UMEM Educational Pearls

Title: Zika Virus -- More than Fetal Microcephaly

Keywords: Zika, Guillain-Barre, GBS, ITP, Critical Care (PubMed Search)

Posted: 5/10/2016 by Daniel Haase, MD
Click here to contact Daniel Haase, MD

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.

Attachments

1605101507_Zika_Dengue_Chikungunya.jpg (131 Kb)