新生儿中枢神经系统单纯疱疹病毒感染的临床横断面研究

目的通过分子生物学方法了解新生儿中枢神经系统单纯疱疹病毒(HSV)感染情况,并对其临床特点进行分析。方法收集考虑中枢神经系统病毒感染新生儿40例的脑脊液(CSF)标本,通过套式PCR检测CSF中HSV-DNA及酶联免疫吸附法检测CSF中特异性HSV-IgM抗体。结果2例患儿检测CSF中HSV-1 DNA( ),其母亲妊娠期均体健,无生殖器疱疹史,无皮损;1例提示为播散性感染,另1例局限为中枢神经系统感染。40例CSF检测HSV-2 DNA均阴性。结论HSV感染占新生儿中枢神经系统病毒感染的5%,不是常见病原;1型可能为新生儿HSV中枢感染的常见类型,可能与我国孕母HSV-2血清感染率较低有关。     

聚合酶链反应结合地高辛标记探针诊断儿童单纯疱疹病毒感染

目的　评价聚合酶链反应 (PCR )结合地高辛分子杂交技术在单纯疱疹病毒 (HSV) DNA检测中的临床意义。方法　应用该方法检测 3 6例HSV感染患儿血白细胞和 3例重症病毒性脑炎患儿脑脊液中HSV DNA。结果　HSV DNA检测阳性率 61.54% (2 4/ 3 9) ,其中HSV Ⅰ型阳性率占 75% (18/ 2 4) ,HSV Ⅱ型占16.66% (4/ 2 4) ,Ⅰ Ⅱ型混合型占 8.3 3 % (2 / 2 4)。结论　HSV病原体的PCR检测结合地高辛分子杂交技术对早期诊断儿童HSV感染及提高HSV感染患儿的疗效具有重要意义     

婴儿癫痫与TORCH 感染的关系

目的 探讨婴儿癫痫与TORCH感染之间的关系.方法 采用ELISA法对40例婴儿癫痫患儿(癫痫组)和30例同龄健康婴儿(健康对照组)进行血清弓形虫(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)和单纯疱疹病毒(HSV-Ⅰ、HSV-Ⅱ)抗体IgM、IgG水平检测.结果 癫痫组TORCH-IgM抗体阳性7例,其中CMV-IgM阳性7例,TOX-IgM、RV-IgM、HSV-Ⅰ-IgM和HSV-Ⅱ-IgM阳性例数均为0,健康对照组TORCH-IgM抗体阳性例数为0,癫痫组CMV-IgM检出阳性率高于健康对照组(P<0.05),其他TORCH系列抗体的检出阳性率与健康对照组比较差异无统计学意义(Pa>0.05).≤6个月癫痫患儿CMV-IgG抗体阳性24例(82.76%),7~12个月的癫痫患儿CMV-IgG抗体阳性5例(45.45%),≤6个月癫痫患儿CMV-IgG抗体阳性率高于7~12个月患儿(P<0.05).≤6个月癫痫患儿CMV-IgM抗体阳性6例(20.69%),7~12个月的癫痫患儿CMV-IgM抗体阳性1例(9.09%),≤6个月和7~12个月癫痫患儿CMV-IgM抗体检出阳性率比较差异无统计学意义(P>0.05).结论 婴儿癫痫与CMV感染有一定关系.     

TORCH特异性抗体检测在儿科临床中的应用

目的 探讨TORCH特异性抗体检测在儿科临床中的应用价值。方法 对178例拟诊为非细菌感染性疾病患儿采用酶免疫斑点技术检测TORCH血清特异性抗体IgG和IgM。结果 187例标本中，检出弓形体特异性IgG3例，IgM 2例；风疹病毒特异性IgG 58例，IgM 24例；巨细胞病毒特异性IgG 149例，IgM 31例；单纯疱疹病毒特异性IgG 119例，IgM 26例。临床确诊为弓形体感染1例，风疹病毒感染24例，巨细胞病毒感染31例，单纯疱疹病毒感染24例。结论 酶免疫斑点技术检测TORCH血清特异性抗体IgG和IgM，具有方法简单、敏感性高、特异性强、可快速获得结果等优点。     

