Zika-associated Shock and Multi-Organ Dysfunction

Over the next 4 days the patient's condition worsened with the development of profound shock, renal failure requiring continuous renal replacement therapy, and severe acute respiratory distress syndrome necessitating endotracheal intubation and neuromuscular blockade for persistent severe hypoxia. On Hospital Day 4, despite aggressive supportive care the patient succumbed to his illness from multiple organ dysfunction syndrome (MODS), intractable hypoxemia (Figure 2), and resistant shock. The crossreaction of dengue, Zika, and yellow fever makes diagnosis by serology particularly difficult in people from endemic areas. 3.What is antibody-dependent enhancement, and how might it explain this patient's severe presentation? ADE is the process whereby preexisting nonneutralizing antibodies facilitate viral uptake, thus resulting in increased viral replication, cytokine production, and increased severity of disease. Insights * Zika infection should be considered in patients with septic shock returning from endemic areas. * PCR-based tests should be ordered in those with suspected arboviral infection due to cross-reaction of serologic tests. * Severe Zika disease may result from antibody-dependent enhancement from a previous flaviviral infection, and critical care physicians should be cognizant of the risk of severe disease. ?