Acute Zika virus infection after travel to Malaysian Borneo, September 2014.

摘要: To the Editor: Zika virus (ZIKV), a mosquito-borne flavivirus, causes fever, self-limiting febrile and exanthematic arthralgia syndrome closely resembling dengue fever. Most often, signs symptoms are maculopapular rash, arthralgia, myalgia, headache, conjunctivitis; edema, sore throat, cough, vomiting occur less frequently (1). The virus, which was initially isolated from rhesus monkey (Macaca mulatta) in 1947 Uganda, has come to attention recently after large outbreak occurred western Pacific region, including French Polynesia, New Caledonia, Easter Island, Cook Islands (2). Travel-related imported infections have thus been increasingly reported sporadically also travelers other regions of world, Thailand, Indonesia, Senegal (2,3). ZIKV is transmitted by different Aedes mosquito species, nonhuman primates play role as reservoirs After beginning epidemic late 2013, 20-fold increase Guillain-Barre incidence noted Polynesia; 1 patient infected week before neurologic started (4). We report an acute infection traveler returning Malaysian Borneo who experienced bilateral hearing difficulties during course illness. On September 1, 2014, 45-year-old woman seen outpatient clinic Heidelberg, Germany for fever up 39°C rash covering her trunk, arms, legs. Fever had on August 30, 6 days she returned 3-week vacation peninsular Malaysia Sabah, Borneo. Laboratory analyses showed slightly elevated C-reactive protein level 5.2 mg/L (reference range <5.0), but liver function test complete blood count results were within reference range. During next 3 days, subsided, conjunctivitis, burning sensation palms soles. These accompanied swelling hands increasing wrists, palms, fingers. There no lymphadenopathy. An indirect immunofluorescence assay (3) demonstrated IgM titer 1:640 IgG 1:320 (cutoff <1:20) day illness (Figure). 1:80 <1:20). Figure Clinical laboratory (reverse transcription-PCR [RT-PCR]) with (ZIKV) acquired Borneo. Two later, sudden dull metallic hearing; left ear, very short delay between sound perception sound. Follow-up serologic testing 11 decreased 1:160 increased 1:2,560 Viral neutralization same sample presence ZIKV-specific neutralizing antibodies. Chikungunya serology negative. archived serum studied real-time reverse transcription PCR negative Hearing lasted 10 resolved gradually During journey several cities villages Borneo, noticed bites even though used repellents. She stayed hotels, private homes, remote church homes under various conditions (Technical Appendix). In Asia, described Cambodia, Indonesia (Java Lombok) (1,3,5,6). On basis incubation time ≈6 (2,3), we assumed that became Keningau or surrounding villages, northern Although detected Ae. aegypti mosquitoes 1969 (7) antibodies against samples 15 79 patients 9 50 1953 (8), not reported. In 2001, seropositivity native Bornean, 2 migrants Bornean orangutans (Pongo pygmaeus) (9). A later study found additional 8 be seropositive (10). Thus, either only rarely infects humans disease mistaken Neurologic complications previously syndrome, Because this symptom spontaneously, audiometry auditory brainstem response performed, cause disorder remains unclear. travel migration heightened clinical awareness, more likely diagnosed outside events. Technical Appendix: Travel itinerary fever. Click here view.(217K, pdf)