{"id":1564,"date":"2018-11-11T14:05:32","date_gmt":"2018-11-11T13:05:32","guid":{"rendered":"http:\/\/www.newslab.sk\/2018\/11\/11\/virus-zika-zikv\/"},"modified":"2018-11-11T14:08:26","modified_gmt":"2018-11-11T13:08:26","slug":"virus-zika-zikv","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/virus-zika-zikv\/","title":{"rendered":"Zika virus"},"content":{"rendered":"

*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.<\/span><\/strong><\/p>\n

 <\/p>\n

\u00davod<\/strong><\/p>\n

V\u00edrus Zika (ZIKV) je arbov\u00edrus zaraden\u00fd do \u010de\u013eade Flaviviridae <\/em>a rodu Flavivirus<\/em>. A\u017e do roku 2015 bol v\u00edrus Zika (ZIKV) pova\u017eovan\u00fd za m\u00e1lo zn\u00e1my tropick\u00fd v\u00edrus. Do povedomia sa dostal pre vysok\u00fd n\u00e1rast pr\u00edpadov mikrocef\u00e1lie u novorodencov v Braz\u00edlii. Vzh\u013eadom na \u0161\u00edriacu sa epid\u00e9miu ZIKV a z\u00e1va\u017enos\u0165 vroden\u00fdch v\u00fdvinov\u00fdch anom\u00e1li\u00ed vyhl\u00e1sila Svetov\u00e1 zdravotn\u00edcka organiz\u00e1cia (WHO) 1. febru\u00e1ra 2016 celosvetov\u00fd n\u00fadzov\u00fd stav, ktor\u00fd trval do novembra 2016. ZIKV v\u0161ak st\u00e1le predstavuje glob\u00e1lnu hrozbu(1,2).<\/p>\n

 <\/p>\n

Hist\u00f3ria<\/h3>\n

V 40. rokoch 20. storo\u010dia prebiehal vo v\u00fdchodnej Afrike program, ktor\u00fd bol zameran\u00fd na zv\u00fd\u0161enie kontroly nad \u0161\u00edren\u00edm v\u00edrusu \u017eltej hor\u00fa\u010dky. Do ugandsk\u00e9ho lesa Zika bola umiestnen\u00e1 sentinelov\u00e1 opica druhu makak r\u00e9zus (Macaca mulatta<\/em>), u ktorej sa rozvinulo febriln\u00e9 ochorenie. V roku 1947 bol v krvi tohto makaka detegovan\u00fd nov\u00fd v\u00edrus. Ten dostal n\u00e1zov pod\u013ea oblasti, v ktorej bol prv\u00fdkr\u00e1t identifikovan\u00fd \u2013 v\u00edrus Zika. Nasleduj\u00faci rok bol ZIKV izolovan\u00fd z kom\u00e1ra Aedes africanus<\/em>, ktor\u00fd poch\u00e1dzal z rovnakej oblasti(1,3,4).<\/p>\n

Prv\u00e1 infekcia ZIKV u \u013eud\u00ed bola zaznamenan\u00e1 v roku 1952 po\u010das s\u00e9rologick\u00fdch v\u00fdskumov u obyvate\u013eov Ugandy a Tanz\u00e1nie. O dva roky bol prv\u00fd \u013eudsk\u00fd ZIKV izol\u00e1t z\u00edskan\u00fd z 10-ro\u010dn\u00e9ho diev\u010da\u0165a z Nig\u00e9rie. Po\u010das nasleduj\u00facich desa\u0165ro\u010d\u00ed sa tento v\u00edrus \u0161\u00edril Afrikou a tropick\u00fdmi \u010das\u0165ami \u00c1zie, kde sporadicky sp\u00f4soboval epid\u00e9mie s podobn\u00fdmi pr\u00edznakmi ako pri infekcii v\u00edrusom dengue (DENV). Po\u010das t\u00fdchto obdob\u00ed v\u0161ak ZIKV nebol pova\u017eovan\u00fd za nebezpe\u010dn\u00fd(5). V \u00c1zii bol ZIKV prv\u00fdkr\u00e1t zaznamenan\u00fd v Malajzii v roku 1966, ke\u010f bol izolovan\u00fd z kom\u00e1ra Aedes aegypti<\/em>(6,7).<\/p>\n

V 50. rokoch 20. storo\u010dia bol uskuto\u010dnen\u00fd experiment\u00e1lny prenos ZIKV z infikovan\u00e9ho jedinca na kom\u00e1ra A. aegyp<\/em>ti<\/em>. Po tomto \u00faspe\u0161nom pokuse bol celosvetovo roz\u0161\u00edren\u00fd kom\u00e1r A. aegypti <\/em>ozna\u010den\u00fd za pravdepodobn\u00e9ho vektora ZIKV. Pr\u00edtomnos\u0165 ZIKV bola nesk\u00f4r potvrden\u00e1 aj pri nieko\u013ek\u00fdch \u010fal\u0161\u00edch druhoch kom\u00e1ra rodu Aedes <\/em>vr\u00e1tane kom\u00e1ra tigrovan\u00e9ho (A. albopictus<\/em>)(1).<\/p>\n

Prv\u00e1 v\u00e1\u017enej\u0161ia epid\u00e9mia ZIKV prepukla v roku 2007 na tichomorskom ostrove Yap v Mikron\u00e9zii. Epid\u00e9mia trvala od apr\u00edla do j\u00fala. Zah\u0155\u0148ala 49 potvrden\u00fdch pr\u00edpadov a 59 pravdepodobn\u00fdch pr\u00edpadov(8). Po epid\u00e9mii na ostrove Yap nieko\u013eko rokov neboli zaznamenan\u00e9 \u017eiadne v\u00e1\u017enej\u0161ie epid\u00e9mie ZIKV. Sporadicky boli potvrden\u00e9 pr\u00edpady infekcie ZIKV u turistov, ktor\u00ed cestovali do Juhov\u00fdchodnej \u00c1zie. V okt\u00f3bri 2013 prepukla ve\u013ek\u00e1 epid\u00e9mia ZIKV vo Franc\u00fazskej Polyn\u00e9zii. Odhaduje sa, \u017ee infekcia sa roz\u0161\u00edrila medzi 66 % celkov\u00e9ho obyvate\u013estva. Epid\u00e9mia trvala do apr\u00edla 2014. N\u00e1sledne sa ZIKV roz\u0161\u00edril na \u010fal\u0161ie ostrovy v ju\u017enej \u010dasti Tich\u00e9ho oce\u00e1na vr\u00e1tane Novej Kaled\u00f3nie, Cookov\u00fdch ostrovov a Ve\u013ekono\u010dn\u00e9ho ostrova. Na konci roku 2014 sa v\u00edrus dostal do Braz\u00edlie, kde s roz\u0161\u00edren\u00edm infekcie ZIKV st\u00fapol aj po\u010det novorodencov s mikrocef\u00e1liou a po\u010det pacientov s Guillainov\u00fdm-Barr\u00e9ho syndr\u00f3mom (GBS)(1).<\/p>\n

