Fatal Sickle Cell Disease and Zika Virus Infection in Girl from Colombia

Prevalence of arboviruses in sickle cell disease patients from two different regions of Brazil, the North and Northeast

Sickle Cell Disease (SCD) is a hereditary disease characterized by extravascular and intravascular hemolysis and clinical variability, from mild pain to potentially life-threatening. Arboviruses include mainly Zika (ZIKV), Chikungunya (CHKV), and Dengue (DENV) virus, and are considered a public and social health problem. The present cross-sectional observational study aimed to investigate the prevalence of arbovirus infection in SCD patients from two Brazilian cities, Salvador and Manaus located in Bahia and Amazonas states respectively. A total of 409 individuals with SCD were included in the study, and 307 (75.06 %) patients tested positive for DENV-IgG, 161 (39.36 %) for ZIKV-IgG, and 60 (14.67 %) for CHIKV-IgG. Only one individual was positive for DENV-NS1 and another for DENV-IgM, both from Salvador. No individuals had positive serology for ZIKV-IgM or CHIKV-IgM. Arbovirus positivity by IgG testing revealed that the SCD group presented high frequencies in both cities. Interestingly, these differences were only statistically significant for ZIKV-IgG (p = 0.023) and CHIKV-IgG (p = 0.005) among SCD patients from Manaus. The reshaping of arbovirus from its natural habitat by humans due to disorderly urban expansion and the ease of international Mobility has been responsible for facilitating the spread of vector-borne infectious diseases in humans. We found the need for further studies on arboviruses in this population to elucidate the real association and impact, especially in acute infection. We hope that this study will contribute to improvements in the personalized clinical follow-up of SCD patients, identifying the influence of arbovirus infection in severe disease manifestations.

Identification of potential inhibitors of Zika virus targeting NS3 helicase using molecular dynamics simulations and DFT studies

Despite the various research efforts towards the drug discovery program for Zika virus treatment, no antiviral drugs or vaccines have yet been discovered. The spread of the mosquito vector and ZIKV infection exposure is expected to accelerate globally due to continuing global travel. The NS3-Hel is a non-structural protein part and involved in different functions such as polyprotein processing, genome replication, etc. It makes an NS3-Hel protein an attractive target for designing novel drugs for ZIKV treatment. This investigation identifies the novel, potent ZIKV inhibitors by virtual screening and elucidates the binding pattern using molecular docking and molecular dynamics simulation studies. The molecular dynamics simulation results indicate dynamic stability between protein and ligand complexes, and the structures keep significantly unchanged at the binding site during the simulation period. All inhibitors found within the acceptable range having drug-likeness properties. The synthetic feasibility score suggests that all screened inhibitors can be easily synthesizable. Therefore, possible inhibitors obtained from this study can be considered a potential inhibitor for NS3 Hel, and further, it could be provided as a lead for drug development.

Modeling the spread of the Zika virus by sexual and mosquito transmission

Zika Virus (ZIKV) is a flavivirus that is transmitted predominantly by the Aedes species of mosquito, but also through sexual contact, blood transfusions, and congenitally from mother to child. Although approximately 80% of ZIKV infections are asymptomatic and typical symptoms are mild, multiple studies have demonstrated a causal link between ZIKV and severe diseases such as Microcephaly and Guillain Barré Syndrome. Two goals of this study are to improve ZIKV models by considering the spread dynamics of ZIKV as both a vector-borne and sexually transmitted disease, and also to approximate the degree of under-reporting. In order to accomplish these objectives, we propose a compartmental model that allows for the analysis of spread dynamics as both a vector-borne and sexually transmitted disease, and fit it to the ZIKV incidence reported to the National System of Public Health Surveillance in 27 municipalities of Colombia between January 1 2015 and December 31 2017. We demonstrate that our model can represent the infection patterns over this time period with high confidence. In addition, we argue that the degree of under-reporting is also well estimated. Using the model we assess potential viability of public health scenarios for mitigating disease spread and find that targeting the sexual pathway alone has negligible impact on overall spread, but if the proportion of risky sexual behavior increases then it may become important. Targeting mosquitoes remains the best approach of those considered. These results may be useful for public health organizations and governments to construct and implement suitable health policies and reduce the impact of the Zika outbreaks.

Identification of potential ZIKV NS2B-NS3 protease inhibitors from Andrographis paniculata: An insilico approach

Andrographis paniculata is a widely used medicinal plant for treating a variety of human infections. The plant's bioactives have been shown to have a variety of biological activities in various studies, including potential antiviral, anticancer, and anti-inflammatory effects in a variety of experimental models. The present investigation identifies a potent antiviral compound from the phytochemicals of Andrographis paniculata against Zika virus using computational docking simulation. The ZIKV NS2B-NS3 protease, which is involved in viral replication, has been considered as a promising target for Zika virus drug development. The bioactives from Andrographis paniculata, along with standard drugs as control were screened for their binding energy using AutoDock 4.2 against the viral protein. Based on the higher binding affinity the phytocompounds Bisandrographolide A (-11.7), Andrographolide (-10.2) and Andrographiside (-9.7) have convenient interactions at the binding site of target protein (ZIKV NS2B-NS3 protease) in comparison with the control drug. In addition, using insilico tools, the selected high-scoring molecules were analysed for pharmacological properties such as ADME (Absorption, Distribution, Metabolism, and Excretion profile) and toxicity. Andrographolide was reported to have strong pharmacodynamics properties and target accuracy based on the Lipinski rule and lower binding energy. The selected bioactives showed lower AMES toxicity and has potent antiviral activity against zika virus targets. Further, MD simulation studies validated Bisandrographolide A & Andrographolide as a potential hit compound by exhibiting good binding with the target protein. The compounds exhibited good hydrogen bonds with ZIKV NS2B-NS3 protease. As a result, bioactives from the medicinal plant Andrographis paniculata can be studied in vitro and in vivo to develop an antiviral phytopharmaceutical for the successful treatment of zika virus.Communicated by Ramaswamy H. Sarma.

