Long-term kinetics of Zika virus RNA and antibodies in body fluids of a vasectomized traveller returning from Martinique: a case report.

BACKGROUND: The magnitude of the current Zika virus (ZIKV) epidemic has led to a declaration of a Public Health Emergency of International Concern by the WHO. Findings of viable viral particles in semen for several weeks are corroborating reports of sexual transmission of ZIKV. Serious consequences of a positive diagnostic result particularly in the pregnant patient are calling for precise diagnostic tools also at later time points after infection. Currently, recommendations suggest a diagnostic period of direct viral detection of 5 to 7 days after onset of symptoms in serum or plasma, and up to 3 weeks in urine samples. CASE PRESENTATION: A vasectomized 41-year-old German returning from Martinique presented at the outpatient clinic of the Department for Infectious Diseases and Tropical Medicine, Munich, with subfebrile temperature, rash, malaise, severe retro-orbital pain and occipital lymphadenopathy. The main complaints resolved after ten days without specific treatment. We are reporting on clinical course and results of direct and indirect detection methods of ZIKV in different sample types including whole blood, ejaculate, urine, serum, plasma and saliva samples up to 119 days post symptom onset. Ejaculate samples remained PCR positive for ZIKV until day 77, whole blood samples until day 101. CONCLUSIONS: The case presentation adds to the still limited knowledge of kinetics of detection of ZIKV by direct as well as indirect methods. Here, a complete data set including results from PCR, serology and cell culture is provided allowing an improved evaluation of optimum diagnostic periods for testing a variety of sample types. Moreover, a high viral load of ZIKV RNA was detected in ejaculate of the vasectomized patient. This finding sheds new light on the possible localizations of ZIKV replication in the human male reproductive tract.

Spectrum of imported infectious diseases among children and adolescents returning from the tropics and subtropics.

BACKGROUND: About 50 million people travel each year from industrialized countries to destinations in the tropics and subtropics. Among them, there are more than 2 million minors traveling. Although their number is increasing constantly, data on health risks during travel are limited. METHODS: This study analyzed demographic, travel, and clinical data of 890 travelers of age <20 years presenting at the outpatient travel clinic of the University of Munich between 1999 and 2009 after returning from the tropics and subtropics. RESULTS: Most (87%) of these young travelers were born in Germany. Among them, the main travel destination was Africa (46%), followed by Asia (35%) and Latin America (19%). The most frequent syndrome groups were acute diarrhea (25%, especially in age 0-4 y), dermatologic disorders (21%, especially in age 0-9 y), febrile/systemic diseases (20%), respiratory disorders (8%), chronic diarrhea (5%), and genitourinary disorders (3%). The 10 most frequent diagnosed infectious diseases were giardiasis (8%), schistosomiasis (4%), superinfected insect bites (4%), Campylobacter enteritis (4%), Salmonella enteritis (4%), cutaneous larva migrans (3%), amebiasis (3%), dengue fever (2%), mononucleosis (2%), and malaria (2%). The relative risk (RR) for acquiring any infectious disease during travel was highest in Central, West, and East Africa, followed by South America, South Asia, and Southeast Asia. CONCLUSIONS: Age of young travelers and destination of travel were the most important variables being strongly correlated with the risk for acquiring infectious diseases in the tropics and subtropics. The highest risk was carried by very young travelers and those staying in sub-Saharan Africa (except Southern Africa).