First report of human astrovirus MLB2 in Brazil detected in feces of children with acute gastroenteritis living in the state of Roraima,Northern Brazil

Human astrovirus (HAstV) 1–8 and highly divergent HAstVMLB1−3 genotypes have been detected in children both with and without acute gastroenteritis (AGE). One hundred and seventy fecal samples from children (≤5 years old) living in the Amazon region were evaluated for the presence of HAstV1–8, HAstV MLB1−3 and HAstVVA1−3, using an usual RT-PCR protocol and a new protocol with specific primers designed to detect HAstVMLB1−3. HAstVMLB1 and HAstV MLB2, as well as the HAstV3 and 5 genotypes were detected. HAstVMLB1−2 genotype was detected for the first time in Brazil at a frequency of 3.5% (6/170).     

嗜酸细胞性胃肠炎4例临床分析

嗜酸细胞性胃肠炎（eosinophilic gastroenteritis,EG）是以嗜酸细胞浸润为特征的罕见胃肠道疾病,临床和内镜表现无特异性。本文总结分析4例EG患者的病史、临床表现、实验室检查、内镜病理表现及治疗。注意本病的诊断线索,结合内镜病理等检查,同时排除其他疾病是诊断EG的关键,激素是治疗EG的有效药物。     

27例嗜酸粒细胞性胃肠炎临床诊治分析

目的探讨嗜酸粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)临床表现、内镜、病理特点及诊治方法。方法回顾性分析我院2003年1月~2008年9月的27例住院EG患者的临床资料,对其临床分型及诊治方法进行分析。结果本组27例EG中黏膜型17例、浆膜型4例、黏膜浆膜混合型5例及黏膜肌层混合型1例。85.19%的患者以腹痛为首发症状,内镜检查病变多分布在胃窦、十二指肠降部和回盲部。活体组织病理学检查或腹水细胞学发现大量嗜酸粒细胞浸润。予以糖皮质激素或抗组胺类药物,腹痛症状均在1周内缓解。结论EG主要发生于20~50岁青中年患者,以黏膜型最常见,多以腹痛为主要症状且常规镇痛药物疗效不佳,内镜活体组织病理学检查或腹水细胞学检查有助于明确诊断。糖皮质激素治疗疗效显著。     

Influenza Vaccine: Epidemiology of norovirus and viral gastroenteritis in Ontario,Canada, 2009–2014

BackgroundNorovirus is the most common cause of acute gastroenteritis in Canada. The illness causes great morbidity and high societal costs. The objective of this article is to describe the epidemiology of norovirus in the province of Ontario, Canada from 2009 to 2014.MethodsTo assess activity of norovirus and viral gastroenteritis (VGE) in Ontario, three datasets were acquired from the provincial government: two traditional surveillance datasets (outbreak and laboratory) and syndromic surveillance data (telehealth), all spanning 2009–2014. All outbreaks, laboratory submissions and telehealth calls were first assessed for total VGE. Norovirus and norovirus-like illness totals were calculated as a proportion of VGE to estimate agent-specific activity levels. Affected institution types, sexes and age groups were also analyzed.ResultsBetween 2009 and 2014, 41.5% of VGE outbreaks, 63.4% of VGE laboratory submissions and 36.6% of all acute gastroenteritis-related (not restricted to viral causes) telehealth calls were attributed to norovirus and norovirus-like illness in Ontario. The most commonly affected institution type was long-term care homes and the most commonly affected age groups were younger (younger than five years) and older (older than 65 years) individuals. Females were slightly more frequently affected than males.ConclusionNorovirus and norovirus-like illnesses were the leading cause of VGE in Ontario between 2009 and 2014. They comprised the greatest percentage of VGE when compared with all other VGE-associated viruses. Additional work is needed to determine all component costs and necessary public health actions to reduce the burden of disease.     

