肺炎支原体感染致儿童传染性单核细胞增多综合征11例临床分析

目的了解肺炎支原体感染引起儿童传染性单核细胞增多综合征(传单综合征)的临床特点,及时做出诊断和治疗,防止误诊。方法对传单综合征的患儿采用ELISA方法检测患儿血清肺炎支原体抗体(MP-IgM),巨细胞包涵体病毒(CMV),腺病毒IgM抗体,HCV-IgM和乙肝二对半均为阴性,EB病毒(EBV),并做嗜异凝集试验,EB-DNA-PCR拷贝。结果 11例MP-IgM>1︰80呈阳性,腺病毒IgM抗体、EB病毒(EBV),HCV-IgM和乙肝二对半、巨细胞包涵体病毒(CMV)抗体阴性,应用红霉素治疗14～28d痊愈。结论 MP感染可致传单综合征,临床症状多样,应用红霉素治疗预后较好。     

对171例下呼吸道感染患儿的病原学分析

目的:掌握本地区患儿下呼吸道感染的病原体及临床特点以提高治愈率。方法:采用ELISA法做了病毒特异性IgM抗体检测,(流感病毒Flu、呼吸道合胞RSV、腺病毒Adv);肺炎支原体抗体Mp-Ab测定;血EB病毒PCR检测。结果:病毒感染已成为下呼吸道感染的主要病原微生物,年龄越小发病率越高,婴幼儿对于Flu、RSV、Adv和EB病毒普遍易感,随着年龄的增长发病率呈下降趋势;肺炎支原体感染仍以年长儿为主;对于病程较长、病情较重、临床迁延不愈者要注意EB病毒、腺病毒、肺炎支原体感染及耐药菌感染。     

48例传染性单核细胞增多症患儿EB病毒核酸定量和异型淋巴细胞的实验室临床意义

目的研究传染性单核细胞增多症（以下简称传单）患儿实验室检测中EB病毒DNA和异型淋巴细胞的辅助诊断的临床意义。方法采取实时荧光PCR技术来定量检测EB病毒DNA的含量拷贝数（〉1.0×103为阳性）和血液室异型淋巴细胞计数检测比例（〉4%为阳性）。结果在48例传单患者中,EB病毒DNA〉1.0×103（阳性）40例,EB病毒DNA〈1.0×103（阴性）8例。异型淋巴细胞〉4%（阳性）22例,异型淋巴细胞〈4%（阴性）26例。EB病毒DNA阳性率占83.3%;异型淋巴细胞阳性率占45.8%。说明实验室检测对传单患儿有较高的辅助诊断价值。结论 EB病毒DNA定量拷贝数检测有相当高的诊断价值,为临床提供传单患者的快速诊断;异型淋巴细胞检测具有45.8%阳性辅助诊断价值,虽然辅助诊断价值没有核酸检测高,但是对实验室条件要求不高,更适合不具备条件开展分子生物实验室的基层医院开展辅助诊断传单患者。     

白细胞介素-2水平对复发性特发性血小板减少性紫癜病毒感染的影响研究

目的 探讨白细胞介素-2(IL-2)水平对复发性特发性血小板减少性紫癜(idiopathic, ITP)病毒感染的影响研究。方法 选取2020年1月至2021年1月南阳市第二人民医院收治的复发性ITP患儿35例作为观察组,同时取同期接受体检的健康儿童35名作为对照组,均为其开展血巨细胞病毒、腺病毒、EB病毒、单疱病毒特异性IgM抗体检测,同时应用放射免疫法对IL-2进行检查,比较两组巨细胞病毒、腺病毒、EB病毒、单疱病毒特异性IgM抗体阳性率以及IL-2水平。结果 观察组血巨细胞病毒、腺病毒、EB病毒、单疱病毒特异性IgM抗体阳性率分别为45.71%、11.43%、34.29%、14.29%,高于对照组,IL-2水平[(0.37±0.10)μg/L]低于对照组,差异有统计学意义(P<0.05);与治疗前比较,观察组患儿治疗后血巨细胞病毒、EB病毒特异性IgM抗体阳性率明显降低,IL-2水平提高,差异有统计学意义(P<0.05)。结论 通过对复发性ITP病毒感染患儿IL-2水平进行检测,可使患儿的疾病感染与免疫状况予以反映,可为疾病的治疗提供指导。     

