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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In contrast to infection by other arboviruses such as dengue virus&#44; which can cause potentially severe disease in humans&#44; infection by Zika virus &#40;ZIKV&#41; is generally benign and self-limiting&#44; with mainly asymptomatic episodes&#46; Recent epidemiological shifts in the geographic distribution of ZIKV&#44; however&#44; have raised health care alarms around the world because of the possible association between ZIKV infection and congenital malformations&#44; particularly microcephaly&#44; and neurologic disorders&#44; including Guillain-Barr&#233; syndrome&#46; Although the discovery of the virus in the Zika forest in Uganda dates back to 1947&#44; fewer than 20 cases of ZIKV infection had been reported in humans up to 2007&#46; Preceded by the outbreaks on the island of Yap in Micronesia in 2007 and in French Polynesia in 2013&#44; the epidemic that started in May 2015 in Latin America continues to expand uncontrolled&#46; On February 1&#44; 2016&#44; the World Health Organization declared ZIKV infection a Public Health Emergency of International Concern&#46; One week later&#44; the Centers for Disease Control and Prevention upgraded its response to the outbreak to Level 1 activation&#44; the agency&#39;s highest level&#46; We present the case of a patient diagnosed with ZIKV infection in our center&#46; Our aim is to increase awareness of this emerging arbovirus among dermatologists&#46; Given the mainly cutaneous symptoms of the infection and the intensity of travel and migratory flows from Latin America&#44; it seems highly likely that we will be diagnosing ZIKV in the coming months&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 25-year-old woman from the Dominican Republic with no personal history of interest who had been living in Spain for 8 years was referred to the dermatology emergency department for assessment of a pruriginous exanthem that had started 48<span class="elsevierStyleHsp" style=""></span>hours previously and was extending down her body&#46; She also had intense asthenia&#44; sensation of poor temperature regulation&#44; mild joint and muscle pain&#44; headache&#44; and ocular pruritus&#46; Physical examination revealed bilateral malar erythema and edema&#44; together with marked conjunctival injection &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>&#41; and subtle generalized micropapular exanthema with follicular accentuation &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; The blood workup revealed only slightly altered cytolysis in the liver&#46; The fact that she had spent a month in her home country and arrived in Spain 12<span class="elsevierStyleHsp" style=""></span>hours before the onset of symptoms led us to suspect ZIKV infection&#46; Therefore&#44; we ordered serology tests and nucleic acid testing in serum and urine using reverse transcriptase polymerase chain reaction &#40;RT-PCR&#41; to detect ZIKV&#46; We also requested a workup for dengue virus and chikungunya virus and the usual protocol for exanthematous viruses&#46; The result of the pregnancy test was negative&#46; Histopathology of the skin revealed a mild superficial perivascular lymphocytic infiltrate&#46; The symptoms resolved completely 6 days after onset&#46; RT-PCR in urine and serum was positive for ZIKV in samples collected at 48<span class="elsevierStyleHsp" style=""></span>hours from onset&#46; The results of serology testing were negative&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">ZIKV is a single-stranded RNA virus belonging to the genus <span class="elsevierStyleItalic">Flavivirus</span> of the Flaviviridae family&#46; It is transmitted mainly by bites from mosquitos of the <span class="elsevierStyleItalic">Aedes</span> genus&#44; in most cases <span class="elsevierStyleItalic">A aegypti</span> &#40;although it is also carried by other species&#44; including <span class="elsevierStyleItalic">A albopictus</span>&#41;&#46; As with other arboviruses&#44; vector-independent routes of transmission have been identified &#40;eg&#44; vertical and transfusional&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Remarkably&#44; in contrast with other arboviruses&#44; sexual transmission has also been documented&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> It remains to be determined whether there is a risk of transmission via other fluids where viral RNA has been detected&#44; such as saliva or breastmilk&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is estimated that only 1 in 5 infected persons develops clinical manifestations&#44; which are generally mild and self-limiting&#46; After an incubation period lasting between 3 and 12 days&#44; the typical manifestations are pruriginous maculopapular rash that extends down the body&#44; mild fever&#44; mild pain affecting mainly the small joints of the hands and feet&#44; and nonpurulent conjunctivitis&#46; The manifestations last 2 to 7 days&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Although the clinical picture coincides with that of other viruses transmitted by the same vector&#44; such as dengue or chikungunya&#44; certain characteristics can orient us toward the causative agent&#44; namely&#44; predominance of rash with little involvement of the patient&#39;s general status in ZIKV infection&#44; persistent joint pain in chikungunya infection&#44; and the classic picture of rash respecting specific areas of skin&#44; thrombocytopenia&#44; and bleeding complications in dengue&#46; The absence of pathognomonic findings&#44; however&#44; necessitates a microbiologic diagnosis based on the detection of viral RNA using RT-PCR assay in serum during the first 5 days with symptoms or in urine for up to 10-15 days&#46; This study can be extended to cerebrospinal fluid in patients with neurological symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> RT-PCR assay is followed by serology testing&#46; This approach is of particular interest in pregnant women&#44; although it is limited because of cross-reactivity with other flaviviruses&#46; Available evidence indicates that ZIKV infection can confer prolonged immunity&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Up to mid-March 2016&#44; the Spanish National Microbiology Center had confirmed 43 cases of ZIKV infection in Spain&#44; all of which were imported&#46; However&#44; the presence of <span class="elsevierStyleItalic">A&#160;albopictus</span> &#40;commonly known as the tiger mosquito&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> along the Mediterranean coast and in the Basque Country and Aragon enables autochthonous transmission of ZIKV in Spain&#44; mainly during summer and winter&#44; which is when vector activity is most intense and more people travel from epidemic areas&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Burillo-Mart&#237;nez S&#44; Fern&#225;ndez-Ruiz M&#44; P&#233;rez-Rivilla A&#44; Zarco-Olivo C&#46; Infecci&#243;n por virus del Zika&#58; una enfermedad emergente que el dermat&#243;logo debe conocer&#46; Actas Dermosifiliogr&#46; 2016&#59;107&#58;687&#8211;689&#46;</p>"
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