抗轮状病毒牛初乳治疗轮状病毒性肠炎的初步研究

为了给临床提供特异有效的治疗婴幼儿轮状病毒感染的生物制剂，以ＳＡ１１轮状病毒免疫受孕乳牛，制备抗轮状病毒免疫牛初乳，从临床治疗角度，对８０例婴幼儿急性轮状病毒感染性腹泻，４３例应用抗轮状病毒牛初乳治疗，３７例应用思密达治疗，对两组进行了疗效对比观察。结果表明：抗轮状病毒免疫牛初乳治疗组的总有效率，显效率和７２小时粪便病毒转阴率分别达９１％，７９％和８９％；而思密达治疗组的疗效及７２小时大便病毒转阴率则相应为４１％，２４％和３９％，差异均有非常显著意义。为临床治疗婴幼儿轮状病毒感染性腹泻提供了安全有效，特异性强的治疗手段     

思密达治疗小儿轮状病毒肠炎114例疗效观察

作者于1992年11月～1993年1月轮状病毒流行季节,对114例≤2岁急性腹泻患儿应用法国博福-益普生制药集团研制生产的思密达(Smecta)作为治疗组。并设对照组69例,结果两组比较,治疗组总有效率88.60%较对照组总有效率36.23%有显著差异。另外对12例病原不明的迁慢性腹泻应用思密达也获得一定疗效(总有效率75.00%)。作者体会对腹泻患者盲目滥用抗生素,或不加选择应用抗动力药物、止泻药,反而可加重病情。     

轮状病毒肠炎的病原学调查和临床观察

为了解轮状病毒肠炎在郑州地区四季流行情况,我们于1983年12月至1984年11月以我院儿科门诊三岁以下腹泻患儿463例之大便标本进行轮状病毒抗原检测,并对50例健康儿童作了对照检查。现将检查结果报告如下:实验对象、方法与结果全年共送三岁以下腹泻患儿大便标本463份,用 ELISA 法检测轮状病毒抗原,其中检测阳性者为183例,检出率为39.5％,同时对其中100例作了轮状病毒 RNA 电泳分析,二者符合率为75％。(一)轮状病毒肠炎全年各月份检出率比较表:     

星状病毒感染性腹泻32例

目的 研究儿童星状病毒（AstV）感染性腹泻的特点。方法 对350例住院腹泻患儿入院后24h内粪便标本行大便常规检查，应用酶免疫法（EIA）分别检测AstV及轮状病毒（RV）抗原，并行电解质、血气分析、肝功能检查，并对其临床表现进行分析。结果本组资料Astv感染率为8．3％，1岁内婴幼儿是AstV主要易感人群。AstV感染的主要症状为腹泻，大便为水样便，伴发热、呕吐、腹痛、食欲减退等，较RV等症状轻微。结论对于婴幼儿腹泻患儿应注意检测AstV，有助于明确诊断及治疗。     

思密达保留灌肠治疗轮状病毒性肠炎临床观察

目的观察思密达灌肠治疗婴幼儿急性轮状病毒性肠炎的效果。方法选择2005年1月～2006年12月住院患儿,年龄在3个月～2岁的急性轮状病毒肠炎204例,并随机分为治疗组140例,对照组64例,进行统计学分析,治疗组应用思密达保留灌肠,对照组应用思密达口服治疗。结果显效48例(34.29%),有效74例(52.85%),无效18例(12.86%),治疗组总有效率(87.14%),对照组总有效率(68.75%),经统计学检验差异有统计学意义(P<0.05)。结论应用思密达保留灌肠治疗婴幼儿急性轮状病毒肠炎有良好效果。     

婴幼儿肺炎伴腹泻患儿轮状病毒检测及其临床意义

目的研究婴幼儿肺炎伴腹泻患儿的病原体。方法以50例婴幼儿肺炎伴腹泻患儿为实验组，50例婴幼儿肺炎而无腹泻患儿为对照组，对实验组及对照组均予大便轮状病毒检测。结果实验组50例婴幼儿肺炎伴腹泻患儿中8例，由轮状病毒感染引起，占16％，对照组50例婴幼儿肺炎而无腹泻患儿亦有1例轮状病毒感染，占2％。结论轮状病毒除侵犯消化道外还侵犯呼吸道，也是引起呼吸道感染的病原体之一，应引起足够的重视。     

