Schwartzmann Pedro V, Ramalho Leandra N Z, Neder Luciano, Vilar Fernando C, Ayub-Ferreira Sílvia M, Romeiro Marília F, Takayanagui Osvaldo M, Dos Santos Antonio C, Schmidt André, Figueiredo Luiz T M, Arena Ross, Simões Marcus V
Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
Mayo Clin Proc. 2017 Mar;92(3):460-466. doi: 10.1016/j.mayocp.2016.12.019.
The World Health Organization considers the Zika virus (ZIKV) outbreak in the Americas a global public health emergency. The neurologic complications due to ZIKV infection comprise microcephaly, meningoencephalitis, and Guillain-Barré syndrome. We describe a fatal case of an adult patient receiving an immunosuppressive regimen following heart transplant. The patient was admitted with acute neurologic impairment and experienced progressive hemodynamic instability and mental deterioration that finally culminated in death. At autopsy, a pseudotumoral form of ZIKV meningoencephalitis was confirmed. Zika virus infection was documented by reverse trancriptase-polymerase chain reaction, immunohistochemistry, and immunofluorescence and electron microscopy of the brain parenchyma and cerebral spinal fluid. The sequencing of the viral genome in this patient confirmed a Brazilian ZIKV strain. In this case, central nervous system involvement and ZIKV propagation to other organs in a disseminated pattern is quite similar to that observed in other fatal Flaviviridae viral infections.
世界卫生组织将美洲的寨卡病毒（ZIKV）疫情视为全球突发公共卫生事件。寨卡病毒感染所致的神经系统并发症包括小头畸形、脑膜脑炎和吉兰-巴雷综合征。我们描述了一例成年心脏移植患者在接受免疫抑制治疗方案后死亡的病例。该患者因急性神经功能损害入院，随后出现进行性血流动力学不稳定和精神状态恶化，最终死亡。尸检确诊为寨卡病毒脑膜脑炎的假瘤样形式。通过逆转录聚合酶链反应、免疫组织化学、免疫荧光以及脑实质和脑脊液的电子显微镜检查证实了寨卡病毒感染。对该患者病毒基因组的测序确认了一株巴西寨卡病毒毒株。在该病例中，中枢神经系统受累以及寨卡病毒以播散方式传播至其他器官的情况与其他致命黄病毒科病毒感染中观察到的情况非常相似。
