Pröll S, Dobler G, Pfeffer M, Jelinek T, Nothdurft H D, Löscher T
Abteilung für Infektions- und Tropenmedizin, Klinikum Innenstadt.
Dtsch Med Wochenschr. 1999 Jun 18;124(24):759-62. doi: 10.1055/s-2007-1024409.
A 57-year-old patient presented with malaise and severe persistent arthralgia of the left shoulder. He reported an acute illness with fever, generalized myalgia and arthralgias of the large joints which had started one month earlier during his flight back to Germany after a two weeks trip to the South Pacific. Physical examination showed extensive pain on palpation of the glenohumeral and acromioclavicular joints with impairment of active and passive mobility. Investigation of the cervical spine was normal.
Apart from elevated C-reactive protein and erythrocyte sedimentation rate levels, routine laboratory investigations were normal including negative immunodiagnostic tests for autoantibodies and various global infections that may be associated with arthritis. Immunofluorescence tests showed significant levels of specific IgM- and IgG-antibodies against Ross River virus (RRV) but not against other arboviruses endemic in the South Pacific and Australia (Dengue, West Nile, Chikungunya, Sindbis, Barmah Forest). This was confirmed by a positive RRV neutralisation test. Attempts at virus isolation and detection of viral RNA by PCR were not successful.
Symptomatic treatment with high doses of diclofenac quickly led to pain relief, and arthralgias receded within 10 days after begin of treatment. However, several bouts of arthralgia of the left shoulder and left knee occurred during a period of 4 months.
Because of the current epidemiological situation in the South Pacific and Australia, infections by arboviruses like RRV should be considered in travellers returning from these areas with severe and persistent arthralgia of unknown origin, even in the absence of fever and other symptoms of acute infection.
一名57岁患者出现全身不适及左肩严重持续性关节痛。他报告称在为期两周的南太平洋之行后返回德国的航班途中，于一个月前开始出现急性疾病，伴有发热、全身肌痛及大关节关节痛。体格检查显示，肩肱关节和肩锁关节触诊时有广泛压痛，主动和被动活动均受限。颈椎检查正常。
除C反应蛋白和红细胞沉降率升高外，常规实验室检查均正常，包括自身抗体及各种可能与关节炎相关的全身性感染的免疫诊断测试均为阴性。免疫荧光试验显示，针对罗斯河病毒（RRV）的特异性IgM和IgG抗体水平显著升高，但针对南太平洋和澳大利亚流行的其他虫媒病毒（登革热、西尼罗河病毒、基孔肯雅热、辛德毕斯病毒、巴马森林病毒）的抗体水平未升高。RRV中和试验呈阳性，证实了这一结果。通过PCR进行病毒分离及检测病毒RNA的尝试均未成功。
高剂量双氯芬酸对症治疗迅速缓解了疼痛，治疗开始后10天内关节痛消退。然而，在4个月的时间里，左肩和左膝出现了数次关节痛发作。
鉴于南太平洋和澳大利亚目前的流行病学情况，对于从这些地区返回且患有不明原因严重持续性关节痛的旅行者，即使没有发热及其他急性感染症状，也应考虑感染RRV等虫媒病毒的可能性。
