Authors
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Tania Regina Tozetto-Mendoza
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Vivian Iida Avelino-Silva
Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias
https://orcid.org/0000-0002-6660-3088
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Silvia Fonseca
Hospital São Francisco
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Ingra Morales Claro
Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias
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Anderson Vicente de Paula
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Anna Sara Levin
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Ester Cerdeira Sabino
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Maria Cassia Mendes-Correa
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Walter Manso Figueiredo
Universidade de São Paulo, Faculdade de Saúde Pública, Serviço Especial de Saúde de Araraquara
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Alvina Clara Felix
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Nathalia C. Santiago Souza
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Angela Aparecida Costa
Universidade de São Paulo, Faculdade de Saúde Pública, Serviço Especial de Saúde de Araraquara
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Marta Inenami
Universidade de São Paulo, Faculdade de Saúde Pública, Serviço Especial de Saúde de Araraquara
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Rosangela M. Gasparetto da Silva
Universidade de São Paulo, Faculdade de Saúde Pública, Serviço Especial de Saúde de Araraquara
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José Eduardo Levi
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Camila Malta Romano
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Glaucia Paranhos-Baccalà
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Aluisio Cotrim Segurado
Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo
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Philippe Mayaud
London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases
Keywords:
Zika virus, Differential diagnosis, Kinetics, Body fluids, Polymerase chain reaction, Real-Time Polymerase Chain Reaction, Serology, Brazil
Abstract
Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.
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