What are the key clinical features of Zika virus infection that I should look for in patients presenting with febrile illness?

Key clinical features of Zika virus infection in patients presenting with febrile illness include:

• Low-grade fever, often mild and transient.
• Maculopapular rash, which is typically pruritic and widespread.
• Conjunctivitis (non-purulent), a distinguishing feature from other arboviral infections.
• Arthralgia or arthritis, commonly affecting small joints of the hands and feet.
• Myalgia and headache, which may accompany the febrile phase.
• General malaise and fatigue.

These symptoms usually appear 2–7 days after the mosquito bite and are generally self-limiting, lasting up to one week. Importantly, neurological complications such as Guillain-Barré syndrome, although rare, should be considered in the clinical assessment.

In the UK clinical context, identifying these features is crucial for differentiating Zika virus infection from other febrile illnesses and arboviral diseases, especially in returning travellers from endemic areas. The presence of conjunctivitis alongside rash and arthralgia is particularly suggestive of Zika virus infection ¹ (Calvet et al., 2016; Sakkas et al., 2016; Sejvar, 2018).