Case history

Case history #1

A 31-year-old woman (gravida 1 para 0) presents at 12 weeks’ gestation to her obstetrician in London. Her husband returned about 1 month ago from a business trip to Brazil. Although he does not recall any specific symptoms over the past month, he experienced mosquito bites during the trip. They have had unprotected vaginal sex since his return.

Case history #2

A 22-year-old woman (gravida 3 para 2) presents at 24 weeks’ gestation (with twins) for a routine antenatal check-up in Recife, Brazil. The woman reports a history of rash at 12 weeks' gestation, but she did not seek medical attention for this. An antenatal ultrasound scan shows periventricular microcalcifications and ventriculomegaly in one of the twins, while the other appears to be normal.

Other presentations

Approximately 80% of people infected with Zika virus are asymptomatic.[13] In those who are symptomatic, patients generally present with a mild, self-limited illness including fever, maculopapular (sometimes morbilliform) rash, arthralgia/myalgia, and conjunctivitis. Less common symptoms include vomiting/diarrhoea, abdominal pain, anorexia, oedema of the lower limbs, and retro-orbital pain.[13] There have been case reports of sepsis and rapid disease progression in patients with comorbidities.[14] Atypical presentations (e.g., patients have presented with generalised rash or fever only) have been reported.[15] Zika-related microcephaly has been reported in both fetuses in a monochorionic diamniotic twin pregnancy.[16]

People may ask about whether to proceed with planned travel to endemic areas and/or preventive measures for avoidance of mosquito bites. Women of childbearing age may ask about whether to proceed with or to defer a planned pregnancy. People may ask about safe sexual practice, including before or during pregnancy. Pregnant women who have possibly been exposed to Zika virus through travel or sexual contact may inquire about Zika virus testing and fetal monitoring.

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