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40 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 6 education PATHOLOGY PERSPECTIVES I recently had a client show me a mosquito bite and ask me if it looked like Zika. I had no clue. I told him if he was concerned to check with his doctor, but what do I know? Zika: What We Know By Ruth Werner Zika virus—is it a momentary distraction, an overblown news blip? Is it a rare-but-tragic contributor to a set of serious birth defects? Or is it a dangerous mosquito-borne contagion that threatens to overwhelm the globe and infect us all? Pathology Perspective articles are usually intended to be "evergreen"—that is, not bound to a specific season or trend. This one is an exception, both because the information is important and changing quickly, and because it is relevant to a specific event: the 2016 Summer Olympic Games in Rio de Janeiro, Brazil. This means Brazil, the first location in the continental Americas where the Zika virus has been identified, was an international travel hub, and traffic into and out of the country may create pathways for this virus and its complications to become more firmly established around the globe. This column will focus on what we understand about the activity of Zika virus in North America, but be aware that this is a worldwide phenomenon, and it has already been declared a global pandemic (see Zika History). WHAT IS ZIKA? Zika virus is a single-strand ribonucleic acid (RNA) vector-borne virus, similar to viruses seen with dengue fever, chikungunya, and yellow fever. Like other viruses of this type, it invades the cytoplasm of its target cells and reprograms the function of those cells to make them literal virus factories. Infected cells release virions: viral particles that can spread to more cells in the body or to other hosts altogether. With Zika virus, this happens mainly through mosquitoes biting infected people and carrying the virus to uninfected people, and also through sexual activity and transplacental pathways. TRANSMISSION Zika virus begins as a vector-borne infection, usually carried by some Aedes species of mosquitoes. Many such species are found in tropical zones throughout the world, but there are two subtypes that are common in up to 30 states in the United States: Aedes aegypti is mostly in tropical areas and cannot tolerate cold weather, and Aedes albopictus, which is hardier, and can survive cooler temperatures. Both of these mosquito species are also carriers of other related illnesses, particularly dengue fever. Zika spreads from one host to another by way of mosquito bites: an insect picks up the virus from one person's blood and injects it into another. Aedes mosquitoes