2006年山西省运城市成人流行性乙型脑炎临床特征与实验室检验

目的 研究2006年山西省运城市成人流行性乙型脑炎的临床及实验室检验特点,为我国乙脑预防控制提供基础资料.方法对2006年运城市第二人民医院收治的45例乙脑病例进行临床资料分析,对部分中老年患者血清和脑脊液标本进行血清学和分子生物学检测.结果收治入院的45例患者以中老年人为主,其中40岁以上病例占病例总数77.8%(35/45),重型和极重型占病例总数60.0%(27/45),大多数患者合并基础性疾病.研究结果显示,血清乙脑病毒IgM抗体检测为阳性,急性期和恢复期双份血清中和抗体存在4倍以上增高;部分患者脑脊液乙脑病毒核酸检测阳性.结论经实验室特异性检测确认山西省运城市2006年病毒性脑炎为乙型脑炎,病例呈现大年龄组发病特点.     

武汉地区128例乙型脑炎患者特异性IgM抗体的检测及临床分析

本文应用IgM抗体捕获酶联免疫吸附试验(MAC ELISA)对武汉地区1986～1987年128例临床诊断符合流行性乙型脑炎(简称乙脑)患者的血清及脑脊液进行JEV IgM检测,并对检测结果及阳性、阴性病例的临床特点进行了分析、讨论,现报告如下。     

我国部分地区病毒性脑炎标本的实验室检测

目的 初步了解我国病毒性脑炎的病原种类及其分布特征.方法用ELISA方法对2004年至2006年从我国6个省份收集的771例临床诊断为病毒性脑炎患者的急性期血清和脑脊液标本检测乙脑病毒IgM抗体,然后对乙脑IgM抗体阴性的所有血清标本检测其他7种常见病毒IgM抗体.此外,用PCR方法对54例脑脊液标本检测肠道病毒、版纳病毒和辽宁病毒的基因.结果经血清学检测,771例患者中的567例(73.5%)检测出病毒特异性IgM抗体,构成顺序为乙脑病毒(47.0%)、腮腺炎病毒(10.6%)、肠道病毒(8.8%)、单纯疱疹病毒(5.7%)、麻疹病毒(0.4%)、水痘-带状疱疹病毒(0.4%)、EB病毒(0.4%)、巨细胞病毒(0.3%);经分子生物学检测,在54例脑脊液中检测到8例(14.8%)肠道病毒基因阳性标本,未检测到版纳病毒与辽宁病毒基因阳性标本.结论乙脑病毒是我国病毒性脑炎的首要病原,腮腺炎病毒次之,肠道病毒和单纯疱疹病毒也是重要的病原.     

788例疑似中枢神经系统感染病例相关病毒IgM抗体检出率的统计分析

目的 统计分析2013年8月至2015年2月天坛医院神经内科门诊及住院患者中疑似中枢神经系统病毒感染病例的血清及脑脊液(cerebrospinal fluid,CSF)标本的病毒IgM抗体检出情况.方法 采用描述性流行病学方法对上述脑脊液及血清标本中的病毒IgM抗体检出率差异进行统计分析.结果 ①血液标本中,病毒抗体检出率由高到低依次为EB病毒(Epstein-Barr virus,EBV)抗体、单纯疱疹病毒(herpes simplex virus,HSV)抗体和风疹病毒(rubella virus,RUB)抗体,检出率分别为6.0％、5.2％和2.2％,余下病毒抗体检出率约为1％.而脑脊液中检出率最高的为HSV抗体,为4.7％,占所有检出抗体的92.5％.②病毒抗体在血清中检出率高于在其对应的脑脊液中.统计表明:单纯疱疹病毒抗体在血清中检出例数高于其在对应的脑脊液样本,差异具有统计学意义(P＜0.01).同样,相比脑脊液标本,在血清中EB病毒和柯萨奇病毒IgM抗体检出率也较高,其P值分别为P＜0.01和0.039.③病毒抗体检出以春、秋、冬三季多见,夏季检出率相对较低.④不同年龄段的患者病毒抗体检出率无差别.结论 单纯疱疹病毒仍是我院疑似中枢神经系统病毒感染病例的主要病原体,该病毒IgM抗体在患者血液和脑脊液中均具有较高的检出率.该病毒在血液标本中的检出率仅次于EB病毒.以上两种病毒是引起中枢神经系统感染的主要病毒,临床诊断中需引起足够的重视.     

