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| REVIEW ARTICLE |
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| Year : 2017 | Volume
: 4
| Issue : 2 | Page : 50-52 |
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Zika virus: A review with oral health implications
Ruchika Khanna1, Maj Sachin Gupta2, Umang Jagga3
1 Department of Oral Medicine and Radiology, Sri Sukhmani Dental College and Hospital, Derabassi, Punjab, India
2 Officer Commanding, 1209 Dental Unit, Leh, Jammu and Kashmir, India
3 Department of Pedodontics, Sri Sukhmani Dental College and Hospital, Derabassi, Punjab, India
| Date of Web Publication | 10-Oct-2017 |
Correspondence Address:
Ruchika Khanna
Department of Oral Medicine and Radiology, Sri Sukhmani Dental College and Hospital, Derabassi, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdrr.jdrr_44_17
Zika virus was first isolated in the year 1947 from the blood of sentinel rhesus macaque of Uganda. The virus was introduced in Brazil from Pacific Islands and thereon spread rapidly. It was considered the first infectious disease to have birth defects. This review highlights the transmission, clinical aspects, clinical features, diagnosis, and possible implications of the virus for the dental team. Keywords: Birth defects, infectious, Zika
How to cite this article:
Khanna R, Gupta MS, Jagga U. Zika virus: A review with oral health implications. J Dent Res Rev 2017;4:50-2 |
| Introduction | |  |
Zika virus is a flavivirus, belonging to the family Flaviviridae. It was first discovered in the year 1947 and was isolated from Aedes Africanus. There was no incidence of human illness earlier until a serosurvey done on people of Uganda showed 6.1% seroprevalence of antibodies against Zika Virus, suggesting human infection to be frequent.[1] Further serosurveys done showed the human spread to much broader geographic areas such as Egypt,[2] East Africa,[3] Nigeria,[4] India,[5] Thailand,[6] Vietnam,[6] the Philippines,[7] and Malaysia (near Kuala Lumpur and in East Malaysia [Sabah and Federal Territory of Labuan]).[8] The first case of human infection of Zika Virus was recognized in Nigeria in 1953. In spite being recognized, only 13 cases were recorded in next 57 years until its outbreak in 2007 on several islands in the state of Yap, Federated States of Micronesia resulting in almost 5000 infections in a total population of 6700.[9] Whereas an outbreak of Zika Virus in French Polynesia in 2013–2014 involved around 32,000 persons.[10],[11],[12] Cases of associated Guillain–Barre syndrome is also noted.[11] Investigators in Brazil in September 2015, noted a sudden increase in the cases of microcephaly in infants in same areas in which Zika Virus was reported.[13] By 2016, almost 4300 cases of microcephaly have been recorded.[14] It is speculated that due to the increasing number of microcephaly associated with Zika Virus cases there will be a significant effect on not only the general health of the patient but also dental health would too be affected.[15],[16] The common features of ZIKV infection are fever, conjunctivitis, cutaneous rash, and arthralgia but the majority of the affected patients with the clinical disease present with only mild symptoms.[17] Recent data show the presence of Zika Virus in body fluids such as blood, semen, urine, saliva suggesting the transmission of the virus through corporal fluids. [Figure 1] shows areas in the world affected by Zika Virus in the past decade.[18]
Mosquito virus transmission
In Africa, sylvatic transmission cycle is seen involving nonhuman primates and forest dwelling species of Aedes mosquitoes which is not seen in Asia.
Species belonging to Stegomyia, Diceromyia of Aedes and Australopithecus africanus, Aedes luteocephalus are likely vectors found in Asia and Africa.[19] Whereas, the transmission seen in urban environments is human-mosquito-human transmission cycle. Species A. Aegypti and Aedes albopictus bite mainly during the daytime and are distributed widely through the tropical and subtropical world.
Non-mosquito transmission
Significant data show that Zika Virus transmits from mother to fetus during pregnancy. Zika Virus has been found in the amniotic fluid of mothers whose fetus had cerebral abnormalities detected by ultrasonography and viral antigen and RNA have been detected in brain tissue and placentas of children born with microcephaly.[20]
Clinical aspects
Acute febrile illness
French Polynesian blood donors reported conjunctivitis, rash, arthralgia, or combination of these symptoms 3–10 days after blood donation.[21] A serosurvey from an outbreak in Yap indicated maculopapular rash in 90% of patients, fever (65%), arthritis or arthralgia (65%), nonpurulent conjunctivitis (55%), myalgia (48%), headache (45%), retro-orbital pain (39%), edema (19%), and vomiting (10%). Other symptoms reported are temporary dull metallic hearing, hand and ankle edema with subcutaneous bleeding.[22]
Neurological effects
An association has been observed between Zika Virus and Guillain–Barr syndrome (GBS) which is an acute paralytic peripheral neuropathy. GBS is characterized by nerve inflammation and demyelination secondary to the action of antibodies against myelin antigens. Zika Virus infection complicated by meningoencephalitis [23] and acute myelitis [24] have been reported in literature.
Adverse fetal outcomes
Maternal Rubella infection can cause various congenital anomalies such as sensorineural hearing loss, eye anomalies, cataracts, cardiac anomalies, neurological effects, brain damage, and microcephaly.[25]
Clinical features
The incubation period lasts from 2 to 7 days. Symptoms can last for up to a week, with a clinical presentation similar to that of other arbovirus infections such as chikungunya and dengue. Common signs of ZIKV infection are headache, and conjunctivitis rash, self-limiting acute fever, arthralgia. Rash that appears is pruritic and maculopapular. Hemorrhagic signs are uncommon (Duffy et al., 2009). Sore throat, vomiting, diarrhea, apthous ulcers, cough (Tappe et al., 2014; Foy et al., 2011).
Diagnosis
The routine diagnosis of Zika Virus is the detection of viral nucleic acid by a real-time polymerase chain reaction and IgM antibodies by IgM capture enzyme-linked immunosorbent assay (MAC-ELISA).
Relevance to dentistry
The dental practice involves close contact to the airway and generation of aerosol sprays posing a higher risk environment to pass and catch various viral infections.[26] However, a considerable reduction of the risk can be done by use of masks and gloves, rubber dam, high volume suction, and preprocedure rinses.
Implications for dental team
With proper knowledge, it is possible to reduce the transmission of emerging infection in dental setting. The implications include:
- Being aware of incubation periods
- Being aware of patients' recent travel history
- Being aware of emerging infections
- Delaying elective treatment of those from affected areas who may have been in contact with cases until the incubation period has passed to reduce risk of transmission.
| Conclusion | | |
Zikv is a new evolving viral infection with global health consequences with microcephaly, Guillain–Barre syndrome and neurological disorders to mention a few. Although the risk of transmission in health-care setting is low, it should be prevented by following standard guidelines of infection control. Additional studies and research are required for better understanding of the disease. Dental professionals too should be aware of such infection as they have a potential to spread by the generation of aerosol sprays in the oral cavity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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