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Year : 2023  |  Volume : 66  |  Issue : 3  |  Page : 673-674
Atypical clinical presentation of Zika virus from India

1 Department of Microbiology, King Georges' Medical University, Lucknow, Uttar Pradesh, India
2 Department of Maximum Containment Facility, National Institute of Virology, Pune, Maharashtra, India
3 Department of Microbiology, 7 Air Force Hospital, Kanpur, Uttar Pradesh, India
4 Directorate of Medical and Health Services, Integrated Disease Surveillance, IDSP, Uttar Pradesh, India

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Date of Submission08-Feb-2022
Date of Decision20-Jul-2022
Date of Acceptance21-Jul-2022
Date of Web Publication16-Nov-2022

How to cite this article:
Shukla S, Yadav PD, Patil S, Jain A, Aggarawal V. Atypical clinical presentation of Zika virus from India. Indian J Pathol Microbiol 2023;66:673-4

How to cite this URL:
Shukla S, Yadav PD, Patil S, Jain A, Aggarawal V. Atypical clinical presentation of Zika virus from India. Indian J Pathol Microbiol [serial online] 2023 [cited 2023 Sep 27];66:673-4. Available from:

Dear Editor,

We, report the first laboratory confirmed ZIKV case from Uttar Pradesh, North, India.

A 56 years old male serving as Air Force employee, presented in emergency with complaints of high-grade fever, breathlessness, generalized body ache, and joint pain since 2 days. Fever was remittent, moderate grade, and without chills and rigor. Fever was also associated with redness of eyes, throat pain, and joint pain. He was a known case of hypertension on medication. There was no other significant medical and/or personal history. He had received both the doses of COVID-19 vaccine.

On general examination, his pulse rate was 110/min, blood pressure was 104/84 mm Hg, respiratory rate was 28/min, SpO2 was 90% on room air, and 94% on oxygen at 2L/min. His both eyes had congested conjunctive. There was blanching erythema over the chest and back. He was having bilateral fine inspiratory crepitations. After blood clinical evaluation laboratory findings, hemoglobin was found to be within normal limits (13.4) with lymphocytosis and thrombocytopenia and deranged international normalized ratio (Total leukocyte count 14400, WBC differential count: neutrophils 82%, lymphocytes 7%, and platelets 1.65 lacs). Kidney function was deranged as serum creatinine (3.2 mg/Dl) and blood urea nitrogen (48 mg/Dl) were high. The liver function test, blood sugar, and serum electrolytes parameters were within normal range. CT chest showed ground glass opacity and edema in dependent parts of lungs. No focal lesion was observed.

Various patient's samples tested negative for other infections, such as Hepatitis B virus, Dengue Virus, Hepatitis C virus, scrub typhus, leptospira, typhoid, and malaria. Patient's nasopharyngeal and oropharyngeal swabs (TS/NS) were tested and found negative for influenza A and B, parainfluenza viruses (1–4), adenoviruses, respiratory syncytial viruses, rhinoviruses, human metapneumovirus, Nipah virus, and SARS-CoV-2 viruses.[1],[2]

Whole blood, serum, and NS/TS samples were subjected to ZIKV testing by using CDC Trioplex (DENV, CHIKV, ZIKV) real-time RT-PCR assay (cut off is 38 Ct); ZIKV-RNA was detected in serum (Ct-31), whole blood (Ct-31), and NS/TS (Ct-32) samples on 22/10/21.[3] The serum was positive for anti-Zika IgM antibodies also.

The positivity was detected for consecutive three weeks 28/10/21, 1/11/21, and 9/11/21. Serum and NS/TS or saliva became negative in third week (CT-18, CT -28, and CT-negative; NS/TS or saliva CT-24, CT-32, and CT-Negative). ZIKA-RNA urine CT values were found positive till 3 weeks (CT-28, CT-32). Thus, ZIKV was first detected in NS/TS sample and was still positive in third week of infection in patient's urine samples.[4] The patient was symptomatically managed. He became afebrile and subsequently recovered completely.

The next-generation sequencing and bioinformatics analysis were carried for index ZIKV case at Indian Council of Medical Research-National Institute of Virology, Pune as per the protocol described earlier.[3] Partial sequence retrieved from the clinical sample of the ZIKV case matched with sequences of Rajasthan outbreak in 2018. The patient was symptomatically managed. He developed acute tubular necrosis subsequently.

