Advertisement
Mayo Clinic Proceedings Home

In Reply–Cardiac Compromise in Zika Virus Infection

Published:February 03, 2018DOI:https://doi.org/10.1016/j.mayocp.2017.12.007
      To the Editor:
      We read with interest the letter from Villamil-Goméz et al,
      • Villamil-Goméz W.E.
      • Ramirez-Vallejo E.
      • Rodriguez-Morales A.J.
      Cardiac compromise in Zika virus infection.
      which reinforces the possibility of frequent subclinical cardiovascular involvement in Zika virus (ZIKV) infection, especially in immunocompromised patients.
      The 2 cases reported by Villamil-Goméz et al are suggestive that ZIKV can frequently affect the heart, as shown by electrocardiograhic changes and pericardial effusion by echocardiogram, but without clinical manifestations of the cardiac involvement. It is relevant to consider that with the lack of documentation of ZIKV presence in heart tissues, the described changes could also be part of a systemic inflammation response and not be due to a direct virus aggression. Nevertheless, this kind of report raises the possibility that ZIKV infection could be more frequently associated with subclinical cardiac involvement than previously suspected, demanding prospective studies to investigate this hypothesis.
      In our previously reported clinical case,
      • Schwartzmann P.V.
      • Ramalho L.N.
      • Neder L.
      • et al.
      Zika virus meningoencephalitis in an immunocompromised patient.
      the patient had undergone cardiac transplantation and was on immunosuppressive therapy previously to the ZIKV infection. During the course of the infection, because of the suspicion of ZIKV meningoencephalitis, we were forced to withdraw the immunosuppressive therapy and the patient unfortunately died as a consequence of acute cardiac rejection and circulatory shock. Therefore, in our previous case, there was no clear evidence of ZIKV infection directly affecting the heart.
      In conclusion, there is preliminary evidence suggesting that ZIKV infection may affect other organs besides neurologic involvement and its impact could be even more significant in immunocompromised patients.

      References

        • Villamil-Goméz W.E.
        • Ramirez-Vallejo E.
        • Rodriguez-Morales A.J.
        Cardiac compromise in Zika virus infection.
        Mayo Clin Proc. 2018;
        • Schwartzmann P.V.
        • Ramalho L.N.
        • Neder L.
        • et al.
        Zika virus meningoencephalitis in an immunocompromised patient.
        Mayo Clin Proc. 2017; 92: 460-466

      Linked Article

      • Cardiac Compromise in Zika Virus Infection
        Mayo Clinic ProceedingsVol. 93Issue 3
        • Preview
          We have read with interest the case report of Schwartzmann et al1 reporting a single case of Zika virus (ZIKV) meningoencephalitis, but also with ZIKV propagation to other organs, including the heart. As in other arboviral diseases (dengue and chikungunya),2-4 cardiovascular disorders such as arrhythmias, among others, are being observed in previously healthy cases. But there is a lack of publications assessing it. We take this opportunity to discuss 2 cases of pregnant women from an endemic area (Sucre, Colombia), with confirmed ZIKV infection who presented with cardiovascular and electrocardiographical (ECG) alterations (myocarditis).
        • Full-Text
        • PDF