Via Emerging Infectious Diseases: Ahead of Print -Febrile or Exanthematous Illness Associated with Zika, Dengue, and Chikungunya Viruses, Panama. Excerpt:
The earliest clinical cases of Zika virus infection were reported from continental South America in 2015, after which the virus spread rapidly through the Americas. Here we describe an investigation of febrile or exanthematous illnesses for possible association with Zika, dengue, or chikungunya virus; these illnesses occurred in the Guna Yala region of eastern Panama, which borders northern Colombia.
We collected and analyzed a convenience sample of 276 serum samples and 26 paired urine samples from 276 patients who sought care at clinics in Guna Yala during November 27, 2015–January 22, 2016, for reported fever or rash of <5 days’ duration in addition to 1 of the following: headache, malaise, arthralgia, myalgia, or conjunctivitis. We also collected data on clinical signs and symptoms, date of illness onset, age, sex, residence, and self-reported status of pregnancy.
At first, we performed real-time reverse transcription PCR (rRT-PCR) tests specific for dengue and chikungunya viruses. However, because all the samples received during the week of November 27 were negative for those viruses and Zika virus was being reported in Colombia as of October 2015, we also tested the samples with a flavivirus-specific rRT-PCR (5), followed by amplicon sequencing; or with an rRT-PCR specific for Zika virus.
Of the 276 patients whose samples were tested, 164 (60%) were female. A total of 22 (8%) samples were positive for dengue; 2 were positive for chikungunya. Of the remaining 252 patients, 50 (20%) had >1 sample that tested positive for Zika virus (50/252 serum samples, 4/26 paired urine samples). Of these 50 patients, 30 (60%) were female. Most of these patients reported illness onset during December 9–27, 2015 (Technical Appendix[PDF - 241 KB - 3 pages] Figure 1). Zika virus infection affected all age groups (median age 35 y, range 0.1–80 y).
The most commonly reported signs and symptoms were fever (86%), exanthema (72%), and headache (62%). The clinical characteristics of these infections showed no statistically significant difference with those associated with dengue and chikungunya virus infections and with cases found to be negative for all 3 viruses, suggesting that the negative cases could represent Zika virus infections (Technical Appendix[PDF - 241 KB - 3 pages] Table).
One of the patients with confirmed Zika virus infection reported being in her second trimester of pregnancy; she underwent a fetal ultrasound at 36 weeks’ gestation, which was interpreted as normal, and the infant was found to have no neurologic defects at birth.