Rao B L, Basu Atanu, Wairagkar Niteen S, Gore Milind M, Arankalle Vidya A, Thakare Jyotsna P, Jadi Ramesh S, Rao K A, Mishra A C
National Institute of Virology, Pune, India.
Lancet. 2004;364(9437):869-74. doi: 10.1016/S0140-6736(04)16982-1.
An outbreak of acute encephalitis of unknown origin with high case fatality (183 of 329 cases) was reported in children from Andhra Pradesh state in southern India during 2003. We investigated the causative agent.
Cell lines and peripheral blood lymphocyte co-cultures were used to isolate the causative agent from clinical samples. Identity of the agent was established by electron microscopy and serological and molecular assays.
Clinical samples tested negative for IgM antibodies to Japanese encephalitis, West Nile, dengue, and measles viruses, and for RNA of coronavirus, paramyxovirus, enterovirus, and influenza viruses. Virus was isolated from six patients with encephalitis and was identified as Chandipura virus by electron microscopy, complement fixation, and neutralisation tests. Chandipura virus RNA was detected in clinical samples from nine patients. Sequencing of five of these RNA samples showed 96.7-97.5% identity with the reference strain of 1965. Chandipura viral antigen and RNA were detected in brain tissue of a deceased child by immunofluorescent antibody test and PCR. Neutralising, IgG, and IgM antibodies to Chandipura virus were present in some patients' serum samples. Serum samples obtained after 4 days of illness were more frequently positive for IgM to Chandipura virus than were those obtained earlier (p<0.001). A similar trend was noted for neutralising antibodies.
Our findings suggest that this outbreak of acute encephalitis in Andhra Pradesh was associated with Chandipura virus, adding to the evidence suggesting that this virus should be considered as an important emerging pathogen.
2003年，印度南部安得拉邦的儿童中报告了一起不明原因的急性脑炎疫情，病死率很高（329例中有183例死亡）。我们对病原体进行了调查。
使用细胞系和外周血淋巴细胞共培养从临床样本中分离病原体。通过电子显微镜、血清学和分子检测确定病原体的身份。
临床样本对日本脑炎、西尼罗河病毒、登革热和麻疹病毒的IgM抗体以及冠状病毒、副粘病毒、肠道病毒和流感病毒的RNA检测均为阴性。从6例脑炎患者中分离出病毒，通过电子显微镜、补体结合试验和中和试验鉴定为钱迪普拉病毒。在9例患者的临床样本中检测到钱迪普拉病毒RNA。对其中5个RNA样本进行测序，结果显示与1965年的参考毒株有96.7%-97.5%的同源性。通过免疫荧光抗体试验和PCR在一名死亡儿童的脑组织中检测到钱迪普拉病毒抗原和RNA。部分患者血清样本中存在针对钱迪普拉病毒的中和抗体、IgG抗体和IgM抗体。发病4天后采集的血清样本中，针对钱迪普拉病毒的IgM阳性率高于早期采集的样本（p<0.001）。中和抗体也呈现类似趋势。
我们的研究结果表明，安得拉邦的这起急性脑炎疫情与钱迪普拉病毒有关，进一步证明该病毒应被视为一种重要的新出现病原体。
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