Zika Virus Non-Structural Protein 1 Antigen-Capture Immunoassay

Infection with Zika virus (ZIKV), a member of the Flavivirus genus of the Flaviviridae family, typically results in mild self-limited illness, but severe neurological disease occurs in a limited subset of patients. In contrast, serious outcomes commonly occur in pregnancy that affect the developing fetus, including microcephaly and other major birth defects. The genetic similarity of ZIKV to other widespread flaviviruses, such as dengue virus (DENV), presents a challenge to the development of specific ZIKV diagnostic assays. Nonstructural protein 1 (NS1) is established for use in immunodiagnostic assays for flaviviruses. To address the cross-reactivity of ZIKV NS1 with proteins from other flaviviruses we used site-directed mutagenesis to modify putative epitopes. Goat polyclonal antibodies to variant ZIKV NS1 were affinity-purified to remove antibodies binding to the closely related NS1 protein of DENV. An antigen-capture ELISA configured with the affinity-purified polyclonal antibody showed a linear dynamic range between approximately 500 and 30 ng/mL, with a limit of detection of between 1.95 and 7.8 ng/mL. NS1 proteins from DENV, yellow fever virus, St. Louis encephalitis virus and West Nile virus showed significantly reduced reactivity in the ZIKV antigen-capture ELISA. Refinement of approaches similar to those employed here could lead to development of ZIKV-specific immunoassays suitable for use in areas where infections with related flaviviruses are common.

Tolerance and humoral immune response to the yellow fever vaccine in sickle cell disease children treated with hydroxyurea: a multicentre prospective study

BACKGROUND

Sickle cell disease (SCD) children are frequent travellers to countries where yellow fever (YF) is endemic, but there are no data regarding the safety and immunogenicity of the vaccine in such children treated with hydroxyurea (HU). The main objective of this study was to compare the tolerance and immune response to YF vaccination in SCD children treated or not with HU.

METHOD

SCD children < 18 years attending the international travel clinics of three large paediatric centres and requiring a first YF vaccination were included in a prospective study. Adverse events were collected 2 weeks after vaccination. YF vaccine antibody titres were measured ~6 months after vaccination.

RESULTS

Among the 52 SCD children vaccinated against YF, 17 (33%) were treated with HU. Only mild adverse events, mainly fever and local reaction, were observed in the HU group with a similar frequency in the non-HU group (57 and 35%, respectively, P = 0.30). YF antibody titres were measured in 15/17 patients in the HU group and 23/35 patients in the non-HU group after a median of 6.0 months (3.5-8.5) following vaccination. The geometric mean of YF antibody titre was similar in both groups. A protective antibody level was observed in 85% of the children in the HU group vs 100% in the non-HU group (P = 0.14), suggesting a lower effectiveness of the vaccine in patients on HU similarly to what has been described in patients on immune suppressive therapy for other vaccines.

CONCLUSION

YF vaccination seems to be safe and efficient in SCD children treated with HU. Considering the potential risk of severe complications in cases of YF while travelling in Africa for those patients, the benefit-to-risk ratio argues for YF vaccination in all SCD children. Control of a protective antibody titre may also be useful to ascertain an adequate response in those treated with HU.

Clinical and Preclinical Evidence for Adverse Neurodevelopment after Postnatal Zika Virus Infection

Although the Zika virus (ZIKV) typically causes mild or no symptoms in adults, during the 2015−2016 outbreak, ZIKV infection in pregnancy resulted in a spectrum of diseases in infants, including birth defects and neurodevelopmental disorders identified in childhood. While intense clinical and basic science research has focused on the neurodevelopmental outcomes of prenatal ZIKV infection, less is known about the consequences of infection during early life. Considering the neurotropism of ZIKV and the rapidly-developing postnatal brain, it is important to understand how infection during infancy may disrupt neurodevelopment. This paper reviews the current knowledge regarding early postnatal ZIKV infection. Emerging clinical evidence supports the hypothesis that ZIKV infection during infancy can result in negative neurologic consequences. However, clinical data regarding postnatal ZIKV infection in children are limited; as such, animal models play an important role in understanding the potential complications of ZIKV infection related to the vulnerable developing brain. Preclinical data provide insight into the potential behavioral, cognitive, and motor domains that clinical studies should examine in pediatric populations exposed to ZIKV during infancy.

Discovery of Zika Virus NS2B/NS3 Inhibitors That Prevent Mice from Life-Threatening Infection and Brain Damage

Zika virus (ZIKV) infection, which initially was endemic only in Africa and Asia, is rapidly spreading throughout Europe, Oceania, and the Americas. Although there have been enormous efforts, there is still no approved drug to treat ZIKV infection. Herein, we report the synthesis and biological evaluation of agents with noncompetitive mechanism of the ZIKV NS2B/NS3 protease inhibition through the binding to an allosteric site. Compounds 1 and 2 showed potent activity in both enzymatic and cellular assays. Derivative 1 efficiently reduced the ZIKV protein synthesis and the RNA replication and prevented the mice from life-threatening infection and the brain damage caused by ZIKV infection in a ZIKV mouse model.

Postnatal symptomatic Zika virus infections in children and adolescents: A systematic review

BACKGROUND

Recent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. However, little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence.

METHODS

We conducted a systematic review on the clinical presentation and complications of children and adolescents aged 0 to 18 years with a robust diagnosis of ZIKV infection. We searched PubMed, Web of Science, LILACs, and EMBASE until 13 February 2020 and screened reference lists of eligible articles. We assessed the studies' risk of bias using pre-specified criteria.

FINDINGS

Our review collated the evidence from 2543 pediatric ZIKV cases representing 17 countries and territories, identified in 1 cohort study, 9 case series and 22 case reports. The most commonly observed signs and symptoms of ZIKV infection in children and adolescents were mild and included fever, rash, conjunctivitis and arthralgia. The frequency of neurological complications was reported only in the largest case series (identified in 1.0% of cases) and in an additional 14 children identified from hospital-based surveillance studies and case reports. ZIKV-related mortality was primarily accompanied by co-morbidity and was reported in one case series (<0.5% of cases) and three case reports. One death was attributed to complications of Guillain-Barré Syndrome secondary to ZIKV infection.

CONCLUSIONS AND RELEVANCE

Based on the current evidence, the clinical presentation of ZIKV infection in children and adolescents appears to be primarily mild and similar to the presentation in adults, with rare instances of severe complications and/or mortality. However, reliable estimation of the risks of ZIKV complications in these age groups is limited by the scarcity and quality of published data. Additional prospective studies are needed to improve understanding of the relative frequency of the signs, symptoms, and complications associated with pediatric ZIKV infections and to investigate any potential effects of early life ZIKV exposure on neurodevelopment.

