Gert van der Hoek
In Memoriam - Editor, Senior Moderator
Eurosurveillance, Volume 21, Issue 2, 14 January 2016
Rapid communication
ZIKA VIRUS INFECTION IN A TRAVELLER RETURNING FROM THE MALDIVES, JUNE 2015
Received:21 December 2015; Accepted:14 January 2016
We report a Zika virus (ZIKV) infection in a patient with fever and rash after returning to Finland from Maldives, June 2015. The patient had dengue virus (DENV) IgG and IgM antibodies but pan-flavivirus RT-PCR and subsequent sequencing showed presence of ZIKV RNA in urine. Recent association of ZIKV with microcephaly highlights the need for laboratory differentiation of ZIKV from DENV infection and the circulation of ZIKV in areas outside its currently known distribution range.
Case report
A 37-year-old Finnish man returned with his family from a half-a-year work-related stay in the Maldives (in Dhiffushi island, situated in North Mal? atoll as the capital Mal?) to Finland 16 June 2015, without any stopovers elsewhere. Two days later he became ill with flu-like prodrome, mild fever and rash in the face and trunk, as well as ocular pain and arthralgia; the symptoms alleviated after a few days. He contacted occupational health and due to suspicion of dengue, a serum sample was taken 24 June, and it was positive for dengue virus IgG (titer 1:1,280, in-house immunofluorescence assay (IFA) test) and IgM (1.9/ cut-off 1.0, Dengue Virus IgM Capture DxSelect ELISA, Focus Diagnostics, USA), but negative for dengue virus (DENV) non-structural (NS) 1 antigen (Dengue NS1 Ag Strip Bio-Rad, France). Along with the serum sample, a urine sample taken on 25 June, the following day, was received for flavivirus RNA detection using a real-time pan-flavivirus NS5 nested RT-PCR [1,2]. RNA from serum and urine samples was extracted using QIAamp Viral RNA Mini Kit (Qiagen).
From the urine (but not the serum) an amplification product was detected and subsequently sequenced (160bp excluding primers, available from the authors upon request). A BLAST search identified the sequence as Zika virus (ZIKV) identical to Asian lineage strains originating from Easter Island 2014 [3], French Polynesia 2013 (GenBank KJ776791), Brazil 2015 (GenBank KU321639) and Thailand 2013 [4] and in phylogenetic analyses the sequence clustered with these strains (Figure). A PCR contamination in the laboratory is further ruled out as no work with ZIKV has ever been conducted, or any positive samples analysed previously in the laboratory - or in the country as a whole.
Rapid communication
ZIKA VIRUS INFECTION IN A TRAVELLER RETURNING FROM THE MALDIVES, JUNE 2015
Received:21 December 2015; Accepted:14 January 2016
We report a Zika virus (ZIKV) infection in a patient with fever and rash after returning to Finland from Maldives, June 2015. The patient had dengue virus (DENV) IgG and IgM antibodies but pan-flavivirus RT-PCR and subsequent sequencing showed presence of ZIKV RNA in urine. Recent association of ZIKV with microcephaly highlights the need for laboratory differentiation of ZIKV from DENV infection and the circulation of ZIKV in areas outside its currently known distribution range.
Case report
A 37-year-old Finnish man returned with his family from a half-a-year work-related stay in the Maldives (in Dhiffushi island, situated in North Mal? atoll as the capital Mal?) to Finland 16 June 2015, without any stopovers elsewhere. Two days later he became ill with flu-like prodrome, mild fever and rash in the face and trunk, as well as ocular pain and arthralgia; the symptoms alleviated after a few days. He contacted occupational health and due to suspicion of dengue, a serum sample was taken 24 June, and it was positive for dengue virus IgG (titer 1:1,280, in-house immunofluorescence assay (IFA) test) and IgM (1.9/ cut-off 1.0, Dengue Virus IgM Capture DxSelect ELISA, Focus Diagnostics, USA), but negative for dengue virus (DENV) non-structural (NS) 1 antigen (Dengue NS1 Ag Strip Bio-Rad, France). Along with the serum sample, a urine sample taken on 25 June, the following day, was received for flavivirus RNA detection using a real-time pan-flavivirus NS5 nested RT-PCR [1,2]. RNA from serum and urine samples was extracted using QIAamp Viral RNA Mini Kit (Qiagen).
From the urine (but not the serum) an amplification product was detected and subsequently sequenced (160bp excluding primers, available from the authors upon request). A BLAST search identified the sequence as Zika virus (ZIKV) identical to Asian lineage strains originating from Easter Island 2014 [3], French Polynesia 2013 (GenBank KJ776791), Brazil 2015 (GenBank KU321639) and Thailand 2013 [4] and in phylogenetic analyses the sequence clustered with these strains (Figure). A PCR contamination in the laboratory is further ruled out as no work with ZIKV has ever been conducted, or any positive samples analysed previously in the laboratory - or in the country as a whole.