特异性HSV抗体检测在生殖器疱疹诊断中的重要性分析

目的探讨生殖器疱疹(GH)患者HSV-Ⅰ、Ⅱ型IgG、IgM抗体检测的临床意义,评价其对GH诊断的重要性和实用性。方法应用酶联免疫吸附试验(ELISA)对生殖器部位有皮损者检测HSV的抗原及IgG、IgM抗体。结果男性患者有生殖器皮损者215例,HSV抗原阳性率45.58%(98/215),抗体阳性率98.14%(211/215)。女性患者有生殖器皮损者193例,HSV抗原阳性率为38.86%(75/193),抗体阳性率99.48%(192/193)。生殖器有皮损者HSV抗体阳性率均明显高于抗原阳性率。男女IgMⅠ型阳性率42.37%(100/236),提示HSV-Ⅰ所致GH明显增加。结论对生殖器皮损时间短的进行HSV抗原检测,及对生殖器皮损时间长或反复者进行抗体检测是判断HSV感染的检测方法。IgM抗体检测对有生殖器皮损但抗原检测阴性,及对无皮损排毒期具有辅助诊断意义。     

寻常型银屑病与单纯疱疹病毒1型相关性的研究

目的 探讨寻常型银屑病与单纯疱疹病毒1型(HSV-1)的可能相关性。方法 应用PCR法检测患者皮损、外周血单一核细胞(PBMCs)和咽拭子中HSV-1DNA,ELISA法检测患者血清中抗HSV-1的IgM、IgG抗体,并与正常人对照做比较。结果 患者皮损、PBMCs和咽拭子中HSV-1DNA检出率分别为37.5%、18.6%和18.8%,血清中抗HSV-1的IgM、IgG抗体检出率分别为37.2%和53.5%.经χ²检验,患者皮损、PBMCs中HSV-1DNA和血清中IgM抗体检出率显着高于正常人对照,点滴状患者的皮损、PBMCs和咽拭子中HSV-1DNA以及血清中抗HSV-1IgM抗体检出率显着高于斑块状患者。结论 寻常型银屑病尤其是皮损呈点滴状者与HSV-1显着相关,患者可能存在HSV-1的近期感染。     

生殖器疱疹患者病毒DNA的定量测定研究

目的 对生殖器疱疹病毒(HSV)患者病毒DNA进行定量测定.方法 以标准的HSV质粒作为标准,用聚合酶链反应(PCR)和酶联免疫吸附法(ELISA),定量测定HSVDNA.结果 100例生殖器疱疹患者中93例HSV测定阳性,7例阴性.在93例阳性者中有58例为HSV-2(占62.4%),35例为HSV-1(占37.6%).93例阳性者定量测定结果,250μL标本混悬液中DNA质粒数为115～1.1×10⁵个,平均7.1×10⁴个;58例HSV-2阳性者,250μL标本悬液DNA质粒数为136～1.1×10⁵个,平均7.6×10⁴个;35例HSV-1阳性者DNA质粒数为115～9.4×10⁴个,平均6.3×10⁴个.分别随机取HSV-2和HSV-1阳性患者各8例已淬取和纯化的DNA混悬液10μL,定量测定结果显示:HSV-2患者最高为2.7×10⁴个DNA质粒数,最低35个,平均1.8×10⁴个.HSV-1最高2.5×10⁴个,最低29个,平均1.6×10⁴个.结论 所用几种检测法中ELISA定量总阳性率为93%,与DNA印迹法阳性率相同.诊断PCR阳性率为91%,HSV分型PCR阳性率为88%.     