Low morbidity and mortality with COVID‐19 in sickle cell disease: A single center experience

Coronavirus disease 2019 (COVID‐19) is caused by SARS‐CoV‐2 infection, which evolved into a global pandemic within a short time. Individuals with sickle cell disease (SCD) suffer from underlying cardiopulmonary comorbidities and are at risk of severe complications such as pneumonia, acute chest syndrome, thrombosis, stroke, and multiorgan failure. Whether COVID‐19 poses a high risk of morbidity and mortality in SCD patients remains unclear. Patients with SCD and COVID‐19 can present with overlapping clinical features such as respiratory symptoms with ground‐glass infiltrates, hyperinflammatory state, and increased risk of thromboembolism. This highlights the need to maintain a low threshold for testing for COVID‐19 infection among symptomatic and hospitalized SCD patients. We report a case series of nine hospitalized SCD patients diagnosed with COVID‐19 from March 18, 2020 to April 30, 2020 at a tertiary medical center in New York City. The mean age of the study population was 27.9 years, and interval since onset of symptoms and hospital presentation was 1–2 weeks. All patients in our series improved and were discharged home. This limited study shows that SCD patients, who are perceived to be high risk, maybe somehow protected from severe symptoms and complications of COVID‐19 infection.

Congenital Zika Syndrome and Extra-Central Nervous System Detection of Zika Virus in a Pre-term Newborn in Mexico

BACKGROUND

During pregnancy, the Zika virus (ZIKV) replicates in the placenta and central nervous system (CNS) of infected fetuses; nevertheless, the ability of ZIKV to replicate in other fetal tissues has not been extensively characterized.

METHODS

We researched whether dissemination of congenitally-acquired ZIKV outside the CNS exists by searching for the accumulation of the viral envelope protein, ZIKV ribonucleic acid (RNA), and infectious viral particles in different organs of a deceased newborn with Congenital Zika Syndrome. A real-time qualitative polymerase chain reaction (qPCR) was used to detect ZIKV RNA in the brain, thymus, lungs, kidneys, adrenal glands, spleen, liver, and small intestine. The same tissues were analyzed by indirect immunofluorescence and immunoperoxidase assays using the monoclonal antibody 4G2 to detect ZIKV envelope antigens. Isolation of infectious ZIKV in a cell culture was carried out using brain and kidney samples.

RESULTS

A postmortem, virological analysis of multiple organs, such as the kidneys (epithelial cells in the renal tubules), lungs (bronchial epithelia), thymus (epithelial cells inside the Hassall's corpuscles), and brain (neurons, ependymal cells, and macrophages) revealed the presence of ZIKV RNA and envelope antigens. Other tissues of the deceased newborn tested positive by qPCR for Epstein-Barr virus and human herpesvirus 6, including the brain cortex (Epstein-Barr) and the thymus, kidneys, and adrenal glands (human herpesvirus 6). The kidneys were identified as a significant niche for viral replication, given that infectious particles were successfully isolated from renal tissues.

CONCLUSIONS

Our findings demonstrate the ability of congenitally-acquired ZIKV to produce disseminated infections and the viral tropism towards epithelial cells.

Zika virus: clinical manifestations and treatment at a primary care institution in Colombia

Introduction: Although Zika virus cases have been reported in Colombia since 2015, its clinical and pharmacological characteristics have not yet been described.Objective: To describe the main clinical manifestations and sociodemographic characteristics of patients diagnosed with Zika and the treatment provided to them at a primary care hospital in a municipality of Colombia.Materials and methods: Descriptive cross-sectional study. The study population consisted of patients diagnosed with Zika between January 1 and July 25, 2016 at a first-level hospital. Sociodemographic, clinical and pharmacological variables, as well as adverse clinical and paraclinical outcomes associated with the infection were included. Descriptive statistics were performed. A χ² test was used for categorical variables, and a multivariate analysis was conducted using Epi info 7.1 software.Results: 254 individuals infected with Zika virus during the study period were identified, and Zika diagnosis was more frequent in women (68.5%). Regarding treatment, 90.9% of the cases were treated using acetaminophen. The most commonly reported symptoms were rash (81.1%) and pruritus (55.9%). In addition, antihistamines were the most frequent comedication (31.9%). Factors such as being a woman, being pregnant and inpatient treatment were associated with adverse clinical and paraclinical outcomes.Conclusion: The clinical manifestations described here are similar to those reported in other populations. Furthermore, inappropriate pharmacological management practices that can lead to complications in this population, such as bleeding, were observed in some cases, thus educational interventions on the proper prescription of medications for treating this disease aimed at general physicians working in Zika affected areas must be implemented in order to improve the prognosis of these patients.

Zika virus infection studies with CD34+ hematopoietic and megakaryocyte-erythroid progenitors, red blood cells and platelets

BACKGROUND

To date, several cases of transfusion-transmitted ZIKV infections have been confirmed. Multiple studies detected prolonged occurrence of ZIKV viral RNA in whole blood as compared to plasma samples indicating potential ZIKV interaction with hematopoietic cells. Also, infection of cells from the granulocyte/macrophage lineage has been demonstrated. Patients may develop severe thrombocytopenia, microcytic anemia, and a fatal course of disease occurred in a patient with sickle cell anemia suggesting additional interference of ZIKV with erythroid and megakaryocytic cells. Therefore, we analyzed whether ZIKV propagates in or compartmentalizes with hematopoietic progenitor, erythroid, and megakaryocytic cells.

METHODS

ZIKV RNA replication, protein translation and infectious particle formation in hematopoietic cell lines as well as primary CD34⁺ HSPCs and ex vivo differentiated erythroid and megakaryocytic cells was monitored using qRT-PCR, FACS, immunofluorescence analysis and infectivity assays. Distribution of ZIKV RNA and infectious particles in spiked red blood cell (RBC) units or platelet concentrates (PCs) was evaluated.

RESULTS

While subsets of K562 and KU812Ep6^EPO cells supported ZIKV propagation, primary CD34⁺ HSPCs, MEP cells, RBCs, and platelets were non-permissive for ZIKV infection. In spiking studies, ZIKV RNA was detectable for 7 days in all fractions of RBC units and PCs, however, ZIKV infectious particles were not associated with erythrocytes or platelets.

