Konjenital Zika Virüs Enfeksiyonu
Özet
Zika virüsü (ZİKV), 1947'de Uganda'da keşfedilen, Aedes sivrisinekleriyle taşınan ve cinsel yolla da bulaşabilen bir flavivirüsüdür. ZİKV'nin maternal enfeksiyonları çoğunlukla asemptomatik olup, semptomlar genellikle hafiftir. Ancak gebelikte geçirilen enfeksiyon, fetal etkiler yaratabilir. 2015-2016 yıllarında Brezilya'daki salgın, ZİKV'nin teratojenik etkilerini ortaya çıkarmış ve Zika sendromu (KZS) adı verilen ciddi fetal anomalilere yol açmıştır ve 2016 yılında Dünya Sağlık Örgütü, Zika salgınını halk sağlığı acil durumu olarak ilan etmiştir. ZİKV, plasentayı geçerek ve nöral hücrelerin gelişimini engelleyerek fetal beyin gelişimini bozabilir, mikrosefali gibi doğumsal beyin anomalilerine sebep olabilir. ZİKV'nin maternal-fetal transmisyon riski %26-65 arasında değişmektedir. Konjenital Zika sendromu, mikrosefali, beyin anomalileri, oküler bulguları, artrogripozis (konjenital kontraktürler) ve işitme kaybı gibi ciddi sonuçlar doğurabilir. ZİKV’e bağlı oluşabilecek anomalilerin tanısı ve takibi prenatal ultrasonografi ile, fetal enfeksiyonun tanısı ise amniyosentezle yapılır. ZİKV'nin erken gebelikte oluşturduğu etkiler, gelişimsel problemleri uzun vadede de sürdürebilir. Zika virüse bağlı gelişecek anomalilerin ciddiyeti, maruz kalınan gebelik haftası ve viral yükle ilişkilidir ve çocukların uzun dönem takibi oldukça önem arz etmektedir.
Zika virus (ZIKV) is a flavivirus discovered in Uganda in 1947, transmitted by Aedes mosquitoes and also spread through sexual transmission. Maternal ZIKV infections are often asymptomatic, with mild symptoms generally appearing. However, infections during pregnancy can cause fetal effects. The outbreak in Brazil between 2015-2016 highlighted the teratogenic effects of ZIKV, leading to serious fetal anomalies known as Zika syndrome (ZKS), and in 2016, the World Health Organization declared the Zika outbreak a public health emergency. ZIKV can cross the placenta and disrupt fetal brain development by affecting neural cells, potentially causing congenital brain anomalies such as microcephaly. The risk of maternal-fetal transmission of ZIKV ranges from 26-65%. Congenital Zika syndrome can result in severe outcomes such as microcephaly, brain abnormalities, ocular findings, arthrogryposis (congenital contractures), and hearing loss. The diagnosis and follow-up of the anomalies caused by ZIKV are done through prenatal ultrasonography, while fetal infections are diagnosed via amniocentesis. The effects of ZIKV in early pregnancy can lead to developmental issues that may persist in the long term. The severity of anomalies associated with Zika virus is related to the gestational age at exposure and viral load, making long-term follow-up of affected children critically important.
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