126例生殖器疱疹的临床和病毒学检查的分析

为了探讨生殖器疱疹的临床和病毒学特征,对126例生殖器疱疹患者的临床资料和病毒检测与分型结果作了分析。结果：皮损为典型的集簇性水疱、脓疱、水溃疡及结痂者占71.4%(90/126),为裂隙、非特异性红斑等不典型损害者占28.6%(36/126)。HSV-2感染占91.3%（115/126）,HSV-1感染占7.1%(9/126),混合感染占1.6%（2/126）;男性初发病例中HSV-1感染占17.2%(5/29)。结果表明生殖器疱疹的临床表现多种多样;我国的生殖器疱疹主要由HSV-2引起,但男性初发病例中HSV-1感染较常见。     

多聚酶链反应与酶标法检测生殖器疱疹病毒感染的比较研究

为探讨多聚酶链反应(PCR)与酶标法检测生殖器疱疹病毒感染的诊断价值。采用PCR和酶标法检测生殖器疱疹病毒感染者45例，并用PCR作病毒分型。结果：临床确诊的45例患者中，酶标法检测抗原HSV阳性27例，阳性率60．0%(27／45)；PCR检测HSV阳性42例，阳性率93．33％(42／45)．其中HSV-11例，占2．38%；HSV-241例，占97．62％。对于有皮损的患者，PCR法较酶标法有较高的阳性检出率。由此可见：(1)HSV-2是主要的致病因素；(2)在对病毒分型及有皮损患者的诊断上，PCR法明显优于酶标法。     

单纯疱疹病毒2型DNA疫苗对豚鼠抗病毒感染的研究

目的 探讨单纯疱疹病毒2型DNA疫苗的抗病毒感染效应.方法 重组DNA疫苗pcgD免疫雌性豚鼠,采用血清中和实验检测抗体,单纯疱疹病毒2型(HSV-2)sav株接种豚鼠,观察DNA疫苗保护动物抵抗HSV-2病毒感染的能力.结果 pc-gD免疫豚鼠产生的中和抗体效价远远高于对照组和生理盐水组,感染病毒后,表现出初发感染推迟,复发感染的严重程度下降.结论 DNA疫苗能有效地保护动物免受HSV-2病毒的攻击,延缓初发感染,减少复发感染.     

对ELISA检测生殖器疱疹患者HSV及其临床应用的评价

目的评价酶联免疫吸附试验(ELISA)检测生殖器疱疹病毒的临床应用价值。方法采用ELISA和分型聚合酶链反应(分型PCR)检测生殖器标本中的单纯疱疹病毒(HSV),两种试验结果不符合者采用不分型PCR检测。结果164例受检者中,ELISA法HSV阳性96例(58.5%),其中具典型皮损者阳性84例(80.8%,84/104),非典型皮损阳性12例(20.0%,12/60);分型PCRHSV阳性98例(59.8%),其中典型皮损者HSV阳性86例(82.7%,86/104),非典型皮损者阳性12例(20.0%,12/60)。HSV1感染者占生殖器疱疹的5.1%,HSV2感染占88.7%,HSV1和HSV2混合感染者占6.1%。ELISA的敏感性和特异性分别为96.7%和94.0%。结论ELISA检测HSV感染,其敏感性高、特异性强,方便、快速,尤其适合大批量样本的检测。     

性病与HIV感染者中HSV2、HBsAg和HCV的检测

目的 比较性病患者和HIV感染者血清中单纯疱疹病毒(HSV)、乙型肝炎病毒(HBV)及丙型肝炎病毒(HCV)的感染情况,为采取综合性的防治方案提供参考依据。方法 对经蛋白印迹法确证的HIV(+)/AIDS库存血清标本和梅毒、淋病及衣原体感染患者血清标本,用ELISA方法同时检测HSV2-IgG、HSV2-IgM、HBsAg和HCV-IgG4项指标,并对2组标本的检测结果进行比较。结果 在76份性病样品中,检出HSV2-IgG24例占31.58%;HSV2-IgM1例占1.32%;HBsAg8例占10.53%和HCV1例占1.32%。在另外分组的14例HIV阳性标本中,检出HSV2-IgG7例占50.00%;HSV2-IgM5例占35.71%;HBsAg8例占57.14%和HCV3例占21.43%。在总共90份标本中,有6例标本同时检测到HSV和HBV;2例标本同时检出HSV-IgM和HBV;2例同时检出上述4项指标。统计分析发现,HIV(+)/AIDS组中HSV、HBV和HCV的检出率明显高于性病组(P<0.05)。结论 HIV(+)/AIDS患者中合并HSV、HBV及HCV的感染率明显高于其他性病患者。     