ZIKV, first identified in Uganda, is an arthropod-borne virus belonging to flaviviridae family.[5] Later on, outbreaks were reported from different zones of world, such as Africa, the United States of America, Asia, and the Pacific.[5] The first case of ZIKV was reported in India in 2017 in Gujarat (3 cases) and later in Tamil Nadu (1 case).[6] Large outbreaks took place in Rajasthan and Madhya Pradesh later in 2018.[6] ZIKV is surpassing all geographical borders and emerging threat in newer areas of India. In the era of COVID-19 pandemic, where majority of pneumonia cases are because of SARS-CoV-2 virus, ZIKV may not be ignored in differential diagnosis. We report an atypical presentation with acute respiratory distress syndrome and features of multi-organ failure. With the detection of the present case, the surveillance was enhanced, and till date, 126 cases of ZIKV are reported from Kanpur District and adjoining area of Uttar Pradesh. Among them, only two cases were symptomatic, rest others were aymptomatic. None other cases were critical and no mortality detected.

A study done by Deng et al.[7] demonstrated that ZIKV infection could be efficiently established via intra-nasal or intra-gastric routes in A129 mice, guinea pigs, and non-human primates. Few in vitro assays have also demonstrated that human respiratory cells are highly susceptible to ZIKV.[7] ZIKV may have tendency to spread by contact or droplets if presenting as acute respiratory illness or may have non-vector-borne human transmission.[8]

ZIKV is a raising concern in India; hence, a continuous and strengthened surveillance in Guillain-Barre syndrome, ante-natal, and acute febrile illness cases throughout the year will enhance further detection of ZIKV and implementing the control measures.

Authors contribution

Shukla S: conceptualization, methodology writing, original draft preparation designing, draft preparation, and testing; Pragya D. Yadav: conceptualized, writing, and critical review the manuscript;, Patel S-Data: reporting, critical review of manuscript; Amita Jain: writing, reviewing and editing, supervision; and Aggarawal V: coordination and supervision.


Authors also appreciate the support from the technical staff of Virology Lab, Department of Microbiology, KGMU and ICMR-NIV, Pune (Sahay R; Prakash S; Shete A M-; Verma A; Khan DN; SapkalGN; Prakash OP; Vangala RK; Bhagat Ak.; Mrs.Triparna Majumdar, Mrs.Savita Patil, Ms.Pranita Gawande, Mrs.Ashwini Waghmare, and Mrs.Kaumudi Kalele). Authors acknowledge the support by CDC, USA for the supply of CDC Trioplex kits.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Prakash S, Shukla S, Ramakrishna V, Mishra H, Bhagat AK, Jain A. Human parvovirus 4: A harmless bystander or a pathogen of severe acute respiratory illness. Int J Infect Dis 2020;90:21-5.  Back to cited text no. 1
Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020;25:2000045. doi: 10.2807/1560-7917.ES.2020.25.3.2000045.  Back to cited text no. 2
Santiago GA, Vázquez J, Courtney S, Matías KY, Andersen LE, Colón C, et al. Performance of the Trioplex real-time RT-PCR assay for detection of Zika, dengue, andchikungunya viruses. Nat commun 2018;9:1-10.  Back to cited text no. 3
Yadav PD, Albariño CG, Nyayanit DA, Guerrero L, Jenks MH, Sarkale P, et al. Equine encephalosis virus in India, 2008. Emerg Infect Dis 2018;24:898.  Back to cited text no. 4
Available from: [Last accessed on 2021 Nov 26].  Back to cited text no. 5
Gupta N, Yadav PD, Patil DY, Sapkal G. Preparedness of public health-care system for Zika virus outbreak: An Indian perspective. J Infect Pub Heal 2020;13:949-55.  Back to cited text no. 6
Deng YQ, Zhang NN, Li XF, Wang YQ, Tian M, Qiu YF, et al. Intranasal infection and contact transmission of Zika virus in guinea pigs. Nat Commun 2017;8:1648.doi: 10.1038/s41467-017-01923-4.  Back to cited text no. 7
Ramos-Rossy J, Flores J, Otero-Domínguez Y, Torres-Palacios J, Rodríguez-Cintrón W. Hypoxemic respiratory failure secondary to Zikavirus infection. P R Health Sci J 2018;37:99-101.  Back to cited text no. 8

Correspondence Address:
Amita Jain
HOD, Department of Microbiology, King Georges' Medical University (KGMU), Lucknow -226 003, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_144_22

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