Viral Infections

  • Andre Avelino Costa BeberEmail author
  • Ana Maria Benvegnú
  • Lia Natália Diehl Dallazem
  • Luiza Nunes Lages


Cutaneous viral infections comprise a heterogeneous group of diseases, with different degrees of severity, ranging from self-limited course to chronic and recurrent infection. The aim of this chapter is to describe viral diseases when skin is the main site of manifestation. Herein are described diseases caused by the human herpesvirus family, the most frequent nongenital disease related to human papillomaviruses, cutaneous enterovirus infections, measles, rubella, erythema infectiosum, Gianotti–Crosti syndrome, smallpox, vaccinia, cowpox, Orf, molluscum contagiosum, and prions. The major emerging viruses Ebola, dengue, chikungunya, and Zika are also briefly described. Epidemiologic aspects and the clinical manifestations and laboratory tests that assist in the diagnosis are addressed, and the main therapeutic approaches to these diseases discussed.


Viral infections Human herpesvirus Herpes simplex viruses Varicella zoster virus Kaposi sarcoma Human papillomavirus Hand-foot-and-mouth disease Measles Rubella Erythema infectiosum Gianotti–Crosti syndrome Smallpox Vaccinia Cowpox Orf Molluscum contagiosum Prions Emerging viruses Dengue Chikungunya Zika 


  1. 1.
    Kukhanova MK, Korovina AN, Kochetkov SN. Human herpes simplex virus: life cycle and development of inhibitors. Biochemistry (Mosc). 2014;79(13):1635–52.CrossRefGoogle Scholar
  2. 2.
    Mendonza N, Madkan V, Sra K, Willison B, Morrison LK, Tyring SK. Human herpesviruses. In: Bolognia JL, Jorizzo JJ, Schaffer JV, editors. Dermatology, vol. 2. 3rd ed. London: Elsevier; 2012. p. 1321–43.Google Scholar
  3. 3.
    Fatahzadeh M, Schwartz RA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. 2007;57(5):737–63; quiz 764–6.Google Scholar
  4. 4.
    Patel R, Alderson S, Geretti A, Nilsen A, Foley E, Lautenschlager S, et al. European guideline for the management of genital herpes, 2010. Int J STD AIDS. 2011;22(1):1–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Cunningham A, Griffiths P, Leone P, Mindel A, Patel R, Stanberry L, et al. Current management and recommendations for access to antiviral therapy of herpes labialis. J Clin Virol. 2012;53(1):6–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Hollier LM, Straub H. Genital herpes. BMJ Clin Evid. 2011;2011Google Scholar
  7. 7.
    Le Cleach L, Trinquart L, Do G, Maruani A, Lebrun-Vignes B, Ravaud P, et al. Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients. Cochrane Database Syst Rev. 2014;8:CD009036.Google Scholar
  8. 8.
    Cernik C, Gallina K, Brodell RT. The treatment of herpes simplex infections: an evidence-based review. Arch Intern Med. 2008;168(11):1137–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Abdool Karim SS, Abdool Karim Q, Kharsany AB, Baxter C, Grobler AC, Werner L, et al. Tenofovir gel for the prevention of herpes simplex virus type 2 infection. N Engl J Med. 2015;373(6):530–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wald A, Corey L, Timmler B, Magaret A, Warren T, Tyring S, et al. Helicase-primase inhibitor pritelivir for HSV-2 infection. N Engl J Med. 2014;370(3):201–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Coleman JL, Shukla D. Recent advances in vaccine development for herpes simplex virus types I and II. Hum Vaccine Immunother. 2013;9(4):729–35.CrossRefGoogle Scholar
  12. 12.
    Sauerbrei A. Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. Eur J Clin Microbiol Infect Dis. 2016;35(5):723–34.CrossRefPubMedGoogle Scholar
  13. 13.
    Whitley RJ. Chickenpox and herpes zoster (Varicella-Zoster virus). In: Bennett JED, Dolin R., Blaser, M.J., editor. Mandell, Douglas, and Bennett’s principles and practice of infectious disease. II. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 1731.Google Scholar
  14. 14.
    Levin MJ, Weinberg A, Schmid DS. Herpes simplex virus and varicella-zoster virus. Microbiol Spectr. 2016;4(3). doi: 10.1128/microbiolspec.DMIH2-0017-2015.Google Scholar
  15. 15.
