急性病毒性肝炎的诊疗

急性病毒性肝炎(AVH)是一种全身感染但主要侵犯肝脏的疾病。AVH主要由嗜肝病毒引起(甲、乙、丙、丁、戊型肝炎)。其他病毒感染偶然情况下可累及肝脏(巨细胞病毒CMV，疱疹病毒，柯萨奇病毒，腺病毒)。甲型肝炎和戊型肝炎是自限性疾病，但丙型肝炎及次之的乙型肝炎则主要转变成慢性感染。     

柯萨奇B组病毒性肝炎56例

为探讨非嗜肝病毒在散发性病毒性肝炎病原学中的地位 ,我们于 1997年开始对 398例肝炎患者进行柯萨奇Ｂ组病毒 (ＣＶＢ)、巨细胞病毒 (ＣＭＶ)和甲～庚型肝炎病毒及输血传播病毒 (ＴＴＶ)等 9种病毒指标的检测 ,共检出抗ＣＶＢ ＩｇＭ阳性 5 6例 ,现将ＣＶＢ感染者情况分析如下。材料与方法一、研究对象5 6例多为肝炎住院患者 ,其中 6例系原因不明丙氨酸转氨酶升高门诊发现。男 39例 ,女 17例 ,年龄 8～ 73岁 ,平均 38.5岁。临床诊断标准参照第五次全国传染病和寄生虫病学术会议修订的病毒性肝炎防治方案[1] 。二、检测方法抗ＣＶＢ ＩｇＭ…     

清开灵注射液为主治疗成人柯萨奇病毒性肝炎6例

柯萨奇病毒感染在儿童时期多见，引起成人肝损害者少见。近几年，我们发现6例成人柯萨奇病毒性肝炎患者，现报告如下。     

150例儿童非嗜肝病毒感染相关性肝炎临床特征分析

目的探讨儿童非嗜肝病毒感染相关性肝炎的临床特征。方法回顾性分析2009年1月～2010年9月期间住院治疗的150例诊断为非嗜肝病毒感染相关性肝炎病例的临床特征。结果150例患儿中,男81例,女69例。引起儿童非嗜肝病毒感染相关性肝炎的病原体以肺炎支原体和EB病毒最常见,分别为69例（46．0％）和59例（39．3％）,治疗后ALT、AST明显下降。结论儿童非嗜肝病毒感染相关性肝炎的临床表现是非特异性的,进行综合性治疗是治愈本病的关键。     

肝炎病毒标志物阴性老年肝功能异常病因及临床特点

目的收集甲~戊型肝炎标志物阴性的老年肝功能异常患者246例,分析其病因及临床特点。方法检测甲~戊型肝炎病毒血清学标志物、EB病毒等非嗜肝病毒抗体、及自身抗体水平,并行腹部B超或CT等影像学检查。对照组分别为甲~戊型老年病毒性肝炎177例、肝炎标志物阴性青中年肝功能异常40例。统计分析采用卡方检验、t检验。结果肝炎标志物阴性老年肝功能异常发生率高,达58.26%。其中位居前4位的病因依次为：病因不明者27.64%,胆源性肝损21.54%,自身免疫紊乱伴肝损20.33%,EB病毒等非嗜肝病毒感染15.04%,和青中年组相比上述病因构成无差别（P〉0.05）;脂肪肝比例（2.85%）低于青年对照组（P〈0.05）。腹胀、肝掌阳性比例高于老年肝炎组（P〈0.05）,尿黄、纳差比例高于青中年肝炎阴性组（P〈0.05）。临床类型多为急性肝损（81.71%）,慢性肝损、肝衰竭、肝硬化发生率低于老年病毒性肝炎组（P〈0.05）,但和青中年组无明显差异（P〉0.05）。结论老年肝功能异常由非病毒性肝炎引起者所占比例较高;临床表现、疾病严重程度比老年病毒性肝炎组轻。     

72例肝硬化失代偿期患者感染非嗜肝病毒临床分析

目的探讨合并非嗜肝病毒感染对肝硬化失代偿期患者肝功能及心肌功能的影响。方法对我院2008年9月至2009年9月收治的合并非嗜肝病毒感染72例肝硬化失代偿期的患者进行回顾性调查研究,分析肝硬化失代偿期患者合并非嗜肝病毒感染的累计感染率及感染时间、感染病毒种类,并以38例无非嗜肝病毒感染肝硬化失代偿期患者为对照,按照患者的性别、年龄、体重、身高进行分层对照研究,探讨非嗜肝病毒感染对肝硬化失代偿期患者的影响。结果与结论肝硬化失代偿期患者感染非嗜肝病毒累计感染率为32.7%,感染时间以冬季多见,感染病毒以腺病毒、EB病毒、呼吸道合胞病毒、柯萨奇病毒感染居多,其中男性、体重较大(60kg);身高较高者(170cm)者,感染后在一定程度上可加重肝功能损害。而女性、体重较轻者感染后则易造成心肌酶升高。     

