Cutaneous Eruption in a U.S. Woman with Locally Acquired Zika Virus Infection

CD8+ T Cells Trigger Auricular Dermatitis and Blepharitis in Mice after Zika Virus Infection in the Absence of CD4+ T Cells

Zika virus (ZIKV) became a public health concern when it re-emerged in 2015 owing to its ability to cause congenital deformities in the fetus and neurological complications in adults. Despite extensive data on protection, the interplay of protective and pathogenic adaptive immune responses toward ZIKV infection remains poorly understood. In this study, using a T-cell‒deficient mouse model that retains persistent ZIKV viral titers in the blood and organs, we show that the adoptive transfer of CD8+ T cells led to a significant reduction in viral load. This mouse model reveals that ZIKV can induce grossly visible auricular dermatitis and blepharitis, mediated by ZIKV-specific CD8+ T cells. Single-cell RNA sequencing of these causative CD8+ T cells from the ears shows an overactivated and elevated cytotoxic signature in mice with severe symptoms. Our results strongly suggest a role for CD8+ T-cell‒associated pathologies after ZIKV infection in CD4+ T-cell‒immunodeficient patients.

Host and viral mechanisms of congenital Zika syndrome

In 2015–2016, in the Americas, and especially in northeast Brazil, a significant number of cases of microcephaly and other congenital brain abnormalities were linked with an outbreak of Zika virus (ZIKV) infection in pregnant women. While maternal symptoms of ZIKV are generally mild and self-limiting, clinical presentation in fetuses and newborns infected is extensive and includes microcephaly, decreased cortical development, atrophy and hypoplasia of the cerebellum and cerebellar vermis, arthrogryposis, and polyhydramnios. The term congenital ZIKV syndrome (CZS) was introduced to describe the range of findings associated with maternal-fetal ZIKV transmission. ZIKV is primarily transmitted by Aedes aegypti mosquitoes, however non-vector-dependent routes are also possible. Mechanisms of maternal-fetal transmission remain unknown, and the trans-placental route has been extensively studied in animal models and in human samples. The aim of this review was to summarize recent studies that helped to elucidate the mechanism of CZS in animal models and observational studies. There are still challenges in the diagnosis and prevention of CZS in humans, due to the large gap that remains in translating ZIKV research to clinical practice. Translational research linking governments, local health workers, scientists and industry is fundamental to improve care for mothers and children.

Characterization of Placental Infection by Zika Virus in Humans: A Review of the Literature

OBJECTIVE

 The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection.

DATA SOURCES

 We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions.

SELECTION OF STUDIES

 The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts) DATA COLLECTION:  We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis.

DATA SYNTHESIS

 The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts.

CONCLUSION

 Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.

Local Transmission of Zika Virus in Miami-Dade County: The Florida Department of Health Rises to the Challenge

As early as 2015, Florida and Centers for Disease Control and Prevention (CDC) public health officials recognized the potential danger of Zika for US residents and visitors. The Zika virus, a mosquito-borne flavivirus, is transmitted through the bite of the Aedes aegypti mosquito. A physician in Miami-Dade notified the Florida Department of Health (DOH) of the first non-travel-related Zika case in the United States. A 23-year old pregnant woman had presented on July 7, 2016, at 23 weeks of gestation, with a 3-day history of fever, widespread pruritic rash, and sore throat. Three more cases, involving men, were reported in Dade and Broward counties. These notifications set into motion additional activities from the DOH's Zika Playbook: increased mosquito surveillance; collaboration with the CDC on recommendations for mosquito abatement techniques; and increased awareness of the risks of Zika. In August, the department reported that active transmission of Zika virus was occurring in one small area in Miami-Dade County known as Wynwood. Mosquito trapping in the area with local transmission identified large numbers of the Zika vector, Aedes aegypti females and a large number of mosquito larval sites. Control efforts included larviciding, eliminating standing water, and backpack and truck spraying of insecticides. A communication strategy was developed that addressed risk mitigation, public concerns over application of noxious pesticides, loss of tourist revenue, and reproductive issues. It was reported on December 28, 2016, that there had been 256 locally acquired cases of infection of Zika, 1011 travel-related cases, and 208 pregnant women with laboratory evidence of Zika. At the end of 2018, 2 years after active Zika virus transmission was controlled in Florida, there have been 101 reported cases of Zika during 2018 but none have been linked to local transmission.

