American Journal of Clinical Dermatology

, Volume 18, Issue 2, pp 231–236 | Cite as

The Emerging Zika Virus Threat: A Guide for Dermatologists

  • Alice He
  • Patrícia Brasil
  • Andre M. Siqueira
  • Guilherme A. Calvet
  • Shawn G. Kwatra
Review Article


We provide a guide for dermatologists to follow if they encounter patients with a rash and clinical history suspicious of Zika virus infection, including diagnostic testing and management options. We also provide an illustrative case report of a patient from Brazil who was diagnosed with Zika virus infection after presenting with a generalized pruritic rash. One of the most prominent symptoms of Zika virus infection is a cutaneous eruption. As such, it is especially necessary for dermatologists to understand this virus so that they may appropriately recognize this entity as a diagnostic consideration in the clinic. The rash associated with Zika virus infection is most commonly an erythematous maculopapular eruption that presents after an initial 3–4 days of fever, headache, and arthralgia or myalgia. The rash typically lasts for an average of 6 days, and can spread to involve any part of the body, including the face, torso, extremities, palms, and soles.



We thank Ana Maria Bispo de Filippis and team from the Flavivirus Laboratory, Oswaldo Cruz Institute/Oswaldo Cruz Foundation for helping with the molecular biology procedures.

Compliance with Ethical Standards

Informed consent was obtained from all individual participants included in the study.

Institutional review board status

Approval not required.



Conflict of interest

Alice He, Patrícia Brasil, Andre M. Siqueira, Guilherme A. Calvet, and Shawn G. Kwatra declare that they have no conflicts of interest relevant to the content of this article.


