儿童慢性活动性EB病毒感染的临床分析

目的 研究儿童慢性活动性EB病毒感染(CAEBV)的临床特征,为CAEBV的诊治提供依据。 方法 回顾性分析2008年1月至2016年1月在我院收治的10例CAEBV患儿的临床资料、实验室血清学、病理学检查和治疗及随访结果。 结果 儿童CAEBV主要临床表现为持续或间断发热、肝脾肿大和淋巴结肿大,其他还伴有乏力、咳嗽、呕血、腹泻、皮疹、视网膜炎、黄疸、咽痛、肌肉关节痛等。多有肝功能和血液学异常等。所有患者均有抗EB病毒衣壳抗原IgG(VCA-IgG)抗体和早期抗原EA-IgG抗体阳性,抗EB病毒衣壳抗原IgM(VCA-IgM)抗体均为阴性。实时定量聚合酶链反应检测外周血EBV-DNA病毒载量中位数为7.15×10 ⁵ copies/ml。随访10例CAEBV患儿中,死亡6例,死亡原因分别为颅内出血1例、呼吸衰竭2例、消化道出血1例、肝衰竭1例,多重感染1例;3例好转,1例病情仍有反复。 结论 CAEBV临床表现多样,预后差,病死率高,临床上存在不明原因的发热、肝脾或淋巴结肿大的病例应及时行病毒学及组织病理学检查以尽早确诊。     

儿童Epstein—Barr病毒感染临床分析

目的探讨慢性活动性Epstein—Barr病毒（EpsteinBarrvirus,EBV）感染、急性EBV感染及正常儿童EBV—DNA及适应性体液免疫的差异。方法慢性活动性EBV感染患儿8例（慢性组）,急性EBV感染患儿13例（急性组）,正常儿童12例（对照组）外周血单个核细胞采用实时荧光定量PCR法检测,3组EBV—DNA水平,采用ELISA、抗体稀释试验评价EBV适应性体液免疫,分析其与EBV感染不同转归的关系。结果慢性组EBV—DNA载量、病毒壳蛋白抗原-IgA、-IgG及早期抗原-IgA水平明显高于急性组和对照组（P〈0．01）,病毒壳蛋白抗原-IgM水平及早期抗原-IgG滴度改变速率低于急性组（P〈O．01）;慢性组与急性组EBV核抗原-IgG抗体水平均低于对照组（P〈0．01）。结论慢性活动性EBV感染存在不同EBV核抗原-LP拷贝数及不同亲和力的抗体谱,可能与慢性活动性病程相关,对早期识别诊治有重要意义。     

An adult-onset case of chronic active Epstein-Barr virus infection with fulminant clinical course

A 56-year-old Japanese male with chronic active Epstein-Barr virus (EBV) infection (CAEBV) who developed systemic gamma-delta T-cell lymphoproliferative disease (LPD) is reported. Although immune cooling therapy was effective, he died of sudden and severe hypoxia and anemia soon after the initiation of cytotoxic chemotherapy that had been previously recommended. There might remain a difficulty to control fulminant adult-onset CAEBV. Additionally, we describe three types of lymphoid cells that were observed in his peripheral blood: morphologically normal lymphocytes, large blastic cells and mature ones with rough granules. Morphological observation appeared to be useful to estimate clinical manifestations. Since CAEBV is extremely rare disease in adult population, it is important to accumulate clinical data to more understand the pathogenesis or to establish treatment strategy.     

慢性活动性EB病毒感染的研究进展

慢性活动性EB病毒感染(CAEBV)是EB病毒(EBV)感染T细胞或自然杀伤(NK)细胞导致的淋巴增殖性疾病,具有炎症性及肿瘤性双重特点,罕见且病死率高。CAEBV患者的特征包括反复或持续发作传染性单核细胞增多症样症状,外周血EBV-DNA载量升高,临床表现通常为反复发热、淋巴结大、肝脾大、EBV肝炎、肝功能损伤、血小板减少等。笔者拟通过对近年CAEBV的发病机制、临床特征、诊治及患者预后等多方面的研究进展进行综述,旨在提高临床医师对该病的认识,尽量做到早诊断、早治疗,改善患者的生存。     

