Woman Who Acquired Zika Locally in US Had Unusual Rash

By Marcia Frellick
WebMD Health News

January 12, 2017

A pregnant woman locally infected in the United States with the Zika virus presented with an unusual rash last year, according to a report published Wednesday in the New England Journal of Medicine.

Lucy Chen, MD, with the University of Miami Miller School of Medicine in Florida and colleagues, described the case.

On July 7, 2016, a 23-year-old woman who was 23 weeks and 3 days pregnant and had not yet sought prenatal care, presented with a 3-day fever, widespread itchy rash, and sore throat. Two days later, myalgias and joint pain developed.

The woman had reddish follicular macules and papules spread across her abdomen, back, and arms, "scattered tender pink papules on the palms, and a few petechiae on the hard palate," the authors write.

Screenings showed no signs of dengue, measles, chickenpox, rubella, syphilis, Epstein-Barr virus, influenza, hepatitis B or C, or mumps. Liver and kidney function were normal.

Zika RNA was detected in both urine and blood and continued to be detected for 2 weeks in urine samples and for 6 weeks in blood samples.

An ultrasound estimated fetal weight on the day the woman came in at 644 g (53rd percentile), with a head circumference of 221 mm (63rd percentile) and normal intracranial anatomy.

The woman's fever and rash subsided after 3 days of care.

The baby was delivered at full term at 6.6 pounds. Head size and intracranial anatomy were normal and there were no calcifications.

No signs of Zika were found in the placental tissue or in neonatal laboratory testing.

As of December 28, 2016, travel-associated cases of Zika in the US numbered more than 4500, with the highest number in states with high numbers of international travelers.

But in this case, neither the patient nor her partner had traveled outside the US in 2 years.

"Medical providers on the front line should be aware of the constellation of symptoms in patients reporting travel to endemic areas, including areas in southern Florida, where other non–travel-associated cases have been confirmed," the authors write.

Florida's Miami-Dade County Department of Health confirmed this was the first non–travel-associated case of Zika infection in the US, according to the report.

As of January 4, locally acquired mosquito-borne cases in the US numbered 216, according to the Centers for Disease Control and Prevention.

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SOURCE: Medscape, January 12, 2017. NEJM. Published online January 11, 2017

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