Collins Matthew H, Waggoner Jesse J
Department of Medicine, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , Georgia 30322 , United States.
Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , Georgia 30322 , United States.
ACS Infect Dis. 2019 Jul 12;5(7):1055-1069. doi: 10.1021/acsinfecdis.9b00003. Epub 2019 Apr 17.
Zika virus (Zika) was recently responsible for a massive epidemic that spread throughout Latin America and beyond. Though Zika is typically asymptomatic or self-limiting, the sheer numbers of Zika infections led to the identification of unexpected phenotypes including sexual transmission, Guillain-Barré syndrome, and teratogenicity. Thousands of infants in South, Central, and North America have now been born with microcephaly or one of a number of fetal anomalies constituting the congenital Zika syndrome (CZS). Diagnosing CZS is based on a combination of clinical risk assessment and laboratory testing (which includes determining whether the mother has experienced a possible Zika infection during her pregnancy). A newborn suspected of having congenital Zika infection (due to maternal Zika infection or a birth defect described in association with congenital Zika infection) is then specifically tested for presence of Zika virus in neonatal tissue or anti-Zika IgM in the blood or cerebrospinal fluid. Though the guidelines are clear, there is room for considerable practice variation to emerge from individualized patient-provider encounters, largely due to limitations in diagnostic testing for Zika. The natural history of Zika further obscures our ability to know who, when, and how to test. Molecular diagnostics are highly specific but may not serve well those with asymptomatic infection. Serologic assays expand the diagnostic window but are complicated by cross-reactivity among related flaviviruses and passive immunity transferred from mother to baby. Furthermore, existing and emerging diagnostic tools may not be widely available due to limitations in resources and infrastructure of health systems in affected areas. Improvements in assay parameters as well as advances in platforms and deployability hold promise for optimizing diagnostic approaches for congenital Zika infection. The diagnostic tools and technologies under development must be integrated with forthcoming clinical knowledge of congenital Zika infection to fully realize the value that laboratory testing holds for diagnosing mother to child transmission but also for understanding, predicting, and managing the health outcomes due to congenital Zika infection.
寨卡病毒（Zika）近期引发了一场大规模疫情，疫情蔓延至拉丁美洲及其他地区。虽然寨卡病毒感染通常无症状或具有自限性，但大量的寨卡病毒感染病例导致了一些意外表型的发现，包括性传播、吉兰 - 巴雷综合征和致畸性。南美洲、中美洲和北美洲已有数千名婴儿出生时患有小头畸形或一系列构成先天性寨卡综合征（CZS）的胎儿异常之一。先天性寨卡综合征的诊断基于临床风险评估和实验室检测相结合的方法（其中包括确定母亲在孕期是否曾感染过可能的寨卡病毒）。对于疑似患有先天性寨卡病毒感染的新生儿（由于母亲感染寨卡病毒或出现与先天性寨卡病毒感染相关的出生缺陷），随后会专门检测新生儿组织中寨卡病毒的存在情况，或检测血液或脑脊液中的抗寨卡病毒 IgM。尽管指南明确，但由于寨卡病毒诊断检测存在局限性，在个体化的医患接触中仍可能出现相当大的实践差异。寨卡病毒的自然史进一步模糊了我们对于谁、何时以及如何进行检测的认知。分子诊断具有高度特异性，但对于无症状感染者可能效果不佳。血清学检测扩大了诊断窗口，但相关黄病毒之间的交叉反应以及母亲传给婴儿的被动免疫使其变得复杂。此外，由于受影响地区卫生系统资源和基础设施的限制，现有及新出现的诊断工具可能无法广泛使用。检测参数的改进以及平台和可部署性方面的进展有望优化先天性寨卡病毒感染的诊断方法。正在研发的诊断工具和技术必须与即将获得的先天性寨卡病毒感染的临床知识相结合，以充分实现实验室检测在诊断母婴传播方面的价值，同时也有助于理解、预测和管理先天性寨卡病毒感染导致的健康结果。