传染性单核细胞增多症患儿肺部损害1例报道

传染性单核细胞增多症是一种由EB 病毒感染引起的急性单核-巨噬细胞系统增生性疾病,儿童多见,病程常具有自限性。临床表现以发热、咽峡炎、淋巴结及肝脾肿大为主,其病变可涉及全身各个系统,在机体处于不同的免疫状态下,感染EB病毒会有不同的临床表现,但严重肺部损害发生的较少。此患儿有持续发热、肝脾淋巴结肿大、咽扁桃体炎及肝功能受损,血清EB病毒抗体测定IgM阳性,血清EB病毒DNA测定阳性,虽然外周血异形淋巴细胞未见明显增高,但骨髓易见异形淋巴细胞,故传染性单核细胞增多症诊断成立。同时此患儿肺部影像学表现为双肺渗出病灶和间质性肺部病变,考虑为EB病毒感染直接侵袭或其引起的变态反应造成的肺损害。我们遇及1例,现报告如下。     

小儿特发性血小板减少性紫癜与多种病原体感染关系的初步探讨

目的探讨小儿特发性血小板减少性紫癜与病原体感染的关系。方法采用酶联免疫吸附试验,对诊断明确的84例ITP患儿分别进行人类巨细胞病毒、风疹病毒、单疱病毒Ⅱ、EB病毒特异性IgM的检测和34例ITP患儿进行乙肝抗原、抗体的检测;采用被动凝集法检测18例ITP患儿的支原体抗体;采用金标法检测33例ITP患儿的幽门螺旋杆菌抗体。结果巨细胞病毒抗体、风疹病毒抗体、单疱病毒Ⅱ抗体、EB病毒抗体、乙肝抗原、抗体、支原体抗体、HP抗体的检测阳性率分别为14%（12/84）、11%（9/84）、11%（9/84）、26%（9/34）、6%（5/77）、22%（4/18）、48%（16/33）。结论小儿特发性血小板减少性紫癜的发病可能与多种病原体感染有关。     

血象异型淋巴细胞患者416例抗HCMV-IgM及抗EBV-IgM的检测

目的　探讨血象中异型淋巴细胞所占百分比及形态的改变与巨细胞病毒 (HCMV)、EBV感染的关系。方法　选择经三次涂片镜检及过氧化酶染色确认有异型淋巴细胞的患者 4 16例 ,采用 EL ISA法进行抗 HCMV- Ig M及抗 EBV- Ig M的血清学检测。结果　血象异型淋巴细胞所占百分比及形态种类分别与抗 EBV- Ig M阳性例数比较 ,差异有非常显著性 (χ2值分别为133.4 1、130 .4 1,P值均小于 0 .0 1) ,并随异型淋巴细胞百分比及形态种类的增加 ,抗 EBV- Ig M阳性率在明显增加 ,而抗 HCMV-Ig M阳性率却略有下降趋势 ,但不明显。结论　血象中异型淋巴细胞所占百分比及形态种类与 EBV感染密切相关 ,与 HCMV感染关系不显著     

