Editorial
Zika virus: Growing guilt from association
Virus de Zika: se expande su culpabilidad por asociación
Orlando Acosta
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oacostal@unal.edu.co
Correspondence to: Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de Colombia, Ciudad Universitaria, Carrera 30, No. 45-03, Bogotá D.C., Colombia.
Correspondence to: Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de Colombia, Ciudad Universitaria, Carrera 30, No. 45-03, Bogotá D.C., Colombia.
Department of Physiological Sciences, Universidad Nacional de Colombia, School of Medicine, Bogotá D.C., Colombia
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The ZIKV genome consists of an RNA molecule (ribonucleic acid) that encodes for a polyprotein which, following processing, results in the production of three structural proteins (C, prM and E) and seven non-structural proteins (NS).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">2,3</span></a> Studies about its molecular evolution point to three main ZIKV lineages: one from Asia and two from Africa.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4,5</span></a> Recent studies have shown that it has undergone several recombination events since it emerged in Uganda early in the 20th century, and then after it moved towards Western Africa and Asia.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a> Phylogenetic tree analyses have shown that the Surinam ZIKV strains belong to the Asian genotype and are intimately related to the strain that circulated in the French Polynesia in 2014, with which they share 99.7% of the genetic information and 99.9% of their identity in the amino acid sequences that make up the protein.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical picture caused by the ZIKV is similar to that of dengue fever and chikungunya. Patients present with fever, headache, arthralgia, myalgia and maculopapular rash, a whole complex of symptoms that renders a differential diagnosis difficult. This is compounded by the fact that a high proportion of ZIKV infections are asymptomatic, and many are associated only with a mild disease.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a> Although the ZIKV vector is the <span class="elsevierStyleItalic">Aedes</span> mosquito species, sexual transmission was suggested when ZIKV was detected in the semen of a patient affected by the outbreak of the virus in the French Polynesia in 2013.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> Potential ZIKV sexual transmission has been reported in three cases,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> creating concern especially during gestation. The possibility of ZIKV transmission through blood transfusions has also been reported,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">11</span></a> and the health authorities in Brazil have reported two cases of ZIKV transmission.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On February 1st 2016, the World Health Organization declared the ZIKV expansion as a worldwide public health emergency.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> Experts have declared a strong space and time association between ZIKV infection and an increase in congenital malformations and neurological complications. However, emphasis is made on the need for additional research in order to determine with scientific certainty the causal relationship between ZIKV and microcephaly, despite the strong suspicion of a relationship between ZIKV infection during pregnancy and microcephaly. An urgent appeal to coordinate international research work has been launched in an attempt to gain a better understanding of the disease and eventually pave the way for the development of a protective vaccine.</p><p id="par0020" class="elsevierStylePara elsevierViewall">ZIKV expansion was reported in 2015 in Latin America and the Caribbean, particularly in Brazil where the number of cases in the latter part of the year were estimated at 440,000–1,300,000<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14,15</span></a> with almost a twenty-fold increase in cases of neonates born with microcephaly associated with ZIKV infection during pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">15–18</span></a> A recent publication in the New England Journal of Medicine (NEJM) (February 9 2016)<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> refers to an association between ZIKV and microcephaly, reinforcing the suspicion of a causal relationship. The publication reports the case of a European citizen infected with the ZIKV in Brazil at 13 weeks of gestation, and includes ultrasound images with no foetal abnormalities at 14 and 20 weeks of gestation. However, between 29 and 32 weeks there were findings of intrauterine growth retardation, microcephaly, diffuse cerebral structures and calcifications in the brain.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> The autopsy performed following the interruption of the pregnancy revealed a severely affected foetal brain, a relatively small brain mass (84<span class="elsevierStyleHsp" style=""></span>g), and absent gyri. Histopathological and molecular tests revealed numerous neuropathological findings, including in particular multifocal calcifications of the cerebral cortex and the subcortical white matter.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However, pursuant to rigorous scientific research, the results are not absolute evidence that ZIKV causes microcephaly.