    Chen N, Li Q, Yang J, Zhou M, Zhou D, He L. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2014;2:CD006866.Google Scholar
  16. 16. Rotine varicella vacination.
  17. 17. Contraindications and precautions for varicella vaccination.
  18. 18.
    Macartney K, Heywood A, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database Syst Rev. 2014;(6):CD001833.Google Scholar
  19. 19.
    Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271–84.CrossRefGoogle Scholar
  20. 20.
    Ansaldi F, Trucchi C, Alicino C, Paganino C, Orsi A, Icardi G. Real-world effectiveness and safety of a live-attenuated herpes Zoster vaccine: a comprehensive review. Adv Ther. 2016;33:1094.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Jeon YH. Herpes Zoster and postherpetic neuralgia: practical consideration for prevention and treatment. Kor J Pain. 2015;28(3):177–84.CrossRefGoogle Scholar
  22. 22.
    Hall LD, Eminger LA, Hesterman KS, Heymann WR. Epstein-Barr virus: dermatologic associations and implications: part I. Mucocutaneous manifestations of Epstein-Barr virus and nonmalignant disorders. J Am Acad Dermatol. 2015;72(1):1–19. quiz -20CrossRefPubMedGoogle Scholar
  23. 23.
    Fernandez-Flores A. Epstein-Barr virus in cutaneous pathology. Am J Dermatopathol. 2013;35(8):763–86.CrossRefPubMedGoogle Scholar
  24. 24.
    Luzuriaga K, Sullivan JL. Infectious mononucleosis. N Engl J Med. 2010;362(21):1993–2000.CrossRefPubMedGoogle Scholar
  25. 25.
    Di Lernia V, Mansouri Y. Epstein-Barr virus and skin manifestations in childhood. Int J Dermatol. 2013;52(10):1177–84.CrossRefPubMedGoogle Scholar
  26. 26.
    Mirvish JJ, Pomerantz RG, Falo LD Jr, Geskin LJ. Role of infectious agents in cutaneous T-cell lymphoma: facts and controversies. Clin Dermatol. 2013;31(4):423–31.CrossRefPubMedGoogle Scholar
  27. 27.
    Eminger LA, Hall LD, Hesterman KS, Heymann WR. Epstein-Barr virus: dermatologic associations and implications: part II. Associated lymphoproliferative disorders and solid tumors. J Am Acad Dermatol. 2015;72(1):21–34. quiz 5-6CrossRefPubMedGoogle Scholar
  28. 28.
    Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus. J Pathol. 2015;235(2):288–97.CrossRefPubMedGoogle Scholar
  29. 29.
    Drago F, Aragone MG, Lugani C, Rebora A. Cytomegalovirus infection in normal and immunocompromised humans. A review. Dermatology. 2000;200(3):189–95.CrossRefPubMedGoogle Scholar
  30. 30.
    Choi YL, Kim JA, Jang KT, Kim DS, Kim WS, Lee JH, et al. Characteristics of cutaneous cytomegalovirus infection in non-acquired immune deficiency syndrome, immunocompromised patients. Br J Dermatol. 2006;155(5):977–82.CrossRefPubMedGoogle Scholar
  31. 31.
    Dauden E, Fernandez-Buezo G, Fraga J, Cardenoso L, Garcia-Diez A. Mucocutaneous presence of cytomegalovirus associated with human immunodeficiency virus infection: discussion regarding its pathogenetic role. Arch Dermatol. 2001;137(4):443–8.PubMedGoogle Scholar
  32. 32.
    Kimberlin DW, Jester PM, Sanchez PJ, Ahmed A, Arav-Boger R, Michaels MG, et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. N Engl J Med. 2015;372(10):933–43.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Wolz MM, Sciallis GF, Pittelkow MR. Human herpesviruses 6, 7, and 8 from a dermatologic perspective. Mayo Clin Proc. 2012;87(10):1004–14.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Agut H, Bonnafous P, Gautheret-Dejean A. Laboratory and clinical aspects of human herpesvirus 6 infections. Clin Microbiol Rev. 2015;28(2):313–35.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Hill JA, Sedlak RH, Jerome KR. Past, present, and future perspectives on the diagnosis of Roseolovirus infections. Curr Opin Virol. 2014;9:84–90.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ramdass P, Mullick S, Farber HF. Viral skin diseases. Prim Care. 2015;42(4):517–67.CrossRefPubMedGoogle Scholar
  37. 37.
