The frequency and clinical presentation of Zika virus coinfections: a systematic review

Abstract

BackgroundThere is limited knowledge on the influence of concurrent coinfections on the clinical presentation of Zika virus (ZIKV) disease.MethodsTo better understand the types, frequencies and clinical manifestations of ZIKV coinfections, we did a systematic review of four databases (PubMed, Embase, Web of Science, LILACS) without restrictions for studies on ZIKV coinfections confirmed by nucleic acid (quantitative real-time-PCR) testing of ZIKV and coinfecting pathogens. The review aimed to identify cohort, cross-sectional, case series and case report studies that described frequencies and/or clinical signs and symptoms of ZIKV coinfections. Conference abstracts, reviews, commentaries and studies with imprecise pathogen diagnoses and/or no clinical evaluations were excluded.ResultsThe search identified 34 articles from 10 countries, comprising 2 cohort, 10 cross-sectional, 8 case series and 14 case report studies. Coinfections were most frequently reported to have occurred with other arthropod-borne viruses (arboviruses); out of the 213 coinfections described, ZIKV infections co-occurred with chikungunya in 115 cases, with dengue in 68 cases and with both viruses in 19 cases. Other coinfecting agents included human immunodeficiency, Epstein-Barr, human herpes and Mayaro viruses, Leptospira spp, Toxoplasma gondii and Schistosoma mansoni. ZIKV-coinfected cases primarily presented with mild clinical features, typical of ZIKV monoinfection; however, 9% of cases in cohort and cross-sectional studies were reported to experience complications.ConclusionBased on the evidence collated in this review, coinfections do not appear to strongly influence the clinical manifestations of uncomplicated ZIKV infections. Further research is needed to confirm whether risk of severe complications is altered when ZIKV infection co-occurs with other infections.PROSPERO registration numberCRD42018111023.

The legacy of ZikaPLAN: a transnational research consortium addressing Zika

“…In addition to reporting on the findings from individual cohorts, our team of investigators has also been actively engaged in wider evidence synthesis and data sharing efforts, leading to two systematic reviews [ 51 , 52 ] and contributing to four critical commentaries [ 6 , 53–55 ] and three planned individual participant data meta-analyses. The first systematic review collates evidence from 34 studies of ZIKV co-infections, and suggests that, while ZIKV co-infections, especially with other arboviruses, are frequently reported, they do not appear to materially alter the clinical presentation or enhance the severity of uncomplicated acute ZIKV disease [ 51 ].…”

“…In addition to reporting on the findings from individual cohorts, our team of investigators has also been actively engaged in wider evidence synthesis and data sharing efforts, leading to two systematic reviews [ 51 , 52 ] and contributing to four critical commentaries [ 6 , 53–55 ] and three planned individual participant data meta-analyses. The first systematic review collates evidence from 34 studies of ZIKV co-infections, and suggests that, while ZIKV co-infections, especially with other arboviruses, are frequently reported, they do not appear to materially alter the clinical presentation or enhance the severity of uncomplicated acute ZIKV disease [ 51 ]. The second systematic review of 32 studies on postnatal ZIKV infections in children and adolescents highlights the scant evidence base in this age range and the need for population-based studies quantifying the associations of pediatric ZIKV infections, especially those occurring in infancy, with neurologic complications and later neurodevelopmental outcomes [ 52 ].…”

Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection

“…Zika virus infection is an acute, self-limited, feverish disease lasting from three to seven days, usually without severe complications. Most infections are asymptomatic, but from 20% to 25% of infected people have nonspecific clinical manifestations, giving room to the need for differential laboratory diagnosis regarding chikungunya and dengue [34][35][36][37][38][39] . Infection must be suspected in the occurrence of two or more of the symptoms described in Figure 2.…”

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecção pelo vírus Zika

“…La mayoría de las infecciones son asintomáticas, pero del 20 al 25% de las personas infectadas presentan manifestaciones clínicas inespecíficas, por lo que es necesario realizar el diagnóstico diferencial de laboratorio en relación con chikungunya y dengue. [34][35][36][37][38][39] La infección debe sospecharse en presencia de dos o más de los síntomas descritos en la Figura 2. La definición de caso sospechoso es la misma para las personas que viven en áreas endémicas y para los viajeros provenientes de esas áreas, así como para sus contactos sexuales sin protección.…”