新生儿轮状病毒肠炎及继发乳糖酶缺陷临床分析

为探讨新生儿腹泻中轮状病毒性肠炎及继发性乳糖酶缺陷的发病情况及临床特点。采用EILASA快速轮状病毒抗原检测方法及醋酸铅法，对38例确诊为轮状病毒性肠炎的病例进行总结分析。51例新生儿腹泻，轮状病毒抗原检测阳性38例(74．51％)，而在确诊为轮状病毒性肠炎38例中，大便乳糖阳性37例(97．37％)。结果提示，在秋冬季节，轮状病毒是新生儿腹泻的首位病原，而新生儿轮状病毒肠炎绝大多数有继发性乳糖酶缺陷。     

益生菌与口服免疫球蛋白辅助治疗儿童轮状病毒肠炎的疗效比较

目的：比较益生菌及口服免疫球蛋白对儿童轮状病毒肠炎的疗效。方法：150例轮状病毒肠炎患儿随机分为3组,每组50例。3组患儿在给予基础治疗的同时给予不同的干预治疗方案。对照组予安慰剂治疗,益生菌组予双歧杆菌乳杆菌三联活菌治疗,免疫球蛋白组予抗轮状病毒鸡卵黄IgY口服治疗。每日记录大便次数、大便性状等临床症状,并于治疗后1、3、5、7、9、11?d收集新鲜大便标本,镜检行大便菌群紊乱分度,放射免疫法检测大便SIgA水平,双抗体夹心酶联免疫法检测大便轮状病毒排泄量。结果：与对照组比较,益生菌治疗组干预用药3 d后菌群失调改善,大便频次减少,继发肠道细菌感染发生率降低（P0.05）。免疫球蛋白组用药1 d后大便SIgA水平显著高于对照组（P<0.05）,治疗3 d后腹泻频次及大便病毒排泄量均低于对照组（P<0.05）。免疫球蛋白组病程较对照组显著缩短（4.5±1.0?d vs 5.8±1.7?d,P<0.05）。结论：对儿童轮状病毒肠炎,益生菌能缓解菌群紊乱及预防继发感染,但缓解临床症状较慢,且不能缩短病程。口服免疫球蛋白显效快,能快速清除病毒及促进机体SIgA生成,且能缩短病程。     

小儿水样腹泻轮状病毒的检测和治疗

目的 观察轮状病毒在小儿水样腹泻粪便中的检出率和健儿清解液的疗效。方法对153例用酶联免疫吸附试验检测水样便中轮状病毒抗原，检测阳性者分治疗组和对照组，治疗组口服健儿清解液5 d，对照组口服复方维生素B液5 d。结果 153例中阳性78例，阳性率51%。≤2岁检出率54%，>2岁组检出率23%，两组比较，P<0.05。秋冬季发病者检出率59%，春夏季发病者检出率46%，两者比较，P<0.05。新生儿检出率40%。治疗组总有效率87%，对照组总有效率70%，两组比较，P<0.05。结论 轮状病毒仍是目前小儿水样腹泻的主要病原之一，多发于2岁以下小儿和秋冬季节。健儿清解液治疗轮状病毒肠炎有效。     

思密达治疗婴幼儿轮状病毒肠炎疗效观察

我院于1992年10月至1993年2月应用法国博福—益普生制药公司生产的思密达治疗婴幼儿急性腹泻120例,另用口服庆大霉素治疗30例作为对照,现将结果报告如下。1 临床资料1.1 病例选择临床诊断为轮状病毒肠炎的急性腹泻患儿,病程在7天之内,大便呈稀水或水样便者(粘冻状或脓血便者不作观察对象),随机分为思密达治     

Lack of impact of rapid identification of rotavirus-infected patients on nosocomial rotavirus infections

The efficacy of rapid identification of rotavirus-infected patients in the control of nosocomial rotavirus infections on an infant and young toddler ward by use of a rotavirus antigen detection test on stool from patients with diarrhea was evaluated by comparing the rate of nosocomial rotavirus infection in children during two separate 5-week periods in the winters of 1984 and 1986. In contrast to 1984 rapid rotavirus antigen testing by latex agglutination of stool from patients with diarrhea was instituted in 1986, in addition to testing for rotavirus by enzyme immunoassay, to determine whether use of rapid antigen testing resulted in an increased incidence of appropriate isolation and a decrease in nosocomial infections. In 1986 rapid identification of rotavirus resulted in an increase in hospitalization of rotavirus-infected patients in single bed rooms from 68% to 100% (P = 0.02, chi square test) but no significant increase in the use of enteric precautions for these patients. The total number of cases of nosocomial rotavirus infection in the two periods did not differ. In both periods 11 cases occurred; the nosocomial infection rate in 1984 was 18.9 cases/1000 days of exposure whereas in 1986 it was 20.2 cases/1000 days. These findings indicate that the use of rapid rotavirus antigen testing of patients with diarrhea is not of appreciable benefit in preventing the nosocomial spread of rotavirus to infants on the ward.     

