Zika Virus Infection Presenting with Postauricular Lymphadenopathy

Thomas Weitzel Programa Medicina del Viajero, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Laboratorio Clínico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.

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Claudia P. Cortes Departamento de Infectología, Clínica Santa María, Santiago, Chile.
Departamento de Medicina, Escuela de Medicina, Universidad de Chile, Santiago, Chile.

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A 28-year-old, otherwise healthy Chilean man presented in December 2015 with fever, headache, and myalgia. He had returned, 2 days ago, from a tourist trip to Colombia, where he had visited Bogota and the northern region including Cartagena de Indias, Santa Marta, and Tayrona National Park. During his return, he suffered nonspecific symptoms including sore throat, anorexia, and myalgia. A day later, he noted high grade fever and tender nodules behind his ears (Figure 1). Physical examination revealed fever (39.0°C), a maculopapular rash of the trunk and extremities (Figure 2), mild conjunctivitis, and a generalized lymphadenopathy with palpable tender axillary, cervical, and bilateral postauricular lymph nodes. After dengue and chikungunya virus infections were excluded by molecular methods, antigen detection, and IgM antibody testing, samples were sent to the national reference laboratory (Instituto de Salud Pública de Chile, Santiago, Chile), where Zika virus (ZIKV) nucleic acids were detected by real-time reverse transcription polymerase chain reaction (RT-PCR) as previously described.1 The sample was also positive using a commercial RT-PCR assay for the detection of ZIKV (Zika Virus genesig® Advanced Kit; Primerdesign Ltd., Southampton, United Kingdom) in the clinical laboratory, Clínica Alemana, Santiago. The patient recovered rapidly and without complications.

Figure 1.
Figure 1.

Bilateral tender postauricular lymphadenopathy in patient with Zika virus infection.

Citation: The American Society of Tropical Medicine and Hygiene 95, 2; 10.4269/ajtmh.16-0096

Figure 2.
Figure 2.

Maculopapular rash on the patient's arm.

Citation: The American Society of Tropical Medicine and Hygiene 95, 2; 10.4269/ajtmh.16-0096

Since 2015, ZIKV is rapidly emerging within the Americas, where it is disseminated by mosquitos of the Aedes genus. However, the virus is also transmitted by blood transfusion and, as recently suggested, by contact with infectious semen.2,3 Because of its possible association with fetal malformations and neurological complications, this epidemic has been declared a global public health emergency by the World Health Organization. The clinical presentation of the infection is similar to dengue including fever, rash, joint pain, conjunctivitis, myalgia, headache, and vomiting.46 Although lymphadenopathy has recently been described in patients with ZIKV infection in Brazil,7,8 it is usually not listed as a typical manifestation. Our case confirms that ZIKV might cause systemic lymphadenopathy including the posterior auricular lymph nodes. Because tender bilateral postauricular lymphadenopathy is a known clinical sign of postnatal rubella, it might mislead ZIKV diagnosis especially in pediatric patients.

  • 1.

    Tognarelli J, Ulloa S, Villagra E, Lagos J, Aguayo C, Fasce R, Parra B, Mora J, Becerra N, Lagos N, Vera L, Olivares B, Vilches M, Fernández J, 2015. A report on the outbreak of Zika virus on Easter Island, South Pacific, 2014. Arch Virol [Epub ahead of print].

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  • 2.

    Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM, 2015. Potential sexual transmission of Zika virus. Emerg Infect Dis 21: 359361.

  • 3.

    Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, Shan Yan A, Cao-Lormeau VM, Broult J, 2014. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 19: 20761.

    • Search Google Scholar
    • Export Citation
  • 4.

    Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick M, Marfel M, Holzbauer S, Dubray C, Guillaumot L, Griggs A, Bel M, Lambert AJ, Laven J, Kosoy O, Panella A, Biggerstaff BJ, Fischer M, Hayes EB, 2009. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 360: 25362543.

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    • Export Citation
  • 5.

    Pan American Health Organization, World Health Organization, 2015. Epidemiological Alert: Zika Virus Infection, 7 May 2015. Available at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=30075&lang=en. Accessed February 4, 2016.

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    • Export Citation
  • 6.

    European Centre for Disease Prevention and Control, 2016. Factsheet for Health Professionals. Available at: http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx. Accessed February 4, 2016.

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    • Export Citation
  • 7.

    Zanluca C, de Melo VC, Mosimann AL, Dos Santos GI, Dos Santos CN, Luz K, 2015. First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz 110: 569572.

    • Search Google Scholar
    • Export Citation
  • 8.

    Marcondes CB, Ximenes MF, 2015. Zika virus in Brazil and the danger of infestation by Aedes (Stegomyia) mosquitoes. Rev Soc Bras Med Trop [Epub ahead of print].

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Author Notes

* Address correspondence to Thomas Weitzel, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Vitacura 5951, Santiago, Chile. E-mail: thomas.weitzel@gmail.com

Authors' addresses: Thomas Weitzel, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile, E-mail: thomas.weitzel@gmail.com. Claudia P. Cortes, Departamento de Medicina, Escuela de Medicina, Universidad de Chile, Santiago, Chile, E-mail: cpcortesm@med.uchile.cl.

  • Figure 1.

    Bilateral tender postauricular lymphadenopathy in patient with Zika virus infection.

  • Figure 2.

    Maculopapular rash on the patient's arm.

  • 1.

    Tognarelli J, Ulloa S, Villagra E, Lagos J, Aguayo C, Fasce R, Parra B, Mora J, Becerra N, Lagos N, Vera L, Olivares B, Vilches M, Fernández J, 2015. A report on the outbreak of Zika virus on Easter Island, South Pacific, 2014. Arch Virol [Epub ahead of print].

    • Search Google Scholar
    • Export Citation
  • 2.

    Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM, 2015. Potential sexual transmission of Zika virus. Emerg Infect Dis 21: 359361.

  • 3.

    Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, Shan Yan A, Cao-Lormeau VM, Broult J, 2014. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 19: 20761.

    • Search Google Scholar
    • Export Citation
  • 4.

    Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick M, Marfel M, Holzbauer S, Dubray C, Guillaumot L, Griggs A, Bel M, Lambert AJ, Laven J, Kosoy O, Panella A, Biggerstaff BJ, Fischer M, Hayes EB, 2009. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 360: 25362543.

    • Search Google Scholar
    • Export Citation
  • 5.

    Pan American Health Organization, World Health Organization, 2015. Epidemiological Alert: Zika Virus Infection, 7 May 2015. Available at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=30075&lang=en. Accessed February 4, 2016.

    • Search Google Scholar
    • Export Citation
  • 6.

    European Centre for Disease Prevention and Control, 2016. Factsheet for Health Professionals. Available at: http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx. Accessed February 4, 2016.

    • Search Google Scholar
    • Export Citation
  • 7.

    Zanluca C, de Melo VC, Mosimann AL, Dos Santos GI, Dos Santos CN, Luz K, 2015. First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz 110: 569572.

    • Search Google Scholar
    • Export Citation
  • 8.

    Marcondes CB, Ximenes MF, 2015. Zika virus in Brazil and the danger of infestation by Aedes (Stegomyia) mosquitoes. Rev Soc Bras Med Trop [Epub ahead of print].

    • Search Google Scholar
    • Export Citation
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