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[马尔堡出血热和埃博拉出血热——病原体、流行病学与治疗]

[Marburg and Ebola hemorrhagic fevers--pathogens, epidemiology and therapy].

作者信息

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出版信息

Med Monatsschr Pharm. 2014 Sep;37(9):324-30; quiz 331-2.

Abstract

Marburg and Ebola hemorrhagic fevers are severe, systemic viral diseases affecting humans and non-human primates. They are characterized by multiple symptoms such as hemorrhages, fever, headache, muscle and abdominal pain, chills, sore throat, nausea, vomiting and diarrhea. Elevated liver-associated enzyme levels and coagulopathy are also associated with these diseases. Marburg and Ebola hemorrhagic fevers are caused by (Lake victoria) Marburg virus and different species of Ebola viruses, respectively. They are enveloped, single-stranded RNA viruses and belong to the family of filoviridae. Case fatality rates of filovirus disease outbreaks are among the highest reported for any human pathogen, ranging from 25 to 90% or more. Outbreaks of Marburg and Ebola hemorrhagic fever occur in certain regions of equatorial Africa at irregular intervals. Since 2000, the number of outbreaks has increased. In 2014, the biggest outbreak of a filovirus-induced hemorrhagic fever that has been documented so far occurred from March to July 2014 in Guinea, Sierra Leone, Liberia and Nigeria. The outbreak was caused by a new variant of Zaire Ebola-Virus, affected more than 2600 people (stated 20 August) and was associated with case-fatality rates of up to 67% (Guinea). Treatment of Marburg and Ebola hemorrhagic fevers is symptomatic and supportive, licensed antiviral agents are currently not available. Recently, BCX4430, a promising synthetic adenosine analogue with high in vitro and in vivo activity against filoviruses and other RNA viruses, has been described. BCX4430 inhibits viral RNA polymerase activity and protects cynomolgus macaques from Marburg virus infection when administered as late as 48 hours after infection. Nucleic acid-based products, recombinant vaccines and antibodies appear to be less suitable for the treatment of Marburg and Ebola hemorrhagic fevers.

摘要

马尔堡出血热和埃博拉出血热是严重的全身性病毒疾病,可感染人类和非人类灵长类动物。其特征为出现多种症状,如出血、发热、头痛、肌肉痛和腹痛、寒战、喉咙痛、恶心、呕吐及腹泻。肝脏相关酶水平升高和凝血病也与这些疾病相关。马尔堡出血热和埃博拉出血热分别由(维多利亚湖)马尔堡病毒和不同种类的埃博拉病毒引起。它们是包膜单链RNA病毒,属于丝状病毒科。丝状病毒病暴发的病死率在所有人类病原体中位居前列,范围从25%至90%或更高。马尔堡出血热和埃博拉出血热的暴发不定期发生在赤道非洲的某些地区。自2000年以来,暴发次数有所增加。2014年,有记录以来最大规模的丝状病毒引起的出血热暴发于2014年3月至7月在几内亚、塞拉利昂、利比里亚和尼日利亚发生。此次暴发由扎伊尔埃博拉病毒的一个新变种引起,感染人数超过2600人(截至8月20日),病死率高达67%(几内亚)。马尔堡出血热和埃博拉出血热的治疗以对症和支持治疗为主,目前尚无获得许可的抗病毒药物。最近,有报道称BCX4430是一种有前景的合成腺苷类似物,在体外和体内对丝状病毒及其他RNA病毒具有高活性。BCX4430可抑制病毒RNA聚合酶活性,在感染后48小时给药时能保护食蟹猴免受马尔堡病毒感染。基于核酸的产品、重组疫苗和抗体似乎不太适合用于治疗马尔堡出血热和埃博拉出血热。

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