First Case of Zika Virus Infection in a Returning Canadian Traveler

Abstract

A woman who recently traveled to Thailand came to a local emergency department with a fever and papular rash. She was tested for measles, malaria, and dengue. Positive finding for IgM antibody against dengue and a failure to seroconvert for IgG against dengue for multiple blood samples suggested an alternate flavivirus etiology. Amplification of a conserved region of the non-structural protein 5 gene of the genus Flavivirus yielded a polymerase chain reaction product with a matching sequence of 99% identity with Zika virus. A urine sample and a nasopharygeal swab specimen obtained for the measles investigation were also positive for this virus by reverse transcription polymerase chain reaction. Subsequently, the urine sample yielded a Zika virus isolate in cell culture. This case report describes a number of novel clinical and laboratory findings, the first documentation of this virus in Canada, and the second documentation from this region in Thailand.

Phylogenetic analysis revealed the central roles of two African countries in the evolution and worldwide spread of Zika virus

“…ZIKV export from Senegal directly to Canada was also detected by our analysis using MIGRA-PHYLA. However, no autochthonous cases were confirmed in Canada and the patient had recently returned from Thailand (Fonseca et al, 2014). It is possible that the pathway from Senegal to Canada was identified by MIGRAPHYLA because the sequence of the strain PLCalZV that was imported to Canada is mostly similar to that of the strain SV0127/14 from Thailand, which had already imported ZIKV strains from Senegal ( Figure 2B).…”

Zika virus disease: a current review of the literature

“…At present, more than 30 countries in Asia, Africa, Oceania, Micronesia and South America have reported indigenous human ZIKV cases [29]. The travel-related cases from epidemic and endemic regions were also reported in North America, Australia, Europe and Japan [30][31][32][33][34][35][36][37]. As of 27th July 2016, a total of 50 territories and countries in the Americas have reported ZIKV infections.…”

“…The other suspected routes of ZIKV transmission include monkey bite, mucocutaneous exposure, organ transplantation or hemodialysis [56,57]. The risk of ZIKV infection among kidney recipients should also be considered if the donors are either residing in or returning from endemic regions, because the virus may be shed in the urine of the infected person for more than 30 days [31,32,58]. Due to occasional detection of viral RNA in saliva samples and nasopharyngeal swab, it is still unknown that ZIKV could be spread through respiratory droplets [52,59].…”

“…In fact, ZIKV may stay in the urine and remain positive for a longer duration than in the serum [51,58]. Several studies have reported the detection of ZIKV RNA in urine more than 10 days after disease onset [20,31,95,96]. Still at this point, there is no validated data that suggests the replacement of blood with urine as a sample specimen [20,31,96].…”

“…Several studies have reported the detection of ZIKV RNA in urine more than 10 days after disease onset [20,31,95,96]. Still at this point, there is no validated data that suggests the replacement of blood with urine as a sample specimen [20,31,96]. A study has reported the time of stay of ZIKV in the semen of infected men for more than 3 weeks [51], while another study has reported ZIKV RNA in the semen for up to 62 days [97].…”