小檗碱衍生物HB-13体外抗单纯疱疹病毒的研究

目的 探讨小檗碱衍生物HB-13及其前体小檗碱体外抗HSV-1和HSV-2的活性.方法 利用Vero细胞体外培养模型,以阿昔洛韦(ACV)为对照药,通过观察细胞病变效应,检测HB-13和小檗碱的细胞毒性、HSV-1和HSV-2液的病毒滴度及药物抑制病毒致细胞病变效应.结果 HB-13、小檗碱和阿昔洛韦的半数中毒质量浓度(TC50)分别为31.99,380和>800 μg/mL;对HSV-1的半数抑制质量浓度(IC₅₀)分别为1.328,>100和0.443 μg/mL,治疗指数分别为24.09,<3.80和>1805.87;对HSV-2的IC₅₀分别为1.344,>100和0.679μg/mL;治疗指数分别为23.80,<3.80和>1178.20.结论 HB-13具有明显的抗HSV作用,而小檗碱无实用抗HSV活性.     

四种商品化单纯疱疹病毒2型特异性IgG抗体检测试剂盒的比较

目的 比较4种商品化单纯疱疹病毒(HSV2)型特异IgG抗体检测试剂盒。方法 125份血清分别取自生殖器溃疡患者及无性传播疾病史的正常人。选择4种商品化HSV2型特异性IgG抗体检测试剂盒。ELISA方法严格按照试剂盒说明进行。结果 以蛋白印迹方法的结果为金标准,国产1、国产2、进口1和进口2共4种试剂盒敏感性和特异性分别为13.1%和98.4%,7.5%和100%,100%和11.1%,87.7%和96.7%;国产1、进口1和进口2三个试剂盒的ROC曲线下面积分别为0.885(0.822～0.948),0.852(0.747～0.902),0.947(0.950～0.998)。结论 进口2试剂盒结果与蛋白印迹结果的一致性最好,而其它3种试剂盒则与蛋白印迹结果的一致性很差。本实验结果表明在选择这类产品之前有必要重新评估其可靠性。     

彩色乳胶免疫层析法检测单纯疱疹病毒1,2型抗原临床应用分析

目的探讨彩色乳胶免疫层析法检测单纯疱疹病毒(HSV)1和2型抗原的临床应用价值。方法采用彩色乳胶颗粒免疫层析法检测各种水疱、溃疡和其他皮损中的HSV-1和2型抗原,同时用实时荧光定量PCR法进行对照。结果免疫层析法可检出≥1×106DNA拷贝/mL的HSV-1型混悬液和≥5×105DNA拷贝/mL的HSV-2型混悬液。132例标本中,免疫层析法检出HSV阳性43例,PCR检出HSV阳性50例。以PCR法为金标准,免疫层析法的灵敏度、特异度、阳性预测值和阴性预测值分别为84.00%,98.78%,97.67%和91.01%。结论免疫层析法检测HSV敏感性和特异性高,具有方便、快速和经济的特点,适于有症状患者的及时检测,对疱疹感染早期诊断和及时治疗有重要作用。     

用聚合酶链反应检测多形红斑皮损中单纯疱疹病毒的DNA

用聚合酶链反应检测２３例多形红斑石蜡组织切块中ＨＳＶ－ＤＮＡ，１６例为阳性（６９．５６％），其中ＨＳＶ－Ⅰ型１３例（８１．２５％），ＨＳＶ－Ⅱ型３例（１８．７５％）。对照组为银屑病３例，大疱性类天疱疮５例，扁平苔藓３例均为阴性。对于探讨ＨＳＶ在多形红斑发病机理中的作用有重要意义。     

Herpes folliculitis: clinical, histopathological, and molecular pathologic observations