梅州市2003—2007年流行性乙型脑炎流行病学分析

目的分析梅州市乙脑流行特征,为乙脑预防控制工作提供科学依据。方法采用描述性流行病学调查、ELISA检测方法对梅州市2003—2007年乙脑病例进行检测和分析。结果2003—2007年梅州市五华等6县（市、区）共发生乙脑流行病例93例。流行高峰为6月份。年龄最小8个月,最大13岁,以6—10岁为多见。发病地区以五华县（64例）为主,占68．82％。临床表现以高热、嗜睡、昏迷、抽搐和锥体受损为主,易诊断为“病毒脑”。乙脑特异性抗体IgM检出率为48．33％。结论梅州市乙脑流行高峰为6月份,流行季节、流行地区发生“病毒脑”时应作乙脑IgM抗体检测鉴别。对≤10周岁的儿童应急接种乙脑灭活疫苗是控制乙脑流行的有效措施,10-15d可达到效果。     

α-2b干扰素治疗流行性乙型脑炎35例疗效观察

流行性乙型脑炎的病死率和致残率较高 ,目前尚缺乏特异性治疗。 1994年7月～ 1997年 9月 ,华北石油总医院使用α 2ｂ干扰素治疗 35例患者取得一定疗效。我们将同期住院的乙脑患者 6 5例随机分为两组 ,治疗组 35例 ,其中男2 0例 ,女 15例 ,年龄 3～ 5 6岁 ,入院病程 1～ 5ｄ(平均 3 5ｄ)。对照组 30例 ,其中男 18例 ,女 12例。在年龄、病情、病程等方面治疗组与对照组差异不明显。本组诊断标准按王季午主编的《传染病学》为依据 ,全部病例均做了脑脊液检查 ,符合病毒性脑炎改变 ,并测定了血清或脑脊液乙脑特异性抗体ＩｇＭ均为阳性。治疗方法…     

吉兰-巴雷综合征患者神经系统感染病原体抗体检测情况分析

目的 了解吉兰-巴雷综合征(Guillain-Barré syndrome,GBS)患者血清中神经系统感染病原体抗体的检测情况,探讨病原体感染与GBS发生的关系.方法 选取93例GBS患者为研究对象,以同期99例中枢神经系统其他疾病患者作为对照组,分别测定血清中巨细胞病毒(cytomegalovirus,CMV)、EB病毒(Epstein Barr virus,EBV)、单纯疱疹病毒(herpes simplex virus,HSV)-1、HSV-2、风疹病毒(rubella virus,RV)、弓形虫(toxoplasma gondii,TOX)及柯萨奇病毒(coxsackievirus,COX)等7种病原体的14种IgG及IgM抗体,并进行脑脊液常规及生化检测.结果 93例GBS患者脑脊液检查表现为典型的蛋白-细胞分离现象,而糖及氯化物含量与对照组差异无统计学意义.两组患者血清中CMV IgG检出率最高,各病原体IgM抗体检出较少,未检测到RV IgM、TOX IgM、EBVCA-IgM及COX IgM等抗体.与对照组相比,93例GBS患者血清中HSV-2 IgG、TOX IgG检出率明显增高,差异有统计学意义(P＜0.05),其他病原体抗体在两组间的检出率差异无统计学意义(P＞0.05).对两组患者同时检出多种病原体抗体情况进行分析,GBS组同时检出6种病原体相应IgG或IgM抗体的检出率明显高于对照组,差异有统计学意义(P＜0.05).结论 HSV-2和TOX感染可能与GBS发病有关联,但仍需进一步研究证实.     

