title: A case series of atypical presentation of Zika Virus infection in Singapore.
abstract: The World Health Organization's and Centers for Disease Control and Prevention's definition of Zika infection are symptoms of fever, rash, joint pain, myalgia, headache and conjunctivitis. The diagnosis of Zika infection is based on the clinical history, physical examination and laboratory investigations which includes blood and urine Zika virus Polymerase Chain Reaction.
  
  
  
  Two patients presented with atypical presentation of Zika infection to Sengkang Health, Alexandra Hospital during the recent Zika outbreak in Singapore in August 2016. Madam A presented with isolated generalized rash with no fever, joint pain, myalgia, headache or conjunctivitis. Mr. B presented with isolated fever of 39.4 °C with no rash, joint pain, myalgia, headache or conjunctivitis. Both patients' blood Zika Polymerase Chain Reactions were positive at the time of presentation.
  
  
  
  The described case reports illustrated the challenges that our community Family Physicians faced in diagnosing patients infected with Zika virus. Coupled with the knowledge that most patients are asymptomatic, Family Physicians need to have a high index of clinical suspicion for early identification of patients infected with Zika virus, so as to institute timely treatment and appropriate measures to mitigate the outbreak of Zika infection in the community. Appropriate epidemiological measures such as ensuring prompt and thorough contact tracing of the cases are instrumental in the control of this public health problem.
authors.affiliation: Department of Family Medicine, Sengkang Health, SingHealth, Alexandra Hospital, 378 Alexandra Road, Singapore, Singapore, 159964. xu.bangyu@skh.com.sg.
authors.forename: Bang Yu
authors.identifier: 0000-0001-7547-4292
authors.initials: BY
authors.lastname: Xu
authors.affiliation: Department of Family Medicine, Sengkang Health, SingHealth, Alexandra Hospital, 378 Alexandra Road, Singapore, Singapore, 159964.
authors.forename: Sher Guan
authors.initials: SG
authors.lastname: Low
authors.affiliation: Department of Family Medicine, Sengkang Health, SingHealth, Alexandra Hospital, 378 Alexandra Road, Singapore, Singapore, 159964.
authors.forename: Richard Tiong Heng
authors.initials: RT
authors.lastname: Tan
authors.affiliation: Department of Family Medicine, Sengkang Health, SingHealth, Alexandra Hospital, 378 Alexandra Road, Singapore, Singapore, 159964.
authors.forename: Farhad Fakhrudin
authors.initials: FF
authors.lastname: Vasanwala
mesh_terms: D000328:Adult; D005076:Exanthema / Q000821:virology; D005260:Female; D005334:Fever / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012846:Singapore; D000071243:Zika Virus Infection / Q000150:complications / Q000175:diagnosis*
keywords: Atypical presentation; Case definition; Case series; Outbreak; Singapore; Zika