CONCLUSION

Viral particles from plasma or contaminating leukocytes, rather than purified CD34⁺ HSPCs or the cellular component of RBC units or PCs, present the greatest risk for transfusion-transmitted ZIKV infections.

knowledge, perceptions and practices regarding zika virus of university students in northern Colombia (Santa Marta, 2016)

This study focuses on 171 university students’ level of knowledge, perceptions and practices regarding Zika virus and its vector in Santa Marta (Colombia) in 2016. A survey was conducted and answers about causative agent and mode of transmission were classified into three levels of knowledge. 32.1% of the students stated that they had suffered from Zika. A 60% stated that they knew what the disease was, however, only 29.2% knew what the causative agent was and 45.6% knew the mode of transmission. Regarding the level of knowledge, only 14.6% knew the causative agent and the mode of transmission (Level 2). In general, the students recognize Zika’s symptoms, and 53.8% consider Zika to be very serious and more than half consider that they, the community and the government are responsible for controlling the vector. Even though more than half the students know the most important strategies as regards on how to control the vector, they do not practice them; this may be explained by the characteristics of their daily live dynamics, the lack of community organization, deficiency in the system of public health and climate change. It is recommended to implement permanent vector control strategies that consider the sociocultural characteristics of at-risk populations.

Fatal Zika virus infection in the Americas: A systematic review

INTRODUCTION

While death due to Zika virus (ZIKV) infection has been described, reports of fatal cases have been infrequent and no systematic reviews on the subject have been published.

METHODS

A systematic review of the literature in four databases was performed to assess fatal outcomes of postnatal ZIKV infection and the available evidence that links ZIKV infection to death.

RESULTS

Three hundred and eleven articles were retrieved; 20 of them were epidemiological reports from surveillance agencies and ministries of health. After screening by abstract and title, 59 articles were selected for full-text assessment. Of these, 35 were excluded (with reasons) and 24 were finally included for qualitative analysis. A total of 51 reported deaths associated with ZIKV infection in nine countries were identified. The majority of cases (56.9%) were not related to Guillain-Barré syndrome. Cases from three countries accounted for 67.6% of the deaths. ZIKV infection was laboratory-confirmed in the majority of cases (64.7%).

DISCUSSION

ZIKV was not considered to be a dangerous, and much less a lethal pathogen, until very recently. However, an increasing number of fatalities have been published in the literature since the first death was reported in 2016. Additional research is needed to elucidate factors that may mediate the pathogenesis of severe, atypical, and fatal disease.

Serologic Tools and Strategies to Support Intervention Trials to Combat Zika Virus Infection and Disease

Zika virus is an emerging mosquito-borne flavivirus that recently caused a large epidemic in Latin America characterized by novel disease phenotypes, including Guillain-Barré syndrome, sexual transmission, and congenital anomalies, such as microcephaly. This epidemic, which was declared an international public health emergency by the World Health Organization, has highlighted shortcomings in our current understanding of, and preparation for, emerging infectious diseases in general, as well as challenges that are specific to Zika virus infection. Vaccine development for Zika virus has been a high priority of the public health response, and several candidates have shown promise in pre-clinical and early phase clinical trials. The optimal selection and implementation of imperfect serologic assays are among the crucial issues that must be addressed in order to advance Zika vaccine development. Here, I review key considerations for how best to incorporate into Zika vaccine trials the existing serologic tools, as well as those on the horizon. Beyond that, this discussion is relevant to other intervention strategies to combat Zika and likely other emerging infectious diseases.

Zika Virus Infection in Children

Zika virus is a mosquito-borne Flavivirus responsible for symptomatic and asymptomatic infections in humans. Zika was first identified in Africa as a cause of sporadic febrile illness. Beginning in 2015, Zika virus infection was identified in Brazil and linked with several symptomatic infections. Notably, congenital infections were observed with marked neurologic abnormalities. Diagnosis relies on detection of Zika virus by real-time polymerase chain reaction or by the presence of anti-Zika antibodies. Treatment of this viral illness remains supportive; however, proactive screening and interventions are indicated in the treatment of infants with symptomatic congenital infection.

Zika Virus Epidemic in Brazil. II. Post-Mortem Analyses of Neonates with Microcephaly, Stillbirths, and Miscarriage

Introduction: The recent Zika virus(ZIKV) epidemic in Brazil was characterized by a range of different clinical presentations, particularly microcephaly, Guillain-Barré syndrome, and death. In this context, we determined the causal relationship between fatal microcephaly cases and ZIKV infection. Methods: Twelve fatal cases of neonates, whose mothers were infected with ZIKV during pregnancy, were examined; cases included nine neonatal deaths due to microcephaly, one miscarriage, and two stillbirths. Tissue samples were obtained from all cases at necropsy and were submitted for virological investigation (RT-qPCR and virus isolation) and/or histopathology (hematoxylin and eosin staining) and immunohistochemical assay for the detection of ZIKV antigens. Results: ZIKV antigens and/or ZIKV RNA were detected in tissue samples of all 12 cases examined. ZIKV was recovered in one case. Results of the virological and immunohistochemical analyses, as well as the anatomic abnormalities and histopathologic changes observed at necropsy on the 12 fatal cases, are presented. Conclusions: Data from these 12 cases provide strong evidence of the causal relationship between ZIKV and congenital disease in fetuses of women who were infected with the virus during pregnancy.

ICR suckling mouse model of Zika virus infection for disease modeling and drug validation

Background

Zika virus (ZIKV) infection causes diseases ranging from acute self-limiting febrile illness to life-threatening Guillain–Barré Syndrome and other neurological disorders in adults. Cumulative evidence suggests an association between ZIKV infection and microcephaly in newborn infants. Given the host-range restrictions of the virus, a susceptible animal model infected by ZIKV must be developed for evaluation of vaccines and antivirals. In this study, we propose a convenient mouse model for analysis of neurological disorders caused by ZIKV.

Methodology

Six-day-old immunocompetent ICR suckling mice were used in the experiment. Different inoculum virus concentrations, challenge routes, and challenge times were assessed. Viremic dissemination was determined in the liver, spleen, kidney, and brain through Western blot assay, plaque assay, absolute quantification real-time PCR, and histological observation. Azithromycin, a well-characterized anti-ZIKV compound, was used to evaluate the ICR suckling mouse model for antiviral testing.

