Top Zika investigators now believe that the birth defect microcephaly and the paralyzing Guillain-Barre syndrome may be just the most obvious maladies caused by the mosquito-borne virus.
Fueling that suspicion are recent discoveries of serious brain and spinal cord infections - including encephalitis, meningitis and myelitis - in people exposed to Zika.
Evidence that Zika's damage may be more varied and widespread than initially believed adds pressure on affected countries to control mosquitoes and prepare to provide intensive - and, in some cases, lifelong - care to more patients. The newly suspected disorders can cause paralysis and permanent disability - a clinical outlook that adds urgency to vaccine development efforts.
Scientists are of two minds about why these new maladies have come into view. The first is that, as the virus is spreading through such large populations, it is revealing aspects of Zika that went unnoticed in earlier outbreaks in remote and sparsely populated areas. The second is that the newly detected disorders are more evidence that the virus has evolved.
"What we're seeing are the consequences of this virus turning from the African strain to a pandemic strain," said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
The Zika outbreak was first detected in Brazil last year and is spreading through the Americas. It has been linked to thousands of suspected cases of microcephaly, a typically rare birth defect marked by unusually small head size, signaling a problem with brain development. Evidence linking Zika to microcephaly prompted the World Health Organization to declare a global health emergency in February.
The suspicion that Zika acts directly on nerve cells began with autopsies on aborted and stillborn fetuses showing the virus replicating in brain tissues. In addition to microcephaly, researchers reported finding other abnormalities linked with Zika including fetal deaths, placental insufficiency, fetal growth retardation and injury to the central nervous system.
Doctors also are worried that Zika exposure in utero may have hidden effects, such as behavioral problems or learning disabilities, that are not apparent at birth.
"If you have a virus that is toxic enough to produce microcephaly in someone, you could be sure that it will produce a whole series of conditions that we haven't even begun to understand," said Dr. Alberto de la Vega, an obstetrician at San Juan's University Hospital in Puerto Rico.
First discovered in the Zika forest of Uganda in 1947, the virus circulated quietly in Africa and Asia, causing rare infections and producing mild symptoms. A 2013 outbreak in French Polynesia, the largest at that time, led researchers to make the Guillain-Barre link. Other neurological effects were noted but scientists made little of them at the time.
A rare and poorly understood condition, Guillain-Barre can weaken muscles and cause temporary paralysis, often requiring patients to need respirators to breathe.
