Hepatic disorder in Zika virus infection

Introduction

Zika virus is an arbovirus that can cause acute febrile illness. At present, it is the big public health threat.^[1] The infection can be serious and can cause neurological complication. In addition, the serious effect on development of fetus in utero can be seen. Hence, World Health Organization document Zika virus infection as an important problem that needs urgent attention and management.^[2]

Briefly, Zika virus infection can cause a dengue like illness and can be easily misdiagnosed.^[3] The acute hemorrhagic fever can be the first presentation of Zika virus infection. Nevertheless, there can be other atypical manifestations. The atypical clinical manifestations can add difficulty in diagnosis of the Zika virus infection. Of several atypical clinical problems, liver disorder can be seen and this is an issue that is less mentioned. In this short commentary, the authors discusses on the liver disorder seen in Zika virus infection.

Evidence of liver disorder in Zika virus infection

There are limited reports on liver pathology in Zika virus infection. Most reports showed no abnormality in liver. In the clinical report of new epidemics, Deng et al.^[4] and Zheng et al.^[5] mentioned for no abnormal liver function in infected cases. In infected death fetus, the molecular pathology also revealed no observed virus in liver tissue.^[6] However, there was an interesting report at the time when the Zika virus had just been discovered by Macnamara that Zika virus could be isolated from the cases presenting with jaundice during the outbreak of jaundice in Africa.^[7] In addition, the recent animal mice model study revealed that the Zika virus RNA can be seen in Zika virus infected mice.^[8,9] In fact, Zika virus is usually included in differential diagnosis of acute febrile illness due to arbovirus infections including to yellow fever.^[10] Hence, the question whether there is any interrelationship between Zika virus infection and liver pathology is still a topic for further research.

Co-infection with hepatitis virus: a topic that is still a myth

Finally, it should be noted that Zika virus can be concomitantly seen with other infections (such as dengue^[11] and human immunodeficiency virus^[12]). In hepatology, the topic that is still a myth is the concomitance between Zika virus infection and viral hepatitis. Although there has never been report on this issue, it is no doubt that the co-infection already occurred in many tropical countries that presently have the problem of Zika virus epidemic. How the Zika virus infection superimpose to viral hepatitis and how viral hepatitis superimpose to Zika virus infection is another topic for further research.

Zika virus, chronic liver problem and hepatoma

An important concern is on the Zika virus infection in the cases with underlying chronic liver problem. As already noted, the evidence on liver pathology in Zika virus infection is extremely limited. For the affect fetus, the recent investigation showed no liver problem.^[13] In fact, the relationship between Zika virus infection and cancer is very interesting. Recently, Benelli et al.^[14] noted that "basic epidemiological knowledge on the relationships occurring between mosquito vector activity and the spread of cancer is urgently needed, as well as detailed information about the ability of Culicidae to transfer viruses or tumor cells among hosts over time." Nevertheless, the long term follow-up of Zika virus affected patients, especially for those with underlying chronic hepatitis is suggested. The observation on the possible emerging hepatoma among these cases is recommended.

Conclusion

It is still inconclusive on the exact effect of Zika virus infection on human liver. The further research on this area is recommended for hepatologists.