儿童病毒性脑炎脑膜炎98例临床分析

目的　探讨病毒性脑炎脑膜炎早期诊断与临床特点。方法　应用酶联免疫吸附 (ELISA)方法对 98例临床诊断病毒性脑炎脑膜炎患儿急性期及恢复期脑脊液进行了单纯疱疹病毒 Ⅰ、单纯疱疹病毒 Ⅱ、柯萨奇B组病毒、埃可病毒、EB病毒、腺病毒及流感病毒特异性IgM抗体检测。结果　病毒性脑炎脑膜炎病毒感染率为6 3 3% (6 2 / 98) ,柯萨奇B组及埃可病毒感染率分别为 2 9 1% (18/ 6 2 )及 33 9% (2 1/ 6 2 ) ,单纯疱疹病毒感染致残率及病死率较高。结论　脑脊液中病毒特异性IgM抗体检测可作为早期病原诊断的指标之一 ;柯萨奇B组及埃可病毒是兰州地区儿童中枢神经系统病毒感染的主要病毒 ;EB病毒感染已有检出 ,预后不良 ;单纯疱疹病毒感染致残率及病死率较其它病毒高 ,早期应用阿昔洛韦治疗可明显降低病死率。     

婴幼儿单纯疱疹病毒性脑炎临床分析

目的 探讨婴幼儿单纯疱疹病毒性脑炎的早期诊断与治疗。方法 应用间接免疫荧光试验(IIF)检测15例婴幼儿病毒性脑炎患儿血清和脑脊液中单纯疱疹病毒(HSV)IgM抗体。结果 脑脊液检查HSV-IgM抗体阳性者10例诊断为单纯疱疹病毒性脑炎(HSVE),占67%,5例为非单纯疱疹性脑炎(NHSVE),占33%。确诊HSVE后立即予以静脉滴注无环鸟昔(ACV),治愈率达60%。结论 HSVE居婴幼儿病毒性脑炎首位,HSV-IgM抗体检测有助于HSVE的病原学早期诊断。早期抗病毒治疗,可降低死亡率,改善预后。     

小儿中枢神经系统单纯疱疹病毒感染的临床横断面研究

目的了解小儿中枢神经系统单纯疱疹病毒(HSV)感染的患病情况,并对其临床特点进行分析。方法收集2001年6月~2002年6月住院的中枢神经系统病毒感染患儿150例的脑脊液(cerebrospinal fluid,CSF)标本,应用套式PCR检测脑脊液中HSV-DNA及酶联免疫吸附法检测脑脊液中特异性HSV-IgM抗体。结果6例患儿脑脊液中HSV1-DNA( ),另1例HSV1-IgM( ),单纯疱疹病毒占中枢神经系统病毒感染的4.67%;呈散发性起病,无明显季节、年龄、性别分布特点,与其他病毒感染相比,惊厥持续状态、精神症状发生率高(P<0.01),意识障碍、病死率差异无显著性。结论①单纯疱疹病毒感染占儿童中枢神经系统感染的4.67%,不是儿童病毒性脑炎的常见病原,呈散发性起病,无明显季节、性别、年龄分布特点;②儿童中枢神经系统单纯疱疹病毒感染多为HSV1的原发感染,可导致脑炎、脑干脑炎、急性播散性脊髓膜炎;③单纯疱疹病毒脑炎(herpes si mplexvirus encephalitis,HSE)起病较危重,出现精神症状较多,及时有效的抗病毒治疗能明显改善病情,降低病死率。     

妇女孕期TORCH感染对胎儿的影响

为了调查本地区孕妇TORCH感染对胎儿的影响,对58例早产儿、56例小于胎龄儿(SGA)、27例畸形儿的母血及脐血中巨细胞病毒(CMV)、单纯疱疹病毒Ⅰ型、Ⅱ型(HSV-1、HSV-2)、风疹病毒(RubV)的IgM抗体、以及弓形体(TOX)的IgG抗体进行了检测,同时设对照组。结果未显示早产与孕期TORCH感染有关、SGA与CMV感染有关,畸形与CMV、HSV-2及RubV惑染有关。且两种和两种以上同时对胎儿有显著影响。     