Adult-onset chronic active Epstein-Barr virus infection: Report of two cases and literature review北大核心CSCD

Objective To report two cases of adult-onset chronic active Epstein-Barr virus (CAEBV) infection, and review the relevant literature to improve the awareness of this disease. Methods The clinical data of 2 CAEBV patients were analyzed retrospectively. We also summarized the current understanding of CAEBV and described recent progress of CAEBV research. Results Two patients were diagnosed with CAEBV. The follow-up data showed that viral load was still detectable in one patient. The other patient lost to follow up. Conclusions The clinical presentations of CAEBV are diverse and nonspecific. The disease is progressive and more aggressive than the childhood-onset cases. The viral load in peripheral blood plays an important role in assessing patients’ conditions and planning therapeutic strategies. Viral load combined with tissue biopsy is an effective way for early diagnosis of this disease. © by Editorial Department of Chinese Journal of Infection and Chemotherapy.     

儿童慢性活动性EB病毒感染的相关血液疾病特征

本研究通过4个病例分析儿童慢性活动性EB病毒（CAEBV）感染相关的血液学病征。总结了临床特点，应用显微镜观察骨髓涂片的细胞形态，流式细胞仪分析淋巴细胞亚群，免疫组织化学检测肝穿刺组织，酶联免疫吸附试验（ELISA）检测血浆EBV抗体，实时定量PCR检测血浆EBV—DNA，原位杂交检测外周血单个核细胞（PBMNCs）EBV编码小RNA-1（EBER-1）。结果显示：4例患儿有持续或反复的发热、肝脾肿大、肝功能异常、贫血、血小板减少症、全身炎症反应；骨髓象表现增生减低、成熟障碍、病态造血和噬血细胞增多；4例患者均有CD8^＋T淋巴细胞增多，其中1例进展为T细胞淋巴瘤；2例EBV—VCA-IgG滴度≥1：5120，1例血浆EBV-DNA拷贝数为3．26×10^3／ml，1例PBMNC的EBER1阳性率为1．7％；最后，4例患者均被诊断为CAEBV。结论：免疫相关性血细胞减少、巨噬细胞活化综合征和淋巴细胞增殖性疾病等是本研究中4例CAEBV患儿的血液学病征。     

Phaeomycotic cysts caused by Phoma species

Phoma species are primarily phytopathogens which have been reported to sporadically cause human disease. We report a patient with phaeohyphomycotic cysts caused by Phoma species, which were initially mistaken for ganglions.     

Epstein-Barr virus and carcinomas

Summary The Epstein-Barr virus, a human B lymphotropic herpes virus, is strongly associated with undifferentiated nasopharyngeal carcinoma, which is endemic in Southern China and North Africa. More recently, an association of the virus with certain other epithelial malignancies has been described, some of which are more common in Western countries. Also, the observation that oral hairy leukoplakia, an acquired immunodeficiency syndrome-related lesion of the tongue, supports Epstein-Barr virus replication in the epithelial cell compartment has further strengthened the notion that Epstein-Barr virus infection of epithelial cells may be an important phenomenon in vivo. The purpose of this article is to review the association of Epstein-Barr virus with nasopharyngeal carcinomas, to examine the evidence suggesting an association of the virus with other epithelial neoplasias and to discuss Epstein-Barr virus infection of non-neoplastic epithelial cells.     

A fatal case with disseminated Myceliophthora thermophila infection in a lymphoma patient

We report a lethal Myceliophthora thermophila infection in an immunocompromised patient. Based upon the clinical and mycological presentation, an initial diagnosis of invasive aspergillosis was made, possibly delaying optimal management in the patient. Melanized fungi are emerging pathogens that require early identification to improve their unfavorable prognosis.     

