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Clinical and Epidemiological Features of Acute Zika Virus Infections in León, Nicaragua

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  • 1 Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
  • | 2 Department of Microbiology and Parasitology, Universidad Nacional Autónoma de Nicaragua-León, Nicaragua;
  • | 3 The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Emory University School of Medicine, Decatur, Georgia;
  • | 4 Division of Molecular Medicine and Virology, Department of Clinical and Biomedical Sciences, Linköping University, Linköping, Sweden;
  • | 5 Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
  • | 6 Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
  • | 7 School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
  • | 8 College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri;
  • | 9 Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
  • | 10 Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

ABSTRACT.

The American Zika virus (ZIKV) epidemic has highlighted the need to gain a better understanding of this emerging virus. The goal of this study was to describe the clinical symptoms, laboratory findings, and risk factors for symptomatic ZIKV infection in an area with ongoing transmission of other arboviral infections. We recruited patients at least 2 years of age seeking care at public health centers in León, Nicaragua, between January 2016 and August 2017, for fever, maculopapular rash, and/or nonsuppurative conjunctivitis with a duration of less than 1 week. A laboratory diagnosis of ZIKV was established using a combination of molecular and serological tests. Clinical and laboratory findings and potential risk factors were compared between participants with and without acute ZIKV infection. Fifty-eight (26%) of the 225 participants included in the analysis were found to have acute ZIKV infection. Pregnancy and reports of previous arboviral infection were associated with a higher risk of ZIKV infection. Rash, conjunctivitis, sore throat, and lower absolute neutrophil counts were associated with acute ZIKV infection. The clinical characteristics and risk factors identified were consistent with those identified by previous studies; however, we found sore throat to be a feature of ZIKV infection. We also found that neutrophil counts were lower in ZIKV-infected subjects. These clinical symptoms and laboratory data may help clinicians suspect ZIKV infection during future outbreaks.

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Author Notes

Address correspondence to Natalie M. Bowman, Division of Infectious Diseases, University of North Carolina at Chapel Hill, CB#7030 Bioinformatics Building, 2nd Floor, 130 Mason Farm Road, Chapel Hill, NC 27599-7030. E-mail: natalie_bowman@med.unc.edu

Financial support: This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (5R21AI129532) and the University of North Carolina School of Medicine Emerging Challenges in Biomedical Research Grant (ECBR_001). NB was supported by K23AI113197. SBD is supported by K24AI141744. YR is supported by an international research capacity-building award from the NIH-Fogarty International Center (D43TW010923). RR is supported by the University of North Carolina School of Medicine Medical Scientist Training Program and T32 GM008719. FB was supported by UJMT Fogarty Global Health Fellowship Program (4R25TW009340-05). Guei-Jiun Alice Liou contributed to this work while at the University of North Carolina at Chapel Hill.

Authors’ addresses: Natalie M. Bowman, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: natalie_bowman@med.unc.edu. Filemón Bucardo, Yaoska Reyes, and Edwing Centeno Cuadra, Department of Microbiology and Parasitology, Universidad Nacional Autónoma de Nicaragua-León, Nicaragua, E-mails: fili_bucardo@hotmail.com, yaobel@hotmail.es, and eduing42@hotmail.com. Matthew H. Collins, Division of Infectious Diseases, Emory University, Emory, GA, E-mail: matthew.collins@emory.edu. Bryan Blett, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: blette@live.unc.edu. Premkumar Lakshmanane, Guei-Jiun Alice Liou, and Aravinda M. de Silva, Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mails: prem@med.unc.edu, gliouuncch@gmail.com, and aravinda_desilva@med.unc.edu. Enrique Paulo Guerra and Rebecca Rubinstein, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mails: quique@live.unc.edu and rebecca_rubinstein@med.unc.edu. Sylvia Becker-Dreps, Department of Family Medicine and Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, E-mail: sbd@unc.edu.

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