Acute severe hypertension associated with acute gastroenteritis in children

Acute severe hypertension in otherwise healthy children with acute illness requiring hospitalization for BP management is uncommon and warrants immediate evaluation. We describe 10 cases of children presenting with acute gastroenteritis and found to have acute severe hypertension. They required admission to the hospital for antihypertensive treatment, including 2 to the intensive care unit, but all had normalization of BP and were able to stop treatment with resolution of the acute illness. All patients had thorough testing for secondary causes of hypertension and for signs of end‐target organ damage, which were unremarkable. To our knowledge, acute severe hypertension in the setting of acute gastroenteritis without underlying kidney pathology and with complete resolution after illness has not been previously described. The mechanism of this association is not clear, although activation of the sympathetic nervous system is suspected. These cases illustrate the importance of thoroughly assessing BP in the acute setting.     

Norovirus Epidemiology and Genetic Diversity in Leipzig,Germany during 2013–2017

Globally and in all age groups, noroviruses are a main cause of gastroenteritis. To assess their local epidemiology and genetic diversity, stool samples of 7509 inpatients with gastrointestinal complaints from all age groups were analyzed. After detection of norovirus genogroup I and II RNA by real-time RT-PCR, viral capsids were genotyped by partial nucleic acid sequencing. In the case of GII.2 strains, polymerase genotypes were also assessed. Between October 2013 and September 2017, presence of norovirus RNA was shown in 611 samples (8.1%), of which 610 (99.8%) were typed successfully. Norovirus positivity rate was higher in patients aged below five years (14.8%) than in older patients (5.7%). Among the 611 norovirus positive samples, GII.4 (56.6%) strains prevailed, followed by GII.6 (11.3%), GII.3 (11.0%) and GII.2 (9.5%). The most common genogroup I (GGI) genotype was GI.3 (3.6%). In addition, rare genotypes such as GII.13, GII.14 and GII.26 were detected. Interestingly, GII.3 infections were most common in children under the age of five years. Assessment of polymerase genotypes in GII.2 viruses showed a shift from P2 to P16, with higher diversity in P2 sequences. The varying distribution of norovirus genotypes depending on season, age and setting of infection highlights the importance of frequent genotyping as a basis for vaccine development and needful adjustments.     

血清降钙素原及IL-6、IL-8在急性胃肠炎患儿中的检测意义

目的探讨血清降钙素原(procalcitonin,PCT)、白细胞介素6(IL-6)、白细胞介素8(IL-8)检测在急性胃肠炎患儿病原体鉴别中的临床意义。方法选择确诊的细菌性胃肠炎患儿35例(细菌组)、轮状病毒性胃肠炎患儿36例(病毒组)、健康儿童35例(对照组),分别检测3组儿童的血清PCT、IL-6、IL-8水平。结果细菌组血清PCT、IL-6水平显著高于病毒组及对照组(P0.05),且病毒组PCT、IL-6显著高于对照组(P0.05),细菌组IL-8水平显著高于对照组(P0.05),但细菌组与病毒组比较,IL-8水平无显著性差异(P0.05);PCT与IL-6诊断细菌性胃肠炎的敏感度分别为71.4%、65.7%(P0.05),特异度分别为72.2%、66.7%(P0.05),均显著高于IL-8(P0.05)。PCT+IL-6检测对细菌性急性胃肠炎诊断的敏感度94.3%,特异度94.4%,均显著高于单独检测PCT或IL-6(P0.05)。结论血清PCT对早期小儿细菌性与病毒性胃肠炎感染的鉴别诊断具有重要意义,而PCT与IL-6联合检测准确性更高。     

南宁市成人散发性腹泻病例中札幌病毒感染研究

目的研究广西南宁市成人散发性腹泻病例中札幌病毒（Sapovirus,SV）的感染状况和流行特征。方法对2007年1月至2008年12月南宁市某医院门诊412例成人腹泻病例的流行病学资料进行分析;并采集粪便标本,应用荧光定量逆转录-聚合酶链反应检测SV。结果在检测的412份粪便标本中,19份阳性,检出率为4.61%（19/412）。病例全部集中在冬春季,年龄范围17-65岁。SV阳性检出率无年龄组和性别差异。结论本研究首次证实SV是南宁市成人散发性腹泻的病原体之一,提示在感染性腹泻病例诊断中要加以考虑SV感染。     