Evaluation of the safety and efficacy of micafungin in Japanese patients with deep mycosis: a post-marketing survey report

The safety and efficacy of micafungin were evaluated in a Japanese post-marketing survey involving 1,142 patients with deep mycosis caused by Candida or Aspergillus. The overall clinical response was 83.0%, and the respective responses for patients with candidiasis or aspergillosis were 86.3 and 70.8%. With regard to drug reactions, 562 adverse reactions were observed in 28.5% of patients. Among the 83 serious adverse drug reactions reported by 53 patients, a causal relationship with micafungin was assessed as definite or probable for 6 reactions in 5 patients. Age and baseline hepatic and renal function status did not affect the incidence of adverse reactions, although incidence increased significantly in proportion to the severity of mycosis and daily dose (p < 0.01). In multiple logistic regression analysis, neither baseline hepatic impairment nor increased daily dose of micafungin affected the incidence of hepatobiliary disorders, however, the severity of mycosis was found to correlate significantly with hepatobiliary disorders (p = 0.031). Taken together, our post-marketing findings show that micafungin is effective against deep mycosis caused by Candida or Aspergillus in patients across a range of backgrounds.     

EB病毒IgM、IgG及DNA检测在儿童呼吸道感染性疾病中的诊断价值分析

目的分析EB病毒(EBV)IgM、IgG及EBV-DNA在儿童呼吸道感染性疾病中的诊断价值。方法选取400例呼吸道感染患儿作为观察组,100例非呼吸道感染住院患儿作为对照组,采用酶联免疫吸附法(ELISA)检测患儿的EBV-IgM和IgG,荧光定量PCR(FQ-PCR)检测病毒DNA。比较观察组和对照组患儿的EBV-IgM、IgG及EBV-DNA阳性率,评价不同指标的诊断价值。结果观察组患儿EBV-IgM阳性率51.00%,EBV-IgG阳性率58.50%,EBV-DNA阳性率56.25%;对照组患儿EBV-IgM阳性率4.00%,EBV-IgG阳性率11.00%,EBV-DNA阳性率5.00%,差异具有统计学意义(P0.05)。EBV-IgM灵敏度51.00%,特异度96.00%,曲线下面积0.617;EBV-IgG灵敏度58.50%,特异度89.00%,曲线下面积0.583;EBV-DNA灵敏度56.25%,特异度95.00%,曲线下面积0.642。结论 EBV-IgM、IgG及EBV-DNA在儿童呼吸道感染中具有诊断价值。     

肺部暗色丝孢霉病1例并文献复习

目的加强对暗色丝孢霉病的临床表现和病原学特点的认识,提高诊治率。方法分析2008年广州医科大学附属第一医院收治的1例甄氏外瓶霉所致的肺部暗色丝孢霉病患者的临床、影像学及病原学资料,结合1995年1月至2013年8月国内报道的23例有完整资料的暗色丝孢霉病病例进行复习。结果 24例暗色丝孢霉病中,男15例,女9例,年龄4～76岁,平均（40.0±21.8）岁。既往体健者17例,有基础疾病者7例。皮肤和皮下组织感染18例,肺部和中枢神经系统感染各2例,鼻窦和睑结膜感染各1例。单纯临床标本培养阳性的5例中,皮肤脓液1例,肺组织2例,脑脊液2例;单纯病理学阳性1例;组织培养和组织病理同时阳性18例。24株暗色丝孢霉中进行了鉴定分型的有22株,以甄氏外瓶霉为主（7株）。23例接受治疗的患者中,单纯药物治疗18例,抗真菌治疗联合手术切除局部病灶4例,抗真菌治疗联合XD-635AB光动力激光治疗1例。其中单用伊曲康唑10例,获得了较好疗效。结论该系列暗色丝孢霉病患者多有基础疾病或使用免疫抑制剂、糖皮质激素史,临床表现以皮肤和皮下组织感染为主,皮损多分布于四肢、面部和胸腹部。最常见者由甄氏外瓶霉引起,其次为疣状瓶霉和棘状外瓶霉。伊曲康唑对大多数病例有效：对于难治性感染,可根据药敏试验结果用药。     