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Epidemiol\u00f3gia<\/h3>\n

V\u0161eobecne plat\u00ed, \u017ee ZIKV poch\u00e1dza z Afriky, konkr\u00e9tne z \u00fazemia Ugandy. Odtia\u013e sa v\u00edrus pravdepodobne roz\u0161\u00edril do \u010fal\u0161\u00edch oblast\u00ed africk\u00e9ho kontinentu a taktie\u017e na ostrovy ju\u017en\u00e9ho Pacifiku a do Juhov\u00fdchodnej \u00c1zie(4). D\u00f4kazom je existencia dvoch geograficky izolovan\u00fdch v\u00fdvojov\u00fdch l\u00edni\u00ed ZIKV. Jednou z nich je africk\u00e1 l\u00ednia a druhou je \u00e1zijsko-americk\u00e1 l\u00ednia, ktor\u00e1 je zodpovedn\u00e1 za epid\u00e9mie v Ju\u017enej Amerike a na tichomorsk\u00fdch ostrovoch(2). Odhaduje sa, \u017ee ZIKV sa dostal z Afriky do Juhov\u00fdchodnej \u00c1zie na za\u010diatku 20. storo\u010dia(1). Prostredn\u00edctvom \u0161t\u00fadi\u00ed gen\u00f3mu ZIKV a fylogenetick\u00fdch anal\u00fdz bolo zisten\u00e9, \u017ee kme\u0148 v\u00edrusu, cirkuluj\u00faci v Ju\u017enej Amerike, je na viac ako 99 % identick\u00fd s kme\u0148om, ktor\u00fd bol izolovan\u00fd po\u010das epid\u00e9mie vo Franc\u00fazskej Polyn\u00e9zii. Z\u00e1rove\u0148 bolo zisten\u00e9, \u017ee s africk\u00fdm kme\u0148om je tento v\u00edrus identick\u00fd na 89 %. In\u00e9 zdroje uv\u00e1dzaj\u00fa a\u017e tri samostatn\u00e9 v\u00fdvojov\u00e9 l\u00ednie: z\u00e1padoafrick\u00e1, v\u00fdchodoafrick\u00e1 a \u00e1zijsk\u00e1(9). V Ugande, kde bol v\u00edrus objaven\u00fd, neboli evidovan\u00e9 choroby vyvolan\u00e9 ZIKV. Napriek tomu bol v\u00fdskyt protil\u00e1tok proti ZIKV v s\u00e9re obyvate\u013eov asi 10 \u2013 20 %(3). \u00c1zijsk\u00e1 v\u00fdvojov\u00e1 l\u00ednia vznikla n\u00e1sledkom hromadenia mut\u00e1ci\u00ed v gen\u00f3me africkej l\u00ednie ZIKV. Tieto mut\u00e1cie sp\u00f4sobili zmeny v interakcii v\u00edrusu s hostite\u013esk\u00fdmi bunkami, v patogenite v\u00edrusu, v schopnosti prenosu prostredn\u00edctvom vektora, ako aj zv\u00fd\u0161en\u00fd epidemick\u00fd potenci\u00e1l(9).<\/p>\n

Americk\u00e9 Centrum pre kontrolu a prevenciu chor\u00f4b (CDC) hl\u00e1silo od decembra 2015 pribli\u017ene 440 000 \u2013 1 300 000 pravdepodobn\u00fdch pr\u00edpadov infekcie ZIKV v Braz\u00edlii. Salv\u00e1dor, Venezuela, Kolumbia, Braz\u00edlia, Surinam, Franc\u00fazska Guyana, Honduras, Mexiko a Panama boli od janu\u00e1ra 2016 pova\u017eovan\u00e9 za krajiny, v ktor\u00fdch pretrv\u00e1vala epid\u00e9mia ZIKV(8). Existuj\u00fa r\u00f4zne te\u00f3rie, pod\u013ea ktor\u00fdch v\u00edrus expandoval z ostrovov ju\u017en\u00e9ho Pacifiku do Ju\u017enej Ameriky po\u010das niektor\u00fdch \u0161portov\u00fdch podujat\u00ed, a to napr\u00edklad po\u010das majstrovstiev sveta v kanoistike 2014 v Braz\u00edlii. Na s\u00fa\u0165a\u017ei sa z\u00fa\u010dastnili aj krajiny ju\u017en\u00e9ho Pacifiku, kde sa v\u00edrus predt\u00fdm vyskytoval. To je v\u0161ak zanedbate\u013en\u00e9, preto\u017ee Braz\u00edlia v\u00edta ro\u010dne okolo 6 mili\u00f3nov turistov. Ve\u013ek\u00e9 mno\u017estvo cestuj\u00facich otv\u00e1ra br\u00e1ny na zanesenie v\u00edrusu do nov\u00fdch oblast\u00ed. Od 2. febru\u00e1ra 2016 boli hl\u00e1sen\u00e9 pr\u00edpady infekci\u00ed ZIKV z mnoh\u00fdch kraj\u00edn a ostrovov Ju\u017enej a Strednej Ameriky. Medzi ne patrili: Americk\u00e1 Samoa, Barbados, Bol\u00edvia, Braz\u00edlia, Kolumbia, Honduras, Kostarika, Ekv\u00e1dor, Salv\u00e1dor, Sv\u00e4t\u00fd Martin, Fid\u017ei, Franc\u00fazska Guyana, Guadeloupe, Guatemala, Guyana, Haiti, Jamajka, Maldivy, Martinik, Mexiko, Nov\u00e1 Kaled\u00f3nia, Nikaragua, Panama, Paraguaj, Portoriko, Dominik\u00e1nska republika, Samoa, Surinam, Venezuela a Americk\u00e9 Panensk\u00e9 ostrovy. Pr\u00edpady boli hl\u00e1sene aj z Thajska a ostrovov Tonga, Vanuatu a \u0160alam\u00fanov\u00fdch ostrovov. Neobvykl\u00e1 z\u00e1va\u017enos\u0165 epid\u00e9mie a vplyv na obyvate\u013estvo na z\u00e1padnej pologuli je v\u00fdsledkom n\u00e1hodn\u00e9ho zavle\u010denia v\u00edrusu do rozsiahlej popul\u00e1cie bez predo\u0161lej z\u00edskanej imunity(1,8). Na za\u010diatku roku 2015 boli registrovan\u00e9 prv\u00e9 pr\u00edpady lok\u00e1lneho prenosu ZIKV prostredn\u00edctvom vektora v severov\u00fdchodnej \u010dasti Braz\u00edlie. V rovnakom \u010dase rap\u00eddne st\u00fapol po\u010det novorodencov s mikrocef\u00e1liou v \u010dastiach Braz\u00edlie infikovan\u00fdch ZIKV. T\u00e1to skuto\u010dnos\u0165 odkryla hrozbu vertik\u00e1lneho prenosu ZIKV z matky na plod. Do febru\u00e1ra 2016 bolo zaevidovan\u00fdch viac ako 4 000 pr\u00edpadov mikrocef\u00e1lie u novorodencov. V s\u00favislosti s t\u00fdmto faktom prebehli retrospekt\u00edvne \u0161t\u00fadie epid\u00e9mie vo Franc\u00fazskej Polyn\u00e9zii. Tieto \u0161t\u00fadie uk\u00e1zali rovnako zv\u00fd\u0161en\u00fd v\u00fdskyt mikrocef\u00e1lie u novorodencov po\u010das epid\u00e9mie v rokoch 2013 a 2014. Kme\u0148 ZIKV z Franc\u00fazskej Polyn\u00e9zie je geneticky najviac pr\u00edbuzn\u00fd kme\u0148om izolovan\u00fdm po\u010das epid\u00e9mi\u00ed na ostrove Yap v roku 2007 a v Kambod\u017ei v roku 2010. Z Franc\u00fazskej Polyn\u00e9zie sa v\u00edrus roz\u0161\u00edril aj do susedn\u00fdch ostrovov ju\u017enej \u010dasti Tich\u00e9ho oce\u00e1nu \u2013 do Novej Kaled\u00f3nie, Cookov\u00fdch ostrovov a Ve\u013ekono\u010dn\u00fdch ostrovov. V\u00edrus bol odtia\u013eto zavle\u010den\u00fd taktie\u017e do Austr\u00e1lie, Japonska, Talianska a N\u00f3rska(3). Po\u010das vzniknutej epid\u00e9mie v Ju\u017enej Amerike sa predpokladalo, \u017ee ZIKV sa roz\u0161\u00edri aj do Severnej Ameriky. Prv\u00e9 pr\u00edpady prenosu ZIKV kom\u00e1rmi boli hl\u00e1sen\u00e9 z Floridy v j\u00fali 2016. Do janu\u00e1ra 2017 bolo v tejto oblasti potvrden\u00fdch 211 pr\u00edpadov. V novembri 2016 boli hl\u00e1sen\u00e9 pr\u00edpady lok\u00e1lneho prenosu ZIKV v Texase. Do janu\u00e1ra 2017 bolo v Texase potvrden\u00fdch \u010fal\u0161\u00edch 5 pr\u00edpadov. K 10. janu\u00e1ru 2017 bolo v USA zaevidovan\u00fdch 37 novorodencov s vroden\u00fdm defektom a 5 potratov asociovan\u00fdch so ZIKV(10). S\u00fa predpoklady, \u017ee ZIKV sa v nasleduj\u00facich rokoch roz\u0161\u00edri na \u00fazem\u00ed USA. Naj- viac by mali by\u0165 zasiahnut\u00e9 ju\u017en\u00e9 oblasti ako Texas a Florida vzh\u013eadom na podnebie vhodn\u00e9 na \u0161\u00edrenie vektorov(11). Av\u0161ak sk\u00fasenosti s podobn\u00fdmi arbov\u00edrusmi (DENV a v\u00edrus chikun- gunya) predpovedaj\u00fa, \u017ee ZIKV sa nedok\u00e1\u017ee roz\u0161\u00edri\u0165 v oblastiach USA(1). Existuje ur\u010dit\u00e9 riziko, \u017ee ZIKV sa bude \u010falej \u0161\u00edri\u0165 po svete vzh\u013eadom na rozvinut\u00fd turizmus. V Eur\u00f3pe zatia\u013e neboli zn\u00e1mky lok\u00e1lneho prenosu ZIKV vektormi. Pr\u00edpady infekcie v Eur\u00f3pe boli zaevidovan\u00e9 u cestuj\u00facich z kraj\u00edn postihnut\u00fdch epid\u00e9miou(6).<\/p>\n