  1. 1.
    Centers for Disease Control and Prevention. Zika Virus 2016; Accessed 20 Feb 2016.
  2. 2.
    Ginier M, Neumayr A, Gunther S, Schmidt-Chanasit J, Blum J. Zika without symptoms in returning travellers: what are the implications? Travel Med Infect Dis. 2016;14(1):16–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Duffy MR, Chen TH, Hancock WT, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009;360(24):2536–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Cao-Lormeau VM, Musso D. Emerging arboviruses in the Pacific. Lancet. 2014;384(9954):1571–2.CrossRefPubMedGoogle Scholar
  5. 5.
    Zika virus disease in the United States, 2015–2016. Zika virus 2016; Accessed 17 Mar 2016.
  6. 6.
    Petersen EE, Staples JE, Meaney-Delman D, et al. Interim guidelines for pregnant women during a Zika virus outbreak—United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(2):30–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Pinto Junior VL, Luz K, Parreira R, Ferrinho P. Zika virus: a review to clinicians. Acta Med Port. 2015;28(6):760–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Mlakar J, Korva M, Tul N, et al. Zika virus associated with microcephaly. N Engl J Med. 2016;374(10):951–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Keighley CL, Saunderson RB, Kok J, Dwyer DE. Viral exanthems. Curr Opin Infect Dis. 2015;28(2):139–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Fagbami A. Epidemiological investigations on arbovirus infections at Igbo-Ora, Nigeria. Trop Geogr Med. 1977;29(2):187–91.PubMedGoogle Scholar
  11. 11.
    Simpson DI. Zika virus infection in man. Trans R Soc Trop Med Hyg. 1964;58:335–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Summers DJ, Acosta RW, Acosta AM. Zika virus in an American recreational traveler. J Travel Med. 2015;22(5):338–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Deng Y, Zeng L, Bao W, Xu P, Zhong G. Experience of integrated traditional Chinese and Western medicine in first case of imported Zika virus disease in China. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2016;28(2):106–9.PubMedGoogle Scholar
  14. 14.
    Zammarchi L, Stella G, Mantella A, et al. Zika virus infections imported to Italy: clinical, immunological and virological findings, and public health implications. J Clin Virol. 2015;63:32–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Calvet GA, Filippis AM, Mendonca MC, et al. First detection of autochthonous Zika virus transmission in a HIV-infected patient in Rio de Janeiro, Brazil. J Clin Virol. 2016;74:1–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Moulin E, Selby K, Cherpillod P, Kaiser L, Boillat-Blanco N. Simultaneous outbreaks of dengue, chikungunya and Zika virus infections: diagnosis challenge in a returning traveller with nonspecific febrile illness. New Microb New Infect. 2016;11:6–7.CrossRefGoogle Scholar
  17. 17.
    Kutsuna S, Kato Y, Takasaki T, et al. Two cases of Zika fever imported from French Polynesia to Japan, December 2013 to January 2014 [corrected]. Euro Surveill. 2014;19(4).Google Scholar
  18. 18.
    Zammarchi L, Tappe D, Fortuna C, et al. Zika virus infection in a traveller returning to Europe from Brazil, March 2015. Euro Surveill. 2015;20(23).Google Scholar
  19. 19.
    Villamil-Gomez WE, Gonzalez-Camargo O, Rodriguez-Ayubi J, Zapata-Serpa D, Rodriguez-Morales AJ. Dengue, chikungunya and Zika co-infection in a patient from Colombia. J Infect Public Health. 2016;9(5):684–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Goorhuis A, von Eije KJ, Douma RA, et al. Zika virus and the risk of imported infection in returned travelers: implications for clinical care. Travel Med Infect Dis. 2016;14(1):13–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Calvet G, Aguiar RS, Melo AS, et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet Infect Dis. 2016;16(6):653–60.CrossRefPubMedGoogle Scholar
  22. 22.
    Hills SL, Russell K, Hennessey M, et al. Transmission of Zika virus through sexual contact with travelers to areas of ongoing transmission—Continental United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(8):215–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill. 2014;19(13).Google Scholar
  24. 24.
    Dupont-Rouzeyrol M, O’Connor O, Calvez E, et al. Co-infection with Zika and dengue viruses in 2 patients, New Caledonia, 2014. Emerg Infect Dis. 2015;21(2):381–2.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Brasil P, Brasil JP, Jr., Raja Gabaglia C, et al. Zika virus infection in pregnant women in Rio de Janeiro—preliminary report. N Engl J Med. 2016;375(24):2321–34.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Leung GH, Baird RW, Druce J, Anstey NM. Zika virus infection in Australia following a monkey bite in Indonesia. Southeast Asian J Trop Med Public Health. 2015;46(3):460–4.PubMedGoogle Scholar
  27. 27.
    Macesic N, Abbott IJ, Johnson DF. Photo Quiz. Fever and rash in a husband and wife returning from the Cook Islands. Clin Infect Dis. 2015;61(9):1445, 1485–1446.Google Scholar
  28. 28.
    Gyurech D, Schilling J, Schmidt-Chanasit J, Cassinotti P, Kaeppeli F, Dobec M. False positive dengue NS1 antigen test in a traveller with an acute Zika virus infection imported into Switzerland. Swiss Med Wkly. 2016;146:w14296.PubMedGoogle Scholar
  29. 29.
    Tappe D, Rissland J, Gabriel M, et al. First case of laboratory-confirmed Zika virus infection imported into Europe, November 2013. Euro Surveill. 2014;19(4).Google Scholar
  30. 30.
    Foy BD, Kobylinski KC, Chilson Foy JL, et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis. 2011;17(5):880–2.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Fonseca K, Meatherall B, Zarra D, et al. First case of Zika virus infection in a returning Canadian traveler. Am J Trop Med Hyg. 2014;91(5):1035–8.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kwong JC, Druce JD, Leder K. Zika virus infection acquired during brief travel to Indonesia. Am J Trop Med Hyg. 2013;89(3):516–7.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Li J. Zika Virus in a traveler returning to China from Caracas, Venezuela, February 2016.Google Scholar
  34. 34.
    Gourinat AC, O’Connor O, Calvez E, Goarant C, Dupont-Rouzeyrol M. Detection of Zika virus in urine. Emerg Infect Dis. 2015;21(1):84–6.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Shinohara K, Kutsuna S, Takasaki T, et al. Zika fever imported from Thailand to Japan, and diagnosed by PCR in the urines. J Travel Med. 2016;23(1). doi: 10.1093/jtm/tav011.
  36. 36.
    Waehre T, Maagard A, Tappe D, Cadar D, Schmidt-Chanasit J. Zika virus infection after travel to Tahiti, December 2013. Emerg Infect Dis. 2014;20(8):1412–4.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Carteaux G, Maquart M, Bedet A, et al. Zika virus associated with meningoencephalitis. N Engl J Med. 2016;374(16):1595–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Meaney-Delman D, Hills SL, Williams C, et al. Zika Virus Infection among U.S. pregnant travelers—August 2015–February 2016. MMWR Morb Mortal Wkly Rep. 2016;65(8):211–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009;15(9):1347–50.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Brasil P, Calvet GA, Siqueira AM, et al. Zika virus outbreak in Rio de Janeiro, Brazil: clinical characterization, epidemiological and virological aspects. PLoS Negl Trop Dis. 2016;10(4):e0004636.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Filipe AR, Martins CM, Rocha H. Laboratory infection with Zika virus after vaccination against yellow fever. Arch Gesamte Virusforsch. 1973;43(4):315–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Olson JG, Ksiazek TG. Suhandiman, Triwibowo. Zika virus, a cause of fever in Central Java, Indonesia. Trans R Soc Trop Med Hyg. 1981;75(3):389–93.CrossRefPubMedGoogle Scholar
  43. 43.
    Heang V, Yasuda CY, Sovann L, et al. Zika virus infection, Cambodia, 2010. Emerg Infect Dis. 2012;18(2):349–51.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Schuler-Faccini L, Ribeiro EM, Feitosa IM, et al. Possible association between Zika virus infection and microcephaly—Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(3):59–62.CrossRefPubMedGoogle Scholar
  45. 45.
    Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med. 2016;374(20):1981–7.Google Scholar
  46. 46.
    Collection and submission of body fluids for Zika virus testing. Zika virus 2016; Accessed March 17, 2016.
  47. 47.
    New CDC laboratory test for Zika virus authorized for emergency use by FDA. CDC Newsroom 2016; Accessed 17 Mar 2016.
  48. 48.
    Zika virus prevention. Zika Virus 2016; Accessed 16 Apr 2016.
  49. 49.
    How to protect yourself. Zika Virus 2016; Accessed 16 Apr 2016.
  50. 50.
    Zika virus: health effects and risks. 2016; Accessed 26 Nov 2016.
  51. 51.
    Cao-Lormeau VM, Blake A, Mons S, et al. Guillain-Barre syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016;387(10027):1531–9.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Moore CA, Staples JE, Dobyns WB, et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr. 2016. doi: 10.1001/jamapediatrics.2016.3982.
  53. 53.
    Weaver SC, Lecuit M. Chikungunya virus and the global spread of a mosquito-borne disease. N Engl J Med. 2015;372(13):1231–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Simmons CP, Farrar JJ, Nguyen VV, Wills B. Dengue. N Engl J Med. 2012;366(15):1423–32.CrossRefPubMedGoogle Scholar
  55. 55.
    Sampathkumar P. West Nile virus: epidemiology, clinical presentation, diagnosis, and prevention. Mayo Clin Proc. 2003;78(9):1137–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of DermatologyJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious DiseasesOswaldo Cruz Foundation (Fiocruz)Rio de JaneiroBrazil

Personalised recommendations