Zika virus infection

Present in tropical regions of Asia and Africa, this virus is currently considered as emerging has been responsible for many outbreaks: in 2007 in Micronesia, in 2013 in French Polynesia, in 2014 in New Caledonia. Since 2015, it causes an epidemic in the Americas especially in Brazil, the most affected country with more than 1.5 million cases.

The Zika virus (ZIKV), is an arbovirus of the Flaviviridae family, type Flavivirus, responsible for the Zika fever in humans. This virus has been identified for the first time in 1947 in the Zika forest in Uganda. It is a RNA virus transmitted by the bite of a type Aedes infected mosquito. This same mosquito can also transmit chikungunya,  dengue fever and yellow fever. In most cases, it is Aedes aegypti, which propagates the Zika virus in tropical and subtropical areas, but Aedes albopictus can also spread the virus and may hibernate to survive in the colder regions. Both species breed and live near homes, preferring to bite humans rather than animals. It is also the only arbovirus for which a sexual transmission has been demonstrated: it has been detected in sperm, blood, urine, amniotic fluid, saliva and body fluids found in the brain and spinal cord. The Zika virus is thus a risk for safety of blood transfusion. The Zika virus infection is usually well tolerated. Often asymptomatic, it can lead to a syndrome similar to other arboviroses : fever, rash, headache and arthralgias with spontaneous recovery after two to seven days. However, the virus has a tropism for neurons: it inhibits neural growth in utero and can cause neurological abnormalities of the fetus of an infected pregnant woman and probably increases the risk of Guillain-Barré syndrome in infected patients. In addition to congenital microcephaly, other problems have been reported in newborns exposed in utero to the Zika virus.

The severity depends on the time when the foetus was infected:

-        malformations of the head: microcephaly, micrognathia,.

-        cerebral anomalies: calcifications, abnormalities of the central structures and the cerebellum, ventriculomegaly, cortical atrophy

-        anomalies of the craniocervical junction: flat occiput, overlaping sutures with excess skin (cutis gyrata) and flattening of the posterior fossa limiting the mobility of the cervical spine. In addition, the spinal cord appears too thin at this level

-        involuntary movements,

-        convulsions,

-        irritability with high-pitched cry

-        dysfunction of the brainstem: swallowing problems.

-        contractures of limbs with arthrogryposis of neurogenic origin (central and peripheral motor neurons damage),

-        ocular (macular damage) and hearing anomalies


Anesthetic implications: 

(1)        general precautions: careful hands cleaning, wearing gloves and a mask with eye shield and a waterproof  gown because viremia persists in children up to 3 months;

(2)        risk of difficult mask ventilation and  intubation due to micrognathia and limited craniocervical  mobility ;

(3)          difficult venous access in case of arthrogryposis;

(4)        risk of seizures;

(5)        in case of active infection, avoid any neuraxial block. sometimes: leukopenia and thrombocytopenia


References : 

-        Kuntz MT, Tutiven JL, Read SP, Ventura CV, Berrocal AM.
Two infants with presumed Zika congenital syndrome presenting for exam under general anesthesia.
Pediatr Anesth 2017; 27: 868-9.

-        Tutiven JL, Pruden BT, Banks JS, Stevenson M, Birnbach DJ.
Zika virus: obstetric and pediatric anesthesia considerations.
Anesth Analg 2017; 124: 1918-29.


Updated: July 2017