Gert van der Hoek
In Memoriam - Editor, Senior Moderator
ZIKA VIRUS - NETHERLANDS ex SURINAME
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Fri 11 Dec 2015
From: Abraham Goorhuis, MD <a.goorhuis@amc.nl> [edited]
We report a confirmed case of Zika virus infection in a 60-year-old and otherwise healthy female patient, who had returned from Suriname on 29 Nov 2015, following a 3-week holiday. She had visited Paramaribo, Carolina Kreek, Klaaskreek and the Commewijne province. On the day of return to the Netherlands, she developed fever, itching in the hands and a red skin rash on the face, neck, trunk and extremities. The skin was painful upon touch and the joints of her fingers and ankles felt stiff. She also reported swelling of both lower legs. She reported multiple insect bites. She presented at our outpatient clinic at the AMC in Amsterdam, the Netherlands, on 2 Dec 2015, the 3rd day of her illness.
Physical examination showed an afebrile patient who was not acutely ill. She had a pronounced macular skin rash of her trunk, extremities, neck and face, as well as a marked conjunctival injection. In addition, she had pitting edema on both lower legs.
Laboratory investigation showed a normal red and white blood cell count, with atypical lymphocytes in the differential. Renal function and liver enzymes were normal, except for a slightly elevated LDH of 297 IU/l.
One day after her initial presentation, the skin rash had improved markedly. She recovered quickly. Upon follow-up on 11 Dec 2015, her only complaints were arthralgias that seemed to further improve.
The clinical diagnosis of Zika virus infection was confirmed by PCR (Erasmus MC, Rotterdam), on a sample taken on 2 Dec 2015 (the 3rd day of illness).
To date, Zika virus infection has been rarely reported as cause of febrile illness among returned travelers and this is the 1st confirmed case in the Netherlands. Because symptomatology and clinical course are often mild, it is likely that the diagnosis is easily missed. Given the expanding base of information regarding complications possibly associated with this disease (such as neurologic manifestations and the reported increase of infants born with microcephaly in endemic areas), it is important to facilitate diagnostic capacities. This case underscores the fact that changing epidemiology of infectious disease also affects the spectrum of disease in returned travelers. Among other arboviral infections, such as dengue and chikungunya, Zika virus infection should be included in the differential diagnosis of any febrile traveler who has returned from an endemic area, such as Suriname.
--
Abraham Goorhuis, MD, on behalf of the medical team
Center of Tropical and Travel Medicine
Academic Medical Center
Amsterdam
The Netherlands
<a.goorhuis@amc.nl>
************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Fri 11 Dec 2015
From: Abraham Goorhuis, MD <a.goorhuis@amc.nl> [edited]
We report a confirmed case of Zika virus infection in a 60-year-old and otherwise healthy female patient, who had returned from Suriname on 29 Nov 2015, following a 3-week holiday. She had visited Paramaribo, Carolina Kreek, Klaaskreek and the Commewijne province. On the day of return to the Netherlands, she developed fever, itching in the hands and a red skin rash on the face, neck, trunk and extremities. The skin was painful upon touch and the joints of her fingers and ankles felt stiff. She also reported swelling of both lower legs. She reported multiple insect bites. She presented at our outpatient clinic at the AMC in Amsterdam, the Netherlands, on 2 Dec 2015, the 3rd day of her illness.
Physical examination showed an afebrile patient who was not acutely ill. She had a pronounced macular skin rash of her trunk, extremities, neck and face, as well as a marked conjunctival injection. In addition, she had pitting edema on both lower legs.
Laboratory investigation showed a normal red and white blood cell count, with atypical lymphocytes in the differential. Renal function and liver enzymes were normal, except for a slightly elevated LDH of 297 IU/l.
One day after her initial presentation, the skin rash had improved markedly. She recovered quickly. Upon follow-up on 11 Dec 2015, her only complaints were arthralgias that seemed to further improve.
The clinical diagnosis of Zika virus infection was confirmed by PCR (Erasmus MC, Rotterdam), on a sample taken on 2 Dec 2015 (the 3rd day of illness).
To date, Zika virus infection has been rarely reported as cause of febrile illness among returned travelers and this is the 1st confirmed case in the Netherlands. Because symptomatology and clinical course are often mild, it is likely that the diagnosis is easily missed. Given the expanding base of information regarding complications possibly associated with this disease (such as neurologic manifestations and the reported increase of infants born with microcephaly in endemic areas), it is important to facilitate diagnostic capacities. This case underscores the fact that changing epidemiology of infectious disease also affects the spectrum of disease in returned travelers. Among other arboviral infections, such as dengue and chikungunya, Zika virus infection should be included in the differential diagnosis of any febrile traveler who has returned from an endemic area, such as Suriname.
--
Abraham Goorhuis, MD, on behalf of the medical team
Center of Tropical and Travel Medicine
Academic Medical Center
Amsterdam
The Netherlands
<a.goorhuis@amc.nl>