Zika virus (ZIKV) has been detected in the blood of a 45-year-old Canadian woman who recently returned from a vacation in southern Thailand. ZIKV is a flavivirus which was first reported from Thailand in 1954.
The patient traveled with other family members to Bangkok from 21–28 January 2013, and spent a week there without noticing many mosquito bites. The party went to Phuket Island from 28 January — 2 February 2013, traveling and spending time at various beaches where the patient noted many more mosquito bites as she was told that it was mosquito season. On her return to Bangkok, on 2 February 2013, she changed her hotel to one by the river, where she sustained numerous bites on her exposed skin. Most noticeably her leg became inflamed and itchy, to which she applied cortisone cream and other emollients. She flew back to Canada on 5 February 2013 and on the flight described feeling restless, irritable, with a headache, chills, and sore back, in addition to the itching and inflammation of the mosquito bitten areas.
Three days after her return to Alberta, Canada, she felt feverish, was diaphoretic, nauseous with vomiting, extremely fatigued, and noted blisters in her mouth. After a brief respite from her symptoms she developed a severe backache with a papular rash, involving her extremities including her palms, for which she sought medical assistance at a local emergency department. The physician tested her for a variety of infectious etiologies, including dengue fever, malaria and measles, but did not admit her for observation or management.
The patient made a relatively uneventful recovery, about two and a half to three weeks after her initial symptoms. None of her immediate family members described overt symptoms, such as fever and rash, although they had stated that they were also bitten by mosquitoes during their stay in Bangkok.
Of interest is that one of her friends, who traveled the entire trip with her, also had a similar non-specific presentation of fever and chills, nausea and joint pain but without the rash, and with a symptom onset one day after the index case. Serology for dengue was negative for both IgM and IgG antibody, and this sample was also negative for ZIKV, using the PCR-based approach described above.
This is the first laboratory confirmed case of ZIKV reported in Canada, and serves as a cautionary reminder of the other viral etiologies that should be considered in returning travelers that may be outside the diagnostic capability of many clinical laboratories.
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