重症手足口病免疫球蛋白治疗的机理探讨

手足口病是由多种肠道病毒感染导致的一种急性儿科传染病.近年来,我国肠道病毒71型(EV71)手足口病发病率急剧上升,重症病例时有报道,严重威胁儿童健康.临床上对于重症手足口病的治疗缺乏有效手段,主要以对症治疗和支持疗法为主.静脉注射人免疫球蛋白由健康献血员血浆提取纯化而来,含有包括EV71在内的多种肠道病毒的中扣抗体,可作为重症手足口病被动免疫和免疫调节的重要手段,值得关注.     

肠道病毒EV71病原学以及致病分子机制的研究进展

手足口病是由某些不同血清型的肠道病毒引起的一种急性传染病,其中以柯萨奇病毒A16型和肠道病毒EV71型最为常见.其可经多种途径传播,全球各地普遍存在,尤以学龄前特别是5岁及以下年龄儿童发病率最高.由于EV71能引起严重的中枢神经系统并发症,本文就以典型的肠道病毒类型EV71的病原学以及其致病的分子机制作一综述,为手足口病的预防与治疗提供依据.     

濮阳市2008—2012年手足口病流行病学特征分析

目的了解濮阳市手足口病流行病学特征,为制定防控策略提供科学依据。方法通过国家疾病监测信息管理系统收集的全市2008—2012年6月6日手足口病疫情资料进行描述和分析,并对部分病例和重症病例标本进行肠道病毒病原学检测。结果全市共报手足口病16 492例,发病高峰是每年的3-5月(第12～20周),呈典型的单峰型曲线;发病年龄以0～4岁居多;男性多于女性;散居儿童多于托幼机构儿童,爆发病例多发生在托幼机构,手足口病病原有EV71、CoxA16和其他肠道病毒,以EV71和CoxA16为主。结论手足口病发病有明显的季节性、年龄和性别差异,小年龄组儿童是手足口病预防控制重点人群,流行年度和流行季节的优势毒株为EV71,重症患者中EV71占到86.35%;非流行年和季节手足病例主要由CoxA16和其他肠道病毒引起。手足口病防控重点应体现在对病例分类管理上,同时应继续加强重症病例疫情监测和爆发控制。     

炎琥宁联合痰热清治疗86例手足口病疗效观察及护理

近年来,手足口病的发病率有增多及严重的趋势,引起手足口病的肠道病毒包括肠道病毒71型（EV71）和A组柯萨奇病毒（CoxA）、埃可病毒（Echo）的某些血清型。EV71感染引起重症病例的比例较大,肠道病毒传染性强,可在短期内流行,我国小范围区域曾流行发病。临床上多采用病毒唑为主及加强对症治疗,为了寻找更有效的治疗方法,我科于2008年4～10月采用炎琥宁联合痰热清治疗手足口病86例,效果满意,现报告如下。     

百色市2014年手足口病流行病学特征分析

目的分析百色市2014年手足口病流行特征,探讨该病的预防控制策略。方法采用描述流行病学方法对百色市2014年手足口病发病特征进行流行病学分析。结果 2014年百色市共报告手足口病44 520例,年发病率为1 258.05/10万,死亡17例,病死率为0.04%。病例报告有明显的季节性,4-6月为发病高峰;以0~5岁年龄组为主,占95.39%;男性发病率高于女性,男女发病比为1.44∶1;职业分布以散居儿童居多;病原学监测结果为EV71、Cox A16和其他肠道病毒混合感染;79.04%的重症病例(含死亡病例)由EV71感染所致。结论百色市手足口病流行情况严重,EV71仍是引起手足口病重症病例和死亡的主要病原体,今后仍需要采取综合性防治措施,开展健康教育,加强重症病人的筛查和救治,降低病死率。     

手足口病防控策略探讨

肠道病毒71型(enterovirus 71,EV71)全病毒灭活疫苗的研发成功,对严重影响婴幼儿健康的手足口病(hand,foot and mouth disease,HFMD)的流行提供了防控手段。在婴幼儿目标人群中大量推广疫苗接种,有望降低HFMD的重症和死亡病例的发生率,具有重大的公共卫生意义。本文旨在分析中国EV71疫苗上市后所产生的结果和影响、HFMD的防控形势及疫苗应用策略等,从而对有关HFMD流行的防控策略进行探讨。     

肠道病毒71型感染动物模型的应用与局限

肠道病毒71型(enterovirus 71,EV71)是一种被忽视的热带传染病——手足口病的主要病原体之一,过去15年在亚太地区引起了多次手足口病暴发。由于脊髓灰质炎病毒的有效控制,EV71已成为最重要的嗜神经肠道病毒,其严重的神经系统并发症威胁着儿童健康。合适的动物模型可帮助更好地了解EV71神经致病机制,并有利于开发有效的疫苗和治疗药物。本文就EV71已建立的3类主要动物模型(非人灵长类动物模型、小鼠适应性模型及转基因小鼠模型)的特征、应用与局限进行综述。     