抗磷脂综合征患者脑脊液单纯疱疹1型病毒和巨细胞病毒抗体阳性病例分析

目的:报道4例与抗磷脂综合征(APS)患者脑脊液有关病毒抗体的阳性结果。方法:检测4例确诊APS患者脑脊液中单纯疱疹1型病毒(HSV-1)和巨细胞病毒(CMV)抗体,结合临床及影像学资料,分析其与APS发病的关系。结果:4例患者脑脊液HSV-1-IgG、CMV-IgG均为阳性,HSV-1-IgM、CMV-IgM均为阴性;例1、例2血清HSV-1-IgG、CMV-IgG阳性,例3、例4阴性;例1、2、3抗心磷脂抗体(aCL)血清水平12RU/ml;例4检出抗β2糖蛋白1(β2GP1)抗体。结论:初步提示HSV-1和CMV感染与APS可能存在相关性。     

流行性乙型脑炎血清和脑脊液特异性IgM,IgG的检测

对４１例小儿流行性乙型脑炎（乙脑）急性期血清和脑脊液抗乙脑病毒（ＪＥＶ）ＩｇＭ和ＩｇＧ的检测结果进行分析。抗ＪＥＶ－ＩｇＭ检出率，血清（７８．９５％）明显高于在脑脊液（６４．３８％），Ｘ２＝３．９０３２，ｐ＜０．０５，抗ＪＥＶ－ＩｇＭ最早检出时间为第３病日血清和第４病日脑脊液。在不同病日，不同年龄组和病情轻、中、重各组之间，抗ＪＥＶ－ＩｇＭ检出率无明显差异。获取患者双份血清（３５例）和双份脑脊液（３２例），抗ＪＥＶ－ＩｇＧ滴度分别有７７．１４％和４６．８８％明显增长。     

β-七叶皂甙钠改善流行性乙型脑炎脑水肿及脑功能的临床观察

流行性乙型脑炎 (简称乙脑 )是一种中枢神经系统急性传染病 ,病死率及致残率均较高 ,多发于儿童。近年来成人发病呈上升趋势 ,至今仍无特效疗法。 5年来我院应用 β 七皂甙钠治疗乙脑病人5 0例 ,发现该药对减轻乙脑病人脑水肿、改善脑功能 ,促进病人康复有良好效果。1　材料与方法1 1　临床资料　所有病人来自我院1992年 7月～ 1997年 9月收治的病例 ,共 10 0例 ,其中男 6 3例 ,女 37例 ,年龄1 5～ 2 6岁 ,平均 6 6岁。诊断与分型按彭文伟主编《传染病学》1989版。入院前均做血 ,脑脊液常规检查 ,入院后均做乙脑特异性ＩｇＭ抗体检查 ,阳性…     

Clinical characteristics and laboratory assay of adult Japanese encephalitis patients in an outbreak in Yuncheng, Shanxi Province, 2006]

OBJECTIVE: To study the clinical and laboratory characteristics of adult Japanese encephalitis (JE) patients in a JE outbreak in Yuncheng, Shanxi Province in 2006. METHOD: All the clinical data from the Second People's Hospital in Yuncheng city were analyzed, part of patients' sera and cerebrospinal fluid were tested by serology and RT-PCR. RESULTS: The majority of patients were middle-aged and elderly, 77.8% (35/45) of the total cases were more than 40 years old. Severe and fulminating type cases accounted for 60.0% (27/45). Most patients had underlying diseases. IgM antibody to JE virus (JEV) in serum was positive in each of the 45 patients analyzed and 4-fold or greater rise in sera neutralization antibody titer were found in convalescent serum. JEV nucleic acid was positive in part of cerebrospinal fluid specimens. CONCLUSION: Viral encephalitis emerged in Yuncheng city, Shanxi Province was Japanese encephalitis B, and most of the cases belonged to elderly group.     

Cross-reactive IgM responses in patients with dengue or Japanese encephalitis.