    Prichard MN, Whitley RJ. The development of new therapies for human herpesvirus 6. Curr Opin Virol. 2014;9:148–53.CrossRefPubMedGoogle Scholar
  38. 38.
    Ablashi DV, Berneman ZN, Kramarsky B, Whitman J Jr, Asano Y, Pearson GR. Human herpesvirus-7 (HHV-7): current status. Clin Diagn Virol. 1995;4(1):1–13.CrossRefPubMedGoogle Scholar
  39. 39.
    Kosuge H. HHV-6, 7 and their related diseases. J Dermatol Sci. 2000;22(3):205–12.CrossRefPubMedGoogle Scholar
  40. 40.
    Kaplan LD. Human herpesvirus-8: Kaposi sarcoma, multicentric Castleman disease, and primary effusion lymphoma. Hematol Am Soc Hematol Educ Program. 2013;2013:103–8.Google Scholar
  41. 41.
    Bhutani M, Polizzotto MN, Uldrick TS, Yarchoan R. Kaposi sarcoma-associated herpesvirus-associated malignancies: epidemiology, pathogenesis, and advances in treatment. Semin Oncol. 2015;42(2):223–46.CrossRefPubMedGoogle Scholar
  42. 42.
    Martinelli PT, Tyring SK. Human herpesvirus 8. Dermatol Clin. 2002;20(2):307–14. vii-viiiCrossRefPubMedGoogle Scholar
  43. 43.
    Kollipara R, Ekhlassi E, Downing C, Guidry J, Lee M, Tyring SK. Advancements in pharmacotherapy for noncancerous manifestations of HPV. J Clin Med. 2015;4(5):832–46.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Kirnbauer RLP. Human papillomaviruses. In: Bolognia JL, Jorizzo JJ, Schaffer JV, editors. Dermatology, vol. 2. 3rd ed. London: Elsevier; 2012. p. 1303–19.Google Scholar
  45. 45.
    Cubie HA. Diseases associated with human papillomavirus infection. Virology. 2013;445(1–2):21–34.CrossRefPubMedGoogle Scholar
  46. 46.
    Bruggink SC, Eekhof JA, Egberts PF, van Blijswijk SC, Assendelft WJ, Gussekloo J. Warts transmitted in families and schools: a prospective cohort. Pediatrics. 2013;131(5):928–34.CrossRefPubMedGoogle Scholar
  47. 47.
    Bruggink SC, de Koning MN, Gussekloo J, Egberts PF, Ter Schegget J, Feltkamp MC, et al. Cutaneous wart-associated HPV types: prevalence and relation with patient characteristics. J Clin Virol. 2012;55(3):250–5.CrossRefPubMedGoogle Scholar
  48. 48.
    Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists’ guidelines for the management of cutaneous warts 2014. Br J Dermatol. 2014;171(4):696–712.CrossRefPubMedGoogle Scholar
  49. 49.
    Dall’oglio F, D’Amico V, Nasca MR, Micali G. Treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2012;13(2):73–96.CrossRefPubMedGoogle Scholar
  50. 50.
    Stalkup JR, Chilukuri S. Enterovirus infections: a review of clinical presentation, diagnosis, and treatment. Dermatol Clin. 2002;20(2):217–23.CrossRefPubMedGoogle Scholar
  51. 51.
    Sawyer MH. Enterovirus infections: diagnosis and treatment. Semin Pediatr Infect Dis. 2002;13(1):40–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Mancini AJS-AA. Other viral disease. In: Dermatology, vol. 2. 3rd ed. London: Elsevier; 2012. p. 1345–65.Google Scholar
  53. 53.
    Nassef C, Ziemer C, Morrell DS. Hand-foot-and-mouth disease: a new look at a classic viral rash. Curr Opin Pediatr. 2015;27(4):486–91.CrossRefPubMedGoogle Scholar
  54. 54.
    Abzug MJ, Michaels MG, Wald E, Jacobs RF, Romero JR, Sanchez PJ, et al. A randomized, double-blind, placebo-controlled trial of pleconaril for the treatment of neonates with enterovirus sepsis. J Pediatr Infect Dis Soc. 2016;5(1):53–62.CrossRefGoogle Scholar
  55. 55.
    Nawas ZY, Tong Y, Kollipara R, Peranteau AJ, Woc-Colburn L, Yan AC, et al. Emerging infectious diseases with cutaneous manifestations: viral and bacterial infections. J Am Acad Dermatol. 2016;75(1):1–16.CrossRefPubMedGoogle Scholar
  56. 56.
