不典型单纯疱疹病毒性脑炎早期诊疗二例

本研究回顾分析我科收治的2例不典型单纯疱疹病毒性脑炎患者的诊治经过,从病因病理特点上分析诊治过程,总结早期诊断及治疗的方法及意义。     

Herpes simplex virus and the rheumatic diseases

Summary A viral aetiology for rheumatoid arthritis and inflammatory connective tissue diseases has been sought in general terms first, by studying viral growth patterns in lymphocytes from the blood and lesions of patients affected second, by analysing lymphocyte concentrations of the interferon-induced enzyme 2–5 oligo-adenylate synthetase (2–5 A); and third, by probing Southern blots of lymphocyte DNA with viral probes. Indirect evidence consistent with a viral aetiology has been found in several such diseases, but direct proof has been difficult to adduce. There is some suggestion that herpes simplex viral (HSV) DNA is present in Behcet's blood lymphocytes, but the findings are inconsistent. It is also plausible that viruses such as HSV do not induce these diseases through classic immunopathological mechanisms, but as promoters of abnormal lymphoproliferation in individuals with predisposing defects, possibly related to selective DNA repair defects.     

持续视频脑电监测对重型单纯疱疹病毒性脑炎早期诊断和预后的意义

目的：分析应用持续视频脑电监测对急性重型单纯疱疹病毒性脑炎早期诊断和预后的影响。方法：对25例伴有意识障碍的临床诊断急性重型单纯疱疹病毒性脑炎患者,入院24h内及入院后1周左右各进行长达8h以上的持续视频脑电监测（CEEG）并与记录的体征及CT等相关检查相比较。结果：入院24h内25例患者中脑电监测以弥漫性θ波为主的7例;以弥漫性D波为主的4例;以a波为主,并有阵发性θ或d波的5例;以局限性θ或。波为主的9例,其中局限于颞额导的6例。25例中脑电监测出现痫性放电的14例,其中局限于颞额导的9例。连续痫性放电达1min以上4例。临床发作13例。癫痫持续状态5例。25例患者行头颅CT或MRI检查,14例患者提示有异常低密度病灶,颞叶病灶12例,额叶颞叶病变5例。治疗1周后19例患者的脑电均有恢复。其中16例患者以弥漫性θ波为主,9例患者以弥漫性a波为主,并有阵发性的θ或d节律慢波。25例患者中痊愈19例;1例器质性精神障碍;2例认知范围缩窄;3例患者中途放弃治疗,均为入院以低波幅σ波为主,其中2例系入院时即表现为去脑强直状态。结论：持续脑电监测对单纯疱疹病毒性脑炎早期诊断具有一定的价值,并对其预后具有一定的预测价值。     

Herpes simplex virus type 1 is the leading cause of genital herpes in New Brunswick

INTRODUCTION:

Little is known about the role of herpes simplex virus (HSV) type 1 (HSV1) in the epidemiology of genital herpes in Canada. Data on herpes viral cultures for two consecutive years obtained from L’Hôpital Dr GL Dumont, which performs all the viral culture testing in New Brunswick, were reviewed. It was hypothesized that HSV1 was the main cause of genital herpes in New Brunswick.

METHODS:

Samples of genital origin sent to the laboratory for HSV culture testing between July 2006 and June 2008 were analyzed. Samples from an unspecified or a nongenital source were excluded from analysis. Multiple positive samples collected from the same patient were pooled into a single sample.

RESULTS:

HSV was isolated from 764 different patients. HSV1 was isolated in 62.6% of patients (male, 55%; female, 63.8%). HSV1 was isolated in 73.2% of patients 10 to 39 years of age and in 32% of patients ≥40 years of age. The difference in rates of HSV1 infection between the 10 to 39 years of age group and the ≥40 years of age group was statistically significant (P<0.001 [χ²]). In a similar Canadian study performed in Nova Scotia, HSV1 was recovered in 53.7% of positive cultures (male, 36.7%; female, 58.1%). The rates of HSV1 infection reported by this study and the present study were significantly different (P<0.001 [χ²] for male, P=0.012 for female).

