נזקי נגיף הזיקה בהריון – דיווח ראשוני

נגיף הזיקה (ZIKA) זוהה לראשונה בברזיל ב-2015 בבדיקת נסיוב של נשים שחלו במחלה וירלית הדומה בתסמיניה לקדחת הנקראת קדחת הדנגי (Dengue Fever) . בהמשך, בשל ריבוי מקרים חריג, הועלה חשד כי זיהום בנגיף בהריון גורם לפגיעות עובריות ומומים מולדים. רשויות הבריאות של ברזיל וקבוצות מחקר עצמאיות החלו לעקוב אחר נשים הרות שנדבקו בנגיף ואחר ילדיהן. תוצאות ראשוניות של אחד המחקרים פורסמו לאחרונה בכתב העת NEJM.

במעקב בין ספטמבר 2015 לפברואר 2016 נעקבו 88 נשים בהריון (בין שבוע 5  ל 38 של ההריון) שסבלו מפריחה בעור וסימנים של מחלה וירלית. כל הנשים עברו בדיקות  דם ושתן לאיתור הנגיף ומהן 72 נשים (82%) נמצאו נשאיות. הסימנים הבולטים אצל נשים אלה כללו פריחה בעור, כאבי פרקים, אודם בלחמיות העיניים  וכאבי ראש. 28 מהחולות סבלו מעליית חום קלה וקצרת מועד. נשים שנמצאו חיוביות לנגיף סבלו מפריחה יותר מנשים שהיו שליליות לנגיף (44% לעומת 12%), גם מעורבות הלחמיות הייתה שכיחה יותר בנשים שחלו בזיקה (58% לעומת 13%) וכך גם הגדלת קשריות הלימפה (40% לעומת 7%). בדיקת אולטרסאונד עוברי בוצעה בקרב-42 נשים חיוביות לזיקה ובכל החולות שהיו שליליות לנגיף. ממצא חריג כלשהו אובחן אצל 12 מ-42 העוברים של הנשים החיוביות לנגיף (29%) , מנגד סקירות האולטרסאונד של עוברי 16 הנשים השליליות לנגיף נמצאו תקינות לחלוטין. בקרב הנשים עם זיהום בזיקה נרשמו שני מקרי מוות עוברי בשבועות 36-38 להריון, 5 עוברים סבלו מעיכוב גדילה תוך רחמי, עם או ללא, היקף ראש קטן. אצל שבעה עוברים אובחנו הסתיידויות או נגעים אחרים במח. נפח לא תקין של מי שפיר או זרימה לא תקינה בכלי דם המוחיים או הטבוריים זוהתה אצל 7 עוברים של נשים שנדבקו בנגיף. ב 8 מ-42 הנשים שעברו בדיקת אולטרסאונד וילדו הממצאים בהריון אושרו לאחר הלידה.

לסיכום, נגיף הזיקה הגורם למחלה קלה למדי בקרב נשים הרות מתגלה כזיהום הרה אסון לילודים. מוות עוברי, מיעוט מי שפיר, עיכוב בגדילה עוברית, היקף ראש קטן, פגיעות מוחיות, הם רק חלק מהפגמים שכבר נקשרו לנגיף, זאת כאשר מרבית המחקרים עדיין בעיצומם ותוצאות ארוכות הטווח של הזיהום בוירוס אינן ידועות בשלב זה.

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