Survival of rotavirus antibody activity derived from bovine colostrum after passage through the human gastrointestinal tract

BACKGROUND: Rotavirus is a major cause of infectious diarrhea in infants and young children. Several studies have shown that hyperimmune bovine colostrum, derived from cows immunized with rotavirus, can prevent rotavirus diarrhea when given passively. The objective of this study was to determine whether colostral antibody activity survived transit through the gut by measuring the level of rotavirus antibody activity in the feces. METHODS: Hyperimmune colostrum containing different levels of rotavirus antibody was administered to 105 children attending nine Adelaide childcare centres. Subjects were asked to drink 100 ml of whole milk supplemented with colostrum 3 times a day, for a period of 6 days. Stool samples were collected from the subjects before, during, and after consumption of the study product. Rotavirus activity was determined using a novel virus reduction enzyme-linked immunosorbent assay (ELISA) and a virus neutralization assay. RESULTS: Rotavirus antibody activity was detected in 521 (86%) of 602 fecal specimens obtained during the study using the virus reduction ELISA. The antibody activity was detected as early as 8 hours after ingestion of hyperimmune colostrum and up to 72 hours after consumption had ceased. There was a strong relation (r = 0.81) between the titer of rotavirus antibody administered to subjects and the level of antibody activity detected in the feces. CONCLUSIONS: The results show that antirotavirus activity survived passage through the gut. Therefore, passive immunotherapy may be used to prevent or treat infectious diseases that affect the entire length of the gastrointestinal tract.     

2009年北京地区儿童感染性腹泻病原学及耐药性分析

目的 研究北京地区儿童急性感染性腹泻的病原学变化、流行病学特征及耐药性变迁情况.方法 对2009年1月～10月肠道门诊疑诊为细菌性腹泻病者便标本做细菌培养和血清分型鉴定,药敏试验采用纸片扩散法,以免疫层析双抗体夹心法定性检测A群轮状病毒抗原.结果 256份标本检出病原菌4种87株(有1份便标本同时检出2种菌),检出率为34.0%.男女检出比为1.69∶1,2岁以下患儿55例(64.0%).沙门菌40株(46.0%),志贺菌23株(26.4%),致泻性大肠杆菌2株(2.3%),金黄色葡萄球菌22株(25.3%).志贺菌中D群13株(56.5%),22株金黄色葡萄球菌有20株发生于＜1岁婴儿.沙门菌和志贺菌的耐药率分别为:氨苄西林(65.0%;95.7%)、复方新诺明(20.0%;78.3%)、环丙沙星(7.5%;8.7%)、头孢曲松(15.0%;73.9%).256份标本中A群轮状病毒检测阳性47份,其中同时便培养阳性者13份.结论 2009年北京地区儿童细菌性腹泻的病原菌以非伤寒沙门菌为主,志贺菌以D群为主要流行株,二者的易感人群以2岁以下婴幼儿为主,金黄色葡萄球菌感染以1岁以下婴儿为主,阳性检出男孩居多.多重耐药仍以志贺菌明显,细菌与轮状病毒混合感染的比例上升.

Abstract：

Objective To investigate the etiology, epidemiologic features and drug resistance tendency of acute infectious diarrhea among children in Beijing area. Methods Enteric pathogenic bacteria were isolated, cultured and identified for serotype from the stool specimens of children with the initial clinical diagnosis of acute bacterial diarrhea in the intestinal clinic from January to October in 2009 ,and the antibiotic susceptibility of bacteria was tested by disk diffusion method. The cluster A rotavirus antigen was also detected by the qualitative technique of immunochromatographic double-antibody sandwich assay. Results Of the 256 stool specimens, 87 strains of 4 species of pathogenic bacteria were detected with the detectable rate of 34. 0% ,of which 2 strains were detected in one stool sample ,including 40 strains of salmonella (46. 0%) ,23 strains of shigella (26. 4%) ,2 strains of diarrheogenic escherichia coli (2. 3%) and 22 strains of staphylococcus aureus (25.3%). The positively detected patients consisted of 54 males and 32 females with the ratio of 1.69∶1 ,of whom 55 cases (64. 0%) were under 2 years of age. Of the 13 strains of shigella, 13 were sonnei shigella (56. 5%). And of the 22 strains of staphylococcus aureus,20 were detected among the infants under 1 year of age. The rates of crug resistance to certain antibiotics were lower in salmonella than in shigella (ampicillin :65. 0% vs. 95.7% ;compound sulfamethoxazole:20. 0% vs. 78. 3% ;ciprofloxacin:7.5% vs.8. 7% ;ceftriaxone: 15.0% vs. 73.9%). Of the 256 stool specimens ,47 were found positive for cluster A rotavirus,of whom 13 were also positive in stool bacteria culture. Conclusion Salmonella is the major pathogen among children with bacterial diarrhea in Beijing in 2009, and sonnei shigella is the main epidemic strains of shigella diarrhea. lnfants under 2 years of age are the susceptible population of the above two species of bacteria, while staphylococcus aureus mainly infect the infants under 1 years of age. Multi-resistance in shigella is still serious. The incidence of mixed infections of bacteria and rotavirus increases in children with infectious diarrhea.     