武汉地区住院患儿EB病毒感染状况

目的：分析武汉地区住院患儿EB病毒（EBV）感染的情况及临床特点,为明确诊断、合理治疗提供帮助。方法：采用ELISA法检测住院患儿EBV衣壳抗原(VCA)抗体IgM、IgG,并按年龄将患儿分为＜6个月、6个月～、1岁～、3岁～、7～15岁5个组,对结果进行统计分析。结果：14 840例住院患儿EBV抗体阳性7 899例,感染率为53.23%;VCA IgM阳性率为4.05%(601/14 840);VCA IgG阳性率为49.18%(7 298/14 840)。VCA IgM阳性率以＜6月组最低(0.11%);VCA IgG阳性率以7～15岁组最高(79.83%)。601例VCA IgM阳性的患儿中,以呼吸道感染最多（429例,71.4%）。结论：武汉地区住院患儿EBV感染率较高,EBV感染的相关疾病以呼吸道感染为主;不同年龄组患儿间EBV感染率不同。     

南京市0～8岁儿童巨细胞病毒感染流行病学调查

目的 调查儿童巨细胞病毒(CMV)感染率及首次感染的年龄,为了解中国CMV感染现状提供循证医学证据.方法 随机抽取2011年6月至9月在南京市儿童医院体检的837例儿童.男513例,女324例;年龄1d～8岁,平均3.6岁.采用固相ELISA酶联免疫试剂,定性检测体检儿童血清中CMV IgM抗体、定量检测CMV IgG抗体浓度及IgG亲合力指数.结果 837例儿童血清中,CMV IgG阳性690例,阳性率为82.4％.其中男童阳性427例,阳性率83.2％;女童阳性263例,阳性率81.2％,男童与女童CMV IgG阳性率之间差异无统计学意义(x2=0.584,P=0.445).在92例6月龄以内的儿童中,其中86例CMV IgG阳性,阳性率为93.5％;7月龄之后阳性率逐渐下降,在9月龄下降至最低,为66.7％,然后随年龄增长而升至80.0％左右(x2=15.4,P＜0.001).从837例儿童中按年龄段随机抽取352例,同时检测其血清CMV IgM,共23例阳性,总IgM阳性率为6.5％,其中以2～3月龄婴儿阳性率最高,达58.3％,之后逐渐下降,6岁以后未检出CMV IgM阳性病例(x2=5.1,P ＜0.001).进一步检测23例活动性感染标本的IgG抗体亲合力指数,发现13例IgG亲合力指数＜30％,原发感染率为56.5％,其中以＜1岁儿童居多(7例),占总原发感染数的53.8％.结论 目前南京地区儿童CMV感染率大约为80.0％,低于成人,其首次感染多数发生在3月龄前.     

Clinical manifestations of primary herpes simplex virus type 1 infection in a closed community.

The clinical features and the molecular epidemiology of primary herpes simplex virus type 1 (HSV-1) infection among children younger than 3 years of age were investigated in day-care nursery. Serial sera were assayed for anti-HSV-1 glycoprotein B antibody by enzyme-linked immunosorbent assay. Serologic examinations revealed 55 cases of primary HSV infection during the observation period. Fifty-one of them (93%) had typical herpetic gingivostomatitis, showing a high rate of clinically overt infection. Four outbreaks of herpetic gingivostomatitis were observed during the observation period. Forty-one children were infected with HSV-1 in the outbreaks. The rates of infection in the susceptible children were 81%, 73%, 78%, and 100%, respectively, in the four outbreaks. Restriction endonuclease analysis of DNA of isolated HSV revealed that only one strain of HSV-1 had been transmitted among children for a long period.     

快速诊断单纯疱疹病毒脑炎

目的探讨快速诊断单纯疱疹病毒脑炎（ＨＳＥ），比较不同病毒学试验的诊断价值。方法用聚合酶链反应技术检测１７７例急性脑炎患儿的脑脊液（ＣＳＦ）标本中单纯疱疹病毒（ＨＳＶ）特异性ＤＮＡ；用酶联免疫吸附方法检测ＣＳＦ和血清标本中ＨＳＶ特异性ＩｇＭ和ＩｇＧ抗体。结果ＣＳＦ中ＨＳＶ特异性ＤＮＡ、ＩｇＭ和ＩｇＧ抗体阳性率分别为１．７％（３／１７７）、１０％（１／１００）和４７０％（４７／１００），血清ＨＳＶＩｇＭ、ＩｇＧ抗体阳性率分别为１２．５％（６／４８）、７２．９％（５１／７０）（因为标本量不足或缺如，未能对全部病例进行抗体检测）；３例患儿确诊为ＨＳＥ。结论用套式ＰＣＲ检测ＣＳＦ诊断ＨＳＥ较敏感、特异。     