甲型、乙型和非甲非乙型暴发性肝炎的临床与预后的差异

本文观察暴发性肝炎(暴肝)73例,其中甲型肝炎(HA)23例(31.5％),乙型肝炎(HB)18例(24.7％),非甲非乙型肝炎(NANB)32例(43.8％)。三组病例在年龄、性别上无显著差异。无1例对巨细胞病毒、EB病毒和单纯疱疹病毒等可能引起肝炎的其它病毒     

柯萨奇病毒性重型肝炎31例

1997年 3月～ 1999年 12月我院传染科共收治柯萨奇病毒性 (ＣｏｘＶ)重型肝炎 31例 ,现将其临床特征总结如下。临床资料一、一般资料本组 31例ＣｏｘＶ重型肝炎患者 ,男 2 2例 ,女 9例 ,年龄5～ 2 1岁 ,平均年龄 9.32岁。其中 5例为急性重型肝炎 ,2 6例为亚急性重型肝炎。诊断按 1995年修订的病毒性肝炎防治方案[1] 。病原诊断经血清学检查柯萨奇病毒Ｂ族特异性ＩｇＭ抗体 (ＣｏｘＶＢ ＩｇＭ)阳性而确诊。其中 6例曾罹患急性甲型肝炎。二、临床表现全部病例均有低热、乏力及恶心、呕吐、腹泻等胃肠道症状 ;肝性脑病 30例 ,其中Ⅱ度以上 2 1…     

吉林地区心脏病患者柯萨奇B组病毒感染情况分析

心脏病是一种严重危害人类健康的多发病、常见病。引发心脏病的原因很多，其中由病毒引发的心脏病占有较大比例。能引起心脏病的常见病毒是柯萨奇病毒，特别是柯萨奇B组病毒最为多见。有关心脏病柯萨奇B组病毒感染情况的报道较多，特别是在心肌炎和克山病的病因研究牛报道较多，但未见有关吉林地区心脏病柯萨奇B组病毒感染情况的报道。本文收集心脏病患者1298例抗柯萨奇B组病毒抗体检测结果，分析柯萨奇B组病毒在心肌炎、心包炎、扩张型心肌病和心肌梗塞等疾病中的感染情况，为心脏病的病因研究提供基础数据。     

非病毒性肝炎肝损害的肝脏病理分析

病毒性肝炎是我国患者导致肝损害最常见原因,但临床上部分患者嗜肝病毒血清标志物均阴性,所谓"不明原因肝损害".我科2006～2010年共完成肝脏活检1 400例,其中非病毒性肝炎所致不明原因肝损害122例,通过肝组织学检查明确诊断,现将结果报道如下: 资料与方法     

Reduction of the observed prevalence of so-called non-A non-B hepatitis using sensitive markers of HBV and herpes viruses infections

In the absence of a specific marker, the observed prevalence of so called non-A non-B hepatitis depends on the sensitivity of the markers of the other viral infections known to induce hepatitis. We have reevaluated this prevalence after using sensitive markers of HBV (HBs monoclonal radioimmunoassay M-RIA and IgM anti-HBc), EBV (IgM anti-VCA), CMV (IgM anti-CMV) and HSV (IgM anti-HSV) in a group of 53 subjects usually considered as having acute or chronic hepatitis. Detection of IgM against HBc, CMV and HSV used immunocapture tests. Among the 37 patients with acute hepatitis, 11 (30 p. 100) were positive for at least one sensitive marker, including 10 markers of HBV (7 M-RIA and 3 IgM anti-HBc) and one IgM anti-CMV. Among the 16 patients with chronic hepatitis, one was positive for HBV by M-RIA; five patients had a false positive reaction to EBV (IgM anti-VCA) disappearing when rheumatoid factor was eliminated. This study shows that many cases of the so-called non-A non-B hepatitis are in fact due to HBV or to a variant of HBV. Definition of non-A non-B hepatitis must include subjects negative for HBV by M-RIA and IgM anti-HBc and negative for CMV by IgM anti-CMV.     

