~ 0 to 3 Days

Asymptomatic phase:

-Proportion-Risk ofGBS-Implicated factors

~4 to 7 Days

Acute Febrille phase:

-Rash-Conjunctivitis-Maleolaroedema

Severe/Atypical Cases:

-Proportion-Risk factors-Predictors- GBS

Convalescence

Chronic burden:

-Microcephaly-Neurological dissability-MentalHealth/Quality ofLife?-CardiovascularDysfunction?

Short-term Mid-term Long-term

Comorbidities Coinfections Risk Factors:ADE?

Zika Clinical Spectrum

Zika Emergence and Socioecological suitability

Hu BX, et al. Virology Journal. 2017. Sun XM, et al Cell Rep. 2017.

Effect of ZIKV on transcriptome

Comorbidities Coinfections Risk Factors:ADE?

Moni MA, et al 2017

Metabolic

Neurological

Cancer

ZIKV

Commorbidites and ZIKV, transcriptome analysis

Report Age(y) Gender Comorbidity CauseofdeathSwaminathan S,etal.2016

73 M Prostate Cancer Septic Shock

AzevedoRS,etal.2016 36 M LES RespiratoryfailureSchwartzmann PV,etal.2017

36 M Hearttransplantrecipient

Cardiogenic shockdue toacutecardiac allograft rejection

SharpTM,etal.2016 72 M HTA,Hyperlipidemia

Severe thrombocytopenia relatedwith severe hemorrhage

Zonneveld R,etal.201661 M HTA SepticShock64 M DM,Epilepsy Septic Shock59 M COPD Septic Shock

Sarmiento-OspinaA,etal.2016

61 M HTA Respiratory failure,acutemyocardial infarction,shock

72 F DM RespiratoryfailureandshockArzuza-OrtegaL,etal.2016

15 F Sickle cell disease Respiratory failure

Comorbidities, impact on clinical outcomes

ZIKV coinfection, clinical aspects

• Diagnostic challenge • Clinical impact • Follow up implications

3 complicated cases

DeathPartially Recovered

Fully Recovered

Triple Coinfection

Other ARBV infection

Bacterialinfection

ZIKV coinfection, clinical aspects

Waggoner JJ, et al 2016

ZIKV coinfection, virology and immune response

ZIKV coinfection, virology and immune response

Badolato-Corrêa J,et al. 2017.

Badolato-Corrêa J,et al. 2017.

CD4+ CD8+ZIKV coinfection, virology and immune response

• There is a lack of evidence about the clinical course and immune impact of ZIKV infection in HIV positive patients

4 Reported cases

3 Women 1 Man

1 Pregnant(B2) Fetal demise

- Variability through HIV spectrum- Effect on viral control, and CD4+

count- Role in development on ZIKV

derived complications

ZIKV on HIV infected patients

ADE as a riks factor for ZIKV derived complications

• There is biological evidence of ADE

Castanha PMS et al, 2017

• There is a need to promote understanding of the role ofcommorbidities and co infections on ZIKV clinicalspectrum.

• ADE still remains as a potential risk factor which clinicalimpact must be studied.

Conclusions