MP—DNA与IgM在儿童肺炎支原体感染病程中动态检测的意义

目的利用FQ—PCR技术和DIGFA试验对儿童呼吸道感染患者分别检测MP—DNA和MP—IgM,观察分析其在不同病程中的变化规律,探讨FQ—PCR检测MP—DNA和DIGFA检测MP—IgM用于儿童肺炎支原体感染中的诊断价值。方法入选患儿留取呼吸道分泌物和血清标本,采用FQ—PCR法检测呼吸道分泌物MP—DNA,用胶体金DIGFA法检测患儿血清MP—IgM。入院患儿被检出单一MP—DNA阳性或MP—IgM阳性或两者双阳性者均确诊为MP感染病例,对确诊的病例观察分析病程不同时期MP—DNA和MP—IgM阳性率消长的动态及其变化规律。结果根据患儿MP—DNA和MP—IgM检出情况,被确诊为肺炎支原体感染的患儿共56例。对这56例患儿进行病程追踪检查分析显示：在病程初期阶段,MP—DNA检出阳性率为82．14％（46／56）,MP—IgM阳性率为35．7l％（20／56）;两种检测阳性率比较,MP—DNA阳性率显著高于MP—IgM阳性率,两者差异有显著性（P〈0．05）。在病程中期,MP—DNA检出阳性率下降为64．29％（36／56）,MP—IgM阳性率上升为80．36％（45／56）;到恢复期,MP—DNA阳性检出率继续下降为1．79％（1／56）,而MP—IgM阳性率在中期升高后又返降为23．21％（13／56）。结论在肺炎支原体感染患儿不同病程中,存在MP—DNA随病程延长逐渐降低而MP—IgM随病程延长逐渐增高至中期又返折下降的消长规律。FQ—PCR检测MP—DNA对MP感染患儿发病初期就诊者确诊价值较高,而DIGFA检测MP—IgM对发病时间已较长而又初次就诊者诊断意义较大。两种方法联合应用既可在诊断上优势互补,又可用于患儿病情转归预测评估。     

类风湿关节炎与EB病毒、巨细胞病毒的相关性分析

目的探讨类风湿关节炎与EB病毒、巨细胞病毒感染的相关联系。方法选取临床已确诊的82例类风湿关节炎患者(RA组),与80例体检健康者作为对照(对照组),检测两组人群血清中EB病毒抗体、巨细胞病毒抗体,样本血清中游离的EB病毒DNA、巨细胞病毒DNA含量。结果 82例类风湿关节炎患者中VCA-IgA、CMV-IgM的阳性率分别为91.5%、45.1%,与之相应的对照组阳性率分别为4.9%、3.8%;然而在RA组患者血清中检测到的EB病毒DNA、巨细胞病毒DNA阳性率分别为8.5%、6.1%,与之相应的对照组阳性率分别为4.9%、3.8%。结论 EB病毒、巨细胞病毒与类风湿关节炎相关,但其感染与类风湿关节炎的发病无直接因果关系。     

婴幼儿哮喘与感染因素的关系

探讨呼吸道病毒及肺炎支原体感染与婴幼儿哮喘的关系。方法 对哮喘患儿进行呼吸道病毒及肺炎支原体特异性抗体IgM快速检测。结果 120例哮喘患儿检测出呼吸道病毒阳性63例,其中呼吸道合胞病毒42例,副流杆病毒13例。流杆病毒10例;肺炎支原体26例。结论 婴幼儿哮喘与感染因素关系密切,应引起高度关注。     

Frequent double infection with Epstein-Barr virus and human herpesvirus-6 in patients with acute infectious mononucleosis.

