Zika Virus: an Emerging Global Pandemic

Monica Madvariya
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Effects On The Fetus
In November 2015, the Brazilian Health Ministry described a connection between the Zika virus and newborn microcephaly. Two cases of severely affected babies in Northwestern Brazil were described, in whom amniocentesis had confirmed the presence of the Zika virus in the amniotic fluid.[22] Antenatal ultrasound imaging showed both foetuses to have microcephaly. One of the fetuses was also found to have calcifications in their eye and microphthalmia. Since then the evidence for the connection between Zika infection in pregnant women and newborn microcephaly has grown stronger, with at least 2,400 suspected cases of microcephaly in the country in 2015 as of 12 December, and 29 fatalities.[24,25] Brain abnormalities reported in infants with microcephaly and laboratory-confirmed congenital Zika infection include microcephaly and disrupted brain growth. A report of 35 infants with microcephaly who were born during an outbreak of Zikus virus infection in Brazil in 2015 described the following brain abnormalities: intracranial calcifications, ventriculomegaly, and neuronal migration disorders (lissencephaly and pachygyria). Other anomalies included congenital contractures and clubfoot. An important distinction is that neither these infants nor their mothers had laboratory-confirmed Zika virus; however, most of the mothers (~75%) reported symptoms consistent with Zika virus.[20]
For infants diagnosed with microcephaly, head size correlates with underlying brain size. However, these measurements do not consistently predict long term sequelae. Neurologic sequelae may include seizures, vision or hearing problems, and developmental disabilities. Symptoms vary with the extent of brain disruption.[20]
No treatment is currently available for Zika virus infection. Care for these infants is focused on diagnosing and managing conditions that are present, monitoring the child’s development over time, and addressing problems as they arise.

The incubation period of Zika virus disease is approximately three to 12 days after the bite of an infected mosquito. Most of the infections remain asymptomatic (between 60 to 80%).
When symptomatic, the infection is usually mild and characterised by a short-lasting self-limiting febrile illness of 4–7 days duration without severe complications and a low hospitalisation rate. Deaths have not been reported.[20]
The main symptoms are macular or papular rash, fever, arthralgia, non-purulent conjunctivitis/conjunctival hyperaemia, myalgia and headache. The maculo-papular rash often starts on the face and then spreads throughout the body. Less frequently, retro-orbital pain and gastro-intestinal signs are present.[21]
These are typical of most arboviral illnesses, like dengue, and don’t help in differentiating cases of Zika from other arboviral illnesses.
During the recent outbreaks in French Polynesia and Brazil in 2013 and 2015 respectively, potential neurological and auto-immune complications of Zika virus disease were reported. Also in Brazil, a simultaneous increase in incidence of Zika virus infections in the general public as well as an increase in babies born with microcephaly has been observed. This has led to the postulation that Zika virus infection during pregnancy can cause microcephaly in the baby, though further research is needed and is underway to fully elucidate the nature of this causation. [22,23]


References
Zika Virus: an Emerging Global Pandemic Zika Virus: an Emerging Global Pandemic 02/10/2016
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