单纯疱疹病毒1型引起的发热出疹性疾病需要与手足口病进行鉴别  

Rash and Fever Illness Caused by Herpes Simplex Virus Type 1 Needs to be Distinguished from Hand,Foot and Mouth Disease

作　　者：祝双利[1] 刘建锋[2] 孙强[1] 李静[1] 李晓嫘[1] 张勇[1] 陈瑛[2] 温小云[2] 严冬梅[1] 黄国虹[1] 张宝敏[1] 张波[1] 安洪秋[1] 李慧[2] 许文波[1] 

机构地区：[1]中国疾病预防控制中心病毒病预防控制所世界卫生组织西太平洋区脊髓灰质炎参比实验室,北京102206 [2]甘肃省疾病预防控制中心,兰州730000

出　　处：《病毒学报》2013年第4期415-420,共6页Chinese Journal of Virology

基　　金：国家自然科学基金(项目号30900063,81101303);国家科技重大专项(项目号2012ZX10004201)

摘　　要：对2008年在甘肃省发生的一起疑似手足口病(HFMD)的发热出疹性疾病的流行进行病原体的实验室检测,明确引起这起传染病流行的病原体。从4名发热出疹患者采集的8份临床标本中(每个患者采集咽拭子和疱疹液标本),首先将临床标本接种到RD和HEp-2细胞上进行病毒分离,对病毒分离阳性的标本提取病毒核酸,然后使用荧光定量-逆转录-聚合酶链式反应(RT-PCR)进行人肠道病毒(HEV)核酸的检测。对HEV检测结果阴性的标本采用序列非依赖的单引物扩增技术(SISPA)进行"未知病原体"的鉴定。分离到的6株病毒均鉴定为单纯疱疹病毒I型(HSV-1),结合分析这起流行中患者的临床表现、流行病学调查结果以及实验室检测结果,表明HSV-1是引起这起发热出疹性疾病流行的病原体。6株HSV-1的gG区核苷酸和氨基酸水平上差异都较小,同源性分别高达98.8%和97.9%,说明这起疫情是由同一个病毒传播链引起的。HSV-1等病毒引起的发热出疹性疾病需要与HFMD进行鉴别诊断,由于仅从临床症状和流行病学资料上判断引起发热出疹性疾病的病原体是非常困难的,因此,必须依赖于实验室的诊断。An epidemic of rash and {ever illnesses suspected of hand, foot and mouth disease （HFMD） occurred in Gansu Province of China in 2008, laboratory tests were performed in order to identify the pathogen that caused this epidemic. Eight clinical specimens collected from the 4 patients （each patient has throat swab and herpes fluid specimens） with rash and febrile illness, were inoculated onto RD and HEp-2 cells for virus isolation, and the viral nucleic acid was then extracted with the positive virus isolates, the dual-channel real-time reverse transcript-polymerase chain reaction （RT-PCR） was performed to detect the nucleic acid of human enterovirus （HEV） in the viral isolates at the same time. For the viral isolates with the negative results of HEV, a sequence independent single primer amplification technique （SISPA） was used for ＂unknown pathogen＂ identification. Totally, 6 viral isolates were identified as herpes simplex virus type 1 （HSV-1）. Comprehensive analyses results of the clinical manifestations of the patients, epidemiological findings and laboratory test indicated that this epidemic of rash and febrile illness was caused by HSV-1. The differences among the gG region of 6 HSV-1 isolates at nucleotide level and amino acid level were all small, and the identities were up to 98. 8~ and 97. 9~, respectively, showing that this outbreak was caused by only one viral transmission chain of HSV-1. HSV-1 and other viruses that cause rash and febrile illnesses need differential diagnosis with HFMD. The etiology of rash and febrile illness is some- times difficult to distinguish from the clinical symptoms and epidemiological data, the laboratory diagnosis is therefore critical.

关 键 词：发热出疹性疾病 手足口病 序列非依赖的单引物扩增技术 单纯疱疹病毒1型 A基因型 

分 类 号：R373.2[医药卫生—病原生物学]