Journal of Practical & Professional Nursing Category: Clinical Type: Case Report
Zika Virus Disease Detection - A Case Report
- Vicki L Chandler1*, Laura T Reed2, Tracy M Collins3
- 1 Nursing, Health Promotion & Disease Prevention Department, College Of Nursing, University Of Tennessee Health Science Center, Memphis, United States
- 2 Nursing, Health Promotion & Disease Prevention Department, College Of Nursing, University Of Tennessee Health Science Center, Memphis, USA, United States
- 3 Department Of Nursing, Loewenberg College Of Nursing, University Of Memphis, Memphis, United States
*Corresponding Author:Vicki L Chandler
Nursing, Health Promotion & Disease Prevention Department, College Of Nursing, University Of Tennessee Health Science Center, Memphis, United States
Received Date: Aug 21, 2017 Accepted Date: Sep 26, 2017 Published Date: Oct 12, 2017
Physical examination revealed normal vital signs (weight 292 pounds, height 74 inches, body mass index 37.5, blood pressure 120/81 mmHg, pulse 74, respirations 16, temperature 98.6), an enlarged, slightly tender right parotid node, a red, confluent maculopapular rash behind the ears radiating to the neck, shoulders, upper chest and upper back. Conjunctiva was unaffected. Heart and lung sounds were normal. Abdominal and testicular exam were normal. The only abnormality on the Complete Blood Count (CBC) was a slightly decreased white blood cell count (3.7). Complete Metabolic Profile (CMP) was unremarkable (Table 1).
|Symptoms||Body aches, sweats, headache, swollen lymph node in neck below ear, non-pruritic rash, loose stools|
|Labs||White blood cell count 3.7 (slightly decreased)|
|Complete metabolic profile unremarkable|
|Physical findings||Red, confluent, maculopapular rash on neck, shoulders, upper chest, upper back|
|Single enlarged, slightly tender parotid lymph node on right|
|Remainder of exam normal, including conjunctiva|
HISTORY OF ZIKA VIRUS
Diagnosing ZIKV can be challenging because false positive tests can occur, and serologic testing fails to determine when the infection actually occurred . Due to his recent travel to Guatemala and suspecting the patient may have ZIKV, the lab provider was contacted, who recommended obtaining ZIKV RNA QL real time RT PCR, which is only for use under the FDA’s emergency use authorization. It identifies Zika viral RNA, and is usually detectable in serum during the acute phase of infection. The patient had a positive result which indicated current infection. Labs are required to report all positive results to public health authorities. The epidemiologist from the local county health department contacted the clinic and provided a Zika Virus Laboratory Testing Decision Tree for use with future patients suspected of having ZIKV (Figure 1).
Negative test results do not rule out ZIKV and should not be used as the sole basis for patient management decisions. Clinical examination, patient history and epidemiological information should also be taken into consideration when caring for a patient suspected of having ZIKV.
Dengue fever antibody (IgM) and Chikungunya antibody (IgM) were also obtained because of the patient’s symptoms and recent travel to Guatemala. Dengue fever is transmitted to humans by a mosquito bite and can cause a high fever, headache, pain behind the eyes, joint pain, muscle and/or bone pain, rash, mild bleeding of the nose or gums, petechiae, easy bruising and a low white count . It can be found in the Indian subcontinent, Southeast Asia, Southern China Taiwan, the Pacific Islands, the Caribbean (except Cuba and the Cayman Islands), Mexico, Africa, and Central and parts of South America . Chikungunya is also a mosquito-borne alphavirus associated with large outbreaks in Asia, Africa and the Caribbean . Local transmission in the United States has been documented. Symptoms include severe arthritis pain, fever, rash and headache . Both the Dengue and Chikungunya antibody titers were negative.
Avoidance to areas where ZIKV has been detected is ideal especially for women of childbearing age, but not always realistic. If travel to ZIKV prone areas is necessary, a mosquito repellant with 20-30% concentration of DEET should be used. Light colored long sleeved clothing and long pants can help prevent mosquito bites. Also, stagnant water removal and rinsing out the container to rid mosquito eggs is recommended. In June 2016 the Food and Drug Administration (FDA) approved 2 newly developed vaccines for ZIKV phase 1 trials in human subjects . The FDA predicts it will take approximately 2-3 years for vaccines to finish clinical trials and be available to be given to women of childbearing age . Researchers predict there may not be enough cases of ZIKV to test the vaccine’s effectiveness by the time the vaccine is available . Some researchers believe the current ZIKV epidemic will be over in the next 1-3 years . A live-attenuated vaccine (10-del ZIKV) is currently being evaluated. A single injection of 10-del ZIKV produced immunity in mice and prevented viremia when challenged with ZIKV . Medications may soon be available to treat active ZIKV. Sofosbuvir, which is used to treat Hepatitis C virus, was discovered to decrease ZIKV levels in infected mice and prevented neuro-motor impairment by inhibiting ZIKV . Ribavirin, another drug used for Hepatitis C, has been found to inhibit ZIKV replication and induce ZIKV cell death in infected mice . In August 2016 the FDA produced a publication for agencies that collect blood in areas with local transmission of the ZIKV by mosquitos stating that the ZIKV was a relevant transfusion-transmitted infection . Specific recommendations such as testing blood donations and screening potential donors for specific ZIKV risk factors were provided to decrease the risk of transmitting the ZIKV via transfusions . For those patients, who developed symptoms of ZIKV, the virus can be spread 3-12 days before symptoms develop . ZIKV can be detected in whole blood up to 58 days after symptoms have begun .
Healthcare providers should educate their patients regarding tips to avoid ZIKV. This includes avoidance of areas where mosquito-borne transmission occurs, using insect repellent with at least 20-30% concentration of DEET, wearing long sleeved shirts and long pants, and emptying any containers with standing water. Healthcare providers should also educate their patients regarding the signs and symptoms of ZIKV, which include acute onset of fever, a maculopapular rash, arthralgias, and/or purulent conjunctivitis, and to seek medical attention immediately if symptoms develop and have positive risk factors for contracting the ZIKV . Pregnant patients and women of childbearing age should be educated to avoid travel to affected areas due to the risk of fetal loss, microcephaly, vision or hearing complications or other serious abnormalities of the brain. Also, all patients who are pregnant should be questioned regarding the potential of having been exposed to ZIKV, such as travelling to an area known to have ZIKV or having sex without a condom. Pregnant women with symptoms and possible exposure should be tested for ZIKV . Testing is no longer routinely recommended to pregnant women without ZIKV symptoms who have had a recent ZIKV exposure, but is recommended to pregnant women who have ongoing ZIKV exposure . Patients who have travelled to or live in an area with ZIKV transmission or who have had unprotected sex with an individual who visited those areas or has ZIKV should be tested for ZIKV.
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Citation:Chandler VL, Reed LT, Collins TM (2017) Zika Virus Disease Detection - A Case Report. J Pract Prof Nurs 1: 001.
Copyright: © 2017 Vicki L Chandler, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.