Pedro Kourí Tropical Medicine Institute, Havana, Cuba.
MEDICC Rev. 2011 Oct;13(4):45-9. doi: 10.37757/MR2011V13.N4.9.
Herpesvirus infections are prevalent worldwide, but most run their course asymptomatically. Clinical presentations in symptomatic cases vary widely and include febrile and mononucleosis-like syndromes. In immunocompromised patients, herpetic infection can be lethal and routine laboratory tests are of little use. Use of novel techniques may provide important improvements in diagnosis and treatment of these patients.
Investigate association between different herpesviruses and the etiology of mononucleosis and febrile syndromes in Cuban immunocompetent and immunocompromised patients.
The study used multiplex nested polymerase chain reaction, enabling simultaneous detection of six herpesviruses--cytomegalovirus, herpes simplex (1 and 2), Epstein-Barr, varicella-zoster and human herpesvirus 6--to study 1157 samples (770 urine and 387 serum samples) from 1140 patients with mononucleosis-like syndrome or febrile syndrome, classified according to history of immunosuppressive disease. Samples were analyzed at the Laboratory for Sexually Transmitted Diseases (Virology) of the Pedro Kourí Tropical Medicine Institute from January 2006 through December 2009. SPSS statistical package was used and incidence rates calculated.
Of samples studied, 20.1% were positive for some herpesvirus. Higher risk of developing active herpesvirus infections was detected in samples from immunocompromised patients with febrile syndrome compared to those of immunocompetent ones (OR 2.02, CI 1.20-3.42, p=0.007). Cytomegalovirus was the most frequently found herpesvirus in both mononucleosis-like syndrome (60.4%) and febrile syndrome (63.6%) and in both children (69.2%) and adults (55.2%), followed by Epstein-Barr virus. Cytomegalovirus was detected in 68.9% of positive urine samples and in just 47.2% of serum samples.
This is the first Cuban study demonstrating the pathogenic role of herpesviruses, particularly cytomegalovirus, in patients with febrile or mononucleosis-like syndrome, in both immunocompetent and immunocompromised patients. Results highlight the importance of including molecular diagnosis of the herpesvirus family in investigating mononucleosis and febrile syndromes of unknown etiology and demonstrate that etiologic diagnosis would not have been feasible in many cases without the use of this diagnostic tool.
疱疹病毒感染在全球范围内普遍存在，但大多数情况下无症状。在有症状的病例中，临床表现差异很大，包括发热和单核细胞增多症样综合征。在免疫功能低下的患者中，疱疹感染可能是致命的，常规实验室检查几乎没有用处。新型技术的使用可能会在这些患者的诊断和治疗方面提供重要的改进。
调查不同疱疹病毒与古巴免疫功能正常和免疫功能低下患者单核细胞增多症和发热综合征病因之间的关系。
该研究使用多重嵌套聚合酶链反应，能够同时检测六种疱疹病毒 - 巨细胞病毒、单纯疱疹（1 和 2）、爱泼斯坦-巴尔病毒、水痘-带状疱疹和人类疱疹病毒 6 - 以研究 1140 例单核细胞增多症样综合征或发热综合征患者的 1157 份样本（770 份尿液和 387 份血清样本），这些患者根据免疫抑制性疾病的病史进行分类。这些样本于 2006 年 1 月至 2009 年 12 月在 Pedro Kourí 热带医学研究所的性传播疾病（病毒学）实验室进行分析。使用 SPSS 统计软件包计算发病率。
在所研究的样本中，有 20.1%的样本检测到某种疱疹病毒呈阳性。与免疫功能正常的患者相比，免疫功能低下的发热综合征患者中检测到更易发生活动性疱疹病毒感染的风险（OR 2.02，CI 1.20-3.42，p=0.007）。巨细胞病毒是单核细胞增多症样综合征（60.4%）和发热综合征（63.6%）、儿童（69.2%）和成人（55.2%）中最常发现的疱疹病毒，其次是爱泼斯坦-巴尔病毒。在 68.9%的阳性尿液样本中检测到巨细胞病毒，而在仅 47.2%的血清样本中检测到巨细胞病毒。
这是古巴首例证明疱疹病毒，特别是巨细胞病毒，在免疫功能正常和免疫功能低下的发热或单核细胞增多症样综合征患者中具有致病性的研究。研究结果强调了在调查不明病因的单核细胞增多症和发热综合征时包括疱疹病毒家族的分子诊断的重要性，并表明如果没有使用这种诊断工具，许多情况下都无法进行病因诊断。
