A 17-year-old male presented to the emergency department due to his father’s concern that the patient was infected with ZIKV. He had no complaints or symptoms at the time of the visit. The patient reported experiencing joint pain, pruritic generalized rash, headache, and fever on the previous day. He denied any ocular complaints. He had returned from Puerto Rico on the previous day. While in Puerto Rico, he was in contact with a friend who experienced the same symptoms. Per the patient, the friend’s physician told him he had a viral condition. On physical exam, he was afebrile and hemodynamically stable. There were no positive relevant findings on physical exam. Blood chemistry tests were all within normal limits. Hematologic tests showed a mildly decreased white blood cell count (3.1 × 103/mL, normal range: 4.5–13.5 × 103/mL) and a mildly increased hemoglobin (15.3 g/dL, normal range: 11.0–15.0 g/dL) and hematocrit (43.7%, 33.0–43.0%). Lymphocyte percentage was decreased (0.9 × 103/µL, normal range: 1.2–6.4 × 103/µL). RT-PCR for ZIKV RNA was positive in urine and negative in serum. Serology was positive for dengue virus (IgM positive, IgG negative) and negative for chikungunya virus (IgM and IgG negative). Body fluid samples were analyzed at an offsite laboratory; therefore, the results were not available at the time of discharge. The patient received no treatment during this visit. On discharge, the patient was instructed to follow up with his primary care physician and to avoid sexual contact.
A 56-year-old female presented to her primary care physician with fever, conjunctivitis, arthralgia, and a rash on her chest, arms, and neck. She reported recent travel to Jamaica. History regarding trip duration and timing relative to symptom onset is not available. Body fluid samples were collected, and RT-PCR for ZIKV RNA was positive in urine and negative in serum. Serum RT-PCR RNA for dengue virus was negative. Serology for dengue virus was negative for IgM and positive for IgG. Serum RT-PCR for chikungunya virus RNA was negative.