Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics

Abstract

Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.

Zika virus infection in the genital tract of non-pregnant females: a systematic review

“…The majority of the studies evaluated ZIKV shedding in FGT of non-pregnant women using lower genital tract samples (LGT) 21,25,[35][36][37][44][45][46][47][48] . Very few samples from the upper genital tract (UGT) have been studied 42,49 (Table 1).…”

“…Subsequently, some studies have reported the presence and persistence of ZIKV RNA in the vaginal and/or cervical samples of non-pregnant women 21,25,36,37,[44][45][46][47][48] . In these studies, the authors reported data on the symptoms, and the variability on the period of viral RNA detection and persistence in vaginal and/or cervical samples.…”

“…Finally, the study of Tozetto-Mendoza et al 48 evaluated symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil. Patients were investigated regarding their clinical characteristics, viral shedding in body fluids and serodynamics.…”

Zika Virus Pathogenesis: From Early Case Reports to Epidemics

“…In recent outbreaks, ZIKV has been detected in a wide variety of bodily fluids, including blood, urine, CSF, saliva, semen, vaginal secretions, cervical mucus, and breast milk (Figure 1) [9,21,29,31,33,34,35]. Sexual transmission has been documented for ZIKV [36,37], however there is currently no evidence to suggest that transmission via blood transfusion, saliva, or breastfeeding may occur.…”

“…Other birth defects linked to ZIKV infection include patent foramen ovale (failure of a natural hole between the left and right atria of the heart to close before birth), clubfoot, cryptorchidism (failure of the testes to descend into the scrotum), ophthalmologic problems, hearing abnormalities, and difficulty swallowing [16,50,51,52]. In some cases, fetal death following maternal ZIKV infection has also been reported [33,53]. Thus, ZIKV infection, particularly early during pregnancy, can have devastating impacts on the infant, with the potential for life-long implications for both infants and their families.…”