Zika Virus

From EyeWiki



Zika Virus
Classification and external resources
DiseasesDB 36480



Disease Entity

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Zika is a viral infection transmitted by the Aedes aegypti mosquito.

Disease

There are several manifestations of the Zika virus, the most devastating associated with pregnancy and fetal transmission.

Etiology

The Zika virus is a member of the family Flaviviridae, genus Flavivirus. It seems to have been

Risk Factors

Geographic risks are predominant. According to the CDC nearly every country in the Americas has been effected.

In the United States, local mosquito-borne Zika virus transmission has been reported in two areas of Miami, FL (over 40 cases) and in three U.S. Territories: American Samoa, US Virgin Islands, and Puerto Rico (which has far and away the most cases estimated at over 15,000).

All but two U.S. states have reported travel related cases (Alaska and Wyoming), however only Florida has shown locally transmitted cases.

General Pathology

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Pathophysiology

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Primary prevention

Avoiding endemic areas if possible are a key to prevention. Otherwise avoiding situations that may expose to mosquito bites are advised. Also using insect repellant, avoid areas with standing water and times when mosquitoes feed (twilight).

Diagnosis

Several tests exist to detect the Zika virus including serum and urine testing. Currently

History

Travel history is imperative to obtain. History in Zika is endemic areas, and, though less common, risk via sexual transmission can be asked during patient interview.

Physical examination

As related to ophthalmology both slit lamp exam and dilated retinal exam should be performed when Zika infection is suspected.

Signs

In neonates:

In older children and adults:

Symptoms

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Clinical diagnosis

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Diagnostic procedures

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Laboratory test

Currently both serum and urine testing is available. The following modalities have been offered: Real Time RT-PCR, Zika IgM ELISA, Zika Virus RNA Qualitative Real-Time RT-PCR, and Zika Plaque Reduction Neutralization Test. There are few labs certified to test for the virus such as the CDC and Health Departments (including those in South Florida). The CDC recommends testing if you have symptoms of Zika or are a pregnant woman AND live in or traveled to an area with Zika or have had sex with a partner who lives in or traveled to an area with Zika. The CDC does NOT recommend testing for asymptomatic men, children, or women who are not pregnant. For results, processing times have been published at around 2-4 weeks. http://www.cdc.gov/zika/hc-providers/testing-for-zikavirus.html

Differential diagnosis

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Management

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General treatment

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Medical therapy

Treatment is symptomatic towards the symptoms and there is not specific medicine for Zika. Hydration and fever reduction using acetaminophen (Tylenol). It is recommended not take aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS such as Advil) until Dengue can be ruled out to reduce the risk of bleeding if one has also traveled to an area where Dengue is endemic.

Medical follow up

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Surgery

Though it has not been documented, a vitreous biopsy might be performed if a diagnosis of intraocular Zika is suspected following a confirmatory systemic laboratory test (as discussed above).

Complications

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Prognosis

Usually Self-Limited

Additional Resources

References

  1. Lucey DR, Gostin LO. The emerging Zika pandemic: enhancing preparedness [published online January 27, 2016]. JAMA. doi:10.1001/jama.2016.0904.
  2. de Paula Freitas B, de Oliveira Dias JR, Prazeres J, et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil [published online February 9, 2016]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2016.0267.
  3. Jampol LM, Goldstein DA. Zika Virus Infection and the Eye. JAMA Ophthalmol. 2016;134(5):535-536. doi:10.1001/jamaophthalmol.2016.0284.