Zika Virus

 

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Definition/Description

Zika virus is in the flavivirus family, which is closely related to dengue, yellow fever, Japanese encephalitis, and West Nile. It is a disease that is spread primarily through the bite of an infected Aedes species mosquito. Zika was first discovered in 1947 and is named after the Zika forest in Uganda. Outbreaks of Zika have been reported in mostly tropical climates including tropical Africa, Pacific Islands, and Southeast Asia.

Prevalence

There are currently fewer than 1000 US cases of Zika Virus per year.

Characteristics/Clinical Presentation

Symptoms of Zika virus are very similar to many other diseases. It is probable that many cases of Zika virus have not been reported. Most people infected with the virus will not have symptoms. The most common symptoms of Zika are: rash, joint pain, conjunctivitis, muscle pain, and headaches. Illness may last for several days to a week after being infected. Death from the disease is rare, and most victims are not aware of the infection. Zika virus usually remains in the bloodstream for about a week and once infected, the subject is likely to be protected from future infections.

Reports from Brazil indicate an increase in severe fetal birth defects and poor pregnancy outcomes in babies whose mothers were infected with the virus while pregnant. Two conditions associated with the Zika virus have made the outbreak more serious. The first is the development of Guillain-Barre syndrome, which manifests as progressive muscle weakness due to damage to the Peripheral Nervous System. The second condition is the surge in congenital microcephaly cases during Zika outbreaks. Further studies are needed to prove a link between microcephaly and Zika virus infection.

Associated Co-morbidities

None

Medications

Currently there is no vaccine to prevent nor medicine to treat Zika virus. Tylenol can be used to reduce fever or pain but do not take aspirin or NSAIDs until dengue can be ruled out due to risk of bleeding. Prevention of mosquito bites is the best means of protection from the virus.

Diagnostic Tests/Lab Tests/Lab Values

For pregnant women, reverse-transcriptase PCR (RT-PCR) can be used to detect the Zika virus during the first week in the host’s blood or the first 4 weeks in the host’s urine. Serology is less reliable due to potential cross reaction with antibodies against similar viruses such as dengue.

Etiology/Causes

Zika virus can be spread by methods other than mosquito bites. If a pregnant mother is infected with the virus, it may spread to her newborn near the time of delivery. A pregnant woman can pass Zika virus to her fetus during pregnancy. However, no reports exist of infants getting Zika virus through breastfeeding. Zika virus may also be spread by sexual contact. In known cases of transmission, the virus can be transmitted before, during, or after symptoms develop. The virus itself is present in semen longer than in blood.

Systemic Involvement

Some of the more common systemic problems include: arthralgia, fever, skin rashes, and malaise. Retinal abnormalities have also been described in pediatric populations with microcephaly attributed to Zika virus infection during pregnancy.

Medical Management (current best evidence)

Currently treatment is predominantly supportive and includes drinking fluids, rest, and medication (antipyretics and analgesics). Patients are advised to not use aspirin or any nonsteroidal anti - inflammatory drug until dengue virus/infection has been ruled out. Dengue virus infection may result in very serious medical complications, including bleeding and even up to death, which may be reduced significantly secondary to supportive treatment and early detection. Women that are pregnant with fever symptoms can and should be treated with acetaminophen.

Physical Therapy Management (current best evidence)

Research on the scope of physical therapy management for patients with Zika Virus is currently limited. Orthopedic physical therapy can be used to help manage joint and muscle pain related to the Zika virus.

Differential Diagnosis

• Dengue
  *Chikungunya
  *Rubella
  *Measles
  *Reiter’s Syndrome
  *Allergic reaction
  *Conjunctivitis
  *Arthritis
  *Gout
  

Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

see adding references tutorial.