    Perry RT, Murray JS, Gacic-Dobo M, Dabbagh A, Mulders MN, Strebel PM, et al. Progress toward regional measles elimination – worldwide, 2000–2014. MMWR Morb Mortal Wkly Rep. 2015;64(44):1246–51.CrossRefPubMedGoogle Scholar
  57. 57.
    Thompson KM, Odahowski CL. Systematic review of measles and rubella serology studies. Risk Anal. 2016;36(7):1459–86.Google Scholar
  58. 58.
  59. 59. Measles vaccination. Available from:
  60. 60.
    Alter SJ, Bennett JS, Koranyi K, Kreppel A, Simon R. Common childhood viral infections. Curr Probl Pediatr Adolesc Health Care. 2015;45(2):21–53.CrossRefPubMedGoogle Scholar
  61. 61.
    Korczynska MR, Paradowska-Stankiewicz I. Rubella in Poland in 2013. Przegl Epidemiol. 2015;69(2):213–8. 341-3PubMedGoogle Scholar
  62. 62.
    Zhu Z, Pan G, Zhou S, Dai J, Chen X, Tang J, et al. Imported genotype 2B rubella virus caused the 2012 outbreak in Anqing Cit, China. PLoS One. 2015;10(9):e0139173.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, mumps, and rubella. Clin Obstet Gynecol. 2012;55(2):550–9.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Martinez-Quintana E, Castillo-Solorzano C, Torner N, Rodriguez-Gonzalez F. Congenital rubella syndrome: a matter of concern. Rev Panama Salud Publica. 2015;37(3):179–86.Google Scholar
  65. 65.
    Banatvala JE, Brown DW. Rubella. Lancet. 2004;363(9415):1127–37.CrossRefPubMedGoogle Scholar
  66. 66.
    Avila Moura A, de Mello MJ, Correia JB. Serological statuses of pregnant women in an urban Brazilian population before and after the 2008 rubella immunization campaign. Vaccine. 2016;34(4):445–50.CrossRefPubMedGoogle Scholar
  67. 67.
    Young NS, Brown KE. Parvovirus B19. N Engl J Med. 2004;350(6):586–97.CrossRefPubMedGoogle Scholar
  68. 68.
    Katta R. Parvovirus B19: a review. Dermatol Clin. 2002;20(2):333–42.CrossRefPubMedGoogle Scholar
  69. 69.
    Llanora GV, Tay CM, van Bever HP. Gianotti-Crosti syndrome: case report of a pruritic acral exanthema in a child. Asia Pac Allergy. 2012;2(3):223–6.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Chuh A, Zawar V, Law M, Sciallis G. Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, unilateral mediothoracic exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome: a brief review and arguments for diagnostic criteria. Infect Dis Rep. 2012;4(1):e12.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Zawar V, Chuh A. Efficacy of ribavirin in a case of long lasting and disabling Gianotti-Crosti syndrome. J Dermatol Case Rep. 2008;2(4):63–6.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Retrouvey M, Koch LH, Williams JV. Gianotti-Crosti syndrome after childhood vaccination. Pediatr Dermatol. 2012;29(5):666–8.CrossRefPubMedGoogle Scholar
  73. 73.
    Cocciolone R, Morey A, Panasiuk P, Whitfeld MJ. Atypical Gianotti-Crosti syndrome in two HIV and hepatitis B co-infected adults. Australas J Dermatol. 2011;52(1):32–6.CrossRefPubMedGoogle Scholar
  74. 74.
    Ricci G, Patrizi A, Neri I, Specchia F, Tosti G, Masi M. Gianotti-Crosti syndrome and allergic background. Acta Derm Venereol. 2003;83(3):202–5.CrossRefPubMedGoogle Scholar
  75. 75.
    Metelitsa AI, Fiorillo L. Recurrent Gianotti-Crosti syndrome. J Am Acad Dermatol. 2011;65(4):876–7.CrossRefPubMedGoogle Scholar
  76. 76.
    Tegnell A, Wahren B, Elgh F. Smallpox – eradicated, but a growing terror threat. Clin Microbiol Infect. 2002;8(8):504–9.CrossRefPubMedGoogle Scholar
  77. 77.