CONCLUSION:

In New Brunswick, HSV1 is the dominant type of HSV isolated in samples collected from a genital site. Significant rate differences were demonstrated between the groups 10 to 39 years of age and ≥40 years of age.     

Herpes simplex and Epstein-Barr virus lymphadenitis in a patient with chronic lymphocytic leukemia treated with fludarabine

Multiple herpes virus co-infection is a very rare complication in patients with chronic lymphocytic leukemia (CLL). We describe a patient with a CLL who developed an herpes virus lymphadenitis. Inmunohistochemical study was positive for HSV-1, HSV-2, and Epstein-Barr Virus (EBV). The coinfection of EBV with a profile of expresion of viral latent genes type III, is usually seen in inmunodepressed patients. To the best of our knowledge, this is the first reported case of a multiple human herpes virus infection mimicking Richter syndrome.     

RNA interference inhibits herpes simplex virus type 1 isolated from saliva samples and mucocutaneous lesions

The aim of this study was to evaluate the use of RNA interference to inhibit herpes simplex virus type-1 replication in vitro. For herpes simplex virus type-1 gene silencing, three different small interfering RNAs (siRNAs) targeting the herpes simplex virus type-1 UL39 gene (sequence si-UL 39-1, si-UL 39-2, and si-UL 39-3) were used, which encode the large subunit of ribonucleotide reductase, an essential enzyme for DNA synthesis. Herpes simplex virus type-1 was isolated from saliva samples and mucocutaneous lesions from infected patients. All mucocutaneous lesions’ samples were positive for herpes simplex virus type-1 by real-time PCR and by virus isolation; all herpes simplex virus type-1 from saliva samples were positive by real-time PCR and 50% were positive by virus isolation. The levels of herpes simplex virus type-1 DNA remaining after siRNA treatment were assessed by real-time PCR, whose results demonstrated that the effect of siRNAs on gene expression depends on siRNA concentration. The three siRNA sequences used were able to inhibit viral replication, assessed by real-time PCR and plaque assays and among them, the sequence si-UL 39-1 was the most effective. This sequence inhibited 99% of herpes simplex virus type-1 replication. The results demonstrate that silencing herpes simplex virus type-1 UL39 expression by siRNAs effectively inhibits herpes simplex virus type-1 replication, suggesting that siRNA based antiviral strategy may be a potential therapeutic alternative.     

Total dysphagia after short course of systemic corticotherapy:Herpes simplex virus esophagitis

A 72 year-old female developed a herpetic esophagitis after 3 d of oral corticotherapy for an acute exacerbation of chronic obstructive pulmonary disease,presenting as odynophagia and total dysphagia.Biospies were taken during a first esophagogastroduodenoscopy(EGD) and the patient was referred to the thoracic surgery service with a presumptive diagnosis of esophageal cancer.A second EGD was planned for dilatation,but by that time the stenosis was completely resolved.The biopsies taken during the first EGD revealed multiple herpetic viral inclusions and ulcerations without any dysplasia or neoplasia.In front of a severe esophageal stenosis,one must still exclude the usual differential diagnosis peptic stenosis and cancer.Visualization of endoscopic lesions can suggest the diagnosis but must be promptly confirmed by biopsy,viral culture or polymerase chain reaction.Although immune systemic effects of corticotherapy are well known and herpetic esophagitis occurs most frequently in immunocompromised individuals,this case emphasizes the importance of clinical awareness concerning short courses of corticotherapy for immunocompetent individuals.This article discusses the reactivation process of herpetic infection in this context and addresses its diagnostic and therapeutic issues.     

