As Mosquito Season Ends, Florida Physicians Call for Continued Zika Surveillance
A team of dermatologists and gynecologists recently described their work with a 23-year-old pregnant woman in Florida who was eventually confirmed as the first documented case of Zika virus infection acquired via a mosquito bite sustained in the local area.
*Updated at 5:11 PM EST
When it comes to the Zika virus, physicians in Florida are hoping that others will learn from their experience, especially their colleagues working in states that are most susceptible to locally transmitted cases.
In a research letter published online on January 11, 2017, by The New England Journal of Medicine, a team of dermatologists and gynecologists at the University of Miami Health System described their work with a 23-year-old pregnant woman who was eventually confirmed as the first documented case of Zika virus infection acquired via a mosquito bite sustained in the local area. The woman presented to their clinic in July and was 10 weeks pregnant at the time; she and her partner had not traveled outside of the United States for more than 2 years.
“The most important population of Zika patients to capture are our pregnant patients,” letter co-author Lucy Chen, MD, a dermatology resident at University of Miami/Jackson Memorial Hospital told Contagion
. “Especially in an urban population, it is easy for these patients to not show up for return visits, or not understand the implications of the infection. At our tertiary care health center, we have a multidisciplinary Zika response team including obstetricians, pediatricians, infectious disease specialists, social workers, and laboratory colleagues, who [all] have a standard protocol for how to follow these patients through their pregnancy and beyond.”
Although the Zika virus outbreak that affected several areas in Miami during the late summer and early fall of 2016 has been largely contained, the state of Florida has more than 1,000 confirmed cases of infection, 257 of which were locally acquired. In December, locally transmitted cases were confirmed in Brownsville, Texas; to date, 6 cases have been confirmed there, and Texas and Florida remain the only states with locally transmitted cases, according to the Centers for Disease Control and Prevention.
In the research letter, Dr. Chen and colleagues note that their patient presented with a 3-day history of “fever, widespread pruritic rash, and sore throat.” She later developed myalgia and joint pain. Notably, upon physical examination, the physicians identified “erythematous follicular macules and papules on the trunk and arms, scattered tender pink papules on the palms, and a few petechiae on the hard palate.” A histopathological exam of the lesions revealed “mild perivascular lymphocytic infiltration in the upper dermis, admixed with some neutrophils.”
Presence of Zika virus RNA in the patient’s urine and blood was confirmed via RT-PCR (and persisted for 2 weeks in urine and 6 weeks in blood), and ultrasonography showed the fetus to be healthy. The patient’s fever and rash subsided following 3 days of supportive care.
The baby was delivered, vaginally, at full term, and neonatal ultrasonography and MRI showed a normal head size and intracranial anatomy, with no calcifications. RT-PCR of placental tissue was negative for Zika.
While the patient in this case, and her baby, did not experience the complications (such as microcephaly) that have been linked with the mosquito-borne virus, Dr. Chen and her colleagues recommend practitioners “be aware of the constellation of symptoms,” most notably rash.
“Many patients who experience a rash do not seek care from a provider,” she said. “Though there are no identifying features to distinguish the Zika rash from other viral rashes, this case study was an opportunity to get an up-close look at what the rash may look like. Medical providers should… know when it is appropriate to test patients [if] there is a concern for the Zika virus infection, and refer them to the right specialists.”
Although the spread of the disease has slowed with the end of the mosquito season in much of the United States, a new commentary published on January 12, 2017 in the Journal of the American Medical Association, written by Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Disease, part of the National Institutes of Health, and his colleague Catharine I. Paules, MD, calls for continued research efforts and funding for Zika response efforts, as the virus becomes endemic in the Americas.
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.
Editor's Note: This article originally stated that the aforementioned study and subsequent commentary were published in 2016. The dates have been updated to read 2017.