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目的确认2005年10月湖南省湘潭县发生的一起家庭聚集性(姐弟二人)不明原因肺炎病例的病因。方法访谈病例发病前后的相关知情人,重现病家暴露环境及发病时间序列,查阅临床病志,对病例和病死禽的密切接触者进行医学观察。采集病例咽拭子,应用逆转录-聚合酶链反应 (RT-PCR)和实时荧光定量PCR法,检测A/H5N1亚型特异的核酸片段,接种SPF鸡胚进行病毒分离。应用马血球血凝抑制试验和微量中和试验检测患者急性期和恢复期血清抗A/H5特异性抗体滴度。结果姐(病例1)弟(病例2)二人分别在其家鸡开始死亡2天和4天后出现发热和肺炎症状,病例1死于急性呼吸窘迫综合征和多器官功能衰竭,病例2痊愈。病例1病后第8天的血清A/H5抗体阴性,病例2急性期和恢复期血清抗体滴度呈4倍以上升高。192名密切接触者中,仅1名(接诊过病例1的医生)出现上呼吸道症状,但血清标本经微量中和试验阴性。结论病例2为中国大陆第一例感染禽流感病毒(H5N1)的确诊病例,病例1为临床诊断病例。二者发病最可能是感染了相同家庭环境中病死禽传播的H5N1病毒,调查中未发现两病例之间有互相传播的证据。
Objective To confirm the etiology of an unexplained pneumonia with family agglomeration (siblings) in Xiangtan County, Hunan Province, in October 2005. Methods Interviewed relatives before and after the onset of disease to reproduce the sequence of exposure and the time of onset of disease. The clinical pathology was reviewed and medical observation was conducted on the close contacts of the patients and the dead birds. Throat swabs were collected and the A / H5N1 subtype-specific nucleic acid fragments were detected by reverse transcription-polymerase chain reaction (RT-PCR) and real-time fluorescence quantitative PCR. Application of horse blood hemagglutination inhibition test and trace neutralization test in patients with acute and convalescent serum anti-A / H5-specific antibody titers. Results Sister (case 1) brother (case 2) developed fever and pneumonia symptoms 2 and 4 days after their chickens began to die, respectively. Case 1 died of acute respiratory distress syndrome and multiple organ failure, and case 2 recovered. Serum A / H5 antibody was negative on the 8th day after the illness in case 1, and the serum antibody titer in the acute and convalescent cases was more than 4 times. Of the 192 close contacts, only 1 (a physician who had had a previous case 1) developed upper respiratory symptoms, but serum samples were negative by the micro-neutralization test. Conclusions Case 2 is the first confirmed case of bird flu virus (H5N1) infection in mainland China. Case 1 is a case of clinical diagnosis. Both were most likely to be infected with H5N1 virus transmitted by dead or dead birds in the same family environment. No evidence of mutual transmission between the two cases was found in the survey.