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Prenos, klinick\u00e9 pr\u00edznaky a patogen\u00e9za<\/h3>\n

Rovnako ako in\u00e9 arbov\u00edrusy sa i ZIKV \u0161\u00edri prostredn\u00edctvom vektora v d\u017eung\u013eovom cykle, pri\u010dom \u010dlovek je iba n\u00e1hodn\u00fdm hostite\u013eom ZIKV. Je v\u0161eobecne zn\u00e1me, \u017ee d\u017eung\u013eov\u00fd cyklus je udr\u017eiavan\u00fd prostredn\u00edctvom nehum\u00e1nnych prim\u00e1tov, ktor\u00e9 sl\u00fa\u017eia ako amplifika\u010dn\u00fd hostite\u013e. Pod\u013ea niektor\u00fdch \u0161t\u00fadi\u00ed v\u0161ak ZIKV koluje aj medzi in\u00fdmi zvieratami, ako s\u00fa napr. kozy, slony, ovce a pod., u ktor\u00fdch boli n\u00e1jden\u00e9 protil\u00e1tky proti ZIKV(13). Najv\u00fdznamnej\u0161\u00edm vektorom ZIKV je kom\u00e1r A. aegypti<\/em>.<\/p>\n

Druh\u00fdm najv\u00fdznamnej\u0161\u00edm vektorom je stredomorsk\u00fd kom\u00e1r<\/p>\n

    \n
  1. albopictus<\/em>. V\u00edrus bol detegovan\u00fd aj pri \u010fal\u0161\u00edch druhoch kom\u00e1ra rodu Ae<\/em>des<\/em> vr\u00e1tane A.<\/em> africanus<\/em>, A.<\/em> apicoar<\/em>genteus<\/em>,<\/li>\n
  2. vitattus<\/em>, A.<\/em> fur<\/em>cif<\/em>er<\/em>, A.<\/em> luteocephalus<\/em>, A.<\/em> hensill<\/em>i<\/em>(8).<\/li>\n<\/ol>\n

    Bol potvrden\u00fd aj sexu\u00e1lny prenos v\u00edrusu a prenos prostredn\u00edctvom transf\u00fazie krvi. V\u00edrus sa taktie\u017e m\u00f4\u017ee \u0161\u00edri\u0165 transplacent\u00e1rne a infikova\u0165 plod \u017eeny v prvom trimestri gravidity. V\u00edrus bol doposia\u013e detegovan\u00fd v krvi, mo\u010di, slin\u00e1ch, ejakul\u00e1te, nervovom tkanive, plodovej vode, ale aj v materskom mlieku infikovan\u00fdch matiek. Po inokul\u00e1cii matersk\u00e9ho mlieka na Vero bunky sa v\u0161ak nena\u0161li stopy replik\u00e1cie v\u00edrusu(1,9).<\/p>\n

    V minulosti sa infekcia ZIKV prejavovala u \u013eud\u00ed ako mierne, spont\u00e1nne odznievaj\u00face ochorenie s pr\u00edznakmi chr\u00edpky, pri\u010dom tieto pr\u00edznaky sa objavili asi u 20 % infikovan\u00fdch pacientov. Po ned\u00e1vnych epid\u00e9mi\u00e1ch sa v\u0161ak infekcia ZIKV d\u00e1va do s\u00favislosti aj so z\u00e1va\u017en\u00fdmi ochoreniami vr\u00e1tane multiorg\u00e1nov\u00e9ho zlyhania a trombocytopenickej purpury(12).<\/p>\n