BACKGROUND: Herpes folliculitis is a rare manifestation of herpes virus infection and it is often misdiagnosed. Diagnostic criteria are not well established, only 24 patients being reported in the literature. Recently it has been suggested that herpetic folliculitis is more common in infections with varicella zoster (VZV) than in those with herpes simplex viruses (HSV-1 and -2). OBJECTIVES: To refine diagnostic criteria for folliculitis caused by VZV, HSV-1 and HSV-2, and to study whether follicular involvement enables morphological differentiation between VZV and HSV infections. PATIENTS AND METHODS: Twenty-one patients with herpetic infection of follicular epithelium were assessed clinically and histopathologically. Polymerase chain reaction (PCR) studies for specific DNA of herpes viruses were performed on paraffin-embedded biopsy specimens. RESULTS: In 17 of our cases PCR was positive for VZV, four were positive for HSV-1, none for HSV-2. The clinical presentation of herpes folliculitis often lacked vesicles or pustules (14/21). Histopathological features were often devoid of ballooning (12/21), multinucleated giant cells (12/21) and keratinocytes with steel grey nuclei (15/21). The most consistent findings were lymphocytic folliculitis and perifolliculitis (20/21) and necrotic keratinocytes in follicular epithelium (12/21). In zoster, but not in varicella eruption or HSV infections, follicular involvement was unaccompanied by marked changes in the epidermal surface. CONCLUSIONS: In biopsy specimens taken from herpes virus infections, involvement of follicular units is more commonly encountered in VZV infections compared with HSV infections. Early in the course, herpes folliculitis presents as lymphocytic folliculitis devoid of epithelial changes considered to be diagnostic of herpes virus infections. Exclusive involvement of follicles is rather typical of zoster.     

女性原发性生殖器疱疹中HSV-Ⅱ的检测及意义

目的探讨单纯疱疹病毒Ⅱ型(HSV-Ⅱ)与女性原发性生殖器疱疹(GH)的相关性及意义。方法应用酶联免疫吸附法(ELISA)分别检测患者血清中HSV-Ⅱ抗体以及分泌物中的HSV-Ⅱ抗原。结果HSV-Ⅱ中IgG均阴性的138例女性生殖器疱疹患者中HSV-Ⅱ抗原阳性78例(56.52%);HSV-Ⅱ中IgM抗体阳性130例(94.20%),抗体阳性率明显高于抗原阳性率(P<0.01)。典型病例组抗原阳性65例(87.84%),IgM抗体阳性66例(89.19%);不典型病例组抗原阳性13例(20.31%),IgM抗体阳性64例(100.00%)。结论对于皮损时间短,症状典型者可检测HSV-Ⅱ抗原;皮损时间长,或反复者可检测HSV-Ⅱ抗体,可以有效提高HSV感染的临床诊断率。     

单纯疱疹病毒2型临床分离株体外对阿昔洛韦和伐昔洛韦的敏感性测定

目的 测定南京地区收集的15株单纯疱疹病毒2型(HSV-2)对阿昔洛韦和伐昔洛韦的敏感性,初步建立空斑法提取阿昔洛韦耐药株.方法 Vero细胞培养法分离扩增出临床毒株,直接免疫荧光法分型,并用MTT法测定15株2型毒株对阿昔洛韦、伐昔洛韦的敏感性.体外阿昔洛韦诱导,空斑纯化HSV耐药株.结果 15株临床株对阿昔洛韦和伐昔洛韦的半数病毒抑制质量浓度(IC₅₀)分别为0.0215～0.2799μg/mL(平均0.0766μg/mL),0.0549～0.4575μg/mL(平均0.1605μg/mL).生殖器疱疹初发组与复发组、用药组与未用药组对2种药物的敏感性采用Wilcoxon秩和检验,P值均>0.05,差异无统计学意义.从15株HSV-2临床株中未提取到耐药空斑;从HSV-1 Sam实验室标准株提取到一个耐药空斑,MTT法测定阿昔洛韦IC₅₀为13.36μg/mL;从HSV-2 333标准株中提取到9个耐药空斑,扩增后MTT法测定其对阿昔洛韦的IC₅₀为1.04～5.08 μg/mL.结论 目前在南京地区收集的HSV-2型毒株对阿昔洛韦和伐昔洛韦敏感性较高,尚未发现耐药株.体外药物诱导、空斑纯化能较快提取到HSV耐药株.     