Conclusions

Signs of illness and neurological disease and high mortality rate were observed in mice injected with ZIKV intracerebrally (10² to 10⁵) and intraperitoneally (10³ to 10⁵). Viremic dissemination was observed in the liver, spleen, kidney, and brain. ZIKV transmitted, rapid replicated, and induced monocyte infiltration into the brain approximately 5 to 6 days post inoculum. Azithromycin conferred protection against ZIKV-caused neurological and life-threatening diseases. The developed model of ZIKV infection and disease can be used for screening drugs against ZIKV and discovering the underlying mechanism of ZIKV pathogenesis.

Mosquito-borne Zika virus (ZIKV) is an emerging threat to human health worldwide. In 2007, a ZIKV outbreak was reported in the Yap Island of Micronesia and was the first outbreak outside Africa and Asia. In 2013 and 2014, another ZIKV outbreak was reported in French Polynesia, and more than 28,800 people were infected by ZIKV. In 2015, the first ZIKV outbreak in America was reported in Brazil; the Brazilian Ministry of Health reported a 20-fold increase in cases of neonatal microcephaly, which was geographically and temporally correlated with the ZIKV outbreak. Recent evidence demonstrated that ZIKV infection leads to severe syndromes, such as Guillain–Barré syndrome and microcephaly in adults and infants, respectively. Thus far, anti-ZIKV drugs and vaccines have not been developed yet. Moreover, the underlying mechanism of ZIKV pathogenesis remains unclear. In this study, we propose a small animal model of wild-type ZIKV infection and associated neurological disorders. In the animal model, ZIKV causes signs of illness and neurological disease, potentially emulating the hallmark of ZIKV infection in human. These features can be used to study the underlying mechanism of ZIKV pathogenesis. The newly developed Zika disease model provides an immunocompetent and time saving framework for development of drugs against ZIKV and ZIKV-caused diseases.

Zika virus: Epidemiological study and its association with public health risk

Propagation of Zika virus has become an alarming global public health issue. The infection is spreading rapidly to different countries by several methods, especially by the transmission through traveling. Bangladesh is also at a risk to be affected with such newly viral infections. Though the virus initially appears to cause mild problems, the long term effects are more devastating to the next generation as seen in case of the delivery of the microcephalic babies. Current review discussed the epidemiologic era of the virus; i.e., the administration of Zika virus in the non-human mammals and finally to the human host across the world. Typical sign-symptoms which can often be considered as dengue or chikungunya for their similarities have been stated. The diagnosis of Zika virus, the protective measures taken by mass people as well as the actions that should be endorsed to prevent acquisition of the infection from travelers are discussed.

Biochemistry and Molecular Biology of Flaviviruses

Flaviviruses, such as dengue, Japanese encephalitis, tick-borne encephalitis, West Nile, yellow fever, and Zika viruses, are critically important human pathogens that sicken a staggeringly high number of humans every year. Most of these pathogens are transmitted by mosquitos, and not surprisingly, as the earth warms and human populations grow and move, their geographic reach is increasing. Flaviviruses are simple RNA-protein machines that carry out protein synthesis, genome replication, and virion packaging in close association with cellular lipid membranes. In this review, we examine the molecular biology of flaviviruses touching on the structure and function of viral components and how these interact with host factors. The latter are functionally divided into pro-viral and antiviral factors, both of which, not surprisingly, include many RNA binding proteins. In the interface between the virus and the hosts we highlight the role of a noncoding RNA produced by flaviviruses to impair antiviral host immune responses. Throughout the review, we highlight areas of intense investigation, or a need for it, and potential targets and tools to consider in the important battle against pathogenic flaviviruses.

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.

Kay SI, Mittal J, Bandstra ES, Younis RT, Chapagain P, Jayaweera DT, Liu XZ. Zika Virus: An Emerging Global Health Threat

Zika virus (ZIKV) is an emerging healthcare threat. The presence of the mosquito Aedes species across South and Central America in combination with complementary climates have incited an epidemic of locally transmitted cases of ZIKV infection in Brazil. As one of the most significant current public health concerns in the Americas, ZIKV epidemic has been a cause of alarm due to its known and unknown complications. At this point, there has been a clear association between ZIKV infection and severe clinical manifestations in both adults and neonates, including but not limited to neurological deficits such as Guillain-Barré syndrome (GBS) and microcephaly, respectively. The gravity of the fetal anomalies linked to ZIKV vertical transmission from the mother has prompted a discussion on whether to include ZIKV as a formal member of the TORCH [Toxoplasma gondii, other, rubella virus, cytomegalovirus (CMV), and herpes] family of pathogens known to breach placental barriers and cause congenital disease in the fetus. The mechanisms of these complex phenotypes have yet to be fully described. As such, diagnostic tools are limited and no effective modalities are available to treat ZIKV. This article will review the recent advancements in understanding the pathogenesis of ZIKV infection as well as diagnostic tests available to detect the infection. Due to the increase in incidence of ZIKV infections, there is an immediate need to develop new diagnostic tools and novel preventive as well as therapeutic modalities based on understanding the molecular mechanisms underlying the disease.

Designing Ecofriendly Bionanocomposite Assembly with Improved Antimicrobial and Potent on-site Zika Virus Vector Larvicidal Activities with its Mode of Action

Dialyzed natural polymer, fibroin, from Bombyx mori was used to synthesize biocompatible silver and gold nanoparticles in-situ in dispersion form. The films of pure fibroin (PF), fibroin-silver nanocomposite (FSNC) and fibroin-gold nanocomposite (FGNC) were fabricated by drop casting method. The characterization of the resultant dispersion and films was performed by visual color change, UV-Vis spectroscopy and atomic force microscopy. The dispersions of PF, FSNC and FGNC were tested for antibacterial activity against E. coli NCIM 2065, S. aureus NCIM 5021, K. pneumoniae NCIM 2957, P. aeruginosa ATCC 9027 and antifungal activity against A. fumigatus NCIM 902. FSNC dispersion exhibited an effective antimicrobial action against all the tested microbes as compared to FGNC dispersion. The mechanism of action for FSNC and FGNC against these microorganisms is proposed. Additionally, the larvicidal activity of the films was investigated against the larvae of Aedes aegypti. The films of FSNC exhibited 100% mortality while the films of FGNC revealed 86-98% mortality against all the larval instars and pupae of A. aegypti. The phytotoxicity study of the nanocomposite films was also carried out to confirm the reusability of water. This is first noble metal nanocomposite based report on larvicidal activity of zika virus vector.