肠道病毒71型与天然免疫系统相互作用的研究进展

肠道病毒71型(enterovirus 71,EV71)为小RNA病毒科肠道病毒属成员,是引起手足口病的主要病原体之一。EV71流行广泛,其感染可引发中枢神经系统疾病,并造成重症手足口病,给公共卫生安全带来极大挑战。EV71的致病机制与病毒和宿主天然免疫系统的相互作用关系密切,涉及病毒逃逸干扰素反应、病毒抑制核因子κB(nuclear factorκB,NF-κB)信号通路及病毒与天然免疫细胞相互作用等多个环节。本文就近年来EV71与宿主天然免疫系统相互作用的研究进展进行综述。     

2007年北京地区儿童手足口病病原的初步筛查

2007年4～6月儿童手足口病流行期间,对北京地区51例皮损症状典型、伴/不伴发热、无重症合并症的手足口病患儿采样,建立RT-PCR方法,以5'非编码区(5'UTR)肠道病毒通用引物、CA16和EV71 VP1区特异性引物直接对82份临床标本进行了初步筛查,肠道病毒阳性率达70.6%。检测病例中CA16阳性25例(25/51)、EV71阳性4例(4/51)、非CA16和EV71的肠道病毒阳性病例7例(7/51),三者比例约为6:1:2。2007年北京地区儿童轻症手足口病主要病原包括CA16和EV71,同时还存在一定比例其它肠道病毒。部分EV71毒株经测序验证及系统进化分析显示为C4基因亚型。     

Brucella abortus in coyotes. I. A serologic and bacteriologic survey in eastern Texas.

Prevalence of Brucella abortus serum antibodies in coyotes from east central Texas was determined by the buffered Brucella antigen (card test), rivanol, standard agglutination tube, and cold complement fixation tube tests. Eighteen percent (9 of 51) of the coyotes were positive serologically. B. abortus biotype 1 was isolated from various tissues from 7 of 43 coyotes by bacteriologic culture. Congenital transmission was found.     

Serologic evaluation of New Zealand sea lions for exposure to Brucella and Leptospira spp

A serologic survey of anti-Brucella and antileptospiral antibodies was conducted on 147 adult, female New Zealand sea lions (Phocarctos hookeri). Most sea lions (n=138) were sampled at Sandy Bay, Enderby Island, Auckland Islands (50°30'S, 166°17'E), January 2000-March 2005. Nine were sampled at Otago, New Zealand (46°0'S, 170°40'E); four in April 2008 and five in March 2009. Serum from one of the Enderby Island females was weakly positive for antibodies to Brucella abortus using the competitive enzyme-linked immunosorbent assay, and one female had a low titer for Leptospira interrogans serovar pomona using the microscope agglutination test. All serum samples from Otago animals were negative. Brucellosis and leptospirosis are therefore considered unlikely to play a major role in population dynamics of these populations, and the low antibody prevalence of these agents suggests that they are an unlikely source of infection for humans, wildlife, or domestic species on mainland New Zealand.     

A micromethod for agglutination and antiglobulin tests for antibody to Brucella abortus

A micromethod has been developed for the standard agglutination and antihuman globulin tests for serum antibodies to Brucella abortus. The test uses a haematoxylin-stained antigen. The test is simple and quick to perform and, in a comparison at two centres involving 367 sera, the micromethod was found to be more sensitive than the classical test. It is highly suitable both for routine serological screening and for large-scale surveys of occupationally exposed industrial groups.     

In vitro markers and biological activity in mice of seed lot strains and commercial Brucella melitensis Rev 1 and Brucella abortus B19 vaccines.

Four seed lots and fourteen batches of Brucella melitensis Rev 1 and B. abortus B19 living anti-Brucella commercial vaccines obtained from six Spanish laboratories were tested in vitro and in vivo in the reference mouse model for quality control. All the strains tested showed the characteristic morphology of their respective Rev 1 or B19 reference strains with the exception of three Rev 1 strains: seed lot SL2 and commercial vaccine R3, in which giant colonies were predominant, and commercial vaccine R5, in which 5% rough colonies were detected. Strains SL2 and R5 (but not the R3) had a deficient activity when tested in the mouse model. All strains but two (Rev 1 strain R1 and B19 strain B2) had standard resistance/ sensitivity patterns to streptomycin and penicillin G. Strains R1 and B2 had an increased resistance to penicillin when incubated in a 10% CO2 atmosphere and both strains showed an increased residual virulence in mice. As residual virulence and immunogenicity in mice were not always correlated one another nor with the in vitro tests, all tests should be performed to control properly the anti-Brucella live vaccines. A computerized statistical procedure to calculate the residual virulence of vaccines is proposed as an alternative to that used in the current method.     

