Kelly Heath, Brussen Kerri A, Lawrence Andrew, Elliot Elizabeth, Pearn John, Thorley Bruce
Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2006 Jun;42(6):370-6. doi: 10.1111/j.1440-1754.2006.00875.x.
Acute flaccid paralysis (AFP) is the most common clinical presentation of acute poliovirus infection, occurring in 0.1-1% of infected cases. AFP surveillance has been used world-wide to monitor the control and eradication of circulating wild poliovirus. This study aims to review the significance of all enteroviruses, including polioviruses, isolated from patients with AFP in Australia between 1996 and 2004.
We undertook a retrospective review of all notified cases of AFP, aged 0-15 years and resident in Australia at the time of notification. We reviewed all available clinical and virological data for these cases and all records of the Polio Expert Committee, which determined the final classification for all cases.
There were 335 notified cases that satisfied the case definition for AFP, 162 (48%) of whom had at least one faecal sample tested. Enteroviruses isolated from the faeces of 26 (16%) of the 162 cases were Coxsackie A24, Coxsackie B5, enterovirus 71, enterovirus 75, echovirus 9, echovirus 11 and echovirus 18. In addition, one or more polioviruses were isolated from the faeces of seven patients. Six of seven polioviruses were characterised as Sabin-like, one was not characterised, but all were considered to be incidental isolates. Five of these cases were classified as infant botulism, one case as transverse myelitis and one as a focal mononeuropathy.
With the eradication of circulating wild polioviruses, other enteroviruses are being more commonly identified as the cause of polio-like illnesses. In the polio end game, when there is increased testing for polioviruses, it is important to consider infant botulism as a differential diagnosis in cases presenting with AFP.
急性弛缓性麻痹（AFP）是急性脊髓灰质炎病毒感染最常见的临床表现，在0.1%至1%的感染病例中出现。AFP监测已在全球范围内用于监测循环野生脊髓灰质炎病毒的控制和根除情况。本研究旨在回顾1996年至2004年期间在澳大利亚从AFP患者中分离出的所有肠道病毒，包括脊髓灰质炎病毒的意义。
我们对所有报告的AFP病例进行了回顾性研究，这些病例年龄在0至15岁之间，报告时居住在澳大利亚。我们审查了这些病例的所有可用临床和病毒学数据以及脊髓灰质炎专家委员会的所有记录，该委员会确定了所有病例的最终分类。
有335例报告病例符合AFP病例定义，其中162例（48%）至少有一份粪便样本进行了检测。从162例中的26例（16%）粪便中分离出的肠道病毒为柯萨奇A24、柯萨奇B5、肠道病毒71、肠道病毒75、埃可病毒9、埃可病毒11和埃可病毒18。此外，从7名患者的粪便中分离出一种或多种脊髓灰质炎病毒。7株脊髓灰质炎病毒中有6株被鉴定为类似萨宾株，1株未鉴定，但所有这些都被认为是偶然分离株。其中5例被分类为婴儿肉毒中毒，1例为横贯性脊髓炎，1例为局灶性单神经病。
随着循环野生脊髓灰质炎病毒的根除，其他肠道病毒越来越多地被确定为类脊髓灰质炎疾病的病因。在脊髓灰质炎终结阶段，当对脊髓灰质炎病毒的检测增加时，在AFP病例中考虑婴儿肉毒中毒作为鉴别诊断很重要。
