Zika virus intrauterine infection auses fetal brain abnormality and microcephaly: tip of the iceberg?

1. Zika virus intrauterine infection auses
fetal brain abnormality and
microcephaly: tip of the iceberg?
Ultrasound Obstet Gynecol 2016; 47:6–7
Published online in Wiley Online Library (wileyonlinelibrary.com).

2. Zika virus
● mosquito-borne disease
● toyellow fever
● dengue
● West Nile and Japanese encephalitisviruses

3. Zika virus

5. Zika virus
茲卡病毒的發病機制
被帶有茲卡病毒的蚊蟲叮咬後，會有3至7天的潛伏期，發病症狀和登革熱相似，包括
發燒、頭痛、關節痛等，還可能引發結膜炎，且沒有專門藥物，也尚未有對應的疫苗，
不過患者可用非阿斯匹靈類的解熱劑解除部分不適感，多補充水分和充分休息，一週
左右即可痊癒。最近，夏威夷一起初生嬰兒罹患小頭症的案例，當地衛生官員表示其
母親曾在5月時到巴西生活，恐因感染該病毒而傳染給胎兒，但該病毒是否為造成小
頭症的直接原因仍有待證實。

6. Zika virus
小心埃及斑蚊及白線斑紋！
他們不但會傳播茲卡病毒，還會傳染黃熱病、登革熱和屈公病(chikungunya)。染上茲
卡病毒者患者通常會出現發燒、皮疹、關節痛和結膜炎，且被叮咬到發作的潛伏期約
3-12天。此外，茲卡病毒會造成新生兒罹患小頭症，影響新生兒發展甚至造成早夭。目
前巴西已經發現有 29個早夭新生兒與茲卡病毒有關。

7. Microcephaly
● 1.6/1000
● 神經發育障礙（neurodevelopmental disorder）
● 頭圍小三個標準差以上
● 染色體隱性異常, 天生, 其他因素

8. Microcephaly
genetic
● Down's syndrome
● cri du chat syndrome
● Seckel's syndrome
● Rubinstein-Taybi syndrome
● trisomy 13
● trisomy 18
● Smith-Lemli-Opitz syndrome
● Cornelia de Lange syndrome

9. Microcephaly
genetic
● Down's syndrome
● cri du chat syndrome
● Seckel's syndrome
● Rubinstein-Taybi syndrome
● trisomy 13
● trisomy 18
● Smith-Lemli-Opitz syndrome
● Cornelia de Lange syndrome
non-genetic
● congenital rubella
● congenital toxoplasmosis
● congenital CMV
● 髓膜炎或腦炎
● 非法藥物
● 抽菸喝酒
● 輻射, 化學污染

10. Case
Two pregnant women suffered from symptoms
related to Zika virus infection.
both patients blood results: (-)Zika virus
amniocentesis: (+)Zika virus
intrauterine transmission of the virus

11. Case 1
30.1 wks gestation
HC: 246 mm (<2.6 SD)
Fetal weight: 1179 g (21%)
AC, FL: normal for gestation age

12. Case 1
30.1 wks gestation
HC: 246 mm (<2.6 SD)
Fetal weight: 1179 g (21%)
AC, FL: normal for gestation age
brain atrophy
cerebellum calcifications
dysgenesis of the corpus
callosum and vermis
caudate calcification

13. Case 1
cerebellum calcifications
dysgenesis of the corpus
callosum and vermis
brain atrophy caudate calcification

14. Case 2
29.2 wks gestation
HC: 229 mm (<3.1 SD)
Fetal weight: 1018 g (19%)
AC: 3%
FL: normal for gestation age

15. Case 2
servere unilateral ventriculomegaly
calcifications in the 4th ventricle
absent thalami and thin brain stem and pons
calcification in both eyes
small proximal eye
29.2 wks gestation
HC: 229 mm (<3.1 SD)
Fetal weight: 1018 g (19%)
AC: 3%
FL: normal for gestation age

16. Case 2
servere unilateral ventriculomegaly
calcifications in the 4th ventricle
absent thalami and thin
brain stem and pons
calcification in both eyes
small proximal eye

17. Conclusion
● 氣候變遷
● 勤洗手, 預防蚊蟲叮咬
● 病媒蚊孳生源清除
● 建議隔兩年再懷孕

18. Refference
https://zh.wikipedia.org/wiki/%E5%B0%8F%E9%A0%AD%E7%95%B8%E5%BD%A2
http://onlinelibrary.wiley.com/doi/10.1002/uog.15831/abstract
http://www.geneonline.news/index.php/2016/01/20/zikavirus/
http://world.yam.com/post.php?id=5305
http://www.skh.org.tw/mnews/165/2-1.htm