Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics.

Tozetto-Mendoza, Tania Regina; Avelino-Silva, Vivian Iida; Fonseca, Silvia; Claro, Ingra Morales; Paula, Anderson Vicente de; Levin, Anna Sara; Sabino, Ester Cerdeira; Mendes-Correa, Maria Cassia; Figueiredo, Walter Manso; Felix, Alvina Clara; +9 more... Souza, Nathalia C Santiago; Costa, Angela Aparecida; Inenami, Marta; Silva, Rosangela M Gasparetto da; Levi, José Eduardo; Romano, Camila Malta; Paranhos-Baccalà, Glaucia; Segurado, Aluisio Cotrim; Mayaud, Philippe; (2019) Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics. Revista do Instituto de Medicina Tropical de Sao Paulo, 61. e19-. ISSN 0036-4665 DOI: https://doi.org/10.1590/S1678-9946201961019

Abstract

Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.