Chapter 2 - Clinical neurological spectrum of adult and congenital ZIKV infection: An overview of virology, pathogenesis, and management

Abstract

Zika virus was first discovered in the Zika Forest of Uganda in 1947 and was until recently believed to be an infection of mild clinical significance. Infection with Zika virus presents with mild clinical symptoms including fever, headache, rash, conjunctivitis, arthralgia, and myalgia—only a small proportion of laboratory-confirmed infections manifested clinically detectable features. In 2016 the World Health Organization declared Zika virus infection and its associated congenital malformations and neurological disorders as a Public Health Emergency of International Concern, following a large-scale outbreak of microcephaly in Brazil. Molecularly confirmed or serologically confirmed acute Zika virus infection was associated with an increased incidence of a spectrum of significant neurological manifestations including Guillain-Barré syndrome, encephalitis, and transverse myelitis. Zika virus infection during the perinatal period results in congenital Zika syndrome, a condition characterized by microcephaly, reduced head circumference, and significant craniofacial disproportion. Although Zika virus is no longer a Public Health Emergency of International Concern, Zika virus screening during pregnancy in endemic regions remains relevant and necessary, due to the severe long-term sequelae and cost to the healthcare systems involved.