Zika virus (ZIKV) is an arbo-borne virus and flavivirus. The first strain of ZIKV was isolated from Aedes aegypti mosquitoes in Malaysia in 1966.  A recent outbreak in Brazil (2015) suggested an association of ZIKV infection with microcephaly. Consequently, WHO declared this as Public Health Emergency of International Concern in 2016. Since then, cases have been reported from Asian countries. To our knowledge, this is the first case of ZIKV infection in pregnancy reported in Malaysia.

A 27-year-old primigravida at 17 weeks period of gestations complaint of fever and muscle weakness. This was followed by maculopapular rashes involving both upper and lower limbs as well as the body trunk. Her husband commutes daily across the straits between Johor Bahru and Singapore for his work requirement. She had a recent visit to Singapore six months ago prior to this presentation.

Examination revealed diffuse maculopapular rashes and abdomen palpation revealed gravid uterus corresponding to date. There were no organomegaly. Investigation showed a normal haemoglobin with normal blood parameters, with normal liver and renal profile.  Dengue non-structural protein (NS1 antigen) and serology IgM and IgG results were negative. Ultrasound examination showed a grossly normal fetal morphology, all growth parameters corresponded to date. Although she was initially quarantine upon diagnosis of ZIKV infection, she was later managed as an outpatient at tertiary centre and subsequently delivered at 37 weeks with birth weight 2.9 kg, head circumference of 35 cm and length of 47 cm. The baby was admitted to neonatal intensive care for 24 hours and discharge well.

Common signs of ZIKV infection include rashes followed by fever, malaise, myalgia, jaundice, muscle weakness, conjunctivitis with majority in first trimester. Adverse outcomes included miscarriage, intrauterine growth restriction, stillbirth and preterm birth. Estimated risk for microcephaly was 95 cases, 84 cases and 0 cases per 10,000 ZIKV infected pregnant women in first, second and third trimester respectively.

The detection of viral RNA of ZIKV can be made from serum, urine and saliva. Reported case from Columbia suggested that co-infection of Zika, Dengue and Chikungunya may share the same vector. There is no specific treatment for the infection.

As an Obstetrician, we should consider ZIKV as a differential diagnosis as clinical symptoms resemble dengue fever. The diagnosis affects obstetric management, particularly the surveillance of fetal growth.