Hepatocellular carcinoma in patients co-infected with hepatitis C virus and human immunodeficiency virus

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share a common route of transmission so that about one third of HIV infected individuals show HCV co-infection. Highly active antiretroviral therapy has offered a longer and better life to infected patients. While has removed AIDS-related diseases from the list of most common causes of death their place has been taken by complications of HCV infection, such as cirrhosis, end stage liver disease and hepatocellular carcinoma (HCC). HIV/HCV co-infection requires complex management, especially when HCC is present. Co-infected patients with HCC undergo the same therapeutic protocol as their mono-infected counterparts, but special issues such as interaction between regimens, withdrawal of therapy and choice of immunosuppressive agents, demand a careful approach by specialists. All these issues are analyzed in this minireview.     

HBV/HIV重叠感染的抗病毒治疗

随着人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染率快速增长,乙型肝炎病毒(hepatitis B virus,HBV)/HIV重叠感染成为一种临床易见疾病.HBV/HIV重叠感染使HBV和HIV的生物学行为发生改变,进而相互影响病情进展,使得HBV/HIV重叠感染患者的抗病毒...     

医院内诺如病毒性急性胃肠炎暴发的流行病学与临床特点分析

目的通过对我院急性胃肠炎聚集病例的调查,了解诺如病毒性急性胃肠炎流行及临床特点。方法调查与分析我院2006年冬季(2006年11月28日—2006年12月24日)聚集发生的急性胃肠炎的临床表现和流行特点,采用PCR法检测患者便标本诺如病毒核酸和免疫印迹法查血清抗体。结果本次流行的急性胃肠炎患者共87例,中老年人发病占大多数,主要临床特点为腹泻、呕吐、腹痛等,大便细菌培养阴性。用PCR法检测20例患者大便标本,其中12例诺如病毒呈阳性。检测24例患者血标本,19例诺如病毒抗体阳性。结论证实2006年我院发生的急性胃肠炎是诺如病毒性急性胃肠炎医院感染的暴发流行,潜伏期24~48h,多表现为腹泻、呕吐等非细菌性胃肠炎,在医院中该病传染性极强,冬季好发,中老年人易感,饮食、接触污染物表面及人与人密切接触等是主要的传播方式。提高对该病的认识、及时识别对治疗与控制具有重要意义。     

Detection and diagnostic value of serum NSE and S100B protein levels in patients with seizures associated with mild gastroenteritis: A retrospective observational study

Benign convulsions with mild gastroenteritis (CwG) and febrile seizures (FS) associated with mild gastroenteritis are 2 different diseases in the spectrum of seizures associated with mild gastroenteritis. However, specific and useful indicators for the identification of the 2 diseases are lacking. A retrospective analysis was performed to compare the serum neuronal-specific enolase (NSE) and S100B protein levels between patients with these 2 diseases to evaluate the value of NSE and S100B for differential diagnosis between these 2 diseases.The clinical data and NSE and S100B protein levels of 81 children with seizure-associated mild gastroenteritis were collected. According to the axillary temperature at the time of convulsions, all patients were classified into an afebrile seizure (AFS) group, hereafter called the CwG group (n = 46), and a febrile seizure group (FS group, n = 35).The serum NSE level was higher in the CwG group than in the FS group (14.046 (11.095, 19.266) pg/ml and 9.034 (7.158, 12.165) pg/ml, respectively, P < .001); however, the serum S100B protein levels in the CwG and the FS group were not significantly different (P > .05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for NSE was 0.806, P = .000, which was statistically significant. The Youden index was largest (0.605) for a serum NSE cut-off value of 10.460 pg/ml, which yielded a sensitivity and specificity of 89% and 71%, respectively, for prediction of a CwG diagnosis.NSE may contribute to the differential diagnosis of CwG and FS associated with mild gastroenteritis.     