成都地区儿童EB病毒感染情况流行病学分析

目的了解EB病毒(EBV)在儿童中的感染情况及流行病学特征。方法收集2013年6月至2014年6月住院和门诊就诊的急性上呼吸道感染、支气管炎、肺炎、扁桃体炎等疾病患儿5 272例的血液,采用酶联免疫吸附试验(ELISA)检测EBV衣壳抗原(VCA)抗体IgM和IgG,分析患儿的感染情况。结果小于1岁患儿(1 943例),1~5岁患儿(2 479例),5~10岁患儿(715例),10~17岁患儿(135例)的EBV-VCA IgM阳性率分别为5.04%、6.13%、3.92%和2.22%,EBV-VCA IgG阳性率分别为24.60%、40.98%、62.66%和77.78%。EBV-VCA IgG阳性率随着年龄增加有增加的趋势,且各年龄组EBV新发感染率和累计感染率比较差异均有统计学意义(P0.05)。春季、夏季、秋季、冬季的EBV-VCA IgM阳性率分别为3.35%、6.26%、6.13%和6.10%,比较差异有统计学意义(P0.05);EBV-VCA IgG阳性率分别为38.98%、38.38%、38.23%和39.80%,比较差异无统计学意义(P0.05)。不同季节EBV新发感染率差异有统计学意义(P0.05)。结论该地区EBV的儿童感染率仍然处于较高水平,因此家长仍需提高对EBV感染预防的认识。     

Chronic active Epstein–Barr virus infection with intrapulmonary shunting: A case report

Chronic active Epstein–Barr virus (EBV) infection (CAEBV) is a high-mortality form of EBV infection. However, chronic hypoxemia is rare in these patients. We herein reported a case of severe hypoxemia due to intrapulmonary shunting in CAEBV. A 17-year-old girl presented with fever, dyspnea, cyanosis, and hepatosplenomegaly. Laboratory tests showed mild liver dysfunction and high copy numbers of EBV-DNA in the peripheral blood. A left supratrochlear lymph node biopsy showed infiltration of highly proliferative T lymphocytes with positive EBV encoded small RNA by in situ hybridization. Technetium-99m-labeled macroaggregated albumin and contrast-enhanced echocardiography confirmed the existence of intrapulmonary shunting, which was probably related to hepatopulmonary syndrome. The final diagnosis was CAEBV with intrapulmonary shunting. The patient was treated with cyclosporine A, etoposide, and dexamethasone. Finally, the patient died of respiratory failure. Intrapulmonary shunting is a rare complication of CAEBV. Early recognition and exploring the cause of hypoxemia should be highlighted in patients with CAEBV.     

儿童EB病毒感染29例临床分析

目的 对儿童EB病毒(EBV)感染的临床表现、实验室检查和误诊情况进行分析,以提高EBV感染的诊断水平.方法 回顾分析我院2007年1月～2009年12月用酶联免疫吸附(ELISA)法检测EBV-VCR-IgM诊断EBV感染29例的临床资料.结果 EBV感染多表现为发热、咽峡炎、淋巴结增大、肝脾大,亦可出现咳嗽、黄疸、...     

Disseminated fusariosis emerged from prolonged local genital infection after cord blood transplantation

Disseminated fusariosis (DF) is a rare life threatening fungal infection in immunocompromised hosts. We herein report a case of a fatal DF mimicking varicella zoster virus (VZV) infection that was emerged from a localized genital infection during cord blood transplantation (CBT) in a patient with severe aplastic anemia (SAA). The patient developed an ulcer following small painful vesicles mimics herpes simplex virus infection (HSV) on the glans penis before CBT, but a Fusarium species was identified. Despite administration of voriconazole, liposomal amphotericin B and granulocyte transfusion, the lesion was extended to extensive skin looked like VZV infection and the patients died after CBT. Massive fusarium infiltration was detected in multiple organs at autopsy. A genetic analysis of the mold identified Fusarium solani after his death. It should be noted that in patients with fusarium infection, localized and disseminated lesions of fusarium infection sometimes mimic HSV and VZV infections, which hampers an early diagnosis.     

慢性阻塞性肺疾病合并肺部真菌感染50例分析

目的:观察慢性阻塞性肺疾病合并肺部真菌感染的临床特点及治疗效果。方法:回顾分析50例慢性阻塞性肺疾病合并肺部真菌感染患者的临床表现、治疗方案和疗效判断。结果:氟康唑治疗后,痊愈30例、显效16例、无效4例,有效率92%。不良反应有胃肠道反应4例、3例肝功能异常。结论:肺部真菌感染逐年增加,占深部真菌感染首位。如果慢性阻塞性肺疾病感染加重,经积极抗生素治疗无效,应考虑并存真菌感染。