title: Three atypical lethal cases associated with acute Zika virus infection in Suriname.
abstract: Acute Zika virus infection usually presents with a self-limiting triad of fever, rash and arthritis. There is limited information on severe or lethal cases. We report three cases of lethal acute Zika infection, confirmed with polymerase chain reaction, in adult patients with some co-morbidities. The patients showed rapid clinical deterioration with hemorrhagic and septic shock, and exaggerated acute and innate inflammatory responses with pronounced coagulopathy, and died soon after admission to the hospital. It remains unclear whether the fatal outcomes were due to acute Zika virus infection alone or to the combination with exacerbated underlying prior disease or co-infection. Nonetheless, the severity of these cases implies that increased awareness for atypical presentations of Zika virus infection, and careful clinical assessment of patients with symptoms of Zika, is warranted during current and future outbreaks.
authors.affiliation: Department of Pediatrics, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname; Scientific Research Center Suriname, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname; Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
authors.forename: Rens
authors.initials: R
authors.lastname: Zonneveld
authors.affiliation: Clinical Laboratory, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Roosblad
authors.affiliation: Intensive Care Unit, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname.
authors.forename: Jan Willem van
authors.initials: JW
authors.lastname: Staveren
authors.affiliation: Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Wilschut
authors.affiliation: Department of Internal Medicine, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname; Center of Excellence for Neglected Infectious Diseases, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname.
authors.forename: Stephen G S
authors.initials: SG
authors.lastname: Vreden
authors.affiliation: Clinical Laboratory, Academic Hospital Paramaribo, Flustraat 1, Paramaribo, Suriname.
authors.forename: John
authors.initials: J
authors.lastname: Codrington
keywords: Hemorrhagic fever; Sepsis; ZIKV; Zika