Zika virus infection: epidemiology, clinical manifestations and diagnosis

PURPOSE OF REVIEW

Zika virus (ZIKV) is an arbovirus previously believed to cause only a mild and self-limiting illness. Recently, it has emerged as a new public health threat that caused a large outbreak in French Polynesia in 2013-2014 and since 2015 an explosive outbreak in Brazil, with an increase in severe congenital malformations (microcephaly) and neurological complications, mainly Guillain-Barré syndrome (GBS). Since then, it has spread through the Americas. On 1 February 2016, the WHO declared the ZIKV epidemic in Brazil a Public Health Emergency of International Concern. We reviewed the epidemiology of ZIKV infection, clinical presentations and diagnosis. We highlighted the clinical features and nonvector borne transmission of the virus.

RECENT FINDINGS

Association between ZIKV infection and severe foetal outcomes, including microcephaly and other birth defects; increased rate of GBS and other neurological complications due to the ongoing ZIKV outbreak; increased evidence to date of ZIKV being the only arbovirus linked to sexual transmission; the challenge of ZIKV diagnosis; and the need for a specific point-of care test in epidemic scenarios.

SUMMARY

The findings illustrate the emergence of a viral disease with the identification of new associated disorders, new modes of transmission, including maternal-foetal and sexual transmission.

Clinical Impact of Non-Congenital Zika Virus Infection in Infants and Children

PURPOSE OF REVIEW

While the Zika virus (ZIKV) has been noted for its distinct neurotropism and identified as a significant cause for a congenital infection syndrome, there has been increased recognition of the importance to better understand the clinical impact of non-congenital ZIKV infection in infants and children. This article reviews reports of perinatal and breast milk transmission of ZIKV and summarizes current clinical outcome data of pediatric non-congenital ZIKV infection.

RECENT FINDINGS

Perinatal transmission and presence of infective ZIKV particles in breast milk have been reported. Most symptomatic non-congenital ZIKV infection in infants and children is mild and self-limited, but long-term follow-up studies are lacking. The mechanism and impact of perinatal and breast milk transmission is unclear. The current WHO infant feeding guidelines in areas of ZIKV transmission support breastfeeding. Unless any scientific data raise concern regarding transmission via breastfeeding, the current guidelines should continue to be followed. Prospective population-based cohort studies to investigate maternal, perinatal, infant, and child outcomes are needed.

Zika Virus Infection

In less than 2 years since entry into the Americas, we have witnessed the emergent spread of Zika virus into large subsets of immunologically naïve human populations and then encountered the devastating effects of microcephaly and brain anomalies that can arise from in utero infection with the virus. Diagnostic evaluation and management of affected infants continues to evolve as our understanding of Zika virus rapidly advances. The development of a safe and effective vaccine holds the potential to attenuate the spread of infection and limit the impact of congenital infection.

Structure-based discovery of clinically approved drugs as Zika virus NS2B-NS3 protease inhibitors that potently inhibit Zika virus infection in vitro and in vivo

Zika virus (ZIKV) infection may be associated with severe complications in fetuses and adults, but treatment options are limited. We performed an in silico structure-based screening of a large chemical library to identify potential ZIKV NS2B-NS3 protease inhibitors. Clinically approved drugs belonging to different drug classes were selected among the 100 primary hit compounds with the highest predicted binding affinities to ZIKV NS2B-NS3-protease for validation studies. ZIKV NS2B-NS3 protease inhibitory activity was validated in most of the selected drugs and in vitro anti-ZIKV activity was identified in two of them (novobiocin and lopinavir-ritonavir). Molecular docking and molecular dynamics simulations predicted that novobiocin bound to ZIKV NS2B-NS3-protease with high stability. Dexamethasone-immunosuppressed mice with disseminated ZIKV infection and novobiocin treatment had significantly (P < 0.05) higher survival rate (100% vs 0%), lower mean blood and tissue viral loads, and less severe histopathological changes than untreated controls. This structure-based drug discovery platform should facilitate the identification of additional enzyme inhibitors of ZIKV.

Zika Virus: Recent Advances towards the Development of Vaccines and Therapeutics

Zika is a rapidly emerging public health threat. Although clinical infection is frequently mild, significant neurological manifestations have been demonstrated in infants born to Zika virus (ZIKV) infected mothers. Due to the substantial ramifications of intrauterine infection, effective counter-measures are urgently needed. In order to develop effective anti-ZIKV vaccines and therapeutics, improved animal models and a better understanding of immunological correlates of protection against ZIKV are required. This review will summarize what is currently known about ZIKV, the clinical manifestations and epidemiology of Zika as well as, the development of animal models to study ZIKV infection, host immune responses against ZIKV, and the current state of development of vaccines and therapeutics against ZIKV.

When is genetic modification socially acceptable? When used to advance human health through avenues other than food

Given the potential for genetic modification (GM) to impact human health, via food and health mechanisms, a greater understanding of the social acceptance of GM is necessary to facilitate improved health outcomes. This analysis sought to quantify U.S. residents’ acceptance of GM across five potential uses (grain production, fruit or vegetable production, livestock production, human medicine, and human health, i.e. disease vector control) and provides an in-depth analysis of a timely case study–the Zika virus (ZIKV). The two categories with the highest levels of acceptance for GM use were human medicine (62% acceptance) and human health (68% acceptance); the proportions agreeing with the use of GM for these two categories were statistically different from all other categories. Acceptance of GM in food uses revealed 44% of the sample accepted the use of GM in livestock production while grain production and fruit and vegetable production showed similar levels of agreement with 49% and 48% of responses, respectively. Two variables were significant in all five models predicting GM acceptance; namely, being male and GM awareness. Being male was significant and positive for all models; respondents who reported being male were more likely (than those who reported female) to agree with all five of the uses of GM studied. Those who were reportedly aware of GM mosquito technology were also more likely to agree with all uses of GM technology investigated. The potential relationship between awareness of GM technology uses and acceptance of other uses could help inform rates of acceptance of new technologies by various population segments.

