Institute for Global Health, University College London, London, UK.
Infectious Diseases Department, Great Ormond Street Hospital, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
Lancet Infect Dis. 2018 Jan;18(1):e1-e13. doi: 10.1016/S1473-3099(17)30398-5. Epub 2017 Aug 30.
Microcephaly is an important sign of neurological malformation and a predictor of future disability. The 2015-16 outbreak of Zika virus and congenital Zika infection brought the world's attention to links between Zika infection and microcephaly. However, Zika virus is only one of the infectious causes of microcephaly and, although the contexts in which they occur vary greatly, all are of concern. In this Review, we summarise important aspects of major congenital infections that can cause microcephaly, and describe the epidemiology, transmission, clinical features, pathogenesis, management, and long-term consequences of these infections. We include infections that cause substantial impairment: cytomegalovirus, herpes simplex virus, rubella virus, Toxoplasma gondii, and Zika virus. We highlight potential issues with classification of microcephaly and show how some infants affected by congenital infection might be missed or incorrectly diagnosed. Although Zika virus has brought the attention of the world to the problem of microcephaly, prevention of all infectious causes of microcephaly and appropriately managing its consequences remain important global public health priorities.
小头畸形是神经畸形的一个重要体征，也是未来残疾的预测指标。2015-2016 年寨卡病毒爆发和先天性寨卡病毒感染引起了全世界对寨卡病毒感染与小头畸形之间关系的关注。然而，寨卡病毒只是导致小头畸形的众多感染性病因之一，尽管它们发生的背景有很大差异，但都值得关注。在这篇综述中，我们总结了可导致小头畸形的主要先天性感染的重要方面，并描述了这些感染的流行病学、传播、临床特征、发病机制、治疗和长期后果。我们纳入了可导致严重损害的感染：巨细胞病毒、单纯疱疹病毒、风疹病毒、刚地弓形虫和寨卡病毒。我们强调了小头畸形分类方面的潜在问题，并展示了一些受先天性感染影响的婴儿如何被漏诊或误诊。虽然寨卡病毒引起了全世界对小头畸形问题的关注，但预防所有感染性病因的小头畸形并适当处理其后果仍然是全球公共卫生的重要优先事项。
