Silva Kelly R, Bica Blanca E R G, Pimenta Eduardo S, Serafim Rodrigo B, Abreu Mirhelen M, Gonçalves Jorge L S, Santana Larissa de S, Cabral-Castro Mauro J, Peralta José M, Cavalcanti Marta G
Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro 21941590, Brazil.
Serviço de Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro 21941590, Brazil.
Diseases. 2018 Jun 21;6(3):53. doi: 10.3390/diseases6030053.
Zika virus (ZIKV) infection usually presents as a mild and self-limited illness, but it may be associated with severe outcomes. We describe a case of a 30-year-old man with systemic erythematous lupus and common variable immunodeficiency who became infected with both Zika (ZIKV) and Chikungunya (CHIKV) virus during the 2016 outbreak in Rio de Janeiro, Brazil. The patient presented with intense wrist and right ankle arthritis, and ZIKV RNA and virus particles were detected in synovial tissue, blood and urine, and CHIKV RNA in serum sample, at the time of the diagnosis. During the follow up, ZIKV RNA persisted for 275 days post symptoms onset. The patient evolved with severe arthralgia/arthritis and progressive deterioration of renal function. Fatal outcome occurred after 310 days post ZIKV and CHIKV co-infection onset. The results show the development of severe disease and fatal outcome of ZIKV infection in an immunosuppressed adult. The data suggests a correlation between immunodeficiency and prolonged ZIKV RNA shedding in both blood and urine with progressive disease. The results also indicate a possible role for arbovirus co-infections as risk factors for severe and fatal outcomes from ZIKV infection.
寨卡病毒（ZIKV）感染通常表现为一种轻度的自限性疾病，但也可能与严重后果相关。我们描述了一例30岁男性病例，该患者患有系统性红斑狼疮和常见变异型免疫缺陷，在2016年巴西里约热内卢疫情期间感染了寨卡病毒（ZIKV）和基孔肯雅病毒（CHIKV）。诊断时，患者出现严重的手腕和右踝关节关节炎，在滑膜组织、血液和尿液中检测到ZIKV RNA和病毒颗粒，在血清样本中检测到CHIKV RNA。在随访期间，症状出现后ZIKV RNA持续存在275天。患者病情进展为严重的关节痛/关节炎和肾功能进行性恶化。ZIKV和CHIKV合并感染发病310天后出现致命结局。结果显示免疫抑制成年患者中寨卡病毒感染会发展为严重疾病并导致致命结局。数据表明免疫缺陷与血液和尿液中ZIKV RNA长期脱落以及疾病进展之间存在关联。结果还表明虫媒病毒合并感染可能是寨卡病毒感染导致严重和致命结局的危险因素。