    Medcalf S, Bilek L, Hartman T, Iwen PC, Leuschen P, Miller H, et al. Smallpox vaccination of laboratory workers at US variola testing sites. Emerg Infect Dis. 2015;21(8):1437–9.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Adalja AA, Toner E, Inglesby TV. Clinical management of potential bioterrorism-related conditions. N Engl J Med. 2015;372(10):954–62.CrossRefPubMedGoogle Scholar
  79. 79.
    Figueiredo Pde O, Silva-Fernandes AT, Mota BE, Costa GB, Borges IA, Ferreira PC, et al. Evaluating anti-Orthopoxvirus antibodies in individuals from Brazilian rural areas prior to the bovine vaccinia era. Mem Inst Oswaldo Cruz. 2015;110(6):804–8.CrossRefPubMedGoogle Scholar
  80. 80.
    Jenson AB, Ghim SJ, Sundberg JP. An inquiry into the causes and effects of the variolae (or Cow-pox. 1798). Exp Dermatol. 2016;25(3):178–80.CrossRefPubMedGoogle Scholar
  81. 81.
    Hajj Hussein I, Chams N, Chams S, El Sayegh S, Badran R, Raad M, et al. Vaccines through centuries: major cornerstones of global health. Front Public Health. 2015;3:269.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Greenberg RN, Hurley MY, Dinh DV, Mraz S, Vera JG, von Bredow D, et al. A multicenter, open-label, controlled phase II study to evaluate safety and Immunogenicity of MVA Smallpox Vaccine (IMVAMUNE) in 18-40 year old subjects with diagnosed atopic dermatitis. PLoS One. 2015;10(10):e0138348.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Overton ET, Stapleton J, Frank I, Hassler S, Goepfert PA, Barker D, et al. Safety and immunogenicity of modified vaccinia Ankara-Bavarian Nordic smallpox vaccine in vaccinia-naive and experienced human immunodeficiency virus-infected individuals: an open-label, controlled clinical phase II trial. Open Forum Infect Dis. 2015;2(2):ofv040.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Pelkonen PM, Tarvainen K, Hynninen A, Kallio ER, Henttonen K, Palva A, et al. Cowpox with severe generalized eruption. Finland Emerg Infect Dis. 2003;9(11):1458–61.CrossRefPubMedGoogle Scholar
  85. 85.
    Vorou RM, Papavassiliou VG, Pierroutsakos IN. Cowpox virus infection: an emerging health threat. Curr Opin Infect Dis. 2008;21(2):153–6.CrossRefPubMedGoogle Scholar
  86. 86.
    Fassbender P, Zange S, Ibrahim S, Zoeller G, Herbstreit F, Meyer H. Generalized cowpox virus infection in a patient with HIV, Germany, 2012. Emerg Infect Dis. 2016;22(3):553.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Brito HS, TE, Aranha J. Doença de Orf. Rev SPDV. 2015;73(2):3.Google Scholar
  88. 88.
    Al-Qattan MM. Orf infection of the hand. J Hand Surg [Am]. 2011;36(11):1855–8.CrossRefGoogle Scholar
  89. 89.
    Olsen JR, Gallacher J, Piguet V, Francis NA. Epidemiology of molluscum contagiosum in children: a systematic review. Fam Pract. 2014;31(2):130–6.CrossRefPubMedGoogle Scholar
  90. 90.
    Martin P. Interventions for molluscum contagiosum in people infected with human immunodeficiency virus: a systematic review. Int J Dermatol. 2016;55(9):956–66.Google Scholar
  91. 91.
    Patient Perspectives: Molluscum Contagiosum. Pediatr Dermatol. 2015;32(6):2.Google Scholar
  92. 92.
    Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, et al. A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children. Pediatr Dermatol. 2006;23(6):574–9.CrossRefPubMedGoogle Scholar
  93. 93.
    van der Wouden JC, van der Sande R, van Suijlekom-Smit LW, Berger M, Butler CC, Koning S. Interventions for cutaneous molluscum contagiosum. Cochrane Database Syst Rev. 2009;4:CD004767.Google Scholar
  94. 94.
    Lupi O. Prions in dermatology. J Am Acad Dermatol. 2002;46(5):790–3.CrossRefPubMedGoogle Scholar
  95. 95.
    Huang WJ, Chen WW, Zhang X. Prions mediated neurodegenerative disorders. Eur Rev Med Pharmacol Sci. 2015;19(21):4028–34.PubMedGoogle Scholar
  96. 96.
