Grohmann G S, Glass R I, Pereira H G, Monroe S S, Hightower A W, Weber R, Bryan R T
Viral Gastroenteritis Unit, Centers for Disease Control and Prevention, Atlanta, GA 30333.
N Engl J Med. 1993 Jul 1;329(1):14-20. doi: 10.1056/NEJM199307013290103.
Diarrhea occurs frequently among persons with the acquired immunodeficiency syndrome, but the cause often remains unknown. We used a group of diagnostic assays to determine which viruses were etiologic agents of diarrhea in a group of persons infected with the human immunodeficiency virus (