寨卡病毒感染

目前未出现寨卡病毒疫情大规模暴发；但有些国家仍在局部传播，还有一些国家发生了小规模疫情暴发。

大部分患者无症状；然而，约有 20% 的感染会导致轻度和自限性的发热、皮疹和结膜炎。

孕妇发生感染时可能更严重。目前科学界已达成明确共识，认为寨卡病毒可引起小头畸形和其他一些先天性异常。观察到的异常范围及其与寨卡病毒之间可能存在的因果关系提示一种新的先天性综合征。

吉兰-巴雷综合征以及其他神经系统疾病与寨卡病毒相关性很高，且疑似由寨卡病毒引起，但其中的关联尚未证实，关于此的研究正在进行中，包括阐明其中可能的机制。

症状性感染的治疗主要为支持性治疗，且在这个阶段还没有特异性抗病毒疗法。通过个人和公共卫生手段预防蚊子叮咬是预防感染的重要方式。

由寨卡病毒（又称 ZIKV）引起的感染，当有症状时（发生于约 20% 的感染）表现为轻度且通常为自限性。寨卡病毒属于黄病毒科（黄病毒属），且为虫媒病毒（由节肢动物传播的病毒）。该病毒以 1947 年首次发现它的乌干达寨卡丛林命名。[1]Kindhauser MK, Allen T, Frank V, et al. Zika: the origin and spread of a mosquito-borne virus. Bull World Health Organ. 2016 Sep 1;94(9):675-86C. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034643 http://www.ncbi.nlm.nih.gov/pubmed/27708473?tool=bestpractice.com

寨卡病毒最初由伊蚊传播给人类，伊蚊同时也是登革热、基孔肯雅热和西尼罗河病毒的传播媒介。也有可能在人类之间经性传播。

发现先天性寨卡综合征是一种由孕期感染寨卡病毒所致的婴儿先天性异常（即，小头畸形、颅内钙化或其他脑部异常、或眼部异常等）。[2]Adebanjo T, Godfred-Cato S, Viens L, et al. Update: interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection - United States, October 2017. MMWR Morb Mortal Wkly Rep. 2017 Oct 20;66(41):1089-99. https://www.cdc.gov/mmwr/volumes/66/wr/mm6641a1.htm?s_cid=mm6641a1_w http://www.ncbi.nlm.nih.gov/pubmed/29049277?tool=bestpractice.com [3]França GV, Schuler-Faccini L, Oliveira WK, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016 Aug 27;388(10047):891-7. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30902-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27372398?tool=bestpractice.com [4]Melo AS, Aguiar RS, Amorim MM, et al. Congenital Zika virus infection: beyond neonatal microcephaly. JAMA Neurol. 2016 Dec 1;73(12):1407-16. http://jamanetwork.com/journals/jamaneurology/fullarticle/2557231 http://www.ncbi.nlm.nih.gov/pubmed/27695855?tool=bestpractice.com [5]Moore CA, Staples JE, Dobyns WB, et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr. 2017 Mar 1;171(3):288-95. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2579543 http://www.ncbi.nlm.nih.gov/pubmed/27812690?tool=bestpractice.com [6]Lucey D, Cummins H, Sholts S. Congenital Zika syndrome in 2017. JAMA. 2017 Apr 4;317(13):1368-9. http://www.ncbi.nlm.nih.gov/pubmed/28384812?tool=bestpractice.com 世界卫生组织表示，有很强的科学共识认为，寨卡病毒是引起小头畸形和这些其他先天性畸形的病因。[7]Costello A, Dua T, Duran P, et al. Defining the syndrome associated with congenital Zika virus infection. Bull World Health Organ. 2016 Jun 1;94(6):406-406A. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890216 http://www.ncbi.nlm.nih.gov/pubmed/27274588?tool=bestpractice.com 美国疾病预防控制中心也提出，产前寨卡病毒感染和小头畸形/其他脑部异常间存在因果关系。[8]Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects - reviewing the evidence for causality. N Engl J Med. 2016 May 19;374(20):1981-7. http://www.nejm.org/doi/full/10.1056/NEJMsr1604338 http://www.ncbi.nlm.nih.gov/pubmed/27074377?tool=bestpractice.com  近年来，支持因果关系的证据有所增加；但在已发表的队列研究或病例对照研究中，调查的病例总数仍然很少。[9]Counotte MJ, Meili KW, Taghavi K, et al. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: a living systematic review. F1000Res. 2019 Aug 14;8:1433. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6852328 http://www.ncbi.nlm.nih.gov/pubmed/31754425?tool=bestpractice.com

吉兰-巴雷综合征以及其他神经系统疾病与寨卡病毒相关性很高，且疑似由寨卡病毒感染引起，但其中的关联尚未证实，关于此的研究正在进行中，包括阐明其中可能的机制。[10]Dos Santos T, Rodriguez A, Almiron M, et al. Zika virus and the Guillain-Barré syndrome - case series from seven countries. N Engl J Med. 2016 Oct 20;375(16):1598-601. http://www.nejm.org/doi/full/10.1056/NEJMc1609015?query=featured_zika http://www.ncbi.nlm.nih.gov/pubmed/27579558?tool=bestpractice.com [11]Parra B, Lizarazo J, Jiménez-Arango JA, et al. Guillain-Barré syndrome associated with Zika virus infection in Colombia. N Engl J Med. 2016 Oct 20;375(16):1513-23. http://www.nejm.org/doi/full/10.1056/NEJMoa1605564#t=article http://www.ncbi.nlm.nih.gov/pubmed/27705091?tool=bestpractice.com [12]Frontera JA, da Silva IR. Zika getting on your nerves? The association with the Guillain-Barré syndrome. N Engl J Med. 2016 Oct 20;375(16):1581-82. http://www.nejm.org/doi/full/10.1056/NEJMe1611840 http://www.ncbi.nlm.nih.gov/pubmed/27705077?tool=bestpractice.com [13]Leis AA, Stokic DS. Zika virus and Guillain-Barre syndrome: is there sufficient evidence for causality? Front Neurol. 2016 Sep 30;7:170. http://journal.frontiersin.org/article/10.3389/fneur.2016.00170/full http://www.ncbi.nlm.nih.gov/pubmed/27746763?tool=bestpractice.com 近年来，支持因果关系的证据有所增加；然而，证据数量仍然少于先天性异常的相关证据。[9]Counotte MJ, Meili KW, Taghavi K, et al. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: a living systematic review. F1000Res. 2019 Aug 14;8:1433. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6852328 http://www.ncbi.nlm.nih.gov/pubmed/31754425?tool=bestpractice.com

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