A review of severe thrombocytopenia in Zika patients - Pathophysiology, treatment and outcome

Travel Med Infect Dis. 2022 Jan-Feb:45:102231. doi: 10.1016/j.tmaid.2021.102231. Epub 2021 Dec 8.

Abstract

Background: During the 2015 Zika virus infection (ZVI) epidemic swiping through the Americas, few cases of ZVI with severe, potentially life-threatening thrombocytopenia were reported. Platelet transfusion, corticosteroids and intravenous immunoglobulins (IVIG) were in most cases applied as therapeutic options, predominantly with success. We present a comprehensive overview concerning the pathophysiology, treatment strategies and outcomes of patients with ZVI and severe thrombocytopenia (platelet count <50 × 109/L).

Method: A literature search was performed.

Results: Eleven case reports and case series with a total of 28 patients met the inclusion criteria; including five cases with lethal outcome. Therapeutic strategies, including platelet transfusion, administration of steroids and/or IVIG were described in 24 cases.

Conclusions: Severe thrombocytopenia is a rare, but potentially life-threatening complication of ZVI. The principal pathophysiological mechanism appears to immune-induced thrombocytopenia. Due to a paucity of cases, the optimal treatment strategy remains to be elucidated.

Keywords: Immune-mediated thrombocytopenia (ITP); Intravenous immunoglobulins (IVIG); Review; Steroid application; Zika virus infection.

Publication types

  • Review

MeSH terms

  • Humans
  • Platelet Count
  • Purpura, Thrombocytopenic, Idiopathic* / drug therapy
  • Thrombocytopenia* / etiology
  • Thrombocytopenia* / therapy
  • Treatment Outcome
  • Zika Virus Infection* / complications
  • Zika Virus Infection* / epidemiology
  • Zika Virus Infection* / therapy
  • Zika Virus*