20例嗜酸性粒细胞性胃肠炎临床及内镜特点分析

目的 探讨嗜酸性粒细胞性胃肠炎(EG)患者的临床表现及内镜检查对该病的诊治价值.方法 对20例EG患者的临床特点、试验室检查、内镜表现和治疗随诊情况进行分析.结果 20例患者中黏膜型12例、浆膜型2例、混合型6例;EG临床表现以腹痛为主,可伴有腹胀、腹泻、腹水、恶心、呕吐;外周血和骨髓中嗜酸性粒细胞计数明显增多(13.5%～50.6%和7.8%～38.5%).腹水中可见大量嗜酸性粒细胞;内镜表现为黏膜充血水肿、糜烂,病理检查可见大量嗜酸性粒细胞浸润;糖皮质激素治疗1～2周内可迅速缓解症状,减量维持,然后逐渐减量至停药;病情可反复,但预后良好.结论 EG患者临床和内镜表现无特异性,外周血和腹水中嗜酸性粒细胞计数明显增多,胃肠黏膜组织中嗜酸性粒细胞浸润是诊断的关键,糖皮质激素治疗效果良好.     

一起由诺如病毒和肠道腺病毒混合感染引起的急性胃肠炎聚集性疫情的病原鉴定及进化分析

目的?对一起儿童急性胃肠炎聚集性疫情的病原进行鉴定、分型及进化分析。 方法?收集本次疫情患儿粪便标本,提取核酸,采用实时荧光PCR初步进行病原鉴定。通过反转录-聚合酶链反应对诺如病毒阳性标本的聚合酶区和衣壳VP1区部分基因序列进行扩增;通过PCR对腺病毒阳性标本的六邻体区部分基因序列进行扩增。对扩增产物进行测序,利用生物信息学软件及网站对病毒进行型别鉴定及进化分析。结果?共收集到3例患儿粪便标本,诺如病毒和腺病毒均为阳性。3株诺如病毒毒株均为诺如病毒GII.P12-GII.3型,其聚合酶区部分基因序列（206 bp）与2015─2018年我国GII.P12-GII.3型诺如病毒参考序列的同源性为98%,且位于同一进化树分支上;3株腺病毒毒株均为腺病毒F亚属41型（F41型）,其六邻体区部分基因序列（420 bp）与2015─2019年我国F41型腺病毒参考序列的同源性为100%,且位于同一进化树分支上。 结论?本次儿童急性胃肠炎聚集性疫情是由GII.P12-GII.3型诺如病毒和F41型腺病毒混合感染引起,毒株序列分别与近年来我国流行的GII.P12-GII.3型诺如病毒及F41型腺病毒序列高度同源。本研究为混合感染急性胃肠炎疫情病原的快速鉴定及溯源分析提供了参考。     

A high frequency of GBV-C/HGV coinfection in hepatitis C patients in Germany

AIM:To detect infection rate of GBV-C/HGV in hepatitis C patients, to determine the methods of higher sensitivity and the primers of higher efficiency for GBV-C/HGV RNA detection and to study the dominant subtype and mutation of GBV-C/HGV.METHODS:Quantitative RT-PCR for detection pf HCV RNA concentration in serum samples, RT-nested PCR with two sets of primers for detection of GBV-C RNA, RT-PCR ELISA with two sets of primers for detection of HGV RNA, nucleotide sequence and putative amino acid sequence analysis.RESULTS:The positive rates of GBV-C RNA at the 5'-NCR and NS3 region in 211 serums amples from the patients with HCV infection were 31.8% and 22.8% respectively. The positive rates of HGV RNA at the 5'-NCR and NS5 region in the same samples were 47.9% and 31.8% respectively. The total positive rate of GBV-C/HGV RNA was as high as 55.5%. HCV copy numbers in the patients without GBV-C/HGV coinfection were statistically higher than that in the patients with GBV-C/HGV coinfection (P<0.01).Frequent mutation of nucleotide residue was present in the amplification products. Frameshift mutation was found in two samples with GBV-C NS3 region nucleotide sequences. All nucleotide sequences from amplification products showed higher homology to HGV genome than to GBV-C genome even though part of the sequences were amplified with GBV-C primers.CONCLUSION:A high frequency of GBV-C/HGV coinfection existed in the hepatitis C patients. RT-PCR ELISA was more sensitive than RT-nested PCR for detection of GBV-C/HGV RNA. The primers derived from the 5'-NCR was more efficient than those derived from the NS3 and NS5 regions. A reverse relationship was found to exist between HCV RNA concentration and GBV-C/HGV infection frequency. HGV was the dominant subtype of the virus in the local area. The major mutations of GBV-C/HGV genomes were random mutation of nucleotide residue.     

