Extensive severe fever with thrombocytopenia syndrome virus contamination in surrounding environment in patient rooms

ObjectivesSevere fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease in Korea and China. Although there is previous evidence of person-to-person transmission via direct contact with body fluids, the role of environmental contamination by SFTS virus (SFTSV) in healthcare settings has not been established. We therefore investigated the contamination of the healthcare environment by SFTSV.MethodsWe investigated the possible contamination of hospital air and surfaces with SFTSV transmission by collecting air and swabbing environmental surface samples in two hospitals treating six SFTS patients between March and September 2017. The samples were tested using real-time RT-PCR for SFTS M and S segments.ResultsOf the six SFTS patients, four received mechanical ventilation and three died. Five rooms were occupied by those using mechanical ventilation or total plasma exchange therapy in isolation rooms without negative pressure and one room was occupied by a patient bedridden due to SFTS. SFTSV was detected in 14 (21%) of 67 swab samples. Five of 24 swab samples were obtained from fomites including stethoscopes, and 9 of 43 were obtained from fixed structures including doorknobs and bed guardrails. Some samples from fixed structures such as television monitors and sink tables were obtained in areas remote from the patients. SFTSV RNA was not detected in five air samples from three patients' rooms.ConclusionsOur data suggest that SFTSV contamination was extensive in surrounding environments in SFTS patients' rooms. Therefore, more strict isolation methods and disinfecting procedures should be considered when managing SFTS patients.     

替诺福韦酯在乙型病毒性肝炎合并肝硬化患者挽救治疗中的应用

目的探讨替诺福韦酯在乙型病毒性肝炎合并肝硬化患者挽救治疗中的应用效果。方法收集2014-2017年沈阳市第六人民医院收治的乙肝合并肝硬化拉夫米定抗病毒治疗失败的患者89例,以替诺福韦酯进行挽救治疗%周。分别依据挽救治疗前患者HBV定量和谷丙转氨酶(ALT)水平将患者进行分组,比较不同分组情况下HBV累积应答率、乙型肝炎E抗原(HBeAg)累积转换率和ALT累积复常率。结果本组89例患者中,HBV累积应答64例,占71.91%;HBeAg累积转换32例,占35.96%;ALT累积复常74例,占83.15%。低定量组与高定量组HBV累积应答率、HBeAg累积转换率、ALT累积复常率差异均有统计学意义(P值均<0.05)。低转氨酶组与高转氨酶组HBV累积应答率、HBeAg累积转换率、ALT累积复常率差异均无统计学意义(P值均>0.05)。结论替诺福韦酯作为挽救治疗用药,可有效抑制乙型肝炎病毒复制,改善转氨酶和肝炎抗体指标,尤其是对病毒定量水平较低的患者,效果更为明显。     

A molecular based diagnosis of positive blood culture in the context of viral haemorrhagic fever: proof of concept

ObjectivesThe aim of this study was to evaluate the possibility of using a PCR-based panel to identify bacterial and fungal bloodstream infections in the setting of suspected or confirmed viral haemorrhagic fever.MethodsThe accuracy of the FilmArray® Blood Culture Identification Panel (BCID) assay was assessed to identify the common bacterial and fungal pathogens associated with bloodstream infections after positive blood culture inactivation using a guanidinium thiocyanate containing buffer lysis that is commonly used for viral haemorrhagic fever molecular diagnostics.ResultsThe FilmArray® BCID panel assay detected 95% (19/20) of the pathogens analysed in this study by using both protocols with and without inactivation. Absolute consistency (100%) was observed in all isolates with phenotypes compatible with the presence of the antibiotic resistance genes mecA, vanA, vanB and blaKPC.ConclusionsThe FilmArray® BCID panel assay coupled to inactivation using a guanidinium thiocyanate containing buffer lysis represents a convenient, sensitive and specific diagnostic tool to detect some of the most pathogens associated with bloodstream infections in the context of a suspected or confirmed viral haemorrhagic fever.     

Viral load in children with congenital cytomegalovirus infection identified on newborn hearing screening

BackgroundCongenital cytomegalovirus (CMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. However, congenital SNHL without other clinical abnormalities is rarely diagnosed as CMV-related in early infancy.ObjectivesThe aim of this study was to identify and treat patients with congenital CMV-related SNHL or CMV-related clinical abnormalities other than SNHL. The association between CMV load and SNHL was also evaluated.Study designNewborns who had abnormal hearing screening results or other clinical abnormalities were screened for congenital CMV infection by PCR of saliva or urine specimens, and identified infected patients were treated with valganciclovir (VGCV) for 6 weeks. The CMV load of patients with or without SNHL was compared at regular intervals during as well as after VGCV treatment.ResultsOf 127 infants with abnormal hearing screening results, and 31 infants with other clinical abnormalities, CMV infection was identified in 6 and 3 infants, respectively. After VGCV treatment, 1 case had improved hearing but the other 5 SNHL cases had little or no improvement. Among these 9 patients with or without SNHL at 1 year of age, there was no significant difference in CMV blood or urine load at diagnosis, but both were significantly higher in patients with SNHL during VGCV treatment.ConclusionsSelective CMV screening of newborns having an abnormal hearing screening result would be a reasonable strategy for identification of symptomatic congenital CMV infection. Prolonged detection of CMV in blood could be a risk factor for SNHL.     