    Inkuba\u010dn\u00e1 lehota ochorenia sa pohybuje od 3 do 12 dn\u00ed. Symptomatick\u00fd priebeh infekcie m\u00f4\u017ee by\u0165 sprev\u00e1dzan\u00fd ak\u00fatnym n\u00e1stupom hor\u00fa\u010dky, makulopapul\u00e1rnou vyr\u00e1\u017ekou, myalgiou, artralgiou, poruchami gastrointestin\u00e1lneho traktu, bo- les\u0165ami hlavy, vracan\u00edm alebo r\u00f4znymi oftalmologick\u00fdmi komplik\u00e1ciami. Konjunktivit\u00eddu vyvol\u00e1va asi u 15 % infikovan\u00fdch jedincov. D\u00f4vodom je pravdepodobne po\u010diato\u010dn\u00e1 infekcia zrakov\u00e9ho org\u00e1nu. U niektor\u00fdch infikovan\u00fdch jedincov sa vyskytli aj z\u00e1vraty, opuch, boles\u0165 za o\u010dami, z\u00e1pal d\u00fahovky, lymfadenopatia, krv v ejakul\u00e1te, probl\u00e9my so sluchom, trombocytop\u00e9nia a podko\u017en\u00e9 krv\u00e1canie. Ak\u00fatny syndr\u00f3m vyvolan\u00fd ZIKV zvy\u010dajne odznie po 1 \u2013 2 t\u00fd\u017ed\u0148och, no artralgia m\u00f4\u017ee pretrv\u00e1va\u0165 aj nieko\u013eko t\u00fd\u017ed\u0148ov po odznen\u00ed choroby(3,8,9,12). Tak\u00e9to klinick\u00e9 pr\u00edznaky neboli v 50. rokoch 20. storo\u010dia v Afrike evidovan\u00e9. Z toho vypl\u00fdva, \u017ee evol\u00facia ZIKV so sebou priniesla zv\u00fd\u0161en\u00fa patogenitu(9). V niektor\u00fdch pr\u00edpadoch m\u00f4\u017ee ma\u0165 infekcia ZIKV dokonca fat\u00e1lne n\u00e1sledky, a to najm\u00e4 u pacientov s predo\u0161l\u00fdmi zdravotn\u00fdmi komplik\u00e1ciami alebo u imunodeficientn\u00fdch jedincov(1). V porovnan\u00ed s ostatn\u00fdmi flaviv\u00edrusmi (napr. z\u00e1padon\u00edlsky v\u00edrus) je ZIKV u dospel\u00fdch \u013eud\u00ed iba zriedkavo neuroinvaz\u00edvny. Sporadicky sp\u00f4sobuje meningit\u00eddu alebo encefalit\u00eddu(12).<\/p>\n

    V\u00edrus mo\u017eno izolova\u0165 z krvi pribli\u017ene 10 dn\u00ed po infekcii. V 99 % pr\u00edpadov v\u00edrus vymizne zhruba po 24 d\u0148och. V mo\u010di m\u00f4\u017ee v\u00edrus zotrva\u0165 12 alebo viac dn\u00ed po infekcii, v ejakul\u00e1te aj viac ako 60 dn\u00ed. Tehotenstvo m\u00f4\u017ee ovplyvni\u0165 d\u013a\u017eku trvania vylu\u010dovania v\u00edrusu. V jednom pr\u00edpade bola \u017eena vo viremickej f\u00e1ze minim\u00e1lne 10 t\u00fd\u017ed\u0148ov po\u010das tehotenstva, no 11 dn\u00ed po ukon\u010den\u00ed v\u00edrus vymizol. Protil\u00e1tky proti ZIKV mo\u017eno detegova\u0165 pribli\u017ene 9 dn\u00ed po infekcii. Zatia\u013e nie je zn\u00e1me, na ak\u00fd dlh\u00fd \u010das sa zachov\u00e1va z\u00edskan\u00e1 imunita proti ZIKV. M\u00f4\u017ee v\u0161ak by\u0165 celo\u017eivotn\u00e1 ako pri ostatn\u00fdch flaviv\u00edrusoch. Kom\u00e1r sa st\u00e1va infek\u010dn\u00fdm zhruba po 10 d\u0148och od bodnutia infikovan\u00e9ho \u010dloveka. ZIKV u kom\u00e1ra pretrv\u00e1va pravdepodobne a\u017e do smrti(1). Pri bodnut\u00ed kom\u00e1rom ZIKV po preniknut\u00ed do ko\u017ee \u010dloveka infikuje fibroblasty v podko\u017enom tkanive, keratinocyty a Langerhansove bunky. Tieto bunky obsahuj\u00fa povrchov\u00e9 \u0161trukt\u00fary, ktor\u00e9 sl\u00fa\u017eia ako receptory na prichytenie viri\u00f3nov ZIKV. S\u00fa to konkr\u00e9tne receptory DC-SIGN, AXL, Tyro3 a TIM-1. Infekcia ZIKV v t\u00fdchto bunk\u00e1ch sp\u00f4sobuje zv\u00fd\u0161enie expresie mRNA pre toll-like receptor 3 (TLR3). TLR3 indukuje synt\u00e9zu interfer\u00f3nov \u03b1 a \u03b2, \u010d\u00edm vznik\u00e1 imunitn\u00e1 odpove\u010f proti v\u00edrusu(13). Aby sa v\u0161ak ZIKV mohol v bunk\u00e1ch replikova\u0165, mus\u00ed t\u00fato imunitn\u00fa odpove\u010f zdola\u0165. Deje sa tak prostredn\u00edctvom ne\u0161trukt\u00farneho prote\u00ednu NS5, ktor\u00fd podporuje proteazom\u00e1lnu degrad\u00e1ciu transkrip\u010dn\u00e9ho faktora STAT2. Ten p\u00f4sob\u00ed ako aktiv\u00e1tor transkripcie g\u00e9nov pre interfer\u00f3ny(12). ZIKV taktie\u017e zvy\u0161uje schopnos\u0165 svojej replik\u00e1cie indukciou autof\u00e1gie v hostite\u013esk\u00fdch bunk\u00e1ch. Po replik\u00e1cii v ko\u017enom tkanive sa v\u00edrus \u0161\u00edri prostredn\u00edctvom krvn\u00e9ho rie\u010diska do region\u00e1lnych lymfatick\u00fdch uzl\u00edn. Odtia\u013eto sa m\u00f4\u017ee v\u00edrus roz\u0161\u00edri\u0165 do \u010fal\u0161\u00edch org\u00e1nov a tkan\u00edv, napr\u00edklad do org\u00e1nov centr\u00e1lnej nervovej s\u00fastavy (CNS) a srdcov\u00e9ho svalu(1,13).<\/p>\n

     <\/p>\n

    Mikrocef\u00e1lia<\/h3>\n

    Po\u010das braz\u00edlskej epid\u00e9mie ZIKV sa infekcia t\u00fdmto v\u00edrusom za\u010dala d\u00e1va\u0165 do s\u00favisu s mikrocef\u00e1liou. Ide o vz\u00e1cnu poruchu plodu, resp. novorodenca. Je definovan\u00e1 zmen\u0161enou ve\u013ekos\u0165ou hlavy (obr\u00e1zok 1) <\/em><\/strong>oproti ostatn\u00fdm zdrav\u00fdm plodom (novorodencom) rovnak\u00e9ho veku, pohlavia a etnika. Mikrocef\u00e1lia je \u010dasto sp\u00e1jan\u00e1 s poruchami intelektu(15).<\/p>\n