Rapid detection of IgM and IgG antibodies to herpesviridae virus

In this study, the immunoconcepts EA indirect enzyme antibody technique (colorzyme) was used not only for detection of IgG antibodies but also for quantitative detection of IgM antibodies to Herpes Simplex virus (HSV), Cytomegalovirus (CMV) and Epstein Barr Virus (EBV) to diagnose recent iactivei infection. Reference reactive and negative antisera and randomly collected human sera were tested by complement fixation test (CFT) against HSV antigens and tested also by immunofluorescent (IF) and colorzyme Immunoconcepts EA tests. All sera that were negative to HSV, CMV and EBV antibodies by CFT were negative by IF and colorzyme EA tests. All antibody positive sera and reference positive antisera were also positive by IF and colorzyme EA tests with slight variation in antibody titres between CFT and colorzyme test results. Human sera which were negative or IgM positive to HSV, CMV and EBV by ELISA as well as negative and positive reference sera from different diagnostic kits were retested by IF and colorzyme EA for IgM antiviral reactivity results were concordance by the three rests. All incubations in colorzyme test were at room temperature and only an ordinary microscope used in IF test or plate washers and readers needed for ELISA test. The colorzyme immunoconcepts is a simple, rapid and sensitive for viral diagnosis and can be used in any private laboratory.     

Heterophil-negative infectious mononucleosis and mononucleosis-like illnesses. Laboratory confirmation of 43 cases.

During a 50-month period the diagnosis of heterophil antibody negative infectious mononucleosis or of a mononucleosis-like illness was made in 43 patients with a variable clinical picture and significant numbers of atypical lymphocytes. Epstein-Barr virus (EBV)-related serologic tests revealed that seven patients had primary EBV infections based on the detection of immunoglobulin M (IgM) antibodies to EB-viral capsid antigens (IgM-VCA) and the absence of anti-Epstein-Barr virus associated nuclear antigen (EBNA) on most initial specimens (six of seven cases). Thirty cases were due to active cytomegalovirus (CMV) infections and both detectable CMV-macroglobulins (≧1:32) and significant anti-CMV titers were present by a complement fixation technic. Abnormalities in liver function were less marked in CMV than in EBV infections in age-matched subjects. Of the remaining six cases, one was due to rubella and one to toxoplasmosis. Four cases were of undetermined etiology. Serums from 38.1 per cent of the patients with heterophil-antibody positive infectious mononucleosis were found to “cross react” in the IgM-CMV test, but serums from patients with acute CMV infection did not cross react in the VCA-specific IgM test. In nine of 36 cases without heterophil antibody (six due to CMV, one due to toxoplasmosis and one apparent infectious hepatitis), anti-D or -R of the early-antigen (EA) complex was detected (1:10 to 1:40), raising the question of reactivation of the EBV-carrier state by intervening infections mainly of viral origin.     

Simultaneous detection of IgM antibodies against the hepatitis A virus and the viral capsid antigen of Epstein-Barr virus in acute hepatitis

The simultaneous detection of IgM antibodies to hepatitis A virus (anti-HAV IgM) and IgM antibodies to viral capsid antigen (anti-VCA IgM) of Epstein-Barr virus (EBV) in patients with acute viral hepatitis has led us to systematically study serological markers of EBV in patients with anti-HAV IgM positive acute hepatitis and to test for anti-HAV IgM in sera of patients with acute hepatitis associated with serological evidence of current primary EBV infection. All patients studied were HBsAg negative and were not drug-addicts, nor homosexuals. In 15 consecutive patients with anti-HAV IgM positive acute hepatitis, anti-HAV IgM and anti-VCA EBV IgM antibodies were simultaneously detected in 9 cases. Of these 9 patients, antibodies to nuclear antigen were positive in 8 cases, antibodies to early antigen were positive in 7 cases and rheumatoid factor was positive in 4 cases. In 5 consecutive patients with acute hepatitis associated with serological evidence of current primary EBV infection, anti-HAV IgM was not detected. Simultaneous presence of anti-VCA EBV IgM, early antigen IgG antibodies and nuclear antigen antibodies in 7 patients with acute hepatitis associated with anti-HAV IgM suggests reactivation of EBV or reactivation of clones secreting antibodies anti-EBV in HAV infections. Furthermore, these results show that anti-VCA IgM only cannot be considered to be a specific marker of early EBV infection in patients with acute hepatitis.     