BACKGROUND: Dengue and Japanese encephalitis viruses co-circulate in Thailand. IgM-capture enzyme-linked immunosorbent assay (ELISA) has been widely used for confirmation of dengue and Japanese encephalitis (JE). OBJECTIVES: To examine the cross-reactivity in IgM responses to dengue and JE viruses in serum and CSF samples from dengue and JE patients. STUDY DESIGN: Two hundred and fifty-eight serum samples from 177 confirmed dengue patients, and 99 serum samples and 37 cerebrospinal fluid (CSF) samples from confirmed JE patients were analyzed. RESULTS: Nine percent of serum samples from dengue patients were positive for anti-JE IgM. Thirteen percent of serum samples and 11% of CSF samples from JE patients were positive for anti-dengue IgM. Levels of cross-reactive IgM were lower than those of specific IgM in all the dengue and JE patients. CONCLUSIONS: Only specific IgM is detected in about 90% of dengue and JE patients, but cross-reactive IgM is also detected in the remainder. The presence of cross-reactive IgM responses should to be considered in the serodiagnosis of dengue and JE, especially in areas where dengue and JE viruses co-circulate.     

泉州市1963-2009年流行性乙型脑炎流行病学特征分析

目的分析泉州市1963-2009年流行性乙型脑炎（乙脑）流行病学特征,为有效控制乙脑提供科学依据。方法对乙脑发病资料进行描述流行病学分析。结果泉州市1963-2009年乙脑发病率呈下降趋势;自2005年起山区县发病率高于沿海县;1990-2009年发病高峰季节前移1个月;2005-2009年10岁以下儿童所占比例比往年下降50%;调查的乙脑病例中无免疫史的占50%。结论泉州市乙脑发病率从60年代的34.93/10万下降至目前的0.08/10万,表明乙脑预防控制取得了显著成效,但仍需继续提高乙脑疫苗的接种率,开展乙脑病例监测,在流动人口聚集地、边远山区、免疫规划薄弱的乡镇进行重点控制是有效预防乙脑的发生和流行的必要措施。     

Rapid Diagnosis of Japanese Encephalitis by Using an Immunoglobulin M Dot Enzyme Immunoassay

Japanese encephalitis (JE) occurs in rural settings in southern and eastern Asia, where diagnostic facilities are limited. For the diagnosis of JE virus (JEV) infection, we developed a nitrocellulose membrane-based immunoglobulin M (IgM) capture dot enzyme immunoassay (MAC DOT) that is rapid, simple to use, requires no specialized equipment, and can distinguish JEV from dengue infection. In a prospective field study in southern Vietnam, 155 cerebrospinal fluid (CSF) and 341 serum samples were collected from 111 children and 83 adults with suspected encephalitis. The JEV MAC DOT, performed on site, was scored visually from negative to strongly positive by two observers, and the results were compared subsequently with those of the standard IgM capture enzyme-linked immunosorbent assay. For the 179 patients with adequate specimens, the MAC DOT correctly identified 59 of 60 JEV-positive patients and 118 of 119 JEV-negative patients (sensitivity [95% confidence intervals], 98.3% [92.1 to 99.9%]; specificity, 99.2% [95.9 to 100.0%]; positive predictive value, 0.98; negative predictive value, 0.99). The MAC DOT also correctly identified three patients with dengue encephalopathy. Admission specimens were positive for 73% of JE patients. Interobserver agreement for MAC DOT diagnosis was excellent (kappa = 0.94). The JEV MAC DOT is a simple and reliable rapid diagnostic test for JE in rural hospitals.     

广西流行性乙型脑炎50年流行趋势分析

目的分析广西乙脑流行趋势和特征,掌握其流行规律,为制定防治对策提供科学依据。方法采用描述性流行病学分析方法回顾性统计广西全区1960-2010年乙脑疫情资料。结果 1960-2010年全区共发生乙脑65384例,死亡11875例,年均发病率为3.38/10万,年均死亡率为0.61/10万,病死率为18.16%;发病流行以1960年代和1970年代为重,年均发病率分别为8.59/10万和9.24/10万,20世纪70年代以后广西开始持续推广使用乙脑疫苗,包括流行季节前突击接种和纳入免疫规划管理,1980-2000年代的年均发病率分别为1.75/10万,1.34/10万,0.44/10万;全区所有县和市辖区都有病例发生,但病例主要集中于桂西北、桂南和桂东地区,这些地区为乙脑的高发区;发病主要集中于5-9月份;患者以0～14岁农村散居儿童为主。结论广西乙脑发病流行呈下降趋势,发病有明显季节性;发病主要集中在低年龄儿童;经过持续多年的乙脑疫苗突击接种和纳入免疫规划管理,广西乙脑防控已取得明显成效。     