A prospective study of rotavirus diarrhea in children under 1 year of age

The aim of this study was to document the changing clinical profile and prognosis of acute diarrhea in infants. This was a prospective observational study with follow-up. Demographic, anthropometric, and clinical data were collected in children younger than 1 year with acute diarrhea. Stool was examined under the microscope, cultured, tested for presence of reducing substance and occult blood, and subjected to electrophoresis to detect rotavirus infection. Thirty-one (91.2%) of the 34 infants were breastfed, 18 exclusively and 13 partially. Twenty-three had rotavirus infection and had slower nutritional recovery than others. There was no difference in the incidence of rotavirus infection between exclusively and partially breastfed infants. Continuation of feeds containing lactose did not affect prognosis, though 23 (67.6%) infants had reducing substance in stool. We documented a high incidence of rotavirus infection, which negatively affected growth of infants by some ill-defined mechanism. Failure of exclusive breastfeeding to protect against rotavirus infection highlights the need for universal rotavirus vaccination. Lactose malabsorption detected in many infants did not affect prognosis after acute diarrhea.     

THE COLOSTRUM-DEPRIVED, ARTIFICIALLY REARED NEONATAL PIG AS A MODEL ANIMAL FOR STUDYING ROTAVIRUS GASTROENTERITIS

Rotavirus gastroenteritis is one of the main causes of acute diarrhea in young humans and animals worldwide. The colostrum-deprived, artificially reared neonatal pig has been extensively used in our laboratory as a model animal for studying an experimentally induced rotaviral gastroenteritis. Details on procurement of newborn pigs, immunologic characteristics, and artificial rearing conditions of colostrum deprived neonatal pigs as well as on rotavirus inoculation, clinical manifestations, and evaluation of intestinal damage caused by rotavirus infection are described. Our experimentally induced rotavirus gastroenteritis model has been characterized clinically by anorexia, diarrhea, occasional vomiting, and high titers of rotavirus shedding in feces. Data reported here provide additional information, particularly on feeding regimens of pigs before rotavirus inoculation, extent of anorexia, severity of diarrhea, and extent of fecal virus shedding, as well as on the effect of rotavirus infection and size of rotavirus inocula on intestinal damage, growth, and mortality during the postinfection period. On the basis of these results and others previously reported by us and by other researchers, and because of the intestinal anatomy and physiology similarities to that of human infants, the colostrum-deprived, artificially reared neonatal pig is the most suitable and useful model animal for studies designed to evaluate prevention and treatment of rotaviral gastroenteritis.     

Clinico-laboratory analysis of the diarrhea syndrome in young children excreting rotaviruses with feces

A total of 404 children admitted to the infectious hospital of the non-intestinal type were examined with the aid of counter immunoelectroosmophoresis. Rotavirus antigen was detected in feces in 46.8% of 126 children admitted with a diagnosis of diarrhea, in 10.8% of 278 without diarrhea, and also in 32.9% of 149 children with diarrhea that occurred at the hospital. The clinical course of acute rotavirus gastroenteritis appeared to be materially influenced by acute respiratory viral infection, particularly influenza, and by certain types of opportunistic bacteria contained in high concentrations by the intestine.     

