单纯疱疹病毒感染后自身免疫性脑炎的研究进展

单纯疱疹病毒脑炎所引发的自身免疫性脑炎日益受到关注,其发病机制可能与单纯疱疹病毒感染神经元后神经元裂解释放抗原引起免疫反应有关。这种继发性的自身免疫性脑炎临床表现多样,早期容易与复发性单纯疱疹病毒性脑炎相混淆,延误治疗导致严重的神经功能缺损及预后不良。脑脊液和血清中检出自身免疫性脑炎相关抗体则有助于诊断,免疫治疗有效。本文结合相关文献综述了单纯疱疹病毒感染后的自身免疫性脑炎的发展历史、发病机制、临床表现、辅助检查和诊疗流程,为临床医生提供借鉴。     

角膜接触镜联合激素治疗病毒性角膜炎的探讨

目的探讨佩戴软性治疗性角膜接触镜联合激素治疗单纯疱疹病毒性角膜葡萄膜炎（溃疡型）的临床疗效。方法对临床确诊的32例单纯疱疹病毒性角膜葡萄膜炎（溃疡型）,静脉滴注或口服阿昔洛韦,0.15%更昔洛韦眼凝胶滴眼、散瞳,佩戴软性治疗性角膜接触镜保护下使用激素治疗。观察眼部刺激症状、角膜溃疡愈合情况,治愈时间。随访3个月。结果佩戴软性治疗性角膜接触镜后药物治疗3天全部改善临床症状,7天浅层溃疡愈合,14-21天中层溃疡愈合,30-35天深层溃疡愈合,40天角膜溃疡小穿孔2眼愈合。32眼治愈29眼,治愈率91%,好转2眼,平均治愈时间16.3天。随访3个月,4眼复发。结论佩戴软性治疗性角膜接触镜联合激素治疗单纯疱疹病毒性角膜葡萄膜炎（溃疡型）临床疗效好,是一种安全实用的治疗方法。     

Herpes simplex virus in idiopathic facial paralysis (Bell palsy).

Sera from all 41 adult patients with idiopathic facil paralysis (Bell palsy) and 35 (85%) of 41 matched controls who had never had Bell palsy contained antibodies to herpes simplex virus (P smaller than.05). The frequency of antibodies to herpes zoster virus did not differ in patients and controls. A rise in antibody titer, indicating primary herpes simplex virus infection, was not found in these patients. That Bell palsy may be caused by reactivation of herpes simplex virus is suggested by (1) clinical, neurologic, laboratory, and immunologic similarities between idiopathic facial paralysis and known manifestations of reactivated herpes simplex virus infection, and (2) the known neurotropism of herpes simplex virus, including its presence in latent form in the trigeminal ganglia, and parallels with known facial paralysis due to varicella zoster virus, a closely related agent. The presence of antibodies to herpes simplex virus is the only common factor among the patients tested in this study.     

10: Herpes simplex and varicella-zoster virus infections

Any new patient with suspected genital herpes should have diagnostic testing with virus identification. Type-specific serological tests that distinguish between antibodies for type 1 and type 2 herpes simplex virus (HSV) may be useful to determine previous exposure but cannot be used to diagnose recurrences of genital herpes. Initial episodes of genital herpes usually require antiviral therapy, while recurrences may be treated with continuous antiviral suppression (if frequent) or episodic therapy; patient counselling and education (including how to recognise lesions) are essential. Topical or systemic therapy is available for initial and recurrent non-genital herpes simplex. Primary varicella infection (chickenpox) and herpes zoster (shingles) are usually diagnosed clinically, but can be confirmed by detection of varicella-zoster virus antigens or nucleic acid from swabs of lesions or by antibody tests. Antiviral therapy should be considered in chickenpox if disease is complicated or the patient is immunocompromised. In herpes zoster, antiviral therapy should be given within 72 hours of onset to patients aged over 50 years or with severe pain or neurological abnormalities to reduce the likelihood and duration of postherpetic neuralgia. The availability of effective antiviral therapy makes early diagnosis vital     