    Moore RA, Head MW, Ironside JW, Ritchie DL, Zanusso G, Choi YP, et al. The distribution of prion protein allotypes differs between sporadic and iatrogenic Creutzfeldt-Jakob disease patients. PLoS Pathog. 2016;12(2):e1005416.CrossRefPubMedPubMedCentralGoogle Scholar
  97. 97.
    Serrano A, Liebner J, Hines JK. Cannibalism, Kuru, and mad cows: prion disease as a “Choose-Your-Own-Experiment” case study to simulate scientific inquiry in large lectures. PLoS Biol. 2016;14(1):e1002351.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Carruthers J, Carruthers A. Mad cows, prions, and wrinkles. Arch Dermatol. 2002;138(5):667–70.CrossRefPubMedGoogle Scholar
  99. 99.
    Elston DM. New and emerging infectious diseases. J Am Acad Dermatol. 2005;52(6):1062–8.CrossRefPubMedGoogle Scholar
  100. 100.
    Roth A, Mercier A, Lepers C, Hoy D, Duituturaga S, Benyon E, et al. Concurrent outbreaks of dengue, chikungunya and Zika virus infections – an unprecedented epidemic wave of mosquito-borne viruses in the Pacific 2012–2014. Euro Surveill. 2014;19(41):2–9.Google Scholar
  101. 101.
    Cardoso CW, Paploski IA, Kikuti M, Rodrigues MS, Silva MM, Campos GS, et al. Outbreak of exanthematous illness associated with Zika, Chikungunya, and Dengue viruses, Salvador, Brazil. Emerg Infect Dis. 2015;21(12):2274–6.CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Franca GV, Schuler-Faccini L, Oliveira WK, Henriques CM, Carmo EH, Pedi VD, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016;388(10047):891–7.Google Scholar
  103. 103.
    Heymann WR. Dengue fever. J Am Acad Dermatol. 2009;60(2):306–7.CrossRefPubMedGoogle Scholar
  104. 104.
    Lima-Camara TN. Emerging arboviruses and public health challenges in Brazil. Rev Saude Publica. 2016;50:36.Google Scholar
  105. 105.
    Burt FJ, Rolph MS, Rulli NE, Mahalingam S, Heise MT. Chikungunya: a re-emerging virus. Lancet. 2012;379(9816):662–71.CrossRefPubMedGoogle Scholar
  106. 106.
    Lucey DR, Gostin LO. The emerging Zika pandemic: enhancing preparedness. JAMA. 2016;315(9):865–6.CrossRefPubMedGoogle Scholar
  107. 107.
    Bonaldo MC, Ribeiro IP, Lima NS, Dos Santos AA, Menezes LS, da Cruz SO, et al. Isolation of infective Zika virus from urine and saliva of patients in Brazil. PLoS Negl Trop Dis. 2016;10(6):e0004816.CrossRefPubMedPubMedCentralGoogle Scholar
  108. 108.
    Martines RB, Bhatnagar J, de Oliveira Ramos AM, Davi HP, Iglezias SD, Kanamura CT, et al. Pathology of congenital Zika syndrome in Brazil: a case series. Lancet. 2016;388(10047):898–904.Google Scholar
  109. 109.
    Martines RB, Bhatnagar J, Keating MK, Silva-Flannery L, Muehlenbachs A, Gary J, et al. Notes from the field: evidence of Zika virus infection in brain and placental tissues from two congenitally infected newborns and two fetal losses – Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(6):159–60.CrossRefPubMedGoogle Scholar
  110. 110.
    CDC. Revised diagnostic testing for Zika, chikungunya, and dengue viruses in US Public Health Laboratories 2016. Available from:
  111. 111.
    Bingham AM, Cone M, Mock V, Heberlein-Larson L, Stanek D, Blackmore C, et al. Comparison of test results for Zika virus RNA in urine, serum, and saliva specimens from persons with travel-associated Zika virus disease – Florida, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(18):475–8.CrossRefPubMedGoogle Scholar
  112. 112.
    Stamm LV. Zika virus in the Americas: an obscure arbovirus comes calling. JAMA Dermatol. 2016;152(6):621–2.CrossRefPubMedGoogle Scholar

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© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Andre Avelino Costa Beber
    • 1
    Email author
  • Ana Maria Benvegnú
    • 1
  • Lia Natália Diehl Dallazem
    • 1
  • Luiza Nunes Lages
    • 1
  1. 1.Hospital Universitario de Santa Maria, Dermatology ServiceUFSM – Federal University of Santa MariaSanta MariaBrazil

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