Demographic rather than behavioral risk factors predict herpes simplex virus type 2 infection in sexually active adolescents

BACKGROUND: Despite the high prevalence of herpes simplex virus type 2 (HSV-2) infection in adults and data indicating that many HSV-2 infections are acquired in late adolescence, the demographic and sexual behavior correlates of HSV-2 infection in high risk adolescents have not been extensively studied. METHODS: Using a cross-sectional design we evaluated serologic evidence of HSV-2 infection in 381 adolescents age 14 to 19 years at an urban sexually transmitted disease clinic and a community clinic. Study enrollment was offered to all patients participating in a project offering free hepatitis B vaccine. Participants were interviewed and blood was drawn for HSV Western blot. RESULTS: Twelve percent [95% confidence interval (CI), 8.6 to 15.1] of 379 adolescents in this study had antibodies to HSV-2. Only 22% of HSV-2-seropositive youth reported a history of herpes. Seropositivity for HSV-2 was significantly associated with African-American race (odds ratio, 2.3; 95% CI 1.1 to 4.8) and female gender (odds ratio, 6.0; 95% CI 2.3 to 15.9); 25% of the African-American girls were HSV-2-seropositive. Self-reported condom use, number of sexual partners in the prior 2 months and history of a sexually transmitted disease did not predict HSV-2 antibody status. CONCLUSIONS: HSV-2 infection among adolescents was prevalent, particularly among African-American girls, and correlated with demographic rather than behavioral variables. As in adults most HSV-2 infections were unrecognized. These data suggest that type-specific serologic testing for HSV-2 infection should be considered in sexually active adolescents. Prevention efforts should target children before initiation of sexual activity.     

Genital herpes in adolescents

Herpes simplex virus (HSV) infections occur commonly among adolescents. Most HSV-2 infections are genital, but genital herpes can be caused by either HSV-1 or HSV-2. Weighted means were calculated based on published seroprevalence data on adolescents from the United States and found HSV-1 rates of 53.1 percent for adolescent males and 49.4 percent for adolescent females. The weighted means for HSV-2 was 15 percent for adolescent females and 12 percent for adolescent males. Most individuals who are infected with HSV-2 are unaware of their infection. Healthcare providers of adolescents should consider genital herpes even when an adolescent presents with nonspecific genital symptoms. In this article, we review current recommendations for diagnosis and management and review the psychological sequelae that can be associated with having genital herpes. Finally, we discuss biomedical interventions that are being developed to help reduce the epidemic of HSV and the challenges that these interventions face with regard to implementation.     

Acute retinal necrosis caused by herpes simplex virus type 2 in a 3-year-old Japanese boy

Acute retinal necrosis (ARN), which is characterized by rapidly progressing peripheral retinal necrosis, is caused mainly by herpes simplex virus type 1, herpes simplex virus type 2 (HSV-2), or varicella-zoster virus. A previously healthy 3-year-old Japanese boy developed ARN in his left eye after being bruised by a milk container. HSV-2 DNA was detected in the aqueous humor of the affected eye. Serological testing suggested that the route of infection was from mother to child, although there was no past history of apparent HSV-2 infection. Childhood ARN has not been previously reported in Japan, possibly because of the low seroprevalence of HSV-2 in Japanese women. Pediatricians must be aware of this rare disease, which can affect individuals without a previous history of HSV even in a country with a low seroprevalence of HSV-2.     

Hepatitis A,B and C seroprevalence in Pakistan

A cross sectional study was conducted to determine the seroprevalence of Hepatitis A, B, and C virus in healthy Pakistani children. HAV IgG antibody was assayed in 258 subjects and it was found that 94% children by 5 years of age had HAV IgG-antibody. The overall seroprevalence of HAV IgG antibody was 55.8% and IgM 5.3%. HBVsAb levels assayed in 236 healthy children showed a seroprevalence of 2.97%. Similarly, HCV antibody seroprevalence was found to be a low 0.44% in healthy children. HAV is a major cause of Hepatitis, as compared to HBV and HCV which are of low endemicity.     