Cutaneous Manifestations of Zika in Peru

This article aims to describe the cutaneous manifestations observed in the Zika epidemic in Peru during 2016 and 2017, as well as discuss the potential differential diagnoses. During the outbreak, the main reason for seeking medical advice was the development of a pruriginous maculopapular rash with a marked papular component, which started on the chest and later generalized to the rest of the body. Similar manifestations were noted in adults, children, and pregnant women. Other manifestations such as conjunctivitis, edema, or petechiae on the palate were rare. We suggest that in areas that are endemic for arboviral infections, in the differential diagnosis of a rash one must consider infections such as dengue, Zika, or chikungunya viruses. In nonendemic areas, the diagnosis is more difficult, as the rash may result from other viral infections not transmitted by arthropods and/or reactive or inflammatory diseases (urticaria, atopic dermatitis, systemic lupus erythematosus). We recommend that primary care health personnel are trained in the recognition of the mucocutaneous lesions caused by Zika virus infection, which could contribute to the identification of suspicious cases, particularly pregnant women.

Mucocutaneous Features of Zika-a Review

PURPOSE OF REVIEW

We review the range of dermatological signs seen in Zika infection and the possible relationship between the rash and viremia. We also hoped to explore the utility of mucocutaneous manifestations in narrowing the differential diagnosis from other similar flaviviruses.

RECENT FINDINGS

Clinical manifestations of Zika infection share many similarities with other mosquito-borne viruses such as dengue. These include non-specific symptoms such as a fever, rash, arthralgia, myalgia, and conjunctivitis. The morphology of the rash in Zika infection is not very specific and commonly described as maculopapular and centrifugal that usually extends to become diffuse. We reviewed 123 publications, encompassing a total of 368 Zika cases. One hundred seven cases with rash had sufficient data for detailed analysis. 8.4% of cases with rash had hemorrhagic manifestations such as palatal petechiae and bleeding ulcers. Only 20 reported cases were tested for viremia during presence of rash, and 70.6% of these cases were positive. While mucocutaneous complications are common in Zika infection, more research is necessary to determine the impact of rash on diagnosis, prognosis, and transmissibility in Zika infection.

Detection of Zika virus infection among asymptomatic pregnant women in the North of Peru

OBJECTIVE

To report an outbreak of ZIKV infection among asymptomatic pregnant women during 2016 in the city of Jaen, Cajamarca.

RESULTS

Zika virus RNA was detected in 3.2% (n = 36) of cases by RT-PCR. The mean age of patients positive for ZIKV infection was 29.6 years. 7 patients (19.4%) infected with ZIKV were in their first-trimester of gestation, 13 (36.1%) were in their second-trimester, and 16 (44%) were in their third-trimester. All of the infected pregnant women were asymptomatic. ZIKV infection remains a major public health issue that calls for constant epidemiological surveillance. It can cause the congenital Zika virus syndrome in the newborns of infected mothers. The lack of molecular diagnostic methods in isolated localities and the similarity of symptoms to other arboviral infections, lead to an under-diagnosis of this disease in endemic areas.

Zika clinical updates: implications for pediatrics

PURPOSE OF REVIEW

Zika virus (ZIKV), a mosquito-borne flavivirus, has gained recognition over the past few years as an important new cause of congenital infection. As a result, it is critical that pediatricians understand its epidemiology, clinical presentation, clinical sequelae, and management.

RECENT FINDINGS

The recent ZIKV epidemiology, clinical presentation of acute infection in children and complications, perinatal infection, and congenital infection will be summarized in this ZIKV review. This will be followed by a brief summary on ZIKV diagnosis, management, treatment, and prevention.

SUMMARY

The field of clinical research in ZIKV has rapidly evolved over recent months. It is critical that pediatricians continue to stay up-to-date with the continuously evolving understanding of the clinical aspects of ZIKV to ensure optimal identification and management of affected infants and children. Given the recent changes in Centers for Disease Control and Prevention guidelines to limit screening of asymptomatic pregnant women in the United States with possible ZIKV exposure, comprehensive ZIKV clinical knowledge becomes even more crucial.

Biphasic Zika Illness With Rash and Joint Pain

During the current Zika virus (ZIKV) outbreak, acute symptomatic ZIKV infection in adults appears to be a mild-to-moderate, self-limited illness. We present a case of ZIKV rash illness that improved and then relapsed without repeat exposure to ZIKV. Clinicians should be alert for relapses in patients with ZIKV infection.