Randomized, placebo-controlled, clinical trial of hyperimmunized chicken egg yolk immunoglobulin in children with rotavirus diarrhea

BACKGROUND: Hyperimmunized bovine colostrum containing antibodies has been shown to be effective in the treatment of rotavirus diarrhea. Antibodies derived from eggs of immunized hens may be a less expensive and more practical alternative. In this study, children with proven rotavirus diarrhea were treated with immunoglobulin extracted from eggs of chicken immunized with human rotavirus strains. METHODS: In a randomized, double-blind study, 79 children with known rotavirus diarrhea were assigned to receive either 10 g hyperimmune egg yolk (HEY) daily in four equally divided doses for 4 days (HEY group) or a similar preparation obtained from nonimmunized chicken (placebo group). The daily stool frequency and amount, oral rehydration solution iORS) intake, and presence of rotavirus in the stool were monitored for 4 days. RESULTS: In the HEY-treated group, there was significant reduction in stool output (in grams per kilogram per day; HEY vs. placebo; 87+/-59 vs. 120+/-75, P = 0.03), and significant reduction of ORS intake (in milliliters per kilogram per day) (HEY vs. placebo; 84+/-46 vs. 122+/-72, P = 0.008) on day 1 and clearance of virus on day 4 (HEY vs. placebo; 73% vs. 46%, P = 0.02). There was, however, no difference in diarrheal duration between the groups. CONCLUSIONS: Treatment with HEY against four human rotavirus strains resulted in modest improvement of diarrhea associated with earlier clearance of rotavirus from stools. These results indicate an encouraging role of HEY in the treatment of rotavirus-induced diarrhea in children. Further studies are needed to optimize the dose and neutralization titer and thus improve the efficacy of egg yolk immunoglobulin IgY derived from immunized hens.     

Kinetics of viral replication in experimental rotavirus infection: effects of high dietary fat.

Epidemiological studies suggest that dietary fat can affect the frequency and severity of diarrhoeal illnesses in childhood. To study the effects of dietary fat on the kinetics of rotavirus antigen, 3-week-old mice of rotavirus-seronegative mothers were fed isocaloric diets with 40% of the total calories as fat [either butter (high saturated fat), olive oil (high monounsaturated fat), or corn oil (high polyunsaturated fat)] with one group on low fat (10% of calories) standard diet as controls. Seven-day-old mice from the first litter were killed and their stomach contents (milk) analyzed for total fatty acids. Seven-day-old mice from the second litter were inoculated with EDIM rotavirus, and some were killed at 48 h and others at 120 h postinoculation. The stool was removed from the distal colon of each mouse and examined for evidence of diarrhoea. The small intestine was removed, the contents washed, and the intestine divided into equal thirds. All stool and tissue samples were made to 10% (wt/vol), homogenised, and tested for rotavirus antigen by ELISA. We found that (a) dietary fat markedly altered the fatty acid profile of milk, (b) high saturated dietary fat (butter) delayed the onset of diarrhoea, reduced the excretion of rotavirus antigen in stool, and reduced mucosal antigen in the lower third of the small intestine at 120 h compared to 48 h postinoculation, (c) high polyunsaturated dietary fat initially increased the frequency of diarrhoea and viral antigen in the middle and lower segment at 120 h, followed by a reduction in rotavirus excretion in stool.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rotavirus diarrhea in Jewish and Bedouin children in the Negev region of Israel: epidemiology, clinical aspects and possible role of malnutrition in severity of illness

We conducted a 1-year prospective study in the Negev region of southern Israel to determine the epidemiologic and clinical patterns of rotavirus diarrhea. A total of 605 patients were studied, 392 Bedouins and 213 Jews, 441 of whom had diarrhea (449 episodes) and 164 did not. Rotavirus was the most common organism detected in children with diarrhea (63 of 444; 14%) but was rarely found in controls (3 of 163; 2%) (P less than 0.001). In 22% (12 of 54) of the rotavirus-positive patients, at least one other organism was also detected. The rate of rotavirus detection decreased as age increased, from 18% in the first year to 8% in the third year of life. Hospitalization with rotavirus diarrhea occurred more frequently in the summer. However, during winter, when diarrhea was less prevalent in the community, the proportion of cases associated with rotavirus was higher. Compared with controls, malnourished children were more likely to be hospitalized. However, rotavirus was detected in similar proportions among well-nourished and malnourished cases with diarrhea. The most prevalent rotavirus serotype was type 1 (in 69%), followed by types 4 and 2 (18 and 13%, respectively). We estimated that during the study period, approximately 2% of all Bedouin infants vs. only 0.2% of Jewish infants were hospitalized with rotavirus disease in their first year of life. Clinical signs and symptoms and stool appearance were not useful in predicting rotavirus detection. Malnutrition seems to be an important indicator of disease severity, which may explain why the toll of rotavirus-associated morbidity and mortality is particularly high among children in developing countries.