    Je sprev\u00e1dzan\u00e1 zn\u00ed\u017eenou schopnos\u0165ou u\u010di\u0165 sa a negat\u00edvne ovplyv\u0148uje fungovanie ka\u017edodenn\u00e9ho \u017eivota. Postihnut\u00ed nie s\u00fa schopn\u00ed samostatne vykon\u00e1va\u0165 ka\u017edodenn\u00e9 potreby \u2013 najes\u0165 sa, stara\u0165 sa o osobn\u00fa hygienu a podobne. Maj\u00fa tie\u017e poruchy zraku a sluchu. M\u00f4\u017ee nasta\u0165 oneskorenie vo v\u00fdvine re\u010dov\u00e9ho prejavu die\u0165a\u0165a a takisto v jeho pohybovom v\u00fdvine.<\/p>\n

    Deti s mikrocef\u00e1liou maj\u00fa probl\u00e9my so seden\u00edm, vst\u00e1van\u00edm a s kr\u00e1\u010dan\u00edm. Stav m\u00f4\u017ee by\u0165 smrte\u013en\u00fd a tieto osoby dok\u00e1\u017eu pre\u017ei\u0165 len v\u010faka lek\u00e1rskemu doh\u013eadu(16).<\/p>\n

    Existuj\u00fa dva druhy mikrocef\u00e1lie. Prim\u00e1rna mikrocef\u00e1lia nast\u00e1va u\u017e po\u010das vn\u00fatromaternicov\u00e9ho v\u00fdvinu plodu, preto b\u00fdva ozna\u010dovan\u00e1 ako kongenit\u00e1lna mikrocef\u00e1lia. Sekund\u00e1rna mikrocef\u00e1lia sa naz\u00fdva postnat\u00e1lna, preto\u017ee sa prejavuje a\u017e po naroden\u00ed. Zatia\u013e \u010do prim\u00e1rna mikrocef\u00e1lia je sp\u00f4soben\u00e1 \u00fabytkom mno\u017estva neur\u00f3nov produkovan\u00fdch po\u010das neurogen\u00e9zy, sekund\u00e1rnu mikrocef\u00e1liu pod\u013ea v\u0161etk\u00e9ho sp\u00f4sobu- je \u00fabytok synaptick\u00fdch spojen\u00ed a pokles vo veden\u00ed nervov\u00fdch vzruchov. U\u017e v minulosti bola prim\u00e1rna mikrocef\u00e1lia asociovan\u00e1 s v\u00edrusovou infekciou, konkr\u00e9tne s infekciou v\u00edrusom rubeoly a cytomegalov\u00edrusom(3).<\/p>\n

    ZIKV prioritne infikuje a po\u0161kodzuje nervov\u00e9 progenitorov\u00e9 bunky (NPC), z ktor\u00fdch diferenci\u00e1ciou vznikaj\u00fa maturovan\u00e9 neur\u00f3ny. To m\u00f4\u017ee vysvet\u013eova\u0165 pr\u00ed\u010dinu nedostato\u010dn\u00e9ho v\u00fdvoja mozgu u novorodencov s mikrocef\u00e1liou(12). Centrozom\u00e1lne abnormality v infikovan\u00fdch bunk\u00e1ch m\u00f4\u017eu by\u0165 taktie\u017e asociovan\u00e9 s mikrocef\u00e1liou. Centroz\u00f3my s\u00fa bunkov\u00e9 organely, ktor\u00e9 sl\u00fa\u017eia na organizovanie mikrotubulov v \u017eivo\u010d\u00ed\u0161nych bunk\u00e1ch. Maj\u00fa d\u00f4le\u017eit\u00fa \u00falohu po\u010das mit\u00f3zy a po\u010das vezikul\u00e1rneho transportu molek\u00fal medzi organelami. Zv\u00fd\u0161en\u00e9 mno\u017estvo centroz\u00f3mov m\u00f4\u017ee sp\u00f4sobi\u0165 poruchy mitotick\u00e9ho delenia buniek a taktie\u017e vyvol\u00e1va\u0165 apopt\u00f3zu. To m\u00f4\u017ee vies\u0165 k nedostatkom po\u010das v\u00fdvoja neur\u00f3nov a v kone\u010dnom d\u00f4sledku k poklesu mno\u017estva mozgov\u00e9ho tkaniva. Zatia\u013e nie je potvrden\u00e9, \u010di ZIKV priamo ovplyv\u0148uje v\u00fdvoj centroz\u00f3mov v bunke. Jedn\u00fdm z d\u00f4kazov by v\u0161ak mohla by\u0165 existencia \u0161pecifick\u00fdch prote\u00ednov, ktor\u00e9 sa z\u00fa\u010dast\u0148uj\u00fa na v\u00fdvoji centroz\u00f3mov, ale aj autof\u00e1gie, do ktorej ZIKV zasahuje(4). V\u00edrusov\u00e9 ne\u0161trukt\u00farne prote\u00edny NS4A a NS4B s\u00fa inhib\u00edtormi bunkovej sign\u00e1lnej dr\u00e1hy Akt-mTOR (obr\u00e1zok 2)<\/strong>. Sp\u00f4sobuj\u00fa tak abnormality v autof\u00e1gii a smr\u0165 NPC buniek(17).<\/p>\n

    S\u00favis ZIKV s mikrocef\u00e1liou podporuj\u00fa laborat\u00f3rne anal\u00fdzy, pri ktor\u00fdch bol detegovan\u00fd v\u00edrus alebo bola stanoven\u00e1 v\u00edrusov\u00e1 g\u00e9nov\u00e1 expresia v plodovej vode, alebo r\u00f4znych tkaniv\u00e1ch plodov s mikrocef\u00e1liou. Analyzovan\u00e9 boli tie\u017e tkaniv\u00e1 det\u00ed, ktor\u00e9 zomreli po\u010das p\u00f4rodu alebo n\u00e1sledkom potratu (tabu\u013eka 1)<\/em><\/strong>. \u0160pecifick\u00e9 IgM protil\u00e1tky proti ZIKV boli detegovan\u00e9 v mozgovomiechovom moku a v s\u00e9re novorodencov s mikrocef\u00e1liou. S\u00favis potvrdzuje aj \u0161t\u00fadia, pri ktorej 13 z 32 novorodencov s mikrocef\u00e1liou bolo infikovan\u00fdch ZIKV,\u00a0 pri\u010dom ani jeden zo 62 kontroln\u00fdch zdrav\u00fdch novorodencov nebol pozit\u00edvny na ZIKV(3).<\/p>\n

