Driss Nadia, Ben-Mustapha Imen, Mellouli Fethi, Ben Yahia Ahlem, Touzi Henda, Bejaoui Mohamed, Ben Ghorbel Mohamed, Triki Henda, Barbouche Mohamed-Ridha
Laboratory of Clinical Virology, WHO Reference Laboratory on Poliomyelitis, Institut Pasteur de Tunis, Tunisia.
Clin Vaccine Immunol. 2012 Oct;19(10):1684-9. doi: 10.1128/CVI.00293-12. Epub 2012 Aug 22.
To estimate the susceptibility to enterovirus infection and the frequency of long-term poliovirus excreters in Tunisian patients with primary immunodeficiencies (PIDs), enteroviruses were assessed in stool specimens of 82 patients with humoral, combined, and other PIDs. Isolated viruses were typed and intratyped by standard molecular techniques, and the whole VP1 region of poliovirus isolates was sequenced. Polioviruses were detected in 6 patients; all isolates were vaccine related. Five patients rapidly stopped excretion; one excreted a poliovirus type 1 isolate for several months, and the isolate accumulated up to 14 mutations in the VP1 region. Nonpolio enteroviruses were identified in 6 patients; 4 of them kept excreting the same strain for more than 6 months. The rate of enterovirus infection was 13.4% of the PID patients and 20.7% of those with an IgG defect; it greatly exceeded the rates generally found in Tunisian supposed-immunocompetent individuals (4.1% during the study period; P = 0.001 and P < 0.0001, respectively). Interestingly, patients with combined immunodeficiencies were at a higher risk for enterovirus infection than those with an exclusively B cell defect. A major histocompatibility complex (MHC) class II antigen expression defect was found in 54% of enterovirus-positive patients and in the unique long-term poliovirus excreter. The study results also suggest that substitutive immunoglobulin therapy may help clearance of a poliovirus infection and that most PID patients have the ability to stop poliovirus excretion within a limited period. However, the high susceptibility of these patients to enterovirus infection reinforces the need for enhanced surveillance of these patients until the use of oral poliovirus vaccine (OPV) is stopped.
为评估突尼斯原发性免疫缺陷（PID）患者肠道病毒感染易感性及长期脊髓灰质炎病毒排泄者的频率，对82例体液免疫、联合免疫及其他PID患者的粪便标本进行了肠道病毒检测。分离出的病毒通过标准分子技术进行分型和型内分析，并对脊髓灰质炎病毒分离株的整个VP1区域进行测序。在6例患者中检测到脊髓灰质炎病毒；所有分离株均与疫苗相关。5例患者迅速停止排泄；1例排泄1型脊髓灰质炎病毒分离株达数月之久，该分离株在VP1区域累积了多达14个突变。在6例患者中鉴定出非脊髓灰质炎肠道病毒；其中4例持续排泄同一毒株超过6个月。肠道病毒感染率在PID患者中为13.4%，在IgG缺陷患者中为20.7%；大大超过突尼斯假定免疫功能正常个体中通常发现的感染率（研究期间为4.1%；P = 0.001和P < 0.0001）。有趣的是，联合免疫缺陷患者比单纯B细胞缺陷患者肠道病毒感染风险更高。在54%的肠道病毒阳性患者及唯一的长期脊髓灰质炎病毒排泄者中发现主要组织相容性复合体（MHC）II类抗原表达缺陷。研究结果还表明，替代免疫球蛋白治疗可能有助于清除脊髓灰质炎病毒感染，且大多数PID患者有能力在有限时间内停止脊髓灰质炎病毒排泄。然而，这些患者对肠道病毒感染的高易感性强化了对这些患者加强监测的必要性，直至停止使用口服脊髓灰质炎疫苗（OPV）。
