Re: The Complex Interpretation and Management of Zika Virus Test Results
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* Sora Yasri
* Viroj Wiwanitkit

Dear Editor, we read the publication titled, “Complex Interpretation and Management of Zika Virus Test Results” with great interest.1 Lin et al concluded that, “*Women with a high pretest probability of Zika virus infection should still receive enhanced prenatal monitoring and newborn evaluation, regardless of the test result. An appropriate interpretation of results depends on what tests are used, patient characteristics, and reasons for testing*.1” We would like to discuss and share ideas on this issue. First, it should note that most cases of Zika virus infection are asymptomatic.2 In the asymptomatic case, the laboratory is the necessary approach to get the diagnosis. The interpretation of the test result depends of several factors as noted by Lin et al.1 Nevertheless, there are also other considerations in clinical pathology that should be taken. First, the quality control of the laboratory test is necessary. The false-positive and false-negative results are possible and this problem can lead to incorrect diagnosis. The good example is the false-positive Zika virus test due to cross reaction by other arbovirus such as dengue.3 Nevertheless, the concurrent Zika virus infection with other infection is also possible and the diagnosis of the concurrence is more difficult. Second, the diagnostic limitation of the Zika virus diagnostic test kit should be mentioned. The different sensitivity and specificity of different available diagnostic test kits is observable.4 According to the external quality assessment study, the surveillance showed difference in analytic sensitivity and specificity of the test methods in different international medical laboratories.5 To correctly interpret the Zika virus test result, the practitioner should aware of the quality and standards of the clinical laboratory of the medical center.

## References

1.  1.Lin KW, Kraemer JD, Piltch-Loeb R, Stoto MA. The complex interpretation and management of Zika virus test results. J Am Board Fam Med 2018;31:924–930.
    
    [Abstract/FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMzEvNi85MjQiO3M6NDoiYXRvbSI7czoyMDoiL2phYmZwLzMyLzIvMjgwLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2.Wiwanitkit S, Wiwanitkit V. Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: Don't miss it! Asian Pac J Trop Med 2016;9:513.
    
    [CrossRef](http://www.jabfm.org/lookup/external-ref?access_num=10.1016/j.apjtm.2016.03.036&link_type=DOI) 
    
    [PubMed](http://www.jabfm.org/lookup/external-ref?access_num=27261865&link_type=MED&atom=%2Fjabfp%2F32%2F2%2F280.atom) 

3.  3.Joob B, Wiwanitkit V. Zika virus infection and dengue: A new problem in diagnosis in a dengue-endemic area. Ann Trop Med Public Health 2015;8:145–146.
    
    

4.  4.Landry ML, St George K. Laboratory diagnosis of Zika virus infection. Arch Pathol Lab Med 2017;141:60–67.
    
    [CrossRef](http://www.jabfm.org/lookup/external-ref?access_num=10.5858/arpa.2016-0406-SA&link_type=DOI) 

5.  5.Donoso Mantke O, McCulloch E, Wallace PS, Yue C, Baylis SA, Niedrig M. External Quality Assessment (EQA) for molecular diagnostics of Zika virus: Experiences from an international EQA Programme, 2016–2018. Viruses 2018;10(9).pii: E491.
    
    [CrossRef](http://www.jabfm.org/lookup/external-ref?access_num=10.3390/v10090491&link_type=DOI)