Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: don’t miss it!

Somsri Wiwanitkit, Viroj WiwanitkitWiwanitkit House, Bangkhae, Bangkok, ThailandVisiting professor, Hainan Medical University, China; Visiting professor, Faculty of Medicine, University of Nis, Serbia; Honorary professor, DR DY Patil Medical University, India

ABSTRACT

Zika virus infection is the present problematic arboviral disease. Classically, this disease cause febrile illness and can result in low platelet count. However, there are some new obervations on atypical clinical presentations of Zika virus infection that can make the diagnosis more diffi cult. The afebrile, asymptomatic and non-thrombocytopenic Zika virus infection can be seen in clinical practice and can lead to missed or delayed diagnosis.

ARTICLE INFO

Article history:

Received 15 January 2016

Received in revised form 16 February 2016

Accepted 15 March 2016

Available online 20 May 2016

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Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: don’t miss it!

Somsri Wiwanitkit1*, Viroj Wiwanitkit21Wiwanitkit House, Bangkhae, Bangkok, Thailand
2Visiting professor, Hainan Medical University, China; Visiting professor, Faculty of Medicine, University of Nis, Serbia; Honorary professor, DR DY Patil Medical University, India

ABSTRACT

Zika virus infection is the present problematic arboviral disease. Classically, this disease cause febrile illness and can result in low platelet count. However, there are some new obervations on atypical clinical presentations of Zika virus infection that can make the diagnosis more diffi cult. The afebrile, asymptomatic and non-thrombocytopenic Zika virus infection can be seen in clinical practice and can lead to missed or delayed diagnosis.

ARTICLE INFO

Article history:

Received 15 January 2016

Received in revised form 16 February 2016

Accepted 15 March 2016

Available online 20 May 2016

Keywords:

Afebrile

Asymptomatic

Thrombocytopenia

Zika virus

Infection

Dear Editor,

The present emerging Zika virus infection becomes the big issue in tropical medicine. The disease is a kind of arboviral infection that can cause acute hemorrhagic fever similar to dengue[1-2]. At present, as a disease control measure, it is suggested that this new disease has to be included in diff erential diagnosis for any cases with acute febrile illness and thrombocytopenia[3 - 4]. However, there are some concerns adding to this suggestion. There are some conditions that practitioners have to know and concern. First, some patients might have no fever [5]. The afebrile presentation can be easily missed and delayed diagnosis can be expected. Indeed, the similar problem can be seen in many hemorrhagic diseases including to dengue [6]. Second, it should also be noted that not all patients have low platelet counts[7 - 8]. Cases without thrombocytopenia are reported in several publications. Finally, the cases that might be the most problematic situation is the asymptomatic infection or very mild symptomatic infection [9]. In fact, many Zika virus positive cases are reported in asymptomatic blood donors in the endemic area [10]. The recent report in Asian Pac Trop Med [11] from Thailand also confi rmed for the existence of previous infection without concern of the cases [11]. Indeed, antenatal testing in asymptomatic pregnant is already recommended in the endemic area [12]. These three problems have to be kept in mind of all practitioners. The atypical case of Zika virus is possible and it is the suggestion that the disease should be always looked for in the present period of worldwide emerging.

Conflict of interest statement

We declare that we have no confl ict of interest.

References

[1] Joob B, Wiwanitkit V. Zika virus infection and dengue: A new problem in diagnosis in a dengue-endemic area. Ann Trop Med Public Health 2015;8:145-146.

[2] Wiwanitkit S, Wiwanitkit V. Acute viral hemorrhage disease: A summary on new viruses. J Acute Dis 2015; 4: 277 – 279.

[3] Oduyebo T, Petersen EE, Rasmussen SA, Mead PS, Meaney-Delman D, Renquist CM, et al. Update: Interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible zika virus exposure - United States. MMWR Morb Mortal Wkly Rep 2016;65(5):122-127.

[4] Vouga M, Musso D, Van Mieghem T, Baud D. DC guidelines for pregnant women during the Zika virus outbreak. Lancet 2016; doi:10.1016/S0140-6736(16)00383-4.

[5] Deng Y, Zeng L, Bao W, Xu P, Zhong G. Experience of integrated traditional Chinese and Western medicine in first case of imported Zika virus disease in China. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2016;28(2):106-109.

[6] Wiwanitkit S, Wiwanitkit V. Afebrile dengue: An easily forgotten manifestation. Ann Trop Med Public Health 2013;6:686.

[7] Tappe D, Rissland J, Gabriel M, Emmerich P, Gunther S, Held G, et al. First case of laboratory-confirmed Zika virus infection imported into Europe, November 2013. Euro Surveill 2014;19(4). pii: 20685.

[8] Kwong JC, Druce JD, Leder K. Zika virus infection acquired during brief travel to Indonesia. Am J Trop Med Hyg 2013;89(3):516-517.

[9] Chan JF, Choi GK, Yip CC, Cheng VC, Yuen KY. Zika fever and congenital Zika syndrome: An unexpected emerging arboviral disease? J Infect 2016;2. pii: S0163-4453(16)00061-X.

[10] Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 2014;19(14). pii: 20761.

[11] Wikan N, Suputtamongkol Y, Yoksan S, Smith DR, Auewarakul P. Immunological evidence of Zika virus transmission in Thailand. Asian Pac J Trop Med 2016;9(2):141-144.

[12] Oduyebo T, Petersen EE, Rasmussen SA, Mead PS, Meaney-Delman D, Renquist CM, et al. Update: Interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible zika virus exposure - United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(5):122-127.

E-mail: somsriwiwan@hotmail.com

doi:Document heading 10.1016/j.apjtm.2016.03.036

*Corresponding author:Somsri Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok, Thailand.