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Clinical Summary

Zika detected in semen after 515 days in an immunosuppressed patient

Takeaway

  • Case report highlights persistence of Zika virus (ZIKV) RNA in semen 515 days postsymptom onset (PSO), detectable for >900 days in an immunocompromised patient.

Why this matters

  • Clinicians should consider that ZIKV RNA shedding in semen might be intermittent and persist longer in patients with immunosuppression.
  • Advise returning male travelers, especially those with immunosuppression and in couples planning pregnancy, that they may be at risk for transmission.

Key points

  • 43-year-old English man with confirmed multicentric reticulohistiocytosis (MRH), diagnosed in 2015.
  • 7 months after starting disease-modifying antirheumatic drugs, 7 days post-Brazilian travel patient experienced fever, new maculopapular rash; ZIKV in serum confirmed by RT-PCR, seroconversion on day 13.
  • Methotrexate and hydroxychloroquine were halted, but patient remained on prednisolone to prevent MRH flare up.
  • Subsequent testing showed ZIKV RNA persistence 515 days PSO, but patient remained asymptomatic.
  • No evidence for cross-contamination that might explain whole genomes in day 515 samples.
  • Clinicians concluded that ZIKV RNA persisted due to failed immune clearance secondary to MRH or immunosuppressive drug treatment.

References


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