降落PCR法与细胞培养法检测生殖器疱疹患者不同标本HSV的对照研究

目的比较降落PCR法与细胞培养法检测生殖器疱疹患者不同标本单纯疱疹病毒(HSV)阳性率,为临床医师选择检验方法提供参考。方法对生殖器疱疹患者每人取2个拭子,分别采用降落聚合酶链式反应(PCR)和VERO细胞培养法对临床株进行分离培养和鉴定。结果共检测41例患者,降落PCR方法32个标本阳性,均为HSV-Ⅱ;细胞培养方法7个标本阳性,经PCR鉴定为HSV-Ⅱ。降落PCR和细胞培养法HSV阳性率分别为78.0%和14.1%,差异有统计学意义(χ2=30.56,P<0.01)。结论检测生殖器疱疹患者标本中的HSV,PCR法优于细胞培养法,值得推广。     

A rare cause of dysphagia： Herpes simplex esophagitis

Herpes simplex esophagitis (HSE) is well documented in immunosuppressed patients. However, it is rare in the immunocompetent host. We present a case of HSE in a 21 year-old healthy lady who was admitted to our unit with dysphagia, odynophagia and chest pain. Clinical examination revealed mild epigastric tenderness and admission bloods including full blood picture, electrolytes and in? ammatory markers were normal. She underwent an esophagogastroduodenoscopy (EGD) which revealed severe exudative, well-circumscribed ulcerations in her distal esophagus. Biopsies confi rmed severe esophagitis with acute ulceration and subsequent polymerase chain reaction (PCR) confirmed herpes simplex virus (HSV) type 1. Subsequent assessment failed to identify an immune disorder. HSE should be suspected when faced with characteristic endoscopic findings, even if the patient is immunocompetent. When the diagnosis of HSE is confi rmed, an immune defi ciency should be sought.     

Herpes simplex virus type 1 in peptic ulcer disease： An inverse association with Helicobacterpylori

AIM: To assess the frequency of herpes simplex virus type I in upper gastrointestinal tract ulcers and normal mucosa with the modern and better assays and also with a larger number of well characterized patients and controls and its relationship to Helicobacter pylori(H pylori). METHODS: Biopsy specimens from 90 patients (34 with gastric ulcer of the prepyloric area and 56 with duodenal ulcer) were evaluated. Biopsies from 50 patients with endoscopically healthy mucosa were considered as the control group. The method used to identify herpes simplex virus-1 (HSV-1) was polymerase chain reaction. H pylori was detected by the CLO-test and by histological method. RESULTS: Herpes simplex virus-1 was detected in 28 of 90 patients with peptic ulcer (31%) [11 of 34 patients with gastric ulcer (32.4%) and 17 of 56 with duodenal ulcer (30.4%)] exclusively close to the ulcerous lesion. All control group samples were negative for HSV-1. The likelihood of H pylori negativity among peptic ulcer patients was significantly higher in HSV-1 positive cases than in HSV-1 negative cases (P = 0.009). Gastric ulcer patients with HSV-1 positivity were strongly associated with an increased possibility of Helicobacter pylori negativity compared to duodenal ulcer patients (P = 0.010). CONCLUSION: HSV-1 is frequent in upper gastrointestinal tract ulcers but not in normal gastric and duodenal mucosa. There is an inverse association between HSV-1 and H pylori infection.     

初发性和复发性生殖器疱疹患者尿道和宫颈排毒的临床研究

目的应用降落PCR法检测初发性和复发性生殖器疱疹患者尿道和宫颈HSV排放情况。方法对每位初发性和复发性生殖器疱疹患者均取1个拭子,采用降落聚合酶链式反应(TD-PCR)对临床标本进行鉴定。结果共检测38例生殖器疱疹患者,男性尿道口标本28个,初发性7个,复发性21个;女性宫颈管标本10个,初发性和复发性各5个。经降落PCR方法鉴定,均为HSV-Ⅱ。初发病例与复发病例的HSV-PCR阳性率分别为83%(10/12)和46.2%(12/26)(χ2=4.66,P<0.05),有显著性差异。结论初发性和复发性生殖器疱疹患者尿道和宫颈HSV排放的情况不同,初发性生殖器疱疹的排毒率高于复发性生殖器疱疹。     

单纯疱疹病毒血清学检测及其临床应用进展

单纯疱疹病毒是一种常见的疱疹病毒.近年来,随着发病率的不断上升,受到越来越多临床和科研工作者的重视,通过血清学方法来检洲单纯疱疹病毒是该领域的热点之一.该文就对用血清学检测方法来诊断单纯疱疹病毒以及其在临床中的应用进行简单的综述.     