    Pokus infikova\u0165 novoroden\u00e9 my\u0161i senegalsk\u00fdm izol\u00e1tom ZIKV viedol k 30 % \u00famrtnosti. Pri \u010fal\u0161om experimente boli novoroden\u00e9 my\u0161i infikovan\u00e9 klinick\u00fdm izol\u00e1tom ZIKV z Portorika. Testovan\u00e9 my\u0161i vykazovali v\u00e1\u017ene neurologick\u00e9 poruchy a stratu hmotnosti, pri\u010dom \u010das\u0165 z nich zahynula. \u010eal\u0161ia \u0161t\u00fadia bola zameran\u00e1 na infekciu 6-t\u00fd\u017ed\u0148ov\u00fdch my\u0161\u00ed, ktor\u00fdm\u00a0ch\u00fdbali tri regula\u010dn\u00e9 transkrip\u010dn\u00e9 faktory pre interfer\u00f3ny. Tieto my\u0161i boli vn\u00edmavej\u0161ie na infekciu ZIKV izol\u00e1tom z Kambod\u017ee. U my\u0161\u00ed nastala infekcia CNS, ktor\u00e1 viedla k apopt\u00f3ze NPC buniek. V inej \u0161t\u00fadii bol gravidn\u00fdm samiciam my\u0161\u00ed subkut\u00e1nne aplikovan\u00fd izol\u00e1t ZIKV z Franc\u00fazskej Polyn\u00e9zie. V\u00edrus infikoval r\u00f4zne trofoblasty, endotelov\u00e9 bunky placenty a napokon cez placentu infikoval hlavu plodu. Kongenit\u00e1lna infekcia u imunodeficientn\u00fdch my\u0161\u00ed mala za n\u00e1sledok obmedzen\u00fd vn\u00fatromaternicov\u00fd rast plodu a v kone\u010dnom d\u00f4sledku jeho \u00famrtie. V\u00e4\u010d\u0161ina pokusov na my\u0161iach bola opakovan\u00e1 aj na nehum\u00e1nnych prim\u00e1toch. Infekcia gravidn\u00fdch sam\u00edc makaka svi\u0148ochvost\u00e9ho (Macaca nemestrina<\/em>) kambod\u017esk\u00fdm izol\u00e1tom ZIKV mala za n\u00e1sledok tvorbu l\u00e9zi\u00ed na mozgu a hypopl\u00e1ziu bielej hmoty(12).<\/p>\n

     <\/p>\n

    Guillainov-Barr\u00e9ho syndr\u00f3m<\/h3>\n

    Retrospekt\u00edvne \u0161t\u00fadie ud\u00e1vaj\u00fa 20n\u00e1sobn\u00fd n\u00e1rast pr\u00edpadov GBS vo Franc\u00fazskej Polyn\u00e9zii po\u010das rokov 2013 a 2014. Ochorenie sa d\u00e1va do s\u00favisu pr\u00e1ve s epid\u00e9miou ZIKV, ktor\u00e1 v t\u00fdchto rokoch na ostrove prepukla. Ide o autoimunitn\u00e9 ochorenie, pri ktorom imunitn\u00e9 bunky nap\u00e1daj\u00fa perif\u00e9rny nervov\u00fd syst\u00e9m. To m\u00e1 za n\u00e1sledok t\u0155pnutie, svalov\u00e9 ochabnutie, paral\u00fdzu \u010di dokonca smr\u0165. GBS bol v minulosti asociovan\u00fd s infekciami DENV a v\u00edrusom chikungunya. Po\u010das ned\u00e1vnej epid\u00e9mie ZIKV v Severnej a Ju\u017enej Amerike bol taktie\u017e zaznamenan\u00fd zv\u00fd\u0161en\u00fd po\u010det pr\u00edpadov GBS. \u0160t\u00fadia na pacientoch s GBS potvrdila v\u00fdskyt anti-ZIKV IgM alebo IgG protil\u00e1tok u 41 zo 42 pacientov s GBS(3). V Kolumbii sa po\u010das epid\u00e9mie ZIKV v\u00fdskyt pr\u00edpadov GBS strojn\u00e1sobil oproti\u00a0po\u010diato\u010dn\u00e9mu v\u00fdskytu ochorenia. Vo Venezuele bol taktie\u017e zaznamenan\u00fd s\u00favis GBS s epid\u00e9miou ZIKV.<\/p>\n

    Doposia\u013e nebol op\u00edsan\u00fd presn\u00fd mechanizmus, ak\u00fdm ZIKV vyvol\u00e1va GBS. Predpoklad\u00e1 sa v\u0161ak, \u017ee opakovan\u00e9 arbov\u00edrusov\u00e9 infekcie dr\u00e1\u017edia imunitn\u00fd syst\u00e9m a sp\u00fa\u0161\u0165aj\u00fa imunopatologick\u00e9 procesy, ktor\u00e9 atakuj\u00fa perif\u00e9rne nervy(19). Existuje nieko\u013eko hypot\u00e9z, ktor\u00e9 vysvet\u013euj\u00fa mechanizmus vzniku GBS, zapr\u00ed\u010dinen\u00e9ho infekciou ZIKV. Jedna z nich sa opiera o autoimunitn\u00fa reakciu mechanizmom molekul\u00e1rnych mimikry. Polyprote\u00edn ZIKV toti\u017e pripom\u00edna prote\u00edny asociovan\u00e9 s myeliniz\u00e1ciou, funkciou ax\u00f3nov a v\u00fdvojom nervov. Neutraliza\u010dn\u00e9 protil\u00e1tky proti ZIKV m\u00f4\u017eu teda vykazova\u0165 skr\u00ed\u017een\u00fa reaktivitu s prote\u00ednmi perif\u00e9rnych nervov, \u010do m\u00f4\u017ee vies\u0165 k ni\u010deniu nervov\u00fdch spojov imunitn\u00fdm syst\u00e9mom. \u010eal\u0161\u00edm mechanizmom vzniku GBS je protil\u00e1tkami zosilnen\u00e1 infekcia (antibody-mediated enhancement<\/em>, ADE) ZIKV. Tak\u00fdto fenom\u00e9n m\u00f4\u017ee nasta\u0165 po predo\u0161lej infekcii in\u00fdm flaviv\u00edrusom, napr\u00edklad DENV. Napriek takmer 40 % genetickej odli\u0161nosti vykazuj\u00fa protil\u00e1tky proti DENV a protil\u00e1tky proti ZIKV skr\u00ed\u017een\u00fa reaktivitu(20). Vo v\u0161eobecnosti sa protil\u00e1tky navia\u017eu na v\u00edrusov\u00e9 \u010dastice, a t\u00fdm ich neutralizuj\u00fa, \u010do ma za n\u00e1sledok ich rozpoznanie a pohltenie fagocytmi(21). Pri ADE sa v\u0161ak protil\u00e1tky iba \u010diasto\u010dne navia\u017eu na viri\u00f3ny ZIKV, \u010do sprostredkuje endocyt\u00f3zu prostredn\u00edctvom Fc-receptora do dendritov\u00fdch buniek, monocytov alebo makrof\u00e1gov. V\u00edrus je n\u00e1sledne schopn\u00fd replikova\u0165 sa vn\u00fatri t\u00fdchto buniek, \u010do vedie k zv\u00fd\u0161enej produkcii v\u00edrusov\u00fdch \u010dast\u00edc(22). V endemick\u00fdch oblastiach DENV, v ktor\u00fdch bola zaznamenan\u00e1 taktie\u017e epid\u00e9mia ZIKV, predo\u0161l\u00e1 infekcia DENV m\u00f4\u017ee u pacienta tak\u00fdmto mechanizmom zosilni\u0165 replik\u00e1ciu ZIKV. \u010eal\u0161\u00ed hypotetick\u00fd mechanizmus m\u00f4\u017ee zah\u0155\u0148a\u0165 imunitn\u00fa odpove\u010f T-lymfocytov, sp\u00fa\u0161\u0165an\u00fa ZIKV. T-lymfocyty m\u00f4\u017eu v tomto pr\u00edpade zacieli\u0165 neur\u00e1lne, axon\u00e1lne a myel\u00ednov\u00e9 antig\u00e9ny aj antig\u00e9ny Schwannov\u00fdch buniek. T\u00e1to hypot\u00e9za vych\u00e1dza z n\u00e1lezu perineur\u00e1lnych infiltr\u00e1tov T-lymfocytov v nervovom tkanive po\u010das autopsie jedincov s GBS. \u0160tvrt\u00fdm mo\u017en\u00fdm mechanizmom vzniku GBS je priamy efekt v\u00edrusovej infekcie na bunky perif\u00e9rneho nervov\u00e9ho syst\u00e9mu. Infekcia m\u00f4\u017ee vies\u0165 k ak\u00fatnej motorickej axon\u00e1lnej neuropatii (AMAN) alebo k ak\u00fatnej z\u00e1palovej demyeliniza\u010dnej polyradikuloneuropatii (AIDP)(20).<\/p>\n

