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Doctors in Miami detail first case of locally acquired Zika in US
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The first patient to acquire Zika virus from a mosquito in the United States was a pregnant woman in Florida who sought treatment for a rash and other symptoms and eventually gave birth to a healthy full-term baby, according to doctors who treated her.
In a case report published in The New England Journal of Medicine, doctors from the University of Miami said the woman, aged 23 years, was more than 23 weeks into her pregnancy and had not yet initiated routine prenatal care when she presented on July 7, 2016 with a 3-day history of widespread pruritic rash, fever and sore throat, followed 2 days later by myalgia and joint pain. Health officials in Miami-Dade County confirmed that it was the first case of Zika in the U.S. that was not related to travel, according to Lucy Chen, MD, dermatology resident in the University of Miami Miller School of Medicine and Jackson Memorial Hospital. The patient and her partner reported not traveling outside the country in the past 2 years.
According to Chen, who was asked to consult on the case after the patient sought care in an obstetrics urgent care area of the hospital, there was nothing unusual about the woman’s rash. It indicated she had a viral infection, but not necessarily Zika. (Chen and colleagues describe the rash in detail in their case report, and pictures of it accompany this article.)
“Putting together her story of having a fever, joint pain and a sore throat, there’s a few viral infections that you would be worried about, especially due to the threat of something bad happening to the infant. There was nothing about the rash that said, ‘This is definitely Zika,’” Chen told Infectious Disease News. “The aim of this report is to demonstrate that Zika patients can get a rash and to show what it looks like.”
Last summer Florida became the first state in the continental U.S. to see Zika cases not related to travel as several locations in and around Miami were designated active transmission zones — areas where infected mosquitoes were biting people. On Dec. 9, the CDC declared Miami-Dade County free of local Zika transmission after more than 45 days without a new case, although the Florida Department of Health has continued to report new cases, including one on Jan. 12.
The state has seen hundreds of local cases since last summer, with some patients being treated by the University of Miami’s Zika response team, which includes obstetricians, infectious disease specialists, pediatricians, radiologists and dermatologists, Chen said.
Neither Chen nor a university spokeswoman could say how many Zika patients the response team has treated, one reason being that patients who are not pregnant are not necessarily tracked after they are seen.
“The multidisciplinary approach that we’ve adopted here with our Zika response team has been very valuable,” she said. “We’ve kind of worked out a good way in diagnosing and approaching these patients since a year ago when all of this started.”
The woman’s urine and serum samples tested positive for Zika virus RNA for 2 and 6 weeks, respectively, after the day she first sought care, Chen and colleagues said. Meanwhile, screenings for measles, varicella, rubella, syphilis, Epstein-Barr virus, influenza, hepatitis B and C viruses, mumps and dengue were unrevealing and tests for liver and renal function were normal.
Among Zika’s potential effects, microcephaly has been the chief concern. According to the case report, an ultrasound on the day the woman sought care for her symptoms showed an estimated fetal weight in the 53rd percentile, an estimated head circumference in the 63rd percentile, and normal intracranial anatomy. Analysis of placental tissue and neonatal laboratory testing were both negative for Zika.
The woman later gave birth vaginally to a full-term baby with a normal head size and intracranial anatomy, Chen and colleagues said. The baby’s current health is unknown.
“From the last report at delivery, the baby was healthy,” Chen said. “We don’t know the long-term consequences for babies with Zika-positive mothers.” – by Gerard Gallagher
Reference:
Chen L, et al. N Engl J Med. 2016;doi:10.1056/NEJMc1610614.
Disclosures: The researchers report no relevant financial disclosures.