Anisakis infestation: a case of acute abdomen mimicking Crohn''s disease and eosinophilic gastroenteritis

Anisakiasis is a rare parasitic disease transmitted to humans by the ingestion of raw fish, which can initially present with acute abdomen. We report the case of a man, a habitual consumer of raw fish, who underwent surgery for acute abdomen, initially attributed to Crohn's disease and then later interpreted as eosinophilic enteritis. Only the subsequent careful histological examination of the surgical specimen, revealing full thickness eosinophilic infiltrate, generally typical of infestation, led to the detection of Anisakis simplex larva. In cases of acute abdomen, in the presence of a positive history of raw fish ingestion, it is therefore reasonable to consider the possibility of anisakiasis.     

慢性丙型肝炎患者混合或重叠感染其他病原体状况分析

目的了解丙型肝炎病毒（HCV）感染者混合或重叠感染乙型肝炎病毒（HBV）、人免疫缺陷病毒（HIV）和梅毒螺旋体（TP）的状况,为HCV感染的防治提供依据。方法采用ELISA法检测乙型肝炎病毒标志物、抗TP和抗HIV;采用化学发光法检测抗HCV;采用蛋白印迹法确认HIV感染。结果在169例HCV感染者中,重叠感染HBV 25例（14.8%）、HIV 4例（2.4%）、TP 9例（5.3%）,重叠感染HBV和TP 2例（1.2%）,重叠感染HBV和HIV 2例（1.2%）;静脉吸毒者重叠感染HIV（6.7%）和TP（11.1%）的比例均明显高于非静脉吸毒者（P〈0.05）;男性患者重叠感染HBV的比例（19.7%）明显高于女性患者（3.8%,P〈0.01）,女性患者重叠感染TP的比例（11.5%）明显高于男性患者（2.6%,P〈0.05）。结论随着感染方式的多元化,慢性丙型肝炎患者重叠感染其他病原体的情况更加常见。     

E抗原和E抗体阳性的慢性乙型肝炎组织病理学研究

目的探讨HBeAg阳性和抗-HBe阳性的慢性乙型肝炎患者的肝组织病理改变的差异性.方法分别对151例HBeAg阳性和62例抗-HBe阳性的慢性乙型肝炎患者进行肝活检,观察肝组织病理分级和分期情况,同时检测血清HBV DNA.结果 (1)肝组织病理分级、分期与血清HBeAg/抗-HBe的出现情况密切相关,抗-HBe阳性者中肝组织病理为G3～G4、S3～S4者明显多于G1～G2、S1～S2者;而在HBeAg阳性者中则相反;两组比较差异有显著性(P＜0.005);(2)在HBeAg阳性患者中HBV DNA检出率为83.4%(126/151);而在抗-HBe阳性患者中HBV DNA检出率为29%(18/62).结论 (1)抗-HBe阳性的慢性乙型肝炎患者中肝组织炎症、坏死及肝纤维化的程度较HBeAg阳性者严重;(2)HBeAg与HBV DNA存在良好的相关性,但在部分抗-HBe阳性的患者中仍可检出HBV DNA.