Zika experience in Puerto Rico

Dr. Mutahher Akcaer interviewed with Dr. Ricardo Fernandez  from Puerto Rico on his experiences on Zika Virus Infections

Introduction to Zika

Zika Virus (ZIKV) epidemic is one of the terrifying infectious events today. It was first isolated in the Zika forest in Uganda in 1947 during a yellow fever surveillance study, and until recently, cases of ZIKV infection had confined to a narrow equatorial belt running across Africa and into Asia. In 2007, the first example of human infection by ZIKV out-sides of Africa and Asia arose in Yap Island in the Federated States of Micronesia in Oceania and thus far, 33 countries have reported ZIKV transmission between January 2014 and February 2016.

ZIKV causes a mosquito-borne Flavivirus infection, but other forms of transmission including blood transfusion and probable sexual and perinatal transmission have been confirmed. In more than 60 years ZIKV infection has not been noted to cause hemorrhagic fever or death, However, in the current outbreak, potential links have been identified between ZIKV infection and increases in serious neurological complications like Guillain-Barre Syndrome and microcephaly.

Here in this interview we intended to post the experiences of Dr. Ricardo Fernandez on Zika Virus infection. He is a pulmonary and critical care physician and currently, he is the program director of a pulmonary fellowship program in San Juan, Puerto Rico.

How many patients did you follow-up in your clinic?

I have seen approximately 10 cases. However, since my subspecialty is critical care, I have followed five patients admitted to the ICU with Guillain Barre Syndrome confirmed by EMG and spinal tap analyses. There were 4 women with the ages ranging from 40 to 60 and the male patient was at 45.

What were the initial complaints of the patients?

Their chief complaints were similar. My personal experience has been that their classic symptoms were general malaise, fever, arthralgia, skin rashes and eye problems. Approximately one or two weeks prior admission they had skin rashes, eye problems and low grade fever. All of them came to the ER presenting with ascending weakness, and one of the woman had facial weakness as well having related dysphagia.

How was the clinical follow up? Which interventions/treatments did you make?

All of the patients were evaluated by neurologists at admission and Guillain Barre Syndrome was confirmed by EMG and spinal tap. One of the patients required mechanical ventilation assistance on day #2 and was extubated in less than a week. The treatment with immunoglobulin was provided and all of the patients responded to 5 days infusion of immunoglobulin. My experience was that between the third and fourth days, the patients demonstrated significant improvements.

When did you confirm the ZIKV infection?

Specimens for the PCR testing have been sent from my patients and it took less than a week for confirmation.

What about their prognosis?

All of these five patients were transferred to skill nurse facilities for rehabilitation and are doing fine. So far I have seen one (the guy) in my office, which is doing fine without sequelae.

Did you follow up any pregnant patient? If so, was there any baby born with microcephaly?

I have not seen any pregnant patient, but to my knowledge there has been none identified in Puerto Rico. In addition, I recently read an article from Florida where a pregnant patient had ZIKV infection and had twins. One of the babies was born with microcephaly.

Many thanks Dr. Fernandez for sharing your experience with ID-IRI