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    Zika: How to counsel concerned patients


    Viral features

    The acute infection generally persists for about five to seven days, and the most common features are fever, arthralgias, non-purulent conjunctival injection, and rash.

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    The rash can be of two types:

    1. flushing prominent on the face and upper chest that commences at the time of the fever; and
    2. a maculopapular rash that develops mostly on the trunk about the time the fever is going away. The presentation of the maculopapular rash covers a spectrum from being very fine and almost imperceptible visually or by palpation to a more florid appearance similar to the eruption seen with measles or rubella. Patients may then develop flaking and pruritus about a week or two later.

    “Patients can have either type of rash, both, or neither, but the maculopapular rash is probably what a dermatologist would be most likely to see,” Dr. Morens says.

    Diagnosing infection

    The only way to make a definitive diagnosis of Zika virus infection is with a polymerase chain reaction test performed during the acute phase of the infection. Once the patient has recovered, ELISA for IgM antibodies will become positive, and IgG will become positive a few weeks later. However, a positive ELISA result may not always be specific for Zika virus infection because of cross-reactivity with related viruses (e.g., dengue) or if a patient ever had a yellow fever vaccine.

    NEXT: Cause for concern


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