Validation of the fluorescence polarization assay and comparison to other serological assays for the detection of serum antibodies to Brucella abortus in bison

A number of serological tests were compared for the detection of antibodies to Brucella abortus in bison (Bison bison). The performance of the fluorescence polarization assay (FPA) in both the preliminary evaluation and a subsequent blind validation indicated that this test was the most suitable for serological diagnosis of brucellosis in bison. The sensitivity and specificity in the preliminary evaluation were 92.1% and 99.4%, respectively. The sensitivity and specificity in a subsequent blind study were 96.3% and 97.6%, respectively. In a double blind study conducted on bison vaccinated with B. abortus strain 19, the data suggests that the FPA can differentiate bison infected with B. abortus from bison vaccinated with B. abortus strain 19. Both the indirect immunoassay (IELISA) and the competitive immunoassay (CELISA) performed nearly as well as the FPA. The buffered antigen plate agglutination test (BPAT) and the complement fixation test (CFT) did not perform as well as the FPA, CELISA or the IELISA in both studies. The FPA is a homogeneous assay eliminating the washing steps and reducing incubation to minutes rather than hours saving on time, equipment, materials, reagents and cost. These attributes, together, with its excellent sensitivity and specificity make the FPA an attractive test for the detection of serum antibodies to Brucella abortus in bison.     

Counter-immunoelectrophoresis for the detection of Brucella antigen and antibodies in the diagnosis of brucellosis in buffaloes

Counter-immunoelectrophoresis was employed for the detection of Brucella antigen in stomach contents of aborted buffalo fetuses and antibody in aborted as well as apparently healthy in contact buffaloes. Five of 16 aborted cases were serologically positive for brucellosis but isolation of Brucella abortus was successful in only two cases. By counter-immunoelectrophoresis, Brucella antigen was detected in the fetal stomach contents of four serologically positive cases.
Of the 68 serum samples from in contact healthy buffaloes, 10 were positive with counter-immunoelectrophoresis: more than were detected by tube agglutination, Rose Bengal plate agglutination, complement fixation and agar gel precipitation test.     

Counter-immunoelectrophoresis for the detection of Brucella antigen and antibodies in the diagnosis of brucellosis in buffaloes

Counter-immunoelectrophoresis was employed for the detection of Brucella antigen in stomach contents of aborted buffalo fetuses and antibody in aborted as well as apparently healthy in contact buffaloes. Five of 16 aborted cases were serologically positive for brucellosis but isolation of Brucella abortus was successful in only two cases. By counter-immunoelectrophoresis, Brucella antigen was detected in the fetal stomach contents of four serologically positive cases. Of the 68 serum samples from in contact healthy buffaloes, 10 were positive with counter-immunoelectrophoresis: more than were detected by tube agglutination, Rose Bengal plate agglutination, complement fixation and agar gel precipitation test.     

Seroprevalence of Neospora caninum and Brucella abortus in dairy cattle herds with high abortion rates

The protozoan Neospora caninum and the bacterium Brucella abortus are well-recognized causes of abortion in dairy cattle. Serum samples (n = 240) from aborting (n = 141) and at-risk (n = 99) animals from 5 herds with high abortion rates in Punjab Province, Pakistan, were tested for antibodies to N. caninum using monoclonal antibody-based ELISA and for antibodies to B. abortus using the serum agglutination test. Antibodies to N. caninum and B. abortus were detected in 105 (43.8%) and 135 (56.3%) cattle, respectively. Prevalences of antibodies to N. caninum and B. abortus were higher in aborting cows (46.8% and 76.6%, P < 0.05) than in animals at risk (39.4% and 27.3%, P > 0.05). Sixty-six animals (27.5%) were seropositive to both N. caninum and B. abortus , and results showed no significant difference (P > 0.05) with respect to geographical district, breed, and age. This is the first report of N. caninum infection among dairy cattle herds in Pakistan.     

Serosurvey for antibodies against Brucella abortus and Leptospira interrogans in pampas deer from Brazil

A survey for antibodies against Brucella abortus, and Leptospira interrogans was conducted on 17 pampas deer (Ozotocerus bezoarticus) from Pantanal Matogrossense (State of Mato Grosso do Sul, Brazil) and on 24 pampas deer from Parque Nacional de Emas (State of Goiás, Brazil). Antibodies against B. abortus were detected by plate agglutination, rose Bengal, and complement fixation tests; antibodies against Leptospira interrogans were detected by the microscopic agglutination test. All sera were negative for B. abortus antibodies and all deer sera from Parque Nacional de Emas were negative for L. interrogans antibodies. Four (24%) of 17 sera from Pantanal Matogrossense were positive for L. interrogans serovar (n = 2) hardjo, wolffi (n = 1) and mini (n = 1). While these diseases do not appear to be of major importance to the health status of Pampas deer, it appears that deer are reservoir for leptospirosis in one of the study areas.     

Experimental infection of captive axis deer with Brucella abortus

Four captive-raised axis deer, Axis axis (Erxleben), which were negative serologically to Brucella were inoculated with 1 X 10(8) virulent Brucella abortus biotype 1 organisms (Texas #221 isolate) administered bilaterally into the conjunctival sac. Sera collected from each deer prior to inoculation and 30 days post-inoculation (PI) were examined for Brucella antibodies by the buffered Brucella antigen (card), the rivanol precipitation, the standard tube agglutination, and the cold complement fixation tube serologic tests. All four axis deer converted serologically as determined by all tests at 30 days PI. Brucella abortus biotype 1 was isolated from 26 of 32 tissue samples collected at necropsy and also from milk from the lactating female.