• Tourniquet test for dengue virus infection
  • inflate a blood pressure cuff on the arm to midway between the patient's systolic and diastolic blood pressure and hold for 5 minutes
  • release pressure and examine arm for 1 minute for petechiae
  • finding 10 or more petechiae in one square inch area is considered positive 
  • demonstrates microvascular fragility
  • specific for Dengue, not great sensitivity
  
  

  Posted 09/27/16 09:43:19 AM by Anna Krigel

• Differential for viral syndrome in traveler from DR
  • mosquito-borne illnesses in the DR = Zika and Dengue
    • three quarters of the viral epitopes are similar in both viruses, thus there is cross-reactivity in the viral assays
  • Chikungunya - presents with a predominance of joint pain 
  • West Nile - also common in this part of the world
  
  

  Posted 09/27/16 09:55:57 AM by Anna Krigel

• Zika, Dengue, and Chikungunya create higher levels of viremia than does West Nile virus, which carries great importance as people traveling on planes with the virus can be vectors when they get to other countries
  
  

  Posted 09/27/16 11:09:52 AM by Anna Krigel

• Zika epidemiology
  • first isolated from a rhesus monkey in the Ziika forest in Uganda during yellow fever surveillance
  • first human cases identified in 1954 in Nigeria
  • Prior to 2007, there were fewer than 35 human cases identified
  • Now over 6400 human cases identified in the US and its territories since 8/2016
  • Over 50% of the cases in NYC have been associated with travel to the DR
  
  

  Posted 09/27/16 11:12:02 AM by Anna Krigel

• Zika severe complications
  • Birth defects
    • increase in the number of infants with microcephaly first noted in September 2015
    • recognition of a similar outbreak in French Polynesia during a Zika outbreak there in 2013 and 2014
    • the virus has now been isolated from fetal brain tissue
  • Guillain-Barre Syndrome
    • increase in GBS also found during the Zika outbreak in French Polynesia in 2013 and 2014
  
  

  Posted 09/27/16 11:39:07 AM by Anna Krigel

• For further reading...

  Dengue in Travelers (NEJM)
  Zika Virus and Birth Defects (NEJM)
  Guillain-Barre associated with Zika Virus infection in French Polynesia (Lancet)
  The Coming Trials of Generation Zika (Dr. Ian Lipkin writing in the Wall Street Journal)
  
  

  Posted 09/27/16 11:47:22 AM by Anna Krigel

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