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[人类狂犬病康复病例及狂犬病病毒脑炎的终身诊断。]

[Сases of human convalescence from rabies and lifetime diagnostics of lyssavirus encephalitis.].

作者信息

Metlin А Е, Botvinkin А D, Elakov А L, Gruzdev К N

机构信息

Federal Center for Animal Health, Vladimir, 600901, Russian Federation.

Irkutstky State Medical University, Irkutsk, 600901, Russian Federation.

出版信息

Vopr Virusol. 2019;64(1):42-48. doi: 10.18821/0507-4088-2019-64-1-42-48.

Abstract

Notwithstanding the availability of effective vaccines, 40 - 60 thousand rabies cases in humans are reported every year. Almost always the disease is fatal because therapeutic treatment of lyssavirus encephalitis has not been developed. Since 1970 the number of reports on rare cases of convalescence including those using experimental treatment protocols has been gradually increasing 20 cases of convalescence, "partial" convalescence or long-term survival of humans (1970-2015) were selected as they were complaint with laboratory criteria of active lyssavirus infection. Children and teenagers were predominant in the analyzed group (85%). The cases were irregularly spread between the continents: Asia - 6 cases, North America - 6 cases, Africa - 2 cases and Europe - 1 case. India and the USA were on the top of the list of countries by the number of described cases. More than 60% humans were infected from dogs, three cases got infection from bats and 2 cases were allegedly associated with an unknown lyssavirus and an unidentified infection source. 70% cases were vaccinated and 10% cases were treated with gamma globulin before the disease onset. Serological tests for detection of antibodies to lyssaviruses in cerebrospinal fluid of infected humans were typically used for diagnostic laboratory verification. Less than 30% IFA and PCR positives were obtained. Lyssaviruses were never detected. Only 4 convalescent patients were treated using experimental protocols. 80% cases demonstrated severe neurological consequences, four (may be more) patients died afterwards within the period from two months to four years. Different perspectives on prospects of Milwaukee protocol use and other therapeutic techniques are given.

摘要

尽管有有效的疫苗,但每年仍报告有4万至6万例人类狂犬病病例。几乎所有病例都是致命的,因为尚未开发出针对狂犬病病毒脑炎的治疗方法。自1970年以来,关于包括使用实验性治疗方案在内的罕见康复病例的报告数量一直在逐渐增加。选择了20例康复、“部分”康复或人类长期存活的病例(1970 - 2015年),因为它们符合狂犬病病毒活跃感染的实验室标准。分析组中儿童和青少年占主导(85%)。这些病例在各大洲分布不均:亚洲6例,北美洲6例,非洲2例,欧洲1例。按所描述病例数量,印度和美国位居各国榜首。超过60%的人是被狗感染,3例是被蝙蝠感染,2例据称与一种未知的狂犬病病毒和不明感染源有关。70%的病例在发病前接种了疫苗,10%的病例在发病前接受了丙种球蛋白治疗。检测受感染人类脑脊液中狂犬病病毒抗体的血清学检测通常用于诊断实验室验证。不到30%的病例获得了间接免疫荧光法(IFA)和聚合酶链反应(PCR)阳性结果。从未检测到狂犬病病毒。只有4例康复患者使用了实验性方案进行治疗。80%的病例出现了严重的神经后遗症,4例(可能更多)患者在发病后的两个月至四年内死亡。文中给出了对密尔沃基方案及其他治疗技术应用前景的不同观点。

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