In healthy, immunocompetent patients, the Zika virus will present as a mild infection with very few symptoms. The condition will be self-limited and usually resolve without the patient even being aware that they had a virus. Studies have shown that 80% of individuals affected by Zika virus and infected by the virus do not even experience any signs/symptoms associated with the virus. While that is the majority of individuals, the other 20% of patients who come into contact with the virus will experience a variance of signs/symptoms. Some of the more commonly associated signs/symptoms of those infected with the Zika virus include:
- Low-grade fever
- Fine maculopapular rash
- Joint pain
- Myalgia
- A headache
- Conjunctivitis.
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The maculopapular rash, which is diffusely located all over the body, including the soles of feet and palms of hands, is characteristic of only a few viruses. Arthralgia, which is joint pain, usually occurs in the small joints of the hands and feet. It is common for patients infected with the Zika virus to complain that their hands and feet hurt. Headaches experienced by patients who have the Zika are classified as Retro-Ocular, meaning the pain is located behind the eyes. Symptoms can occur for a minimum of 2 days but averagely last approximately 7 days. As with any virus, there are rare instances in which the patient may develop Guillain-Barre Syndrome after being infected with the Zika virus. Guillain-Barre Syndrome is an acute inflammatory syndrome in which symmetrical paralysis and loss of reflexes occur. It normally begins in the lower extremities and then progresses in an ascending fashion. Symptoms associated with Guillain-Barre Syndrome include; facial droop, diplopia, dysarthria, dysphagia, numbness, and paresthesias. It can also be associated with pain that is both aching and throbbing. Another rare complication from Zika is hypertensive iridocyclitis.
One of the major concerns surrounding Zika the lasting effects that may occur if the individual is or about to be pregnant. Zika can be transmitted across the placenta from mother to fetus. The congenital malformation that results if the pregnant woman has Zika virus is Microcephaly, which is a smaller than average head size. The formal definition of Microcephaly is when an individual’s head size is more than 2 standard deviations smaller than the normal head size. Microcephaly can result in brain damage which is devastating. After the baby is born, it is recommended by the World Health Organization that the babies head circumference be measured at day 1 and day 7 after birth. At this time if the circumference of the babies head is greater than 2 standard deviations below the normal head circumference, then the baby will be diagnosed with Microcephaly. If the babies head circumference is greater than 3 standard deviations below the normal head circumference, then it is diagnosed as Severe Microcephaly, and imaging studies must be done immediately to rule out any brain damage.
Other severe symptoms that can occur when a fetus is exposed to Zika virus include loss of foveal reflex, macular pigment mottling, chorioretinal macular atrophy, optic nerve head hypoplasia and optic nerve double-ring sign. Not all fetuses that are affected will develop complications.
