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
References