Diagnosis and outcomes of pregnant women with Zika virus infection in two municipalities of Risaralda, Colombia: Second report of the ZIKERNCOL study.

BACKGROUND: Zika virus (ZIKV) infection has emerged as a significant threat for pregnant women and newborns in populations living in or visiting Latin America. We previously reported a preliminary analysis in Sucre, Colombia, as the first group of pregnant women with RT-PCR-confirmed ZIKV (ZIKa enEmbarazadas yReciénNacidos enCOLombia, ZIKERNCOL). METHODS: In this second report, findings of the first 86 pregnant women from La Virginia and Dosquebradas (municipalities), Risaralda, Colombia, with RT-PCR-confirmed ZIKV infection are reported. Clinical, demographical and obstetrical findings are described. RESULTS: All women reported ZIKV symptoms during pregnancy: 79.1% rash, 55.8% fever, among others. In addition to ZIKV, RT-PCR was positive for dengue in 18.6%; 45.3% Dengue IgM+; 5.8% RT-PCR positive for chikungunya; 3.6% Chikungunya IgM+. STORCH screening in mother: 11.6% IgG + anti-Toxoplasma gondii, 6% IgG + anti-rubella, 4.7% IgG + CMV. The rest of STORCH tests were negative. Microcephaly was observed in 2.4% of the newborns. No calcifications or other CNS alterations were detected. One newborn had cleft palate and one had bilateral renal ectopy. CONCLUSIONS: The rate of microcephaly in our cohort was consistent with other studies. Pregnant women in endemic areas should be followed and tested according to standard protocols, and asymptomatic ZIKV infection should be considered. Long-term follow-up of children is required in the congenital Zika syndrome (CZS) assessment.

Zika virus: clinical manifestations and treatment at a primary care institution in Colombia / Virus del Zika: manifestaciones clínicas y tratamiento en una institución de primer nivel en Colombia

Abstract Introduction: Although Zika virus cases have been reported in Colombia since 2015, its clinical and pharmacological characteristics have not yet been described. Objective: To describe the main clinical manifestations and sociodemographic characteristics of patients diagnosed with Zika and the treatment provided to them at a primary care hospital in a municipality of Colombia. Materials and methods: Descriptive cross-sectional study. The study population consisted of patients diagnosed with Zika between January 1 and July 25, 2016 at a primary care hospital. Sociodemographic, clinical, and pharmacological variables, as well as adverse clinical outcomes associated with the infection were included. Descriptive statistics were performed. A x2 test was used for categorical variables, and a multivariate analysis was conducted using Epi info 7.1 software. Results: 254 individuals infected with Zika virus during the study period were identified, and Zika diagnosis was more frequent in women (68.5%). Regarding treatment, 90.9% of the cases were treated using acetaminophen. The most commonly reported symptoms were rash (81.1%) and pruritus (55.9%). In addition, antihistamines were the most frequent comedication (31.9%). Factors such as being a woman, being pregnant and inpatient treatment were associated with adverse clinical outcomes. Conclusion: The clinical manifestations described here are similar to those reported in other populations. Furthermore, inappropriate pharmacological management practices that can lead to complications in this population, such as bleeding, were observed in some cases. Thus, educational interventions on the proper prescription of medications for treating this disease aimed at general physicians working in Zika affected areas must be implemented to improve the prognosis of these patients.

Resumen Introducción. Aunque el virus del Zika está presente en Colombia desde el 2015, sus características clínicas y farmacológicas aún no han sido descritas. Objetivo. Describir las principales manifestaciones clínicas y características sociodemográficas de pacientes diagnosticados con zika, así como el tratamiento que recibieron en un hospital de primer nivel. Materiales y métodos. Estudio descriptivo de corte transversal. La población estuvo constituida por los pacientes diagnosticados con zika entre el 1 de enero y el 25 de julio de 2016 en un hospital de primer nivel. Se incluyeron variables sociodemográficas, clínicas y farmacológicas, además de los resultados adversos clínicos y paraclínicos asociados a la infección. Se realizó estadística descriptiva; para las variables categóricas se usó la prueba x2 y el análisis multivariado se realizó a través del programa Epi Info 7.0. Resultados. Se identificaron 254 pacientes con zika, siendo más frecuente en mujeres (68.5%). El 90.9% de la población recibió tratamiento con acetaminofén. Los síntomas más comunes fueron sarpullido (81.1%) y prurito (55.9%). Además, los antihistamínicos fueron la comedicación más frecuente (31.9%). Los factores asociados con resultados clínicos y paraclínicos adversos fueron ser mujer, estar embarazada y tener manejo intrahospitalario. Conclusión. Las manifestaciones clínicas encontradas fueron similares a las reportadas en otras poblaciones. En algunos casos se observó un manejo farmacológico no recomendado, lo que puede generar complicaciones como sangrados; en consecuencia, se deben implementar intervenciones educativas sobre la prescripción adecuada de medicamentos para tratar esta enfermedad, dirigidas a médicos generales que trabajen en regiones afectadas por el zika para, así, mejorar el pronóstico de estos pacientes.