甲型流感病毒非结构蛋白1抑制干扰素抗病毒反应的研究进展

IFN-α/β是机体对抗外来病原体的第一道防线，其产生和后续激活的细胞信号转导可诱导具有抑制病毒感染和复制作用的IFN刺激基因的表达。然而，大多数病毒可通过表达一种或多种蛋白抵抗宿主细胞的抗病毒反应。流感病毒非结构蛋白1（nonstructural protein 1，NS1）作为多功能毒力因子，在流感病毒感染过程中起重要作用。此文概述了NS1的结构与功能及抑制IFN-α/β产生和抗病毒效应作用的机制，为研究流感病毒致病机理提供参考。     

益心舒胶囊治疗病毒性心肌炎的临床观察

目的：观察益心舒胶囊对病毒性心肌炎临床疗效。方法：将115例病毒性·,22肌炎患者以随机抽样法分为治疗组和对照组，其中治疗组60例，对照组55例，2组患者均常规给予5％葡萄糖注射液250ml＋三磷酸腺苷（ATP）40mg＋辅酶A200＋维生素C5．0g静脉滴注治疗，1日1次，治疗2周；治疗组患者在常规治疗的基础上，口服益心舒胶囊1次3粒，1日3次，疗程为4周。观察治疗前后2组患者的临床症状、心电图及心肌酶谱等变化。结果：治疗组患者临床症状、心电图、心肌酶谱的改变均明显优于对照组，2组比较差异有统计学意义（P〈0．05）；2组患者治疗前后血尿常规、肝肾功能等各项指标均无异常变化，未见明显不良反应。结论：益心舒胶囊治疗病毒性心肌炎有良好疗效，且安全性好，体现了中药的独特优势。     

Evaluation of five circulating strains of variant infectious bursal disease virus (varIBDV) for their immunogenicity as broiler breeder vaccines and protective efficacy in neonatal broiler chicks

The majority of infectious bursal disease virus (IBDV) strains circulating in the broiler chicken industry in Canada are variant strains (varIBDV). Despite high levels of maternally derived antibodies (MtAb), the circulating varIBDVs can establish infection and cause severe immunosuppression in broiler chicks. The objective of this study was to evaluate circulating varIBDVs as broiler breeder vaccine candidates and investigate their protective efficacy against varIBDV challenge in their progeny chicks. Six groups of breeders (20 females/group) were vaccinated with varIBDV strains, SK09, SK10, SK11, SK12, and SK13 or saline at the age of 13 weeks and antibody response was determined by ELISA at 3–7-, and 20- weeks post-vaccination. We also included commercial chicks for the comparison. Results showed that SK-09 is the most antigenic strain, followed by SK-10, SK-12, and SK-13. In contrast, SK-11 showed the lowest antibody response, and over time, antibody titers steadily decreased. Eggs from breeders were collected at 21-week post-vaccination and incubated to produce their respective progenies. The serum antibody titer in day-old chicks showed a successful MtAb transfer. Progeny chicks (n = 40/group) were orally challenged with varIBDV-SK-09 strain at 6 days of age and serum antibody titer (19 d and 35 d of age), bursa to body weight ratio (19 d and 35 d of age), bursal viral load (9 d and 19 d of age) was examined to assess the protection against IBDV. Following the challenge, we found a significant increase in the antibody titers in MtAb-free and commercial vaccine groups than in the varIBDV groups, both at 19 d and 35 d of age. The BBW ratio and viral load data indicated a significant homologous and heterologous protection against varIBDV-SK-09 challenge by SK-09 and SK-10 MtAbs, respectively. Overall, this study demonstrated the feasibility of developing breeder vaccines using circulating varIBDV as candidate vaccine antigens.     

更昔洛韦治疗小儿手足口合并病毒性脑炎122例疗效观察

目的：探讨更昔洛韦治疗小儿手足口合并病毒性脑炎的临床疗效。方法：122例患儿按入院顺序随机分为研究组和对照组，各61例，所有患儿均根据临床不良反应给予对症的物理降温、水电解质平衡纠正、补液、抗病毒治疗、脑神经营养等，研究组在此基础上加用更昔洛韦。结果：经治疗研究组患儿总有效率明显高于对照组，数据经统计学比较具有显著差异(P<0.05)。患儿退热时间比较两组间数据无显著差异(P>0.05)，研究组疱疹消退时间、神经体征缓解时间和平均住院时间均明显短于对照组，数据经统计学比较具有极显著差异(P<0.01)。结论：更昔洛韦不仅可达到更好的治疗效果，还有助于提高治疗效率、加快改善患儿的临床不良反应，适合于手足口病合并病毒性脑炎的临床治疗。