Sero-epidemiology of hepatitis E virus (HEV) in urban and rural children of North India

OBJECTIVE: To estimate the prevalence of anti-HEV IgG and IgM antibodies to ORF3 peptide of Hepatitis E virus genome in an age stratified urban and rural population of children. DESIGN: Cross sectional survey. SETTING: Pediatric out-patient clinics in a tertiary hospital and a rural dispensary. METHODS: Study subjects between 6 months and 10 years with minor, non-hepatic illnesses were recruited for the study from March to December 1996. Baseline demographic details, drinking water source, sewage disposal methods, reasons for attending the hospital, histories of parenteral exposure in the past 12 months and acute hepatitis in the subjects and the family in the previous six months were obtained. Serum anti-HEV IgG antibodies were screened in all subjects, and in those who were positive, anti-HEV IgM antibodies were assayed as an indicator of recent infection. Serum aminotransferase (ALT) was estimated in those who were anti-HEV IgM antibody positive. RESULT: Out of 2160 subjects recruited, 2070 samples could be screened for anti-HEV IgG antibodies. In the urban population (n = 1065) anti-HEV IgG antibodies were detected in 306 subjects (28.7%; 95% CI 26.0-31.6) and of these 131 (42.8%; 95%CI 37.2-48.6) were anti-HEV IgM antibody positive. Amongst 1005 rural children, anti-HEV IgG antibodies were present in 239 (23.8%; 95% CI 21.1-26.4) and IgM antibodies in 113 (47.3%; 95% CI 40.9-53.7) children. The antibodies were present since the first year of age till 10 years of age and, increased with advancing age. Serum transaminases were raised in 7.5% (9/120) and 5.5% (5/88) of subjects with anti-HEV IgM antibodies in urban and rural centers respectively. Overall the seroprevalence of IgG antibodies against HEV were significantly more in urban as compared to that in rural subjects (p = 0.011). However, proportion of children with anti-HEV IgG carrying IgM antibodies was similar in the two study groups (p = 0.298). A model for estimating expected prevalence of anti-HEV IgG antibodies was developed. The observed antibody prevalence in both urban and rural subjects at each age interval after 48 months was less as compared to the expected levels and this gap increased with advancing age categories. It appeared that there was a decay of HEV antibodies with time. CONCLUSIONS: Children are susceptible to HEV infection since early infancy. The probability of exposure to HEV during childhood was higher in urban than rural population. Seropositivity to HEV antibodies increased by over 2 times beyond 4 years of age as compared to younger age. Anti-HEV IgG antibodies appear to wean off with increasing age.     

Prevalence of herpes simplex virus types 1 and 2 among children and adolescents attending a sexual abuse clinic

BACKGROUND: Children and adolescents with a history of sexual abuse are at risk for acquiring herpes simplex virus (HSV) type 2. We evaluated the prevalence of HSV-1 and HSV-2 and the usefulness for this population of 2 commercially available tests. METHODS: Sera from 150 children seen in a sexual abuse clinic were analyzed for type-specific HSV antibodies using Focus HerpeSelect HSV-2 ELISA (Focus), Biokit HSV-2 Rapid Test (Biokit), and by Western blot (WB). RESULTS: The patient sample was 81% female, had a mean age of 11.6 years (range, 1 to 18 years), and was 46% Caucasian, 28% Hispanic, 25% African American, and 2% other. According to WB, 77 (51%) of the children were HSV-1 seropositive. For HSV-2, there was 1 "true positive" (positive by all 3 tests) and 1 patient whose serum had atypical HSV-2 bands by WB but was positive by Focus. There were 6 sera that were positive by Focus and negative by WB. Index values of these 6 Focus tests were not predictive of WB status. For the 105 samples for which Biokit data were available, all samples were concordant with WB. CONCLUSIONS: The findings of this study suggest that routine screening for HSV-2 in sexually abused children does not have a high yield. The Focus test has an unacceptably high rate of false-positive results in children; however, Biokit may be an acceptable substitute for WB in evaluating children for HSV-2 antibodies.