单纯疱疹病毒Ⅰ、Ⅱ型感染的临床和实验诊断研究

目的 探讨生殖器疱疹（GH）患者单纯疱疹病毒Ⅰ型、Ⅱ型（HSV-Ⅰ、Ⅱ）抗原检测的临床意义，评价其实验诊断的必要性和实用性。方法应用酶联免疫吸附试验（ELIsA）对有GH皮损或无GH皮损但有泌尿生殖道症状的1859例患者（男1104例，女755例）检测HSV-Ⅰ、Ⅱ抗原，无GH症状者同时检测其他性病病原体。结果 1104例男性患者中，无GH皮损但有尿道症状者498例，检出HSV抗原阳性159例，阳性率31．9％；有GH皮损者606例，检出HSV抗原阳性367例，阳性率60．56％。有和无GH皮损两组HSV抗原阳性率的差异有非常显著的统计学意义（χ^2=88．70，P〈0．001）。755例女性患者中，无GH皮损但阴道分泌物不正常或外阴不适者333例，有GH皮损者422例，HSV抗原阳性率分别为30．63％（102／333）和35．31％（149／422）。有和无GH皮损两组HSV抗原阳性率无显著性差异（χ^2=1．63，P〉0．05）。男、女无GH皮损组分别有90例和36例，除HSV抗原阳性外，还伴有其它性病病原体阳性。结论 应对有GH皮损患者进行HSV抗原检测，但在无GH皮损患者中也可在泌尿生殖道中查到较高的HSV抗原检出率，提示对有泌尿生殖道不适症状者，即使没有皮损，也可发生HSV感染。所以对该类患者除检测常规性病病原体外。还应同时检测HSV，防止漏诊。     

酶联免疫斑点法检测抗1型单纯疱疹病毒IgM分泌细胞在单纯疱疹病毒性脑炎早期诊断中的作用

目的 观察酶联免疫斑点法(ELISPOT)检测抗1型单纯疱疹病毒IgM(抗-HSV-1 IgM)分泌细胞在单纯疱疹病毒性脑炎(HSV-1脑炎)早期诊断中的作用并探讨其价值.方法 采用ELISPOT法和ELISA法分别检测患者脑脊液中的抗-HSV-1 IgM分泌细胞和抗-HSV-1 IgM,并对HSV-1腩炎23例、临床对照组40例进行回顾性分析,统计学处理采用Fisher精确检验法.结果 ELISPOT法检测HSV-1脑炎组9例患者2周内脑脊液中抗-HSV-1 IgM分泌细胞,8例阳性.敏感度为88.9%;临床对照组检测16例,15例阴性,特异度为93.8%.ELISA法榆测HSV-1脑炎组12例患者脑脊液2周内抗-HSV-1 IgM,2例阳件,敏感度为16.6%;临床对照组检测17例,15例阴性,特异度为88.2%.两种方法敏感度比较差异有统汁学意义(P<0.01).结论 应用ELISPOT法检测HSV-1脑炎患者脑脊液中抗-HSV-1 IgM分泌细胞优于 ELISA方法检测抗-HSV-1 IgM,具有更好的早期诊断意义.     

单纯疱疹病毒感染与冠心病急性心肌梗死的关系

目的　探讨单纯疱疹病毒 (HSV )感染与冠心病心肌梗死的关系。方法　测定 5 1例急性心肌梗死 (AMI)和 42例陈旧性心肌梗死 (OMI)及 3 1例冠脉造影正常者 (对照组 )的HSV 1抗体、C 反应蛋白 (CRP)、血脂水平。结果　AMI组HSV 1IgG阳性率及水平高于对照组 (P <0 .0 5 ) ,血HSV 1DNA检测结果与之吻合。校正冠心病危险因素前、后 ,HSV 1IgG阳性与AMI均有相关关系 (OR4.2 66,OR3 .3 2 1)。AMI组中HSV 1( +)组CRP、TC、LDL C高于HSV 1( -)组(均P <0 .0 5 ) ,并且IgG与CRP、TC、LDL C呈正相关。 结论　HSV 1感染与AMI之间存在明显的相关性 ,与血脂、CRP也存在相关性