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.

The full arti­cle may be accessed at http://www.promedmail.org/direct.php?id=20130529.1744108

(ProMED 5/29/2013)