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> The causality criteria proposed by Robert Koch in 1891<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a> require isolation of the causative agent and the reinfection event of a susceptible individual in order to reproduce the disease and isolate the causative agent. Given the devastating and intractable manifestations of the disease, it has been found difficult to apply Koch's criteria,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> the recommendation being to use a combination of scientific and epidemiological evidence.</p><p id="par0030" class="elsevierStylePara elsevierViewall">An association has also been found between ZIKV infection and the infrequent but very worrisome Guillain-Barré syndrome (GBS). This autoimmune syndrome has been reported in patients from French Polynesia and Brazil during ZIKV outbreaks,<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">15,17,22</span></a> although emphasis has been placed on the need for further research in order to understand the potential association. In Brazil, 1.708 cases of GBS were reported between January and November 2015, with increases ranging between 100% and 500% in several states where ZIKV and other flavivirus circulate, compared to 2014.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> Case-control studies are under way in Brazil to determine the causes of this rise in GBS and confirm or rule out a causal relationship with ZIKV.</p><p id="par0035" class="elsevierStylePara elsevierViewall">While waiting for the scientific research that may shed light on the basic mechanisms involved in ZIKV replication and that may eventually pave the way for developing primary prevention strategies and therapeutic interference of the viral infection, the public health infrastructure in the affected countries will have to face up to the challenge of controlling and eradicating the vector, implementing diagnostic procedures, strengthening contraceptive programmes and programmes for the prevention of sexually transmitted diseases, providing care to pregnant women and guaranteeing their right to interrupt pregnancy, among other related challenges.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">The author did not receive sponsorship to undertake this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Acosta O. Virus de Zika: se expande su culpabilidad por asociación. Rev Colomb Anestesiol. 2016;44:83–85.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Zika virus outside Africa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 22 | 7 | 29 |
| 2024 September | 38 | 8 | 46 |
| 2024 August | 24 | 7 | 31 |
| 2024 July | 21 | 6 | 27 |
| 2024 June | 26 | 5 | 31 |
| 2024 May | 19 | 7 | 26 |
| 2024 April | 29 | 20 | 49 |
| 2024 March | 31 | 7 | 38 |
| 2024 February | 50 | 9 | 59 |
| 2024 January | 22 | 5 | 27 |
| 2023 December | 36 | 9 | 45 |
| 2023 November | 15 | 7 | 22 |
| 2023 October | 14 | 8 | 22 |
| 2023 September | 13 | 4 | 17 |
| 2023 August | 10 | 8 | 18 |
| 2023 July | 6 | 11 | 17 |
| 2023 June | 7 | 3 | 10 |
| 2023 May | 6 | 3 | 9 |
| 2023 April | 6 | 3 | 9 |
| 2023 March | 6 | 2 | 8 |
| 2023 February | 7 | 4 | 11 |
| 2023 January | 11 | 3 | 14 |
| 2022 December | 12 | 4 | 16 |
| 2022 November | 19 | 14 | 33 |
| 2022 October | 8 | 10 | 18 |
| 2022 September | 9 | 4 | 13 |
| 2022 August | 9 | 8 | 17 |
| 2022 July | 8 | 12 | 20 |
| 2022 June | 13 | 5 | 18 |
| 2022 May | 6 | 4 | 10 |
| 2022 April | 11 | 7 | 18 |
| 2022 March | 11 | 7 | 18 |
| 2022 February | 10 | 4 | 14 |
| 2022 January | 9 | 5 | 14 |
| 2021 December | 8 | 11 | 19 |
| 2021 November | 10 | 8 | 18 |
| 2021 October | 7 | 9 | 16 |
| 2021 September | 7 | 5 | 12 |
| 2021 August | 4 | 9 | 13 |
| 2021 July | 8 | 6 | 14 |
| 2021 June | 9 | 4 | 13 |
| 2021 May | 10 | 11 | 21 |
| 2021 April | 9 | 8 | 17 |
| 2021 March | 13 | 13 | 26 |
| 2021 February | 6 | 8 | 14 |
| 2021 January | 6 | 6 | 12 |
| 2020 December | 5 | 3 | 8 |
| 2020 November | 4 | 3 | 7 |
| 2020 October | 3 | 3 | 6 |
| 2020 September | 8 | 5 | 13 |
| 2020 August | 5 | 9 | 14 |
| 2020 July | 8 | 9 | 17 |
| 2020 June | 5 | 5 | 10 |
| 2020 May | 7 | 4 | 11 |
| 2020 April | 4 | 2 | 6 |
| 2020 March | 6 | 2 | 8 |
| 2020 February | 5 | 5 | 10 |
| 2020 January | 5 | 3 | 8 |
| 2019 December | 6 | 7 | 13 |
| 2019 November | 3 | 1 | 4 |
| 2019 October | 5 | 2 | 7 |
| 2019 September | 4 | 1 | 5 |
| 2019 August | 1 | 1 | 2 |
| 2019 July | 1 | 1 | 2 |
| 2019 June | 5 | 7 | 12 |
| 2019 May | 1 | 10 | 11 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 4 | 2 | 6 |
| 2018 May | 30 | 12 | 42 |
| 2018 April | 32 | 7 | 39 |
| 2018 March | 22 | 10 | 32 |
| 2018 February | 19 | 10 | 29 |
| 2018 January | 21 | 9 | 30 |
| 2017 December | 16 | 8 | 24 |
| 2017 November | 18 | 9 | 27 |
| 2017 October | 14 | 17 | 31 |
| 2017 September | 18 | 10 | 28 |
| 2017 August | 14 | 8 | 22 |
| 2017 July | 17 | 6 | 23 |
| 2017 June | 21 | 10 | 31 |
| 2017 May | 28 | 12 | 40 |
| 2017 April | 39 | 15 | 54 |
| 2017 March | 18 | 9 | 27 |
| 2017 February | 11 | 6 | 17 |
| 2017 January | 17 | 6 | 23 |
| 2016 December | 31 | 10 | 41 |
| 2016 November | 26 | 17 | 43 |
| 2016 October | 27 | 10 | 37 |
| 2016 September | 79 | 7 | 86 |
| 2016 August | 28 | 6 | 34 |
| 2016 July | 18 | 6 | 24 |
| 2016 May | 5 | 18 | 23 |
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