美國及英格蘭皆發現間質肺病毒新病例


  June 5, 2003 -根據六月號的《小兒科》(Pediatrics)的報導,來自耶魯的研究人員也許是美國第一位發現間質肺病毒(hMPV)新案例的人,間質肺病毒首先是在荷蘭鑑定出來,在英格蘭也發現類似病例,但是還需要更多研究以決定感染的範圍。
  
  間質肺病毒(hMPV)在美國境內流傳,病患症狀與呼吸道疾病有關,但並非是由呼吸道融合瘤病毒、流行性感冒、副流行性感冒及腺病毒所引起,康乃迪克州耶魯醫學院Frank Esper醫師及同事表示,還需要更多研究以定義流行病學以及由hMPV引發的疾病佔總人口的比例。
  
  從2001年10月30日到2002年2月28日,研究人員透過直接螢光抗體檢測,收集296名五歲以下孩童的呼吸道樣本,經過檢驗顯示,呼吸道融合瘤病毒、流行性感冒A型及B型、副流行性感冒1-3型,及腺病毒都呈陰性反應,另外在296名接受篩檢的病患中,逆轉錄-聚合鍊反應也顯示19名病患有感染hMPV的證據(6.4%)。
  
  感染hMPV的病患都有上或下呼吸道感染,出現氣喘、組織性缺氧、及胸部X光不正常的現象,例如病灶侵入(focal infiltrates)或支氣管邊包裹(peribronchial cuffing)的現象;其中至少有一名病患出現醫院感染、顯示需要重新評估許多醫療設施的隔離或集中標準。
  
  這項研究的限制包括收集呼吸道樣本是由醫療團隊自行處理,所以無法研究無症狀的嬰兒及兒童,以及研究中只有包含五歲以下的小孩,作者表示,可在使用免疫學檢驗及案例控制研究,以確定hMPV在呼吸道感染中扮演的角色。
  
  作者指出,我們發現hMPV的確在美國傳播,而且可能是很多嬰兒及兒童呼吸道感染的主要成因,作者同時指出,診斷工具更進一步的發展及應用,將可決定由新發現的病原體所導致的疾病負擔。
  

New Cases of Metapneumovirus I

By Laurie Barclay, MD
Medscape Medical News

June 5, 2003 — Investigators from Yale are perhaps the first to find cases of metapneumovirus (hMPV) in the U.S., according to a report in the June issue of Pediatrics. It was first identified in the Netherlands and others have found it in England, but more research is needed to determine the extent of this infection.

"hMPV is circulating in the United States and is associated with respiratory tract disease in patients with respiratory illnesses not caused by respiratory syncytial virus, influenza, parainfluenza viruses, and adenovirus," write Frank Esper, MD, and colleagues from Yale University School of Medicine in New Haven, Connecticut. "Additional studies are required to define the epidemiology and the extent of disease in the general population caused by hMPV."

From October 30, 2001, to February 28, 2002, the investigators collected respiratory specimens from 296 children who were younger than five years and had a negative result for respiratory syncytial virus, influenza A and B, parainfluenza viruses 1 to 3, and adenovirus by direct fluorescent antibody test. Of the 296 patients screened, reverse transcriptase–polymerase chain reaction revealed evidence of hMPV infection in 19 patients (6.4%).

Patients with hMPV had either upper or lower respiratory tract infection or both, with wheezing, hypoxia, and abnormal findings on chest x-rays, such as focal infiltrates or peribronchial cuffing. At least one patient had a nosocomial infection, suggesting the need for re-evaluation of criteria for isolation and cohorting in many healthcare facilities.

Study limitations include collection of respiratory samples at the discretion of the medical team, failure to study asymptomatic infants and children, and inclusion only of children younger than five years. The authors recommend immunologic assays and case-control studies to confirm the role of hMPV in respiratory infections.

"We demonstrated that hMPV is circulating in the U.S. and may be a major cause of respiratory tract infection in infants and children," the authors write. "Future development and application of diagnostic tools will determine the burden of disease caused by this newly discovered pathogen."

Pediatrics. 2003;111:1407-1410

Reviewed by Gary D. Vogin, MD

    
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