Zika: Acute Signs and Symptoms

Zika symptoms

Symptoms in 1,112 PCR Positive Patients

  • Fever (83%)
  • Rash (69%; maculopapular)
  • Conjunctivitis (39%)
  • Myalgia and/or arthralgia (39%)
  • Headache (21%)
  • Nausea and vomiting (~5%)

62% of asymptomatic Zika patients had a viral load of less than 103 and 100% of patients with a viral load of 105 were symptomatic.

Courtesy of the Zika Foundation and Rescue Medicine, 2016.

Case studies

Case 1

Zika case study 1

24 year old Japanese traveler to Yap developed conjunctivitis at day 3 of fever, day 2 of headache. Other symptoms included mild nausea and GI discomfort. Viral load unknown.


Case 2

Zika case 2

19 year old anglo male develops blanching rash at day 2 of fever. Viral load was 10ml


Laboratory Abnormalities

154 ill Zika patients from Brazil and Columbia (in press).

All patients had a viral load of less than 104

  • AST >1.25X ALT ratio (41/154)
  • Thrombocytopenia (43/154)
  • Elevated d-dimer (19/154)
  • LDH > 4x ULN (20/154)
  • Lactate >2.0 (12/154)

Treatment and Risk Assessment

  • Oral fluids with electrolytes
  • Fever and pain: use acetaminophen, 500-1000mg Q8h
  • Avoid NSAIDs due to bleeding
  • Severe pain: Tremadol can be used with caution
  • Woman: pregnancy test, if positive counseling and ultrasound
  • Men: correct use of condoms for 90 days after return followed by physician history and exam and PCR testing if high-risk travel exposure
  • Keep patient from being bitten by local mosquitos (thus preventing spread of infection to new areas)
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