与急性结膜炎相关病毒病原体的分子鉴定：一项前瞻性对照研究。
Molecular identification of viral agents associated with acute conjunctivitis: a prospective controlled study.
作者信息
Akçay Emine, Çarhan Ahmet, Hondur Gözde, Tufan Zeliha Koçak, Duru Necati, Kılıç Selçuk, Ensari Ezgi Naz, Uğurlu Nagihan, Çağıl Nurullah
机构信息
Yıldırım Beyazıt, University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey.
Yıldırım Beyazıt, University Faculty of Medicine, Department of Medical Biology, Ankara, Turkey.
出版信息
Braz J Infect Dis. 2017 Jul-Aug;21(4):391-395. doi: 10.1016/j.bjid.2017.03.016. Epub 2017 May 20.
BACKGROUND
Viral conjunctivitis are the most frequent infections in ophthalmology clinics. The diagnosis is usually relying on clinical findings and medical history. However, topical antibiotics are often used unnecessarily addition to symptomatic treatment because of unsure agents. We aimed to detect the Adenovirus, Coxsackievirus and Enterovirus from conjunctiva and pharyngeal samples of patients.
METHODS
The conjunctiva and pharyngeal samples of the patients with conjunctivitis were taken by Virocult transport media and kept at -80̊C up to study day. Adenovirus spp, Enterovirus 70 and Enterovirus 71, Coxsackie A24 and Coxsackie A16 were detected by real-time PCR. Samples from healthy health care workers of ophthalmology clinic were used for control group.
RESULTS
A total of 176 samples (conjunctival and pharyngeal samples of 62 patient and 26 healthy subjects) were included. The mean age of 34 (55.7%) male and 27 (44.3%) female patients was 34±17. Twenty five (40.3%) of the patients were receiving antibiotic drops at first visit. The main etiologic agent in conjunctival samples was found to be Adenovirus (46/62, 74.2%) followed by Enterovirus 70 (4/62, 6.4%) and Enterovirus 71 (4/62, 6.4%). Coxsackievirus 16 and 24 were also found in 2 patients (1/62 each, 1.6%). Pharyngeal samples were also positive for Adenovirus (20/62, 32.3%), Enterovirus 70 and 71 (7/62, 11.3% and 5/62, 8.1% respectively), Coxsackievirus 16 and 24 (2/62, 3.2% and 1/61, 1.6%).
CONCLUSIONS
It is very difficult in viral conjunctivitis to make clinical differentiation caused by different agents because of common clinical signs and symptoms. In routine clinical work, the viral conjunctivitis usually related with Adenovirus. But almost one fourth of the patients' conjunctivitis were not related to Adenovirus, which shows the importance of the laboratory diagnostics. True diagnosis plays an important role on prevention of contamination and unnecessary use of antibiotics in viral conjunctivitis.
背景
病毒性结膜炎是眼科门诊最常见的感染性疾病。诊断通常依靠临床表现和病史。然而，由于病原体不明确，除了对症治疗外，局部抗生素常常被不必要地使用。我们旨在从患者的结膜和咽拭子样本中检测腺病毒、柯萨奇病毒和肠道病毒。
方法
用Virocult运送培养基采集结膜炎患者的结膜和咽拭子样本，并在-80℃保存至研究日。通过实时PCR检测腺病毒属、肠道病毒70型和肠道病毒71型、柯萨奇A24型和柯萨奇A16型。眼科门诊健康医护人员的样本用作对照组。
结果
共纳入176份样本（62例患者和26名健康受试者的结膜和咽拭子样本）。34名（55.7%）男性和27名（44.3%）女性患者的平均年龄为34±17岁。25名（40.3%）患者初诊时正在使用抗生素滴眼液。结膜样本中的主要病原体为腺病毒（46/62，74.2%），其次是肠道病毒70型（4/62，6.4%）和肠道病毒71型（4/62，6.4%）。2例患者（各1/62，1.6%）的样本中还检测到柯萨奇病毒16型和24型。咽拭子样本中腺病毒也呈阳性（20/62，32.3%），肠道病毒70型和71型（分别为7/62，11.3%和5/62，8.1%），柯萨奇病毒16型和24型（分别为2/62，3.2%和1/61，1.6%）。
结论
由于常见的临床症状和体征，病毒性结膜炎很难通过临床鉴别不同病原体所致。在日常临床工作中，病毒性结膜炎通常与腺病毒有关。但近四分之一患者的结膜炎与腺病毒无关，这表明实验室诊断的重要性。准确诊断对预防病毒性结膜炎的感染传播和避免不必要使用抗生素起着重要作用。
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