Successful treatment of an aciclovir-resistant herpes simplex type 2 infection with cidofovir in an AIDS patient

Management of the increasing frequency of aciclovir-resistant herpes simplex virus (HSV) infections among immunocompromised human immunodeficiency virus-infected people demands additional treatment options. We report the case of a 38-year-old patient with acquired immune deficiency syndrome who suffered from a perianal butterfly ulcer, which was HSV-2 positive by polymerase chain reaction (PCR) analysis. The ulcer appeared during treatment of a cytomegalovirus (CMV) pneumonitis with ganciclovir. Despite additional valaciclovir therapy the lesion gradually progressed in size. Investigations including histology, PCR analysis and in situ hybridization of a biopsy from the growing ulcer margin confirmed the presence of HSV-2 infection. Importantly, HSV isolates from this specimen were resistant to aciclovir. Based on a report about the successful treatment of aciclovir-resistant HSV infection with cidofovir, our patient received this drug intravenously at a dose of 5 mg kg-1 body weight once weekly for a total of 3 weeks. Concomitant oral probenecid and prehydration were administered to minimize nephrotoxicity. Within 30 days of treatment the ulcer had almost (> 95%) completely healed. We conclude that cidofovir is a potent antiviral drug with a potential usefulness in the treatment of aciclovir-resistant HSV-2 infection. It deserves further investigation in clinical trials.     

National survey of diagnostic services for genital herpes

OBJECTIVE: To investigate the provision of diagnostic services for genital herpes simplex virus (HSV) infection in the United Kingdom. METHODS: National survey of laboratories providing diagnostic services for genital herpes. RESULTS: Completed questionnaires were returned from 25/32 (78%) laboratories participating in the Clinical Virology Network, including seven in London, 12 in the rest of England, one in Wales, four in Scotland, and one in Northern Ireland. Virus culture was the diagnostic method of choice in 20/25 (80%) laboratories; 5/25 (20%) routinely used HSV DNA detection by polymerase chain reaction (PCR). HSV PCR for DNA detection in cerebrospinal fluid (CSF) was available in 17/25 (68%) laboratories. Typing of isolates (HSV-1 or HSV-2) was performed routinely in 22/25 (88%) laboratories. Only 2/25 (8%) laboratories offered HSV type specific serology, although an additional 12/25 (48%) referred requests elsewhere. Consistent with this finding, the number of HSV type specific antibody tests referred to the Health Protection Agency increased by nearly fivefold between 1997 and 2003. CONCLUSIONS: Virus culture remains the preferred diagnostic method for genital herpes, despite evidence indicating that its sensitivity is suboptimal compared to PCR. As HSV PCR is widely available for testing of CSF, it is recommended that clinicians and virologists discuss ways to implement PCR testing of genital swabs, thus enabling greater diagnostic accuracy. A call is made for studies to assess the use of HSV type specific serology in genitourinary medicine (GUM) settings, now that rapid and validated assays have become available and guidelines have been issues to provide recommendations on their use.     

The heterogeneous clinical spectrum of genital herpes

BACKGROUND AND OBJECTIVE: Most data of genital herpes have been collected in STD clinics in the USA where unrecognized forms accounted for 80% of HSV-2 infections. Our aim was to study the clinical features in an outpatient clinic of dermatology. METHODS: The charts of 170 patients, previously monitored prospectively for a HIV prevalence study, with culture-confirmed genital herpes or herpetic infection with HSV-2 at any other site presenting between 1995 and 1999 were analyzed. RESULTS: 111 (65%) men and 59 (35%) women were identified with a mean age of 44 years. Only 49% had a typical cluster of genital lesions. Eighty-six (51%) presented with either lesions at extragenital sites [mostly the buttocks 33/170 (19%), thigh 10/170 (6%), anal region 9/170 (5%) and fingers 8/170 (5%)] or showed morphologically atypical forms of isolated genital lesions [single ulcer 16/170 (9%), erosion 6/170 (4%), crust 3/170 (2%) and fissure, edema or erythema each 1/170 (1%)]. Women significantly presented more often with extragenital infections of HSV-2 [36/59 (61%)] than men [18/111 (16%)]. CONCLUSIONS: More than half of the patients with genital herpes of a mainly immunocompetent population presented with atypical manifestations. The underdiagnosis of genital herpes seems largely due to misinterpretation of atypical genital and extragenital lesions.