Can you tell Zika from dengue fever?

zika
A patient with the Zika virus. Click the image to see the original case on Figure 1.

Zika virus has been declared a “public health emergency of international concern” by the World Health Organization. The virus, first identified in Uganda in 1947, resurfaced in Brazil and has now spread to surrounding countries. While Zika is spread by the same Aedes mosquito as dengue and chikungunya, it is uniquely associated with microcephaly (an abnormal smallness of the head) in newborns. Most troubling is the fact that most patients with Zika don’t experience any symptoms at all.

From Feb. 3 to 5, we asked the more than 500,000 healthcare professionals on our global case-sharing platform about their firsthand experience with Zika. We received 3,401 responses from healthcare professionals in 25 countries. Here is a selection of their responses (edited for spelling and clarity).

Experience with Zika

Many healthcare professionals practicing in endemic countries like Brazil have already treated patients with the Zika virus. They explained the complexity of diagnosis.

“It seems like an arbovirus. The differential diagnostic is dengue and chikungunya. We don’t know how to confirm it with only clinical features, and sometimes serology [a diagnostic test] is missing.”
Intern, Brazil

One common presentation of Zika is a petechial rash, a skin reaction caused by conditions as broad as trauma, viral infections, and allergic reactions. The image below illustrates how petechiae caused by dengue is very similar to petechiae caused by Zika (shown above).

petechiae
#Petechiae caused by the #Dengue virus. Click the image to see the original case on Figure 1.

“The clinical symptoms are not found in all of the cases. Some patients will only develop the rash. Others will have skin manifestations and unspecific symptoms like headache or muscle pain.”
Intern, Brazil

“I live and work in Brazil. Clinically, it’s not that hard to manage, since the symptoms on the average patient are light to mild, though it is scary to not have much definitive information to inform our patients about the true extent of that disease.”
General practitioner, Brazil

Fears about Zika

Most providers in the U.S. have not yet been approached by their patients with questions and concerns about Zika. Those working with pregnant women and those located on the southern U.S. border were most likely to have heard concerns.

“I’ve personally heard a ton of apprehension: “Is it going to come here?” (No) “Should I avoid getting pregnant?” (No) “Is it true that it is sexually transmitted?” (It can be, yes!)”
Nurse, United States

“I live in South Texas. Many residents live on both sides of the border, and many other people work with inter-Mexico travelers. Many people [are] worried about mass infection.”
Researcher, United States

“They are worried about travel. Even the men are afraid that if they contract Zika it will affect their sperm/future children.”
Emergency medicine physician, United States

“[I’ve been asked:] Is this a scare like Ebola was? Answer: Ebola was not a scare tactic. We were informed about it and hospitals prepared accordingly due to symptoms of patient and last travel.”
Emergency medicine physician, United States

“Many pregnant women have shown concern and distress. Some patients that have travelled to South America a little while ago have asked for testing.”
Registered nurse, Spain

“I am an OB-gyn provider. Lots of questions from currently pregnant patients in the U.S. about their risk and how they can protect themselves.”
Obstetrician/gynecologist, United States

“Would it show an impact in the non affected areas like in India, due to the presence of Aedes?”
Medical student, India

Moving the conversation to prevention

As public health campaigns and media coverage raise awareness of Zika, one physician in Peru made the point that simple, low-cost sanitation procedures must be part of the solution.

“Focus seems to go to vaccination and expensive kinds of treatment. Since the carrier is the same Aedes aegypti mosquito responsible for dengue and leishmaniasis transmission, it pains me to see even in Peru (endemic for both diseases) people forget about stopping larvae cultivation and still keep water in open barrels and empty tires for poultry.”
General practitioner, Peru


You can find all of the cases from this post on the Figure 1 app. Interested in learning more about Figure 1? Email us at communications@figure1.com.