Effect of prior dengue infection on severity and outcome of Japanese encephalitis

Japanese encephalitis (JE) virus and dengue virus are closely related flaviviruses but interaction between them is scarcely studied in humans. The objective of this study was to compare the outcome of JE patients who are positive and negative for dengue IgG antibodies. Patients of acute encephalitis syndrome (AES) fulfilling predecided inclusion and exclusion criteria underwent a detailed standardized workup incorporating JE IgM testing in cerebrospinal fluid (CSF) or serum. Dengue IgG in serum was tested in all. Outcomes and clinical features were compared between JE patients who were dengue IgG positive and negative in hospital and after 3 months. A total of 182 patients of JE were enrolled over 3 seasons. After excluding equivocal cases, hospital outcome was compared between 105 dengue IgG-positive and 50 dengue IgG-negative patients. Dengue IgG-positive patients had a significantly better outcome (relative risk 1.4; 95% confidence interval 1.1–1.8). On follow-up after 3 months, again, outcome was significantly better among 95 dengue IgG-positive patient than 47 dengue IgG-negative patients (relative risk 1.3; 95% confidence interval 1.01–1.8). Presence of pre-existing dengue IgG antibodies in JE patients is associated with improved outcomes.     

Field trial of a Japanese encephalitis diagnostic kit

Serum and cerebrospinal fluid (CSF) obtained from patients in rural Thailand during an encephalitis epidemic were assayed with a Japanese encephalitis rapid diagnosis kit. Japanese encephalitis was diagnosed by detection of virus-specific IgM (JEV IgM) in CSF (1:10 dilution) or serum (1:100 dilution) with an antibody capture enzyme-linked immunosorbent assay. Specimens were assayed immediately on site at the provincial hospital and scored by visual examination within 4 h. Each specimen was retested carefully later to accurately determine its activity (units) at a single screening dilution; each was tested also at serial dilutions to determine its end-point titer. On-site kit results showed close agreement with subsequent laboratory results for detection and quantitation of JEV IgM and JEV IgG in either serum or CSF. Using the kit on site, admission CSF from 35 (73%) of 48 laboratory-proven JEV-infected patients were scored as definitely positive for JEV IgM, while all 17 CSF specimens from non-JEV infected patients were read as negative (sensitivity 73%, specificity 100%). A rapid and early diagnosis of acute Japanese encephalitis can be accomplished almost anywhere.     

Virus-specific antibody-producing cells in blood and cerebrospinal fluid in acute Japanese encephalitis

During an epidemic of Japanese encephalitis (JE) in northern Thailand, cerebrospinal fluid (CSF) leukocytes and blood leukocytes from 28 patients with suspected JE were tested for spontaneous in vitro synthesis of antibodies to JE virus (JEV). Sixteen patients were subsequently proven to be infected with JEV. Supernatant fluids of three-day cultures of unstimulated peripheral blood mononuclear leukocytes or unstimulated unfractionated CSF leukocytes were tested for JEV IgM and IgG antibodies with isotype-specific "antibody capture" radioimmunoassays. Blood-derived leukocytes from all sixteen JEV-infected patients and CSF-derived leukocytes from four JEV-infected patients synthesized JEV antibodies. Blood-derived and CSF-derived leukocytes from all 12 patients with central nervous system infections caused by agents other than JEV uniformly failed to synthesize JEV antibodies. Virus-specific antibody-producing cells can be detected in the blood and CSF early in the clinical course of acute JE.