cases suspected of being transmitted sexually. Of the cases confirmed in the continental United States, all have been acquired during travel to regions where mosquito-borne Zika virus infection is prevalent. However, some projections suggest that competent mosquito vectors within the United States will acquire the virus and that s significant Zika epidemic could emerge this summer. For this reason, the FDA just approved for wide distribution a Quest Diagnostics Zika blood test based on RNA detection. Heretofore, the only approved tests (IgM-based ELISA and RT-PCR) were only offered by the CDC and CDC-approved regional laboratories.

The rash associated with Zika virus is maculopapular, either morbilliform or scarlatiniform. It starts on the face on the first day of illness and spreads all over the body. It begins to fade within 2-3 days and is gone completely within a week.