Lau Susanna K P, To Wing-Kin, Tse Philomena W T, Chan Alex K H, Woo Patrick C Y, Tsoi Hoi-Wah, Leung Annie F Y, Li Kenneth S M, Chan Paul K S, Lim Wilina W L, Yung Raymond W H, Chan Kwok-Hung, Yuen Kwok-Yung
Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital.
J Clin Microbiol. 2005 Sep;43(9):4515-21. doi: 10.1128/JCM.43.9.4515-4521.2005.
Owing to the difficulties in isolating the virus and the lack of routine surveillance, the clinical significance of human parainfluenza virus 4 (HPIV-4) is less well defined than that of the other human parainfluenza viruses. We describe the first outbreak of HPIV-4 infection in a developmental disabilities unit, involving 38 institutionalized children and three staff members, during a 3-week period in autumn 2004. Most subjects had upper respiratory tract infections (URTI), while lower respiratory tract infections (LRTI) occurred in three children (7%), one complicated by respiratory failure requiring ventilation support. All patients recovered. Nasopharyngeal aspirates tested for HPIV-4 were positive by reverse transcriptase PCR (RT-PCR) in all 41 cases (100%), by direct immunofluorescence in 29 of 39 tested cases (74%), and by cell cultures in 6 of 37 cases (16%), and serum was positive for antibodies against HPIV-4 in all 35 cases (100%) with serum samples available. In addition, RT-PCR detected HPIV-4 in four children (three LRTI and one URTI) out of 115 patients with community-acquired respiratory tract infection. Molecular analysis of the 1,198-bp phosphoprotein sequences showed that HPIV-4 isolates among the cases were genetically similar, whereas the community controls were more genetically distant, supporting nosocomial transmission of a single HPIV-4 genotype during the outbreak. Moreover, the HPIV-4 causing the outbreak is more closely related to HPIV-4A than HPIV-4B. HPIV-4 may be an important cause of more severe respiratory illness in children. The present RT-PCR assay is a sensitive, specific, and rapid method for the diagnosing HPIV-4 infection. To better define the epidemiology and clinical spectrum of disease of HPIV-4 infections, HPIV-4 should be included in the routine panels of respiratory virus detection on respiratory specimens.
由于病毒分离困难且缺乏常规监测，人类副流感病毒4型（HPIV - 4）的临床意义相较于其他人类副流感病毒而言，其明确程度较低。我们描述了2004年秋季为期3周的时间里，在一个发育障碍机构中首次爆发的HPIV - 4感染事件，涉及38名住院儿童和3名工作人员。大多数患者患有上呼吸道感染（URTI），而3名儿童（7%）发生了下呼吸道感染（LRTI），其中1例并发呼吸衰竭需要通气支持。所有患者均康复。对41例患者的鼻咽抽吸物进行HPIV - 4检测，通过逆转录酶聚合酶链反应（RT - PCR）检测全部呈阳性（100%）；在39例接受检测的病例中，29例（74%）通过直接免疫荧光检测呈阳性；在37例病例中，6例（16%）通过细胞培养检测呈阳性；在所有35例有血清样本的病例中，血清抗HPIV - 4抗体检测均呈阳性（100%）。此外，在115例社区获得性呼吸道感染患者中，RT - PCR在4名儿童（3例LRTI和1例URTI）中检测到HPIV - 4。对1198bp磷蛋白序列的分子分析表明，此次爆发中的HPIV - 4分离株在基因上相似，而社区对照在基因上差异更大，这支持了此次爆发期间单一HPIV - 4基因型的医院内传播。此外，引发此次爆发的HPIV - 4与HPIV - 4A的关系比与HPIV - 4B的关系更为密切。HPIV - 4可能是儿童更严重呼吸道疾病的重要病因。目前的RT - PCR检测方法是诊断HPIV - 4感染的一种灵敏、特异且快速的方法。为了更好地明确HPIV - 4感染疾病的流行病学和临床谱，应将HPIV - 4纳入呼吸道标本常规呼吸道病毒检测项目中。
