Human picornavirus and coronavirus RNA in nasopharynx of children without concurrent respiratory symptoms.

The prevalence of human rhino-, entero-, and coronaviruses was investigated by RT-PCR in nasopharyngeal aspirates from 107 children without concurrent respiratory symptoms. The children were admitted to the hospital for elective surgery. The parents filled a questionnaire about the occurrence of respiratory symptoms four weeks before and two weeks after the surgery. The rate of viral detection was 45% in children with related past or recent respiratory infection whereas 20% of the samples taken from children without any related past or recent respiratory infections were positive for picornavirus RNA, P = 0.008. Thirty-one (29%) of the nasopharyngeal aspirates were positive for viral RNA, 18% for rhinovirus, and 11% for enterovirus RNA. Coronavirus RNA was not found in any of the children. Fifty-five percent of the children with virus-positive samples had an infection-related diagnosis. In addition, 81% of the children with virus-positive samples had had previously respiratory symptoms or there were concurrent respiratory symptoms in other family members. Only four of the 31 virus-positive samples were from children without infection-related diagnosis or recent past (or immediate future) respiratory symptoms.     

A coxsackievirus B5‐associated aseptic meningitis outbreak in Shandong Province,China in 2009

In 2009, a major outbreak of aseptic meningitis was noted in Linyi city, Shandong province, China. From June to September 2009, a total of 2,104 cases were involved in this outbreak, and 98.6% of patients were <16 years of age. To determine the pathogen of the outbreak, 42 cerebrospinal fluid specimens collected from aseptic meningitis cases were tested for cell culture, and 17 (40.5%) enteroviruses were isolated and identified as Coxsackievirus B5 (CVB5). Homologous comparison indicated that these isolates had 0–7.7% nucleotide divergence with each other. Phylogenetic reconstruction showed global CVB5 could be separated into four genogroups, and all Linyi CVB5 isolates belonged to the genogroup C which had been circulating for recent 27 years in Asia and Europe. Interestingly, two distinct lineages were observed for the 17 isolates in the phylogenetic tree, indicating that at least two different transmission chains of CVB5 were responsible for this outbreak. This study showed that CVB5‐associated aseptic meningitis is an emerging concern in China. J. Med. Virol. 85:483–489, 2013. © 2012 Wiley Periodicals, Inc.     

逆转录—多聚酶链反应检测柯萨奇B组病毒

研究目的用分子生物学方法对柯萨奇Ｂ组病毒（ＣＢＶ）进行检测并探讨与临床症病的关系。研究方法对我院２９８例疑似ＣＢＶ感染的患儿，采用特异性引物进行逆转录－多聚酶链反应（ＲＴ－ＰＣＲ）检测ＣＢＶ。结果检出ＣＢＶ阳性１２７人，阳性率４２．６％。感染与年龄有关，夏秋季多见。８０例健康儿童中，阳性５人，占６．２５％。２０例ＲＴ－ＰＣＲ检测阳性标本用ＥＬＩＳＡ法检测，１７例阳性。结论ＲＴ－ＰＣＲ可快速、敏感、准确地检出标本中的ＣＢＶ。此病毒可侵犯多种器官，引起各种临床症病，有较强的传染性。     

Therapeutic efficacy of milrinone in the management of enterovirus 71-induced pulmonary edema

Hand, foot, and mouth disease and herpangina are the major clinical manifestations of enterovirus 71 (EV71) infections. Brain-stem encephalitis and pulmonary edema are severe complications that can lead to death. This study was designed to evaluate the potential therapeutic effect of milrinone, a phosphodiesterase (PDE) inhibitor, in the treatment of patients with EV71-induced pulmonary edema. We conducted a historically controlled trial of 24 children with severe EV71-induced pulmonary edema from April 1998-June 2003 in southern Taiwan. Patients were divided into groups treated before and after the introduction of milrinone therapy. Etiological diagnosis was established by viral cultures and confirmed by specific immunofluorescence and neutralization tests. All 24 patients were below 5 years of age. The mortality was lower in the milrinone-treated vs. nontreated group (36.4% vs. 92.3%, P=0.005). Sympathetic tachycardia was decreased in patients treated with milrinone compared to controls (144 +/- 17/min vs. 206 +/- 26/min, P=0.004). A marked decrease in IL-13 (77 +/- 9 pg/ml vs. 162 +/- 88 pg/ml, P=0.001) was observed in milrinone-treated patients compared to controls. There was a significant reduction in white blood cell (10,838 +/- 4,537/mm3 vs. 19,475 +/- 7,798/mm3, P=0.009) and platelet (257 +/- 45 x 10(3)/mm3 vs. 400 +/- 87 x 10(3)/mm3, P=0.001) counts in milrinone-treated patients compared to controls. These results were associated with improvement in sympathetic regulation and decrease in IL-13 production. Milrinone therapy may provide a useful therapeutic approach for this highly lethal disorder.     

三种细胞在脊髓灰质炎病毒检测中的应用比较

为了比较在常规应用条件下L20B细胞与RD、Hep-2细胞对脊髓灰质炎(脊灰)病毒(PV)的敏感性和选择性,同时用3种细胞检测急性弛缓性麻痹(AFP)病例412份粪便标本,进行PV分离鉴定及效价测定.结果表明,L20B细胞对PV更敏感,对PV有完全的选择性和良好的特异性,对同时混有非脊灰肠道病毒(NPEV)和PV的粪便标本,L20B细胞能更快地检测出PV,而RD、Hep-2细胞被NPEV的生长所掩盖.L20B细胞的PV检出率(5.34%)高于RD(4.61%)、Hep-2细胞(2.67%).L20B、RD、Hep-2细胞对PV的敏感性分别为88%、76%、44%,但3种细胞对PV都出现了不同程度的漏检.从25株PV效价滴定结果分析,3种细胞对PV的滴度均为L20B、RD细胞高于Hep-2细胞.表明L20B细胞能简化粪便标本PV检测过程.它的应用对PV分离不失为一种便捷、省时、省力、经济和可靠的方法.     

Critical management in patients with severe enterovirus 71 infection

OBJECTIVE: The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection. METHODS: A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison. RESULTS: The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2+/-5.0 vs 4.9+/-1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute-stage and long-term survival rates were higher in the study group (100% vs 43%, 87% vs 29%). CONCLUSION: Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management.