Clinical infectious mononucleosis (IM) represents a benign self-limited form of lymphoproliferative disease which is usually caused by infection with Epstein-Barr virus (EBV). Microscopic characteristics of this lymphoproliferative disorder, however, are not ultimately specific for EBV infection, but can also be seen in infections with other lymphotropic viruses, especially of the herpesvirus family. Human herpesvirus-6 (HHV-6) infection can apparently be associated with a number of diseases also seen in EBV infection. Also, postinfectious chronic fatigue syndrome (PICFS) which may follow IM is in more than 60% of the cases accompanied by persistent active HHV-6 infection. We thus screened serologically 215 cases of acute IM for evidence for infection with EBV, HHV-6 and CMN. Patients were tentatively grouped into those having primary infection or reactivated (probably non-primary) infections. Cases were followed for two years to monitor changes in titers. Of all 215 cases, 211 (98.1%) were positive for EBV, 137 (63.7%) for primary infections, 21 (9.8%) for reactivated infection, and 53 (24.6%) for latent EBV. Thirty-three (15.3%) cases had primary HHV-6 infection, 63 (29.3%) active or reactivated HHV-6 infection, and 71 (33.9%) latent HHV-6. Double active EBV and HHV-6 infection, including primary and reactivated infections, amounted to 89 (39.5%) cases. Cytomegalovirus (CMV) antibody titers were found in 81 (37%) cases, 48 (22.3%) of which indicated latent infection and 33 (15.3%) active infection. Only two cases had evidence of active CMV infection alone, 1 cases of active CMV and HHV-6 infection. Serologic titers in 12 (5.6%) cases indicated combined active infection with CMV, EBV and HHV-6.(ABSTRACT TRUNCATED AT 250 WORDS)     

Isolation of human herpesvirus-6 (HHV-6) from patients with collagen vascular diseases.

The prevalence and activity of human herpesvirus-6 in patients with collagen vascular diseases (CVD) was determined. One hundred and fifty patients with CVD (56 with systemic lupus erythematosus-SLE, 92 with rheumatoid arthritis-RA, 1 with Sharp's syndrome and 1 with atypical polyclonal lymphoproliferation-APL and rheumatoid features) were screened serologically (IFA and ELISA) for antibodies against human herpesvirus-6 (HHV-6), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Virus isolation was attempted from peripheral blood lymphocytes (PBL) of 25 persons with various disorders. PBL were grown in tissue culture and tested with standard HHV-6-positive antisera for viral antigen expression. Supernatants of the patient's lymphocyte cultures were used to infect HSB2 cells, and virus infection in these cells was proven by IFA, in situ hybridization and by electron microscopy. Fifty-five percent of the SLE patients, 6.5% of the RA patients and both patients with Sharp's syndrome or with APL had antibody titers indicative of active HHV-6 infection. Virus cultures were positive in 9 of the 25 attempts with establishment of stable virus lines. These patients were 5 with SLE or UCVD, and one each with RA, CFS, APL as well as one healthy control. Reactivated and chronic active HHV-6 infections are frequent in SLE like EBV in RA. The role of these viruses in the pathogenesis of the diseases or in their reactivation still needs further investigation.     

Aspirin induces lytic cytotoxicity in Epstein-Barr virus-positive cells

Epstein-Barr virus (EBV) infection in tumor cells is generally restricted to the latent forms of viral infection. Switching the latent form of viral infection into the lytic form may induce tumor cell death. High levels of nuclear factor (NF)-kappaB can inhibit EBV lytic replication, and aspirin has the ability to inhibit NF-kappaB activity. The aims of the current study were to determine the effects of aspirin on inducing EBV lytic infection, and thus to reveal the possibility of targeting EBV-positive cancer cells by aspirin. Our results showed that aspirin depleted NF-kappaB (p65) in the nucleus and reactivated EBV into lytic replication. Cells exhibited decreased viability in a dose- and time-dependent manner when incubated with aspirin. When ganciclovir was used in combination with aspirin to treat EBV-positive B95.8 cells and Raji cells, the cytotoxic effect of aspirin was amplified. We demonstrated that aspirin reduced the viability of EBV-positive B lymphocytes due to its ability to induce EBV lytic replication.     

