Abstract
Fever in a returning traveller is a common clinical scenario for physicians in primary and acute care. Differential diagnoses for these patients are generated based on presenting clinical symptoms, travel destinations, potential exposure activities as well as the incubation period of common etiologic agents. In a case of fever and rash in a woman returning to Canada from El Salvador in November 2015, measles, dengue and chikungunya viral infections were queried as possible causes. Subsequent molecular testing using amplification of conserved regions of the flavivirus genome from nasopharyngeal and urine samples was positive, suggesting an active flavivirus infection. Sequencing was significant for the identification of Zika virus, a flavivirus that has only recently become endemic to Brazil and is now emerging throughout Central America. Zika virus should now be included in the differential diagnosis for travelers returning from Central and South America with a febrile illness and rash. To our knowledge this is the first reported case of Zika virus in Canada related to the most recent outbreak in Central America, South America and the Caribbean.
Highlights
Zika virus is an emerging arthropod-borne member of the flavivirus genus that is closely related to other medically significant viruses including dengue, Japanese encephalitis virus, West Nile virus and yellow fever virus [1]
Cases of Zika virus infection were first identified in the Americas in Brazil in 2014, and autochthonous transmission has been seen in northeastern regions of that country [14,15]
The history of a centripetal rash raised the possibility of measles, but both a nasopharyngeal swab (NPS) and a urine sample collected for measles PCR were negative
Summary
Zika virus is an emerging arthropod-borne member of the flavivirus genus that is closely related to other medically significant viruses including dengue, Japanese encephalitis virus, West Nile virus and yellow fever virus [1]. The primary purpose of her recent 14-day trip was to visit friends and relatives She did not seek pre-travel medical advice, and her vaccination status was unclear. A 52-year-old woman whose past medical history was significant for Parkinson’s disease presented to the emergency department with fever and a new rash after recent travel to El Salvador. The patient was immune through vaccination for hepatitis B Despite her age, the history of a centripetal rash raised the possibility of measles, but both a nasopharyngeal swab (NPS) and a urine sample collected for measles PCR were negative. Our patient was IgG positive and IgM negative, which is compatible with a history of previous flavivirus infection. Two weeks after first presentation, was positive for both IgM and IgG
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