doi: http://dx.doi.org/10.5195/ijms.2016.198
Volume 4, Number 3: 132-133
Received 17 09 2016: Accepted 14 11 2016
To the Editor,
The Zika virus (ZIKV) was identified for the first time in 1947, almost 70 years ago. Despite being known during all these decades, it has been neglected until the current outbreak in Brazil. This an emergent disease that has been developing slowly throughout these years; we still have limited information and scientific knowledge about this illness and its potential outcomes.1
This infection causes fairly mild effects, as 80% of the patients go unnoticed.2 The most common symptoms are fever, rash, joint pain, and conjunctivitis, which last for several days to a week after the infection.3 The primary mode of transmission is through the bite of an infected mosquito of the Aedes species. Apart from mosquitoes, other non-vector means of transmission are sexual intercourse and during pregnancy. Furthermore, there is a strong possibility that ZIKV can be spread through blood transfusions. It is suggested that breastfeeding could be another way of transmission, due to the fact that it has been found in breast milk. However, there are no reports up to date about other means of transmission. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas where ZIKV is found (Available from: http://www.cdc.gov/zika/about/overview.html; cited 2016 Jul 28).
Since ZIKV can cross the blood brain barrier,4 a relationship with some severe congenital neurologic defects, such as microcephaly and Guillian-Barré syndrome, has been established. Mlakar et al described that the cases of microcephaly increased by a factor of 20 among newborns in the northeast of Brazil.4,5 Many other authors also describe severe brain injuries, inflammatory signs and calcifications, leading them to think that it is likely that an intrauterine infection brings about the abnormal brain development, and can lead to cerebral palsy after birth.123 It is also suggested that the low maternal supplementation of nutrients may affect other organs as well,6 although this is yet to be determined.
The World Health Organization declared ZIKV a ‘Public Health Emergency of International Concern”;7 as it threatens to become a global pandemic. Up to date, there is no cure or vaccine available (Available from: http://www.cdc.gov/zika/about/overview.html; cited 2016 Jul 28). There are different methods for diagnosing ZIKV. One of them is the real-time reverse transcription-polymerase chain reaction (rRT-PCR), which must only be conducted on urine or serum samples collected during the first 14 days after symptoms onset. This test has a high sensitivity and a poor specificity. If the rRT-PCR is negative in a high risk patient, the ELISA for qualitative detection of IgM (Zika MAC-ELISA) is used.8 However, a cross-reaction with other flaviviruses is present, as such the test has poor specificity in people living in endemic areas that have been previously exposed to the dengue and yellow fever viruses.6789 Therefore, results may be difficult to interpret in Latin America.
System-wide barriers impede health care delivery in our region. Latin American health providers have the obligation to generate awareness amongst our people about ZIKV. The need for a stronger surveillance system, suitable diagnostics methods, communication about ZIKV outbreak risks, vector control and adequate guidance to pregnant women is necessary.3
The authors would like to express their gratitude to everyone who supported them throughout their undergraduate education, especially Instituto de Medicina Tropical Alexander von Humboldt, which provided them with the knowledge and guidance to write this manuscript.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
Conceptualization, Data collection, Writing, Critical revision of the manuscript: JY, MB. Approval of the final version: JY.
1. Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DD, Cavalcanti DP, Pessoa A, et al. Possible association between zika virus infection and microcephaly – Brazil 2015. MMWR Morb Mortal Wkly Rep. 2016 Jan;65(3):59–62.
2. Petersen E, Wilson ME, Touch S, McCloskey B, Mwaba P, Bates M, et al. Rapid spread of Zika virus in the Americas – implication for public health preparedness for mass gatherings at the 2016 Brazil Olympic Games. Int J Infect Dis. 2016 Mar;44:11–5.
3. Heymann DL, Hodgson A, Sall AA, Freedman DO, Staples JE, Althabe F, et al. Zika virus and microcephaly: why is this situation a PHEIC? Lancet. 2016 Feb 20;387(10020):719–21.
4. Tetro JA. Zika and microcephaly: causation, correlation, or coincidence? Microbes Infect. 2016 Mar;18(3):167–8.
5. Mlakar J, Korva M, Tul N, Popovic M, Poljsak-Prijatelj M, Mraz J, et al. Zika virus associated with microcephaly. N Engl J Med. 2016 Mar 10;374(10):951–8.
6. World Health Organization. WHO statement on the first meeting of the International Health Regulations. Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations; 2016.
7. Vogel G. Evidence grows for Zika virus as pregnancy danger. Science. 2016 Mar 11;351(6278):1123–4.
8. Lazear HM, Stringer EM, de Silva AM. The emerging Zika virus epidemic in the Americas: research priorities. JAMA. 2016 May 10;315(18):1945–6.
9. Narayaran R. Zika virus therapeutics: drug targets and repurposing medicine from the human genome. MOJ Proteomics Bioinform. 2016;3(3):00084.
Joselyn Ye, 1 Faculty of Medicine, Cayetano Heredia University, Lima, Peru.
Marcelo Bedoya, 1 Faculty of Medicine, Cayetano Heredia University, Lima, Peru.
About the Author: Joselyn Ye is currently a fifth-year medical student at Cayetano Heredia University, Lima, Peru of a seven-year program.
Correspondence Joselyn Ye. Address: Facultad de Medicina Alberto Hurtado. Universidad Peruana Cayetano Heredia, Lima, Perú. Email: joselyn.ye.t@upch.pe
Cite as: Kakisaka Y, Fujikawa M, Gaillard S. Structured didactic education program for writing case reports can motivate medical students. Int J Med Students. 2016 Sep-Dec;4(3):131-2.
Copyright © 2016 Joselyn Ye, Marcelo Bedoya
International Journal of Medical Students, VOLUME 4, NUMBER 3, December 2016