通用引物检测儿童血和脑脊液的6种疱疹类病毒

目的:通过PCR-RFLP、DNA克隆和测序分析来检测和区分6种疱疹类病毒,探讨其在临床上的应用价值.方法:在疱疹类病毒高度同源序列DNA多聚酶基因中设计两对通用引物,一对扩增单纯疱疹病毒1型和2型、爱泼斯坦-马尔病毒、人巨细胞病毒4种病毒,另一对扩增水痘-带状疱疹病毒和人类疱疹病毒6型2种病毒,经DNA PCR扩增,并对扩增产物进行分子克隆、序列分析后,选择BamHⅠ或BstUⅠ酶切扩增产物进行鉴别.最后,对临床38份脑脊液(CSF,临床诊断为病毒性脑炎的病例)和49份血标本(其中27份为确诊病例,22份为临床诊断病例)进行疱疹病毒的检测.结果:38份CSF标本中13份阳性(34.2%),27份确诊病例标本均阳性(100%),22份临床诊断病例标本16份阳性(72.7%).这些阳性标本通过BamHⅠ或BstUⅠ两种酶切后能明确系何种疱疹类病毒.68例正常健康儿童的血和9份非病毒感染的脑脊液标本6种疱疹类病毒DNA均为阴性.结论:聚合酶链反应加限制性内切酶片段长度多态性分析为疱疹类病毒感染的临床诊断提供了一种有效的手段.     

典必殊辅助治疗病毒性角膜炎的疗效观察

目的：观察典必殊辅助治疗病毒性角膜炎的临床疗效。方法：将54例病毒性角膜炎患者随机分为治疗组和对照组,对照组给予0．1％无环鸟苷滴眼液与贝复舒滴眼液交替滴眼,1次／2h;治疗组给予0．1％无环鸟苷滴眼液与典必殊滴眼液交替滴眼,1次／2h。结果：对深层型,治疗组有效率（87．5％）明显优于对照组（66．7％）,两组比较,差异有统计学意义（P〈0．05）。浅层型,两组有效率均为100．0％。结论：典必殊辅助治疗HSK,具有明显的协同作用,能提高治愈牢,缩短病程,降低复发,特别对深层型疗效更显著。     

Disseminated herpes simplex virus infection in an apparently immunocompetent woman

A young, previously healthy woman developed bilateral exudative tonsillitis that was associated with severe systemic symptoms. This was followed by evidence of multisystem disease with acute abdominal pain, raised liver enzyme levels, respiratory difficulty, increasing drowsiness and multiple vesicular skin lesions. Herpes simplex virus type-1 was isolated from skin lesions and a throat swab and herpes simplex virus type-1 antigen was detected in a liver biopsy sample. She recovered rapidly without any sequelae after treatment with intravenously administered acyclovir.     

Frequency of asymptomatic shedding of herpes simplex virus in women with genital herpes

Twenty-seven women with recurrent genital herpes simplex virus infection underwent daily home culturing to detect asymptomatic genital herpes simplex virus shedding. Asymptomatic herpes simplex virus shedding was documented on 1% of the days on which cultures were obtained. Asymptomatic shedding from the vulva was as frequent as asymptomatic cervicovaginal shedding, and 45% of asymptomatic episodes were identified only by positive results from vulvar cultures. All women who obtained samples on more than 100 days and 80% of women who obtained samples on more than 50 days had documented asymptomatic viral shedding, compared with only 6% of those who obtained samples for fewer than 25 days. Asymptomatic shedding was not related to contraceptive use or menstrual cycle. These data suggest that all women with recurrent genital herpes simplex virus infection should be instructed about the possible risk, albeit infrequent, of asymptomatically shedding virus from the genital tract.     

Neonatal herpes simplex virus infection occurring in second twin of an asymptomatic mother. Failure of a modern protocol

A case of neonatal herpes that occurred after vaginal delivery in the absence of genital lesions is presented. The mother had a history of drug addiction and genital herpes. Asymptomatic shedding of herpes simplex virus type 2 from the cervix was noted in the second trimester of pregnancy. Despite being followed with a protocol of close surveillance and serial culturing of the genital tract, the patient gave birth to twins, one of whom developed herpes simplex virus type 2 in the postpartum period. This report presents discussion of this case and herpes surveillance protocols.     