     <\/p>\n

    \u010eal\u0161ie neurologick\u00e9 ochorenia, asociovan\u00e9 s v\u00edrusom<\/h3>\n

    Zika<\/strong><\/p>\n

    Okrem mikrocef\u00e1lie a GBS s\u00fa so ZIKV sp\u00e1jan\u00e9 \u010fal\u0161ie neurologick\u00e9 ochorenia. Ich s\u00favis s v\u00edrusovou infekciou je v\u0161ak diskutabiln\u00fd, preto\u017ee je dolo\u017een\u00fd iba 1-2 pr\u00edpadmi. U 81-ro\u010dn\u00e9ho mu\u017ea infikovan\u00e9ho ZIKV sa po 10 d\u0148och od pr\u00edchodu z Novej Kaled\u00f3nie prejavila vysok\u00e1 hor\u00fa\u010dka a strata vedomia. Tieto sympt\u00f3my a sn\u00edmky z magnetickej rezonancie nazna\u010dovali meningoencefalit\u00eddu. ZIKV bol potvrden\u00fd pomocou polymer\u00e1zovej re\u0165azovej reakcie s reverznou transkripciou (RT-PCR), ale aj kultiva\u010dn\u00fdm vy\u0161etren\u00edm mozgovomiechov\u00e9ho moku. Bol op\u00edsan\u00fd aj pr\u00edpad fat\u00e1lnej meningoencefalit\u00eddy u pacienta infikovn\u00e9ho ZIKV, ktor\u00e9mu boli podan\u00e9 imunosu- pres\u00edva po transplant\u00e1cii srdca. Infekcia ZIKV bola potvrden\u00e1 pomocou RT-PCR, imunohistochemick\u00fdm vy\u0161etren\u00edm, imunofluorescenciou a elektr\u00f3novou mikroskopiou mozgov\u00e9ho parench\u00fdmu a mozgovomiechov\u00e9ho moku. P\u00e4tn\u00e1s\u0165ro\u010d- n\u00e9mu diev\u010da\u0165u z Guadeloupe lek\u00e1ri diagnostikovali ak\u00fatnu myelit\u00eddu 7 dn\u00ed po expoz\u00edcii ZIKV. Pr\u00edtomnos\u0165 v\u00edrusovej RNA bola potvrden\u00e1 met\u00f3dou RT-PCR v mozgovomiechovom moku, v s\u00e9re a v mo\u010di. Pr\u00edtomnos\u0165 ZIKV v mozgovomiechovom moku poukazuje na skuto\u010dnos\u0165, \u017ee v\u00edrus je vysokoneurotropn\u00fd(23). Je pravdepodobn\u00e9, \u017ee s pokrokom vo v\u00fdskume bud\u00fa zn\u00e1me \u010fal\u0161ie neurologick\u00e9, ale aj in\u00e9 ochorenia asociovan\u00e9 so ZIKV(3).<\/p>\n

     <\/p>\n

    Profylaxia a terapia<\/h3>\n

    Napriek tomu, \u017ee symptomatick\u00e1 infekcia ZIKV m\u00e1 v\u00e4\u010d\u0161inou \u013eahk\u00fd priebeh, pacienti by mali by\u0165 monitorovan\u00ed vzh\u013ea- dom na mo\u017en\u00e9 nebezpe\u010denstvo koagulopatie a zlyhania org\u00e1nov. Zatia\u013e neexistuje \u017eiadne cielen\u00e9 antivirotikum proti tomuto v\u00edrusu. V symptomatick\u00fdch pr\u00edpadoch sa vyu\u017e\u00edva iba symptomatick\u00e1 lie\u010dba (napr. antipyretik\u00e1 alebo antihistaminik\u00e1). Neodpor\u00fa\u010da sa aplikova\u0165 nesteroidn\u00e9 antiflogistik\u00e1 a aspir\u00edn pre nebezpe\u010denstvo krv\u00e1cania(8).<\/p>\n

    Najv\u00e4\u010d\u0161ou v\u00fdzvou je v s\u00fa\u010dasnosti v\u00fdvoj efekt\u00edvnej vakc\u00edny proti ZIKV. V\u00fdvoj vakc\u00edn proti flaviv\u00edrusom je limitovan\u00fd povahou epid\u00e9mi\u00ed, ktor\u00e9 s\u00fa sporadick\u00e9 a nepredv\u00eddate\u013en\u00e9. To je hlavnou prek\u00e1\u017ekou aj pri rap\u00eddnom v\u00fdvoji vakc\u00edn s cie\u013eom zabr\u00e1ni\u0165 \u0161\u00edreniu ZIKV. Prevent\u00edvne o\u010dkovanie obyvate\u013estva na zabr\u00e1nenie vzniku epid\u00e9mie sa navy\u0161e m\u00f4\u017ee javi\u0165 ako neprimerane drah\u00e9. Za\u010diatkom roka 2016 sa objavili spr\u00e1vy o tom, \u017ee ist\u00e1 indick\u00e1 biotechnologick\u00e1 spolo\u010dnos\u0165 ohl\u00e1sila v\u00fdvoj dvoch kandid\u00e1tskych vakc\u00edn, ktor\u00e9 \u010dakali na predklinick\u00e9 sk\u00fa\u0161ky(9). Americk\u00e1 spolo\u010dnos\u0165 SynCon Pharmaceuticals vyvinula DNA vakc\u00ednu proti ZIKV, ktor\u00e1 mala podst\u00fapi\u0165 prv\u00fa f\u00e1zu klinick\u00fdch \u0161t\u00fadi\u00ed do konca roka 2016. DNA vakc\u00ednu a \u017eiv\u00fa atenuovan\u00fa vakc\u00ednu vyvinuli v americkom N\u00e1rodnom in- \u0161tit\u00fate pre alergie a infek\u010dn\u00e9 choroby (NIAID). V s\u00fa\u010dasnosti prebiehaj\u00fa klinick\u00e9 \u0161t\u00fadie t\u00fdchto vakc\u00edn. Vedci NIAID pracuj\u00fa aj na v\u00fdvoji mRNA vakc\u00edn, ktor\u00e9 mali vst\u00fapi\u0165 do klinick\u00fdch \u0161t\u00fadi\u00ed koncom roka 2017(13,24).<\/p>\n