The influence of health concern on travel plans with focus on the Zika virus in 2016

Tourists consider many factors, including health, when choosing travel destinations. The potential for exposure to novel or foreign diseases alone can deter travelers from selecting high-risk locations for disease transmission. The 2015-2016 Zika Virus (ZIKV) outbreak in the Americas and Caribbean prompted the World Health Organization (WHO) to declare a Public Health Emergency of International Concern. This study investigated factors that may contribute to travel avoidance to areas experiencing ZIKV transmission while also considering different levels of health concern and awareness among groups with varying demographics. An online survey was administered February 10-12, 2016 to a sample of U.S. residents (n = 964). Demographics, information about travel behaviors, and levels of health concern were collected. Ordered logit models were employed to assess the impacts of the ZIKV outbreak on travel planning. Respondents giving higher levels of attention to general health were more likely to avoid travel to areas experiencing ZIKV transmission. It is anticipated that the findings of this study may be of interest to public health officials, healthcare providers, and government officials attempting to mitigate impacts of ZIKV. Disease outbreaks in regions of the world typically frequented by vacation or leisure travelers are particularly problematic due to the increased amount of exposure to disease in an immunologically naïve population that may then contribute to the outbreak through their travel plans. Avoiding travel to destinations experiencing outbreaks of disease due to health concerns may be interpreted positively by the public health community but can have negative economic consequences.

Zika Virus: A Serious Global Health Threat

In February 2016, the World Health Organization declared Zika virus (ZIKV) infection a public health emergency of international concern, given the precipitous spread of the virus across the Americas. Unlike arboviruses such as Chikungunya and Dengue, which have also recently emerged in the western hemisphere, ZIKV was identified in communities where concurrent neurologic conditions such as microcephaly and Guillain-Barre (GB) syndrome were occurring at alarming rates. Thus, investigations to systematically evaluate the link between ZIKV, congenital malformations (including microcephaly) and GB syndrome remain a top priority.

Mapping the ecoepidemiology of Zika virus infection in urban and rural areas of Pereira, Risaralda, Colombia, 2015-2016: Implications for public health and travel medicine

OBJECTIVE

Geographical information systems (GIS) have been demonstrated earlier to be of great use to inform public health action against vector-borne infectious diseases.

METHODS

Using surveillance data on the ongoing ZIKV outbreak from Pereira, Colombia (2015-2016), we estimated incidence rates (cases/100,000 population), and developed maps correlating with the ecoepidemiology of the area.

RESULTS

Up to October 8, 2016, 439 cases of ZIKV were reported in Pereira (93 cases/100,000 pop.), with highest rates in the South-West area. At the corregiments (sub-municipalities) of Pereira, Caimalito presented the highest rate. An urban area, Cuba, has 169 cases/100,000 pop., with a low economical level and the highest Aedic index (9.1%). Entomological indexes were associated with ZIKV incidence at simple and multiple non-linear regressions (r² > 0.25; p < 0.05).

CONCLUSIONS

Combining entomological, environmental, human population density, travel patterns and case data of vector-borne infections, such as ZIKV, leads to a valuable tool that can be used to pinpoint hotspots also for infections such as dengue, chikungunya and malaria. Such a tool is key to planning mosquito control and the prevention of mosquito-borne diseases in local populations. Such data also enable microepidemiology and the prediction of risk for travelers who visit specific areas in a destination country.

Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review

BACKGROUND

In the last three years, chikungunya virus disease has been spreading, affecting particularly the Americas, producing more than two million cases. In this setting, not only new disease-related epidemiological patterns have been found, but also new clinical findings have been reported by different research groups. These include findings on the cardiovascular system, including clinical, electrocardiographic and echocardiographic alterations. No previous systemic reviews have been found in major databases about it.

METHODS

We performed a systematic review looking for reports about cardiovascular compromise during chikungunya disease. Cardiac compromise is not so common in isolated episodes; but countries where chikungunya virus is an epidemic should be well informed about this condition. We used 6 bibliographical databases as resources: Medline/Pubmed, Embase, ScienceDirect, ClinicalKey, Ovid and SciELO. Dengue reports on cardiovascular compromise were included as well, to compare both arbovirus' organic compromises. Articles that delved mainly into the rheumatic articular and cutaneous complications were not considered, as they were not in line with the purpose of this study. The type of articles included were reviews, meta-analyses, case-controls, cohort studies, case reports and case series. This systematic review does not reach or performed a meta-analysis.

RESULTS

Originally based on 737 articles, our reviewed selected 40 articles with 54.2% at least mentioning CHIKV cardiovascular compromise within the systemic compromise. Cardiovascular manifestations can be considered common and have been reported in France, India, Sri Lanka, Malaysia, Colombia, Venezuela and USA, including mainly, but no limited to: hypotension, shock and circulatory collapse, Raynaud phenomenon, arrhythmias, murmurs, myocarditis, dilated cardiomyopathy, congestive insufficiency, heart failure and altered function profile (Troponins, CPK).

CONCLUSIONS

Physicians should be encouraged to keep divulgating reports on the cardiovascular involvement of chikungunya virus disease, to raise awareness and ultimately encourage suitable diagnosis and intervention worldwide. More research about cardiovascular involvement and manifestations of systemic Chikungunya virus infection is urgently needed.

Cardiovascular involvement and manifestations of systemic Chikungunya virus infection: A systematic review

BACKGROUND

In the last three years, chikungunya virus disease has been spreading, affecting particularly the Americas, producing more than two million cases. In this setting, not only new disease-related epidemiological patterns have been found, but also new clinical findings have been reported by different research groups. These include findings on the cardiovascular system, including clinical, electrocardiographic and echocardiographic alterations. No previous systemic reviews have been found in major databases about it.

METHODS

We performed a systematic review looking for reports about cardiovascular compromise during chikungunya disease. Cardiac compromise is not so common in isolated episodes; but countries where chikungunya virus is an epidemic should be well informed about this condition. We used 6 bibliographical databases as resources: Medline/Pubmed, Embase, ScienceDirect, ClinicalKey, Ovid and SciELO. Dengue reports on cardiovascular compromise were included as well, to compare both arbovirus' organic compromises. Articles that delved mainly into the rheumatic articular and cutaneous complications were not considered, as they were not in line with the purpose of this study. The type of articles included were reviews, meta-analyses, case-controls, cohort studies, case reports and case series. This systematic review does not reach or performed a meta-analysis.

RESULTS

Originally based on 737 articles, our reviewed selected 40 articles with 54.2% at least mentioning CHIKV cardiovascular compromise within the systemic compromise. Cardiovascular manifestations can be considered common and have been reported in France, India, Sri Lanka, Malaysia, Colombia, Venezuela and USA, including mainly, but no limited to: hypotension, shock and circulatory collapse, Raynaud phenomenon, arrhythmias, murmurs, myocarditis, dilated cardiomyopathy, congestive insufficiency, heart failure and altered function profile (Troponins, CPK).