TORCH检查的意义及应对措施

目的：为有效贯彻落实优生优育政策,临床探究孕妇产前TORCH检查的意义并根据结果分析相对应对措施。方法方便选取并回顾性分析该院2014年7月—2015年7月期间300例入院进行产检的孕妇,对49例出现不良妊娠以及60名正常者TORCH检查进行比照。结果不良妊娠组与正常组孕妇在年龄、孕周、孕次上差异无统计学意义,P>0.05;正常组弓形虫感染、风疹病毒、巨细胞病毒、乙肝检查、单纯疱疹病毒Ⅰ、梅毒螺旋体检查、单纯疱疹病毒Ⅱ分别为0.0%、0.0%、1.7%、1.7%、3.3%、1.7%,不良妊娠组依次为6.1%、10.2%、8.2%、12.2%、6.1%、14.3%,两组在乙肝检查异常率上差异无统计学意义,P>0.05,不良妊娠组较正常组在弓形虫感染、风疹病毒、巨细胞病毒、单纯疱疹病毒Ⅰ、单纯疱疹病毒Ⅱ异常率高,P<0.05。结论孕妇产前TORCH检查对避免不良妊娠、胎儿先天缺陷、畸形、死胎等情况均有重要意义。     

PCR-RFLP法对单纯疱疹病毒感染诊断和分型的研究

目的 建立单纯疱疹病毒的聚合酶链反应-限制性片段长度多态性（PCR-RFLP）检测法,为生殖器疱疹的诊断及分型提供可靠而特异的方法。方法 以特异性引物法为对照,用一对单纯疱疹病毒外层通用引物扩增出长度为438bp的片断,并进行酶切以分型。结果 PCR-RFLP法可特异性检测出单纯疱疹病毒并进行分型,同特异性引物法比较。两种方法无显著性差异。结论 PCR-RFLP法是一种准确、特异的对单纯疱疹病毒感染进行诊断和分型的方法。     

Viral etiology of chronic cervicitis and its therapeutic response to a recombinant interferon.

Chronic cervicitis was shown to be related to papillomavirus type 16(HPV-16), herpes simplex virus type 2 and cytomegalovirus (CMV) infections as demonstrated by DNA hybridization technique and virus isolation method from samples taken from erosive and normal cervices. After one course of treatment with recombinant interferon alpha 1 (rIFN-alpha 1), 93.8% of cases showed clinical improvement and 60% marked improvement. The HPV-16 and HSV detection rates dropped down significantly after rIFN-alpha 1 treatment as compared with those before treatment. Astragalus membranaceus, a Chinese herbal drug, was shown to be synergic to interferon therapy.

     

阿昔洛韦联合聚肌胞治疗单疱病毒性角膜炎疗效观察

目的 探讨阿昔洛韦联合聚肌胞治疗单疱病毒性角膜炎的临床效果,以期提高治愈率.方法 根据病情将我院38例患者,共60眼平均分成3组,采用阿昔洛韦滴眼液点眼,聚肌胞球周注射,分别单独应用与联合应用治疗单疱病毒性角膜炎.结果 阿昔洛韦滴眼液联合聚肌胞球周注射治疗单疱病毒性角膜炎,疗效显著,疗程缩短1～2周.结论 阿昔洛韦联合聚肌胞注射液球周注射,二者联合应用有协同功效,疗效显著,疗程缩短,且无毒副作用,操作简单,安全可靠.     

Relapse of herpes simplex encephalitis after conventional acyclovir therapy

Acyclovir sodium is the drug of choice for the treatment of herpes simplex encephalitis. We treated an immunocompetent patient with a ten-day course of intravenous acyclovir sodium at the recommended dosage of 10 mg/kg every eight hours for clinically apparent herpes simplex encephalitis. After marked improvement, his condition deteriorated four days after completing acyclovir therapy. A subsequent brain biopsy specimen disclosed acyclovir-sensitive herpes simplex virus type 1. A longer duration of acyclovir therapy (14 to 21 days) should be considered for treating herpes simplex encephalitis.     

Herpes simplex oesophagitis in young children

Herpes simplex oesophagitis is usually associated with debilitated, traumatized or immunologically-compromised hosts. We report here two cases of severe self-limiting oesophagitis in immunologically competent young children that were caused by herpes simplex type 1. This diagnosis should be considered in the differential diagnosis of acute severe pain on swallowing in children for whom oral and pharyngeal pathology have been excluded.     

Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group

A total of 432 patients underwent brain biopsy for presumptive herpes simplex encephalitis. Three patient groups were identified. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). The second group, 95 patients (22%), had diseases that were identified but that were not caused by herpes simplex virus. Three subgroups were recognized: (1) 38 patients (9%) with treatable disease, (2) 40 patients (9%) with nontreatable but diagnosed viral infection, and (3) 17 patients (4%) with identified diseases neither of viral etiology nor treatable. The third group, 142 patients (33%), remained without a diagnosis. Clinical presentation of patients in the second group was similar to that of those with herpes simplex encephalitis and those without a diagnosis. Patients in the subgroup with nontreatable but diagnosed viral infections had the greatest likelihood of returning to normal.     

病毒性脑炎急性期治疗的进展

病毒性脑炎是指病毒感染引起的脑实质的炎症。发热、头痛、意识障碍、精神症状、抽搐、神经系统定位体征是其主要临床表现。许多病毒可引起该病,常见的有单纯疱疹病毒、水痘-带状疱疹病毒、巨细胞病毒、肠道病毒70及71、麻疹病毒、风疹病毒、流行性腮腺炎病毒及黄病毒属等,单纯疱疹病毒性脑炎是最常见的。目前临床大多采取综合性的治疗,抗病毒、脑细胞的保护、重要脏器功能的维持及并发症的预防。文章对该病急性期治疗的进展予以综述。     

FQ-PCR和ELISA法检测生殖器疱疹病毒抗原检测结果比较

本文对FQ-PCR和ELISA法检测生殖器疱疹病毒抗原的检测结果进行比较,为临床诊断治疗提供参考。分析邢台市第三医院皮肤性病科2015~2017年诊治的生殖器疱疹60例患者临床资料。采用酶联免疫吸附测定法(ELISA法)和荧光定量PCR法(FQ-PCR)检测样本中单纯疱疹病毒,检测结果不一致的样本采用单纯疱疹病毒通用引物分析。结果显示60例样本中FQ-PCR法检测阳性为46例,占76.7%,ELISA法检测阳性为48例,占80.0%,检测结果不一致样本为6例,占10.0%;1例FQ-PCR法阳性而ELISA法阴性样本经第二次检测后为阴性,3例ELISA法检测阳性而FQ-PCR法检测阴性样本经第二次检测后阳性为2例,阴性为1例;FQ-PCR法的敏感性、特异性、阳性预测值和阴性预测值分别为92.4%、96.3%、93.7%和94.5%,而ELISA法的上述指标分别为94.4%、96.3%、93.8%和95.8%。因此,ELISA法检测生殖器疱疹病毒抗原敏感性和特异性高,值得临床推广。     

泰州市2012年呼吸道综合监测结果分析

目的了解我市呼吸道病原的活动规律,全面掌握我市呼吸道病原的病原谱。方法在呼吸道综合监测监测点采集流感样病例、急性上呼吸道感染病例和住院严重急性呼吸道感染病例的咽拭子,提取核酸,进行荧光定量PCR检测,分析结果结果。结果全年完成流感核酸检测713份,阳性率23．5％,亚型为H3N2和B型,完成呼吸道其他病原核酸检测240份,阳性率35．0％,病原谱分布以鼻病毒、单纯疱疹病毒、肺炎链球菌为主。结论流感病毒、鼻病毒、单纯疱疹病毒、肺炎链球菌是我市呼吸道感染病例的主要病原。     

新生儿单纯疱疹病毒Ⅰ型重症肺炎1例并文献复习

本文报告单纯疱疹病毒(herpes simplex virus，HSV)Ⅰ型感染新生儿重症肺炎1例并文献复习。该新生儿以“气促、口吐泡沫、呛奶”呼吸系统表现为主，肺部CT提示双肺呈广泛弥漫性网格影改变，临床较少见，经及时诊断及给予更昔洛韦静滴联合干扰素雾化抗病毒及支持治疗，患儿恢复良好，出院随访1年，生长发育正常。