Pérez-Vélez Carlos M, Anderson Marsha S, Robinson Christine C, McFarland Elizabeth J, Nix W Allan, Pallansch Mark A, Oberste M Steven, Glodé Mary P
Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and The Children's Hospital, Denver, Colorado 80218, USA.
Clin Infect Dis. 2007 Oct 15;45(8):950-7. doi: 10.1086/521895. Epub 2007 Sep 13.
Similar to poliovirus, enterovirus type 71 (EV71) causes severe disease, including aseptic meningitis, encephalitis, acute flaccid paralysis, and acute cardiopulmonary dysfunction. Large epidemics of EV71 infection have been reported worldwide.
After recognition of a cluster of cases of EV71 disease, we reviewed records of patients with EV71 disease who required hospitalization at The Children's Hospital in Denver, Colorado, from 2003 through 2005. The presence of enterovirus was detected by reverse-transcriptase polymerase chain reaction (PCR) and/or viral culture of specimens from multiple sources, and the virus was typed as EV71 using genetic sequencing.
Eight cases of EV71 disease were identified in both 2003 and 2005. Fifty-six percent of patients with EV71 disease were < or = 6 months of age (range, 4 weeks to 9 years). All 16 patients had EV71 central nervous system infection. Enterovirus PCR (EV-PCR) of cerebrospinal fluid specimens yielded positive results for only 5 (31.2%) of the 16 patients; all of these patients were < 4 months of age and had less severe disease. However, EV-PCR of upper respiratory tract specimens yielded positive results for 8 (100%) of 8 patients, and EV-PCR of lower gastrointestinal tract specimens yielded positive results for 7 (87.5%) of 8 patients.
An outbreak of neurologic EV71 disease occurred in Denver, Colorado, during 2003 and 2005. Likely, EV71 disease remains unrecognized in other parts of the United States, because EV-PCR of cerebrospinal fluid frequently yields negative results. EV-PCR of specimens from the respiratory and gastrointestinal tracts had higher diagnostic yields than did EV-PCR of cerebrospinal fluid. EV71 infection should be considered in young children presenting with aseptic meningitis, encephalitis, acute flaccid paralysis, or acute cardiopulmonary collapse. EV71 infection may be an underrecognized emerging disease in the United States.
与脊髓灰质炎病毒相似，肠道病毒71型（EV71）可引发严重疾病，包括无菌性脑膜炎、脑炎、急性弛缓性麻痹和急性心肺功能障碍。全球已报告多起EV71感染的大规模流行。
在识别出一组EV71疾病病例后，我们回顾了2003年至2005年期间在科罗拉多州丹佛市儿童医院住院的EV71疾病患者的记录。通过逆转录聚合酶链反应（PCR）和/或对多个来源的标本进行病毒培养来检测肠道病毒的存在，并使用基因测序将病毒鉴定为EV71型。
2003年和2005年各发现8例EV71疾病病例。56%的EV71疾病患者年龄小于或等于6个月（范围为4周至9岁）。所有16例患者均患有EV71中枢神经系统感染。脑脊液标本的肠道病毒PCR（EV-PCR）检测结果显示，16例患者中仅有5例（占31.2%）呈阳性；所有这些患者年龄均小于4个月，病情较轻。然而，8例患者中有8例（占100%）的上呼吸道标本EV-PCR检测呈阳性，8例患者中有7例（占87.5%）的下消化道标本EV-PCR检测呈阳性。
2003年至2005年期间，科罗拉多州丹佛市发生了神经性EV71疾病的暴发。在美国其他地区，EV71疾病可能仍未得到识别，因为脑脊液的EV-PCR检测结果经常呈阴性。呼吸道和胃肠道标本的EV-PCR检测诊断阳性率高于脑脊液的EV-PCR检测。对于出现无菌性脑膜炎、脑炎、急性弛缓性麻痹或急性心肺功能衰竭的幼儿，应考虑EV71感染。在美国，EV71感染可能是一种未被充分认识的新发疾病。
