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A female Aedes aegypti mosquito, known to be a carrier of the Zika virus, acquires a blood meal.
A female Aedes aegypti mosquito, known to be a carrier of the Zika virus, acquires a blood meal. Photograph: Andre Penner/AP
A female Aedes aegypti mosquito, known to be a carrier of the Zika virus, acquires a blood meal. Photograph: Andre Penner/AP

Mystery Zika case in Utah may have been spread via tears or sweat

This article is more than 7 years old

Experts examine whether virus can be passed on in sweat or tears after man appears to catch Zika at father’s bedside

Experts are investigating the possibility that the Zika virus can be passed on in sweat or tears, after the infection of a 38-year-old man in the US who appears to have caught the virus at his father’s hospital bedside.

Until now it was thought that Zika was only transmitted through the bite of infected mosquitoes and, in rare instances, via semen and from pregnant women to their foetuses.A paper in the New England Journal of Medicine, however, recounts the case of a 38-year-old man in Utah that appears to challenge the assumption. It also raises new questions about the deadliness of the virus. The man’s 73-year-old father died of organ failure, even though he had been relatively fit and healthy.

The deceased man was a US national who had emigrated from Mexico in 2003. Eight days after returning from a three-week holiday on the south coast of Mexico, he was admitted to hospital in Salt Lake City with abdominal pain and low blood pressure. During his trip, he said he had been bitten by mosquitoes.

Doctors suspected the dengue virus, but tests revealed high levels of the Zika virus in his blood.

Five days later, his son reported a fever, conjunctivitis and a rash. The Zika virus was identified in his urine, but not his blood.

An expectant mother receives a free Zika test from a temporary clinic in Miami, Florida. Photograph: Joe Raedle/Getty Images

The son recovered, but his infection is a mystery. There have been no reports of Aedes aegypti mosquitoes carrying Zika in Utah and he had neither been to Mexico with his father or anywhere else where the virus is endemic, or had sex with anyone who had.

The son had been at the bedside of his ill father and had helped a nurse move him in the bed without wearing gloves. He had also wiped his father’s eyes, again without gloves. He did not, however, come into contact with his father’s blood. None of the nurses looking after the father became ill.

Doctors believe the son must have picked up the infection from his father, who had a very high level of the virus in his body. “Infectious levels of virus may have been present in sweat or tears, both of which Patient 2 [the son] contacted without gloves,” say the authors of the paper, Dr Sankar Swaminathan and colleagues from the University of Utah School of Medicine in Salt Lake City.

“Whether contact with highly infectious body fluids from patients with severe Zika virus infection poses an increased risk of transmission is an important question that requires further research.”

The other mystery is why the father died. He was not frail, did not have underlying medical conditions that might compromise his ability to fight off the virus, and did not smoke or drink. He had, however, recently completed a course of radiotherapy to treat prostate cancer. Doctors speculate the virus may have been able to reproduce at a faster rate in radiation-damaged tissues.

Both men had previously been infected with the dengue virus and recovered. The authors of the paper say the case suggests more people may be at risk of sudden-onset Zika infection than previously assumed, and that people who are not frail or have a compromised immune system may still be at risk of dying from it.

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