Hepatitis due to Epstein–Barr virus and cytomegalovirus: clinical features and outcomes

Objective: To determine the frequency of cytomegalovirus (CMV) and Epstein–Barr virus (EBV) hepatitis among those with acute CMV and EBV infection in a population based setting and to compare these two types of hepatitis and analyze the outcomes.

Methods: A retrospective search was undertaken on all patients with IgM antibodies to CMV and EBV during the period of 2006–2015 in the virological database of the University Hospital of Iceland covering the metropolitan area of Reykjavík (population 202,255). Patients with available liver tests at the University Hospital and/or admitted to this institution were included and relevant clinical data obtained from medical records.

Result: Overall, 190 patients had acute EBV infection during the study period and 118 patients were diagnosed with acute CMV. Overall, 82% of patients with acute EBV infection had hepatitis, males 43%, median age 17 years, 15% had jaundice and 26% hospitalized. Among those with acute CMV infection, 69% had elevated liver tests, 63% males, median age 33 years, 9% had jaundice and also 26% hospitalized. Overall, 17% of those with CMV hepatitis were immunosuppressed, 6% were pregnant and 4% developed Guillain–Barré syndrome following the infection.

Conclusion: A high proportion of patients with acute CMV and EBV developed hepatitis and jaundice, most of those patients have good prognosis. Patients with CMV hepatitis were more often immunosuppressed, required hospitalization or were pregnant in comparison with patients with EBV hepatitis.     

Presence of cytomegalovirus and herpes simplex virus in middle ear fluids from children with acute otitis media.

Twenty-seven (10%) of 271 infants and children with acute otitis media (AOM) were found to be infected with cytomegalovirus (CMV) or herpes simplex virus type 1 (HSV). CMV or HSV, alone or in combination with bacteria or other viruses, was isolated from the middle ear fluid (MEF) of 10 patients. In three cases, CMV alone was isolated from the MEF, and in one case, HSV alone was isolated. One of the CMV cases involved an acute primary or reactivation of CMV infection, with CMV-bacterial otitis and conjunctivitis as major manifestations. One patient with AOM and stomatitis had purulent otitis associated with the presence of HSV in MEF, with no other bacterial or viral pathogens noted in MEF or nasal wash specimens. While most patients with CMV infection were probably asymptomatic excreters at the time of development of AOM, CMV did enter the middle ear. The presence of CMV in MEF was prolonged, and the patients continued to have clinical signs of otitis despite negative bacterial cultures. Among patients with bacterial otitis, a higher proportion of those who had CMV found only in nasal wash specimens had persistent bacteria in MEF, compared with those who were concurrently infected with other viruses (57% vs. 19%; P less than .04). This report is the first to suggest an etiologic role for CMV and HSV in AOM.     

Comparison between sporadic cytomegalovirus hepatitis and Epstein-Barr virus hepatitis in previously healthy adults

Abstract: In order to determine the factors responsible for the differentiation of cytomegalovirus (CMV) hepatitis and Epstein-Barr virus (EBV) hepatitis, the clinical features and laboratory data of both types of hepatitis were retrospectively analyzed in 20 patients with CMV and 11 patients with EBV. While most signs and symptoms of CMV and EBV hepatitis showed no significant differences, we found that cervical lymphadenopathy was more common in EBV hepatitis than in CMV hepatitis (p < 0.01). Frequency of epigastralgia was more common in CMV hepatitis than EBV hepatitis (p<0.05). The percentage of peripheral blood monocytes in the white blood cell count in CMV hepatitis was greater than in EBV hepatitis (p<0.01). Low CD4 levels and high CD8 levels made CD4/CD8 low in peripheral lymphocytes of both groups of hepatitis. Ten EBV hepatitis patients received antibiotics in the early stage of the disease in which two (25%) developed severe erythematous rashes. Four CMV hepatitis patients received antibiotics and did not develop rashes. Identification of early clinical parameters capable of differentiating CMV hepatitis from EBV hepatitis is important.     

