Abstract
BackgroundThe magnitude of the current Zika virus (ZIKV) epidemic has led to a declaration of a Public Health Emergency of International Concern by the WHO. Findings of viable viral particles in semen for several weeks are corroborating reports of sexual transmission of ZIKV. Serious consequences of a positive diagnostic result particularly in the pregnant patient are calling for precise diagnostic tools also at later time points after infection. Currently, recommendations suggest a diagnostic period of direct viral detection of 5 to 7 days after onset of symptoms in serum or plasma, and up to 3 weeks in urine samples.Case presentationA vasectomized 41-year-old German returning from Martinique presented at the outpatient clinic of the Department for Infectious Diseases and Tropical Medicine, Munich, with subfebrile temperature, rash, malaise, severe retro-orbital pain and occipital lymphadenopathy. The main complaints resolved after ten days without specific treatment. We are reporting on clinical course and results of direct and indirect detection methods of ZIKV in different sample types including whole blood, ejaculate, urine, serum, plasma and saliva samples up to 119 days post symptom onset. Ejaculate samples remained PCR positive for ZIKV until day 77, whole blood samples until day 101.ConclusionsThe case presentation adds to the still limited knowledge of kinetics of detection of ZIKV by direct as well as indirect methods. Here, a complete data set including results from PCR, serology and cell culture is provided allowing an improved evaluation of optimum diagnostic periods for testing a variety of sample types. Moreover, a high viral load of ZIKV RNA was detected in ejaculate of the vasectomized patient. This finding sheds new light on the possible localizations of ZIKV replication in the human male reproductive tract.
Highlights
The magnitude of the current Zika virus (ZIKV) epidemic has led to a declaration of a Public Health Emergency of International Concern by the WHO
Serology Serological testing was conducted in all serum samples using commercially available immunofluorescence tests for the detection of IgG and IgM antibodies against ZIKV, dengue virus (DENV), chikungunya virus (CHIKV), Japanese encephalitis virus (JEV), tick-borne encephalitis virus (TBEV), West Nile virus (WNV) and yellow fever virus (YFV) (Euroimmun, Lübeck, Germany)
The ZIKV epidemic in Latin America is affecting German travellers returning from regions with circulating ZIKV infections
Summary
The ZIKV epidemic in Latin America is affecting German travellers returning from regions with circulating ZIKV infections. Based on the results of this study, whole blood seems to be the most promising candidate for late detection of viral particles in patients, especially, when IgM antibodies are no longer detectable Ejaculate is another option in male patients and allows late direct diagnosis, but is less suitable in routine diagnostics due to the restriction to male patients and the effort of specimen collection it should be mainly considered as diagnostic sample for certain clinical settings, such as fertility clinics or couples wishing to become pregnant that travel frequently to or are residing in endemic regions. The periods of recommended use of barrier protection, such as condoms, is currently set to six months after return from an endemic region These time frames are based on reports of observations of direct ZIKV detection in ejaculate, such as in this patient, rounded up by a safety time buffer [22, 23].
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