    Pre in vitro <\/em>v\u00fdskum cielenej antiv\u00edrusovej lie\u010dby ZIKV boli pripraven\u00e9 \u013eudsk\u00e9 NPC bunky. Vzh\u013eadom na pr\u00edbuznos\u0165 ZIKV a DENV by mohlo by\u0165 mnoho poznatkov o DENV aplikovan\u00fdch aj pri v\u00fdvoji antivirotika proti ZIKV. Najpodstatnej\u0161ou \u00falohou by v\u0161ak mal by\u0165 v\u00fdskum cielenej lie\u010dby pre infikovan\u00e9 tehotn\u00e9 \u017eeny(9).<\/p>\n

    Medzi prevent\u00edvnymi opatreniami nesmie ch\u00fdba\u0165 doh\u013ead nad vektormi. V oblastiach v\u00fdskytu ZIKV je d\u00f4le\u017eit\u00e1 ochrana pred u\u0161tipnut\u00edm kom\u00e1rom. \u013dudia, ktor\u00ed cestovali do oblast\u00ed, zamoren\u00fdch ZIKV, by mali zv\u00e1\u017ei\u0165 darovanie krvi(8). Mu\u017ei, ktor\u00ed cestovali do oblast\u00ed s v\u00fdskytom ZIKV, by sa mali vyvarova\u0165 nechr\u00e1nen\u00e9ho pohlavn\u00e9ho styku s tehotnou partnerkou. Cestuj\u00facim z t\u00fdchto kraj\u00edn, ktor\u00ed nevykazuj\u00fa \u017eiadne zn\u00e1mky ochorenia, sa odpor\u00fa\u010da pou\u017e\u00edva\u0165 antikoncepciu 28 dn\u00ed od n\u00e1vratu. V oblastiach s lok\u00e1lnym v\u00fdskytom ZIKV poskytuj\u00fa zdravotn\u00edcke org\u00e1ny pr\u00edstup k antikoncepcii, predp\u00f4rodnej starostlivosti a v pr\u00edpade komplik\u00e1ci\u00ed k vykonaniu bezpe\u010dnej interrupcie(9).<\/p>\n

     <\/p>\n

    LITERAT\u00daRA<\/strong><\/p>\n

      \n
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    14. https:\/\/en.wikipedia.org\/wiki\/Microcephaly<\/li>\n
    15. Wu J, Huang DY, Ma JT, et Available Evidence of Association between Zika Virus and Microcephaly. Chin Med J 2016; 129(19): 2347-2356.<\/li>\n
    16. Rather IA, Lone JB, Bajpai VK, et Zika Virus Infection during Pregnancy and Congenital Abnormalities. Front Microbiol 2017; 8: 581.<\/li>\n
    17. Souza BSF, Sampaio GLA, Pereira CS, et Zika virus infection induces mitosis abnormalities and apoptotic cell death of human neural pro- genitor cells. Sci Rep 2016; 6: 39775.<\/li>\n
    18. Liang Q, Luo Z, Zeng J, et Zika Virus NS4A and NS4B Proteins Deregulate Akt-mTOR Signaling in Human Fetal Neural Stem Cells to Inhibit Neurogenesis and Induce Autophagy. Cell Stem Cell 2016; 19(5): 663-671.<\/li>\n
    19. Bl\u00e1zquez AB, Saiz Neurological manifestations of Zika virus infection. World J Virol 2016; 5(4): 135-143.<\/li>\n
    20. Mu\u00f1oz LS, Barreras P, Pardo Zika Virus-Associated Neurological Disease in the Adult: Guillain-Barr\u00e9 Syndrome, Encephalitis and Myelitis. Semin Reprod Med 2016; 34(5): 273-279.<\/li>\n
    21. Tsunoda I, Omura S, Sato F, et Neuropathogenesis of Zika Virus Infection: Potential Roles of Antibody-Mediated Pathology. Acta Med Kinki Univ 2016; 41(2): 37-52.<\/li>\n
    22. Vatti A, Monsalve DM, Pacheco Y, et Original antigenic sin: A comprehensive review. J Autoimmun 2017; 83: 12-21.<\/li>\n
    23. Russo FB, Jungmann P, Beltr\u00e3o-Braga PCB. Zika infecion and the development of neurological Cell Microbiol 2017; 19(6): e12744. https:\/\/www.niaid.nih.gov\/diseases-conditions\/zika-vaccines<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

      *All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.   \u00davod V\u00edrus Zika (ZIKV) je arbov\u00edrus zaraden\u00fd do \u010de\u013eade Flaviviridae a rodu Flavivirus. A\u017e do roku 2015 bol v\u00edrus Zika (ZIKV) pova\u017eovan\u00fd za m\u00e1lo zn\u00e1my tropick\u00fd v\u00edrus. Do povedomia<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[292],"tags":[1010,1012,1005,1011,1009],"class_list":["post-1564","post","type-post","status-publish","format-standard","hentry","category-microbiology","tag-arboviruses","tag-congenital-malformations","tag-flaviviridae-en","tag-transplacental-transmission","tag-zika-virus","typ_clanku-review-article"],"acf":{"abstrakt":"

      Zika virus (ZIKV) is a mosquito-transmitted flavivirus that was first isolated from a sentinel rhesus macaque in the Zika Forest in Uganda in 1947. Over the last decade, ZIKV has emerged from a relatively obscure status to causing large epidemics in countries in the Western Hemisphere. While ZIKV infection symptoms are typically nonspecific and mild, consisting of fever, maculopapular rash, arthralgia and conjunctivitis, there have been reports of more severe reactions associated with neurological complications. Much of the concern surrounding
      \nZIKV has focused on the link between infection in pregnancy and foetal microcephaly and other congenital malformations.<\/p>\n

      Keywords:<\/strong> Zika virus, arboviruses, Flaviviridae, transplacental transmission, congenital malformations<\/p>\n","casopis":[{"ID":1513,"post_author":"7","post_date":"2018-11-05 11:53:53","post_date_gmt":"2018-11-05 10:53:53","post_content":"

        \r\n \t
      • Genetically important aberrations in patients with mye-lodysplastic syndrome and laboratory methods of their detection<\/li>\r\n \t
      • Molecular \u2013 genetic diagnostics of Human Papillomavirus (HPV) and monitoring of HPV patients<\/li>\r\n \t
      • Laboratory diagnostic possibilities for Clostridium difficile infections<\/li>\r\n \t
      • Chorangiosis of Placenta - Disorder of Unclear Etiology (Case Report and Overview of Current Knowledge)<\/li>\r\n \t
      • Circulating tumor DNA and its utilization as marker with prognostic, predictive and diagnostic value in patients with oncological diseases<\/li>\r\n<\/ul>","post_title":"newsLab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-2","to_ping":"","pinged":"","post_modified":"2018-11-05 11:57:18","post_modified_gmt":"2018-11-05 10:57:18","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-2\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"92","upload_clanok":{"ID":1562,"id":1562,"title":"V\u00edrus Zika","filename":"V\u00edrus-Zika.pdf","filesize":313402,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2018\/11\/V\u00edrus-Zika.pdf","link":"https:\/\/www.newslab.sk\/en\/virus-zika-zikv\/virus-zika-2\/","alt":"","author":"7","description":"","caption":"","name":"virus-zika-2","status":"inherit","uploaded_to":1564,"date":"2018-11-11 13:05:21","modified":"2018-11-11 13:05:21","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1564","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1564"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1564\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1564"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1564"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1564"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}