婴儿型胆总管囊肿形成的病因分析

目的:探讨婴儿型胆总管囊肿形成的病因及炎症介质在其发生中的作用机制。方法:回顾性分析我院2000年—2006年收治的1岁以下的胆总管囊肿29例,采用免疫组化技术分别检测CD4、CD8、CMV、EBV在胆总管囊肿上皮细胞中的表达情况,并结合术中造影检查分析。结果:术中行胆道造影17例,其中显示胆胰管结合部囊肿11例,6例(54.5%)存在胆胰管合流异常。在囊肿壁上可以检测到CD4、CD8的表达,其中CD4表达11例(37.9%),CD8表达22例(75.9%)。在囊肿壁中可以检测到4例(13.8%)CMV表达,EBV表达为12例(41.4%)。结论:胰液逆流入胆道系统可以造成胆道上皮细胞破坏,病毒感染可以引起胆道上皮的炎症反应,引起CD8的高表达,胆道上皮破坏,脱落上皮形成蛋白栓阻塞胆总管远端造成胆总管囊肿的形成。     

EB病毒感染患儿的免疫功能研究

目的：了解EB病毒（EBV）感染疾病类型与患儿免疫功能的关系。方法：选取2010年12月至2015年12月我院儿科收治的EBV感染儿童80例（EBV感染组）以及同期在我院体检的正常儿童38例（对照组）,采用散射比浊法检测血清免疫球蛋白和补体,采用流式细胞仪检测外周血淋巴细胞分化抗原T淋巴细胞（CD3+）、辅助性T细胞（CD4+）、细胞毒性T细胞（CD8+）、B淋巴细胞（CD19+）及NK细胞（CD56+）阳性率以及CD4+/CD8+。结果：两组IgA水平比较差异无统计学意义（P>0.05）。EBV感染组IgM、IgG、IgE、C3和C4表达均升高,与对照组比较差异均有统计学意义（P<0.05）。EBV感染组CD3+、CD8+、CD19+、CD56+计数高于对照组,CD4+、CD4+/CD8+低于对照组,差异有统计学意义（P<0.05）。结论：EBV感染疾病与患儿的免疫功能相关,与CD4+ T细胞和B细胞计数减少有明显的关系,可以采用外周血淋巴细胞分化抗原测定方法检测EBV感染后的淋巴细胞亚群变化。     

Inhibition of host kinase activity altered by the LMP2A signalosome-a therapeutic target for Epstein-Barr virus latency and associated disease

Epstein-Barr virus (EBV) is a human herpesvirus that establishes a lifelong latent infection in the majority of the human population. The virus resides in a latent state in B lymphocytes and is associated with a variety of cancers in the human host. In normal individuals, latent infection with EBV typically poses no health risk, but upon immunosuppression, either following organ transplantation or HIV infection, malignancies and lymphoproliferative diseases can result. Latent membrane protein 2A (LMP2A) is a virally encoded membrane protein that is expressed in EBV latent infection and in most of the tumors associated with EBV infection. Previous studies have indicated that LMP2A expression alters the activity of the Src family protein tyrosine kinases, the Syk protein tyrosine kinase, the Btk protein tyrosine kinase, and phosphatidylinositol 3-kinase (PI3-kinase). In this study, inhibitors of each of these kinases were tested using an in vitro system dependent on LMP2A expression for B cell colony formation in IL-7 containing methylcellulose media. Of the inhibitors tested, only piceatannol, a Syk tyrosine kinase inhibitor, demonstrated a specific effect on LMP2A expressing cells and not control cells. These studies provide a basis for targeting LMP2A function in EBV latency and may allow for the identification of novel therapeutics for the treatment or eradication of EBV latent infections and associated proliferative disorders.     

New strategies and patent therapeutics in EBV-associated diseases

Epstein-Barr virus (EBV) is a virus present all throughout the world that causes infectious mononucleosis (IM) and is highly associated with certain malignancies. This study is a review of current knowledge concerning the pathogenic mechanisms of EBV in tumor and auto-immune diseases and the different new strategies to treat EBV associated pathologies. Phenomena surrounding the proliferation and immortalization of B lymphocytes, the mechanisms of immune escape and the role of CD8+ and CD4+ T cells in the infection by EBV are explained. An analysis is made of the role of EBV proteins during the biological events that take place in primary infection, persistent chronic infection together with an update of the approaches of novel patented therapeutics. Currently there is no vaccine protecting against EBV-associated disorders and no treatment that may inhibit or eliminate their progression. Thus, it is crucial to obtain additional information on the function and importance of genes that play a role on the development of those diseases with which it is associated, as well as on the humoral and cellular immune processes involved in them.     

