Levi Marilyn E
Department of Internal Medicine, Division of Infectious Diseases, University of Colorado Hospital, Aurora, Colorado, USA.
Curr Opin Infect Dis. 2017 Aug;30(4):340-345. doi: 10.1097/QCO.0000000000000384.
Worldwide, the number of countries reporting Zika virus (ZKV) infection continues to increase. Although 80% of cases are asymptomatic, ZKV has been identified as a neurotropic virus associated with congenital microcephaly, Guillain-Barre' syndrome, and meningoencephalitis. Until recently, infection in transplant recipients has not been identified. This study will review the existing literature on ZKV infection, laboratory testing, and management in transplant recipients.
Donor-derived transfusion of contaminated blood products and naturally occurring ZKV infections have been recently reported in solid organ and stem cell transplant recipients, ranging from asymptomatic infections to meningoencephalitis. Interpretation of diagnostic testing of ZKV is evolving, with prolonged viral shedding identified in blood, semen, and urine of unclear significance. Serologic testing may be associated with cross-reactivity with other flaviviridae, requiring plaque reduction neutralization testing for confirmation. Thus far, donor screening guidelines for transplantation have not been established.
The study reviews the limited existing literature in transplant recipients infected with ZKV, available laboratory testing and management. Ultimately, guidelines are needed for donor screening from high-risk areas, interpretation of studies and management of infected patients to ensure safe transplantation.
在全球范围内，报告感染寨卡病毒（ZKV）的国家数量持续增加。尽管80%的病例无症状，但ZKV已被确认为一种嗜神经病毒，与先天性小头畸形、吉兰 - 巴雷综合征和脑膜脑炎有关。直到最近，才发现移植受者感染该病毒的情况。本研究将综述关于移植受者ZKV感染、实验室检测及管理的现有文献。
近期报道了实体器官和干细胞移植受者中因输入受污染血液制品导致的供体源性感染以及自然发生的ZKV感染，感染程度从无症状感染到脑膜脑炎不等。ZKV诊断检测的解读正在不断发展，在血液、精液和尿液中发现病毒长期脱落，但其意义尚不明确。血清学检测可能与其他黄病毒科病毒存在交叉反应，需要进行蚀斑减少中和试验来确诊。到目前为止，尚未制定移植供体筛查指南。
本研究综述了移植受者感染ZKV的现有有限文献、可用的实验室检测方法及管理措施。最终，需要制定针对高风险地区供体筛查、研究解读及感染患者管理的指南，以确保安全移植。
