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Teratogenicidade a Zika : um novo síndrome congénito?
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A recente epidemia do vírus Zika (ZIKV) cativou a atenção da audiência global, sendo que a 1 de Fevereiro de 2016 a Organização Mundial de Saúde declarou o estado de Emergência de Saúde Pública, de importância internacional, após identificação do aumento do número de casos de microcefalia concomitantes com o aumento do número de casos de infecção pelo ZIKV.
Este vírus foi isolado, pela primeira vez, no macaco Rhesus, no Uganda, em 1947. Posteriormente, reconheceu-se que o microorganismo era transmitido por um vector artrópode do género Aedes, entre os quais se destaca o Aedes aegypti.
O primeiro caso de infecção pelo ZIKV no humano foi descrito em 1954, no Uganda, sendo que a partir deste ponto se distribuiu pelo continente africano e sudeste asiático, onde os casos se apresentavam assintomáticos ou com clínica ligeira. No entanto, em 2007, um surto na ilha de Yap, na Micronésia, fez com que 75% da população fosse infectada pelo ZIKV. Este manteve-se confinado a uma pequena banda equatorial correspondente a África e Ásia até 2014, quando surgiram os primeiros casos na América do Sul.
No Brasil, verificou-se uma relação temporo-espacial entre o aumento do número de casos de infecção pelo ZIKV e o aumento das anomalias do desenvolvimento neuronal fetal, como a microcefalia. Múltiplos dados indicam uma coesa associação entre a infecção pelo ZIKV durante a gravidez e microcefalia, embora a relação causal exacta ainda esteja por esclarecer.
Como tal, com este trabalho pretende-se estudar o papel da infecção pelo ZIKV durante a gestação: os processos fisiopatológicos na base da infecção do embrião ou feto descritos recentemente, o espectro de anomalias fetais associadas a este microorganismo, o diagnóstico da infecção materna e fetal no período prenatal e neonatal, bem como quais as estratégias de prevenção implantadas.
The recent Zika virus (ZIKV) epidemic captured the attention of the global audience, and on February 1, 2016 the World Health Organization declared the State of Public Health Emergency of international importance after identifying the increase in the number of cases of microcephaly concomitant with an increase in the number of cases of ZIKV infection. This virus was isolated for the first time in the Rhesus monkey in Uganda in 1947. Subsequently, it was recognized that the microorganism was transmitted by an arthropod vector of the genus Aedes, among which Aedes aegypti stands out. The first case of ZIKV infection in humans was described in 1954 in Uganda, and from that point it was distributed throughout the continent of Africa and Southeast Asia, where the cases were asymptomatic or with mild clinical signs. However, in 2007, an outbreak on the island of Yap in Micronesia caused 75% of the population to be infected with ZIKV. It remained confined to a small equatorial band corresponding to Africa and Asia until 2014, when the first cases appeared in South America. In Brazil, there was a spatiotemporal relationship between the increase in the number of cases of ZIKV infection and anomalies of fetal neuronal development, such as microcephaly. Multiple data indicate a close association between ZIKV infection during pregnancy and microcephaly, although the exact causal relationship remains to be clarified. As such, this work intends to study the role of ZIKV infection during pregnancy: the pathophysiological processes on the basis of embryo or fetus infection, the spectrum of fetal anomalies associated with this microorganism, the diagnosis of maternal infection and fetal period in the prenatal and neonatal period, as well as the prevention strategies implemented.
The recent Zika virus (ZIKV) epidemic captured the attention of the global audience, and on February 1, 2016 the World Health Organization declared the State of Public Health Emergency of international importance after identifying the increase in the number of cases of microcephaly concomitant with an increase in the number of cases of ZIKV infection. This virus was isolated for the first time in the Rhesus monkey in Uganda in 1947. Subsequently, it was recognized that the microorganism was transmitted by an arthropod vector of the genus Aedes, among which Aedes aegypti stands out. The first case of ZIKV infection in humans was described in 1954 in Uganda, and from that point it was distributed throughout the continent of Africa and Southeast Asia, where the cases were asymptomatic or with mild clinical signs. However, in 2007, an outbreak on the island of Yap in Micronesia caused 75% of the population to be infected with ZIKV. It remained confined to a small equatorial band corresponding to Africa and Asia until 2014, when the first cases appeared in South America. In Brazil, there was a spatiotemporal relationship between the increase in the number of cases of ZIKV infection and anomalies of fetal neuronal development, such as microcephaly. Multiple data indicate a close association between ZIKV infection during pregnancy and microcephaly, although the exact causal relationship remains to be clarified. As such, this work intends to study the role of ZIKV infection during pregnancy: the pathophysiological processes on the basis of embryo or fetus infection, the spectrum of fetal anomalies associated with this microorganism, the diagnosis of maternal infection and fetal period in the prenatal and neonatal period, as well as the prevention strategies implemented.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Vírus Zika Gravidez Microcefalia Anomalia congénita Obstetrícia