CONCLUSIONS

Physicians should be encouraged to keep divulgating reports on the cardiovascular involvement of chikungunya virus disease, to raise awareness and ultimately encourage suitable diagnosis and intervention worldwide. More research about cardiovascular involvement and manifestations of systemic Chikungunya virus infection is urgently needed.

Improved detection of Zika virus RNA in human and animal specimens by a novel, highly sensitive and specific real-time RT-PCR assay targeting the 5'-untranslated region of Zika virus

OBJECTIVE AND METHOD

We developed and evaluated five novel real-time RT-PCR assays targeting conserved regions in the 5'-untranslated region (5'-UTR), envelope (E'), non-structural protein 2A (NS2A), NS5 and 3'-UTR of the ZIKV genome.

RESULTS

The ZIKV-5'-UTR assay exhibited the lowest in vitro limit of detection (5-10 RNA copies/reaction and 3.0 × 10^-1 plaque-forming units/ml). Compared to the modified version of a widely adopted RT-PCR assay targeting the ZIKV-E gene, the ZIKV-5'-UTR assay showed better sensitivity in human clinical specimens, and representative mouse specimens, including many organs which are known to be involved in human ZIKV infection but difficult to obtain in clinical settings. The ZIKV-5'-UTR assay detected ZIKV RNA in 84/84 (100.0%) ZIKV-E'-positive and an additional 30/296 (10.1%, P < 0.01) ZIKV-E'-negative mouse specimens. The higher sensitivity of the ZIKV-5'-UTR assay was most significant in kidney and testis/epididymis specimens (P < 0.01). No in vitro or in vivo cross-reactivity was found between the ZIKV-5'-UTR assay and dengue virus, yellow fever virus, Japanese encephalitis virus, West Nile virus, hepatitis C virus and Chikungunya virus.

CONCLUSIONS

The highly sensitive and specific ZIKV-5'-UTR assay may help to improve the laboratory diagnosis of ZIKV infection.

Antiviral activity of peptide inhibitors derived from the protein E stem against Japanese encephalitis and Zika viruses

Japanese encephalitis virus (JEV) and Zika virus (ZIKV) are mosquito-borne viruses of the Flavivirus genus that cause viral encephalitis and congenital microcephaly, respectively, in humans, and thus present a risk to global public health. The envelope glycoprotein (E protein) of flaviviruses is a class II viral fusion protein that mediates host cell entry through a series of conformational changes, including association between the stem region and domain II leading to virion-target cell membrane fusion. In this study, peptides derived from the JEV E protein stem were investigated for their ability to block JEV and ZIKV infection. Peptides from stem helix 2 inhibit JEV infection with the 50% inhibitory concentration (IC₅₀) in the nanomolar range. One of these peptides (P5) protected mice against JEV-induced lethality by decreasing viral load, while abrogating histopathological changes associated with JEV infection. We also found that P5 blocked ZIKV infection with IC₅₀ at the micromolar level. Moreover, P5 was proved to reduce the histopathological damages in brain and testes resulting from ZIKV infection in type I and II interferon receptor-deficient (AG6) mice. These findings provide a basis for the development of peptide-based drugs against JEV and ZIKV.

Novel antiviral activity and mechanism of bromocriptine as a Zika virus NS2B-NS3 protease inhibitor

Zika virus (ZIKV) infection is associated with congenital malformations in infected fetuses and severe neurological and other systemic complications in adults. There are currently limited anti-ZIKV treatment options that are readily available and safe for use in pregnancy. In this drug repurposing study, bromocriptine was found to have inhibitory effects on ZIKV replication in cytopathic effect inhibition, virus yield reduction, and plaque reduction assays. Time-of-drug-addition assay showed that bromocriptine exerted anti-ZIKV activity between 0 and 12 h post-ZIKV inoculation, corroborating with post-entry events in the virus replication cycle prior to budding. Our docking model showed that bromocriptine interacted with several active site residues of the proteolytic cavity involving H51 and S135 in the ZIKV-NS2B-NS3 protease protein, and might occupy the active site and inhibit the protease activity of the ZIKV-NS2B-NS3 protein. A fluorescence-based protease inhibition assay confirmed that bromocriptine inhibited ZIKV protease activity. Moreover, bromocriptine exhibited synergistic effect with interferon-α2b against ZIKV replication in cytopathic effect inhibition assay. The availability of per vagina administration of bromocriptine as suppositories or vaginoadhesive discs and the synergistic anti-ZIKV activity between bromocriptine and type I interferon may make bromocriptine a potentially useful and readily available treatment option for ZIKV infection. The anti-ZIKV effects of bromocriptine should be evaluated in a suitable animal model.

Zika Virus Infection in Dexamethasone-immunosuppressed Mice Demonstrating Disseminated Infection with Multi-organ Involvement Including Orchitis Effectively Treated by Recombinant Type I Interferons

BACKGROUND

Disseminated or fatal Zika virus (ZIKV) infections were reported in immunosuppressed patients. Existing interferon-signaling/receptor-deficient mouse models may not be suitable for evaluating treatment effects of recombinant interferons.

METHODS

We developed a novel mouse model for ZIKV infection by immunosuppressing BALB/c mice with dexamethasone.

RESULTS

Dexamethasone-immunosuppressed male mice (6-8weeks) developed disseminated infection as evidenced by the detection of ZIKV-NS1 protein expression and high viral loads in multiple organs. They had ≥10% weight loss and high clinical scores soon after dexamethasone withdrawal (10dpi), which warranted euthanasia at 12dpi. Viral loads in blood and most tissues at 5dpi were significantly higher than those at 12dpi (P<0.05). Histological examination revealed prominent inflammatory infiltrates in multiple organs, and CD45+ and CD8+ inflammatory cells were seen in the testis. These findings suggested that clinical deterioration occurred during viral clearance by host immune response. Type I interferon treatments improved clinical outcome of mice (100% vs 0% survival).

CONCLUSIONS

Besides virus dissemination, inflammation of various tissues, especially orchitis, may be potential complications of ZIKV infection with significant implications on disease transmission and male fertility. Interferon treatment should be considered in patients at high risks for ZIKV-associated complications when the potential benefits outweigh the side effects of treatment.