Zika: How to counsel concerned patients

Zika virus infection is a brand new disease in the western Hemisphere, and, to date, there are only a limited number of cases reported in the United States. The situation may change in the coming months. For that reason and because rash is one of the most common features of Zika virus infection, dermatologists may find themselves playing a role in diagnosis and management, said Captain David M. Morens, M.D., senior advisor to the director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.

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“Zika virus infection was first reported in the 1940s, but until recently cases were limited to the tropical belt regions of Africa and Asia. Therefore, virtually no one in the United States will be immune to this infection,” Dr. Morens says.

“Now with outbreaks of Zika virus infection in countries in Central and South America and the Caribbean, more cases of Zika in the United States are anticipated, particularly involving people who acquire the infection when traveling to those regions.”

Counseling patients

If asked, dermatologists can counsel patients that Zika virus infection is a relatively harmless disease for the affected individual. Some patients may develop Guillain-Barré syndrome as a later complication, but there is almost no likelihood of death or even becoming severely ill, and only about 20% of people who are infected with Zika develop recognizable symptoms.

NEXT: Viral features

Viral features

The acute infection generally persists for about five to seven days, and the most common features are fever, arthralgias, non-purulent conjunctival injection, and rash.

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The rash can be of two types:

• flushing prominent on the face and upper chest that commences at the time of the fever; and

• a maculopapular rash that develops mostly on the trunk about the time the fever is going away. The presentation of the maculopapular rash covers a spectrum from being very fine and almost imperceptible visually or by palpation to a more florid appearance similar to the eruption seen with measles or rubella. Patients may then develop flaking and pruritus about a week or two later.

“Patients can have either type of rash, both, or neither, but the maculopapular rash is probably what a dermatologist would be most likely to see,” Dr. Morens says.

Diagnosing infection

The only way to make a definitive diagnosis of Zika virus infection is with a polymerase chain reaction test performed during the acute phase of the infection. Once the patient has recovered, ELISA for IgM antibodies will become positive, and IgG will become positive a few weeks later. However, a positive ELISA result may not always be specific for Zika virus infection because of cross-reactivity with related viruses (e.g., dengue) or if a patient ever had a yellow fever vaccine.

NEXT: Cause for concern

Cause for concern

A potential association between Zika virus infection during pregnancy and birth of a child with microcephaly is the major cause for public health concern with this disease.

“CDC recommendations about how people who live in or travel to Zika epidemic areas can prevent infection have been published and updated, including specific recommendations that pregnant women, or women planning to become pregnant consider avoiding travel and taking extensive precautions to avoid mosquito bites if they do travel,” Dr. Morens says.

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Reports of sexually transmitted Zika virus infection are now appearing in the news. Dr. Morens says that while rare, sexual transmission is a known method of disease communication for other viruses and is explained by the immune privileged status of the gonads that allows the virus to survive. While it appears this phenomenon may occur more often with Zika than with other viruses, the jury is still out on whether that observation is real.

“It is important to make patients aware that if they have any concern about acquiring Zika through sexual contact, they should be using a condom to prevent infection,” Dr. Morens says.