Viral infections and phenotypic heterogeneity in Gaucher disease

Gaucher disease, the most common lysosomal storage disorder, is remarkable for its tremendous phenotypic heterogeneity even among patients with the same genotype. Beyond mutations at the 1q21 locus, there may be other genetic and environmental factors that impact on the natural course of Gaucher disease and indeed may trigger symptoms and signs. Among candidate events are viral infections such as the Epstein-Barr virus (EBV) or cytomegalovirus (CMV). The purpose of this study was to ascertain if indeed prior infection with EBV or CMV in patients homozygous for the most common mutation, N370S (1226G), is predictive of a more severe phenotype. Evidence for an EBV virus was IgG and IgM antibodies to early antigen and IgG anti-EBNA. For CMV infection, IgG and IgM antibodies were sought. This study failed to demonstrate any correlation between prior EBV or CMV infection and clinical course of Gaucher disease in patients homozygous for the N370S (1226G) mutation. The only positive finding was a higher level of anti-EBNA antibodies among patients with moderate/severe disease. In conclusion, other than a small subset of patients who showed a pattern comparable to immunosuppression, there was no association between severity of Gaucher disease and prior EBV or CMV infection.     

Primary Cytomegalovirus Infection in an Outpatient Setting—Laboratory Markers and Clinical Aspects

Abstract. Background: Occasionally, primary cytomegalovirus (CMV) infection may give rise to more or less severe clinical illness in immunocompetent adults. We retrospectively analyzed cases of acute CMV infection in medical outpatients. Patients and Methods: Over a 6-year period, we identified 22 patients with a febrile illness and hepatitis suffering from primary CMV infection. This was diagnosed on the basis of a strongly positive CMV IgM antibody test result and/or CMV IgG seroconversion. Clinical features as well as relevant laboratory results were analyzed. We also tested available samples for CMV glycoprotein B-specific antibodies and CMV IgG avidity and analyzed results of Epstein-Barr virus (EBV)-specific antibody assays. In addition, current age-specific CMV IgG seroprevalence rates were determined using 9,870 routine patient samples. Results: At presentation, all patients complained of malaise and fever higher than 38 °C, and many also complained of cephalgia. Most patients who underwent abdominal ultrasonography had an enlargement of the spleen. Most patients had a relative lymphocytosis but only three had a mild leukocytosis. C-reactive protein was only slightly elevated in 13 patients; all 22 patients had elevated levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). Half the patients reported travel to areas outside western Europe, mostly to tropical and subtropical areas, within 3 weeks before onset of illness. Primary CMV infection was confirmed by negative anti-gB antibody test results and the absence of high-avidity CMV antibodies. In contrast, despite past EBV infection demonstrated by positive anti-EBNA-1 results, 15 out of 21 patients tested for EBV markers had positive or nonspecific IgM test results. The overall CMV IgG seroprevalence rate in the routine samples was 64.4%, with marked age-dependent increases. Conclusion: CMV is a relevant differential diagnosis in feverish illnesses accompanied by hepatitis in otherwise healthy adults, about 40% of whom are CMV-naïve. Half our patients seem to have acquired their CMV infection abroad, so that a diagnosis of CMV infection needs to be taken into account in travelers, in addition to infectious illnesses more commonly considered in this context, such as dengue or hepatitis A. For diagnosis, both CMV and EBV antibody studies should be performed and the inclusion of assays able to demonstrate past infection is helpful for achieving a definite diagnosis.     

The role of viral agents in aetiopathogenesis of acute rheumatic fever

The reason why abnormal immune response exists in acute rheumatic fever is not exactly explained. The influence of co-pathogens like certain viruses were mentioned regarding the initiation of the immunological reaction in acute rheumatic fever patients by several authors since 1970. This study was designed to find the role or effect of some viral infections in the development of rheumatic fever. In this study, 47 cases with acute rheumatic fever (acute rheumatic arthritis, acute rheumatic carditis, and chorea), 20 cases with chronic rheumatic fever, 20 cases with streptococcal pharyngitis, and 20 healthy age- and gender-matched control cases were involved. Serological and molecular tests were made including hepatitis B virus, hepatitis C virus, rubella virus, herpes simplex virus (HSV group 1), and Epstein-Barr virus (EBV). HBsAg, rubella IgM and EBV IgM positivity were not seen in any of patients with rheumatic fever. Although antiHBs seropositivity was higher in the control group, it was not statistically significant (p > 0.05). There was no difference in rubella IgG, HSV IgM seropositivity, either (p > 0.05). EBV DNA was searched by the polymerase chain reaction technique; due to the latent nature of the virus, no significant difference was found between the control group and the other groups (p > 0.05). In this study, no positive correlation could be found to support the synergism theories regarding the streptoccocus infection and viral infections in the development of acute rheumatic fever. Only EBV DNA positivity was found in all acute rheumatic fever cases but not in the control group may lead to further studies with larger series of patients.