The extract of Chrysanthemum indicum Linne inhibits EBV LMP1-induced NF-κB activation and the viability of EBV-transformed lymphoblastoid cell lines

Epstein-Barr virus (EBV) latent infection transforms B lymphocytes into proliferating lymphoblastoid cell lines (LCLs). EBV latent infection membrane protein 1 (LMP1) is required for EBV-mediated B lymphocyte transformation, and LMP1-induced NF-κB activation is essential for LCL survival. To identify a novel inhibitor candidate for LMP1-induced NF-κB activation, crude ethanol extracts of medicinal plants were screened for the potential NF-κB inhibitory activity. Seventy percent ethanol extract of Chrysanthemum indicum Linne extract (CIE) strongly reduced LMP1-induced NF-κB activation. In addition, CIE inhibited LMP1-induced IKKα or IKKβ activation. Interestingly, CIE treatment rapidly reduced LCL viability without exhibiting any adverse effects on the viability of human foreskin fibroblasts (HFF), EBV negative Burkitt’s lymphoma cell lines (BL41) or HeLa cells.     

Infectious mononucleosis-like syndromes in febrile travelers returning from the tropics

Infectious mononucleosis (IM), resulting from Epstein-Barr virus (EBV) infection, and IM-like syndromes, mainly due to cytomegalovirus (CMV), Toxoplasma gondii, or human immunodeficiency virus (HIV), have been occasionally reported in travelers returning from the tropics. Our objective was to investigate the prevalence, outcome, and diagnostic predictors of these syndromes in febrile travelers. Between April 2000 and March 2005, all febrile travelers and migrants presenting at our referral centers within 12 months after a tropical stay were prospectively included. We identified all patients serologically diagnosed with IM or IM-like syndrome and compared them with the rest of the cohort. During the 5-year period, 72/1,842 patients (4%) were diagnosed with an IM-like syndrome, including 36 CMV, 16 T gondii, 15 EBV, and 5 HIV primary infections. All patients were western travelers or expatriates. Mean delay before consultation was 2 weeks. Most patients had consulted other practitioners and/or received presumptive treatment. A minority of patients presented with IM clinical features. Lymphocytosis > or =40% of the white blood cells (WBC) and reactive/atypical lymphocyte morphology were observed in 60 and 30% of the patients. The four diseases were indistinguishable. Protracted fever and asthenia were common but complications rarely occurred. IM-like syndromes were independently associated with fever >7 days, lymphadenopathy, elevated liver enzymes, and lymphocytosis > or =40% of WBC. Diagnostic probability increased to >20% if at least three of these predictors were present. Diagnosis of IM and IM-like syndrome is not uncommon in febrile travelers, with a higher proportion of primary CMV, T gondii, and HIV infections than in nonimported series. Consequently, classic IM clinical and laboratory features are often lacking. All four pathogens should be systematically considered because early diagnosis should avoid unnecessary investigations and treatment and allow early intervention in case of primary HIV infection.     

婴儿特发性血小板减少性紫癜134例临床分析

目的探讨婴儿特发性血小板减少性紫癜（ITP）的临床特点。方法对我院收治的134例ITP婴儿的临床资料进行分析。结果134例ITP婴儿以男婴为主,男：女=3．96：1;年龄以6个月以下多见（74．6％）。临床多表现为发病急,出血症状轻,但血小板数量重度减少多见（69．4％）。发病前有感染史57例（42．5％）。血小板抗体检查阳性率52．7％。巨细胞病毒的感染率（51．7％）明显高于EB病毒和肺炎支原体的感染率。肾上腺皮质激素联合人免疫球蛋白治疗93例,有效率达88．2％。结论婴儿ITP大多发病急,血小板数量重度减少,多数有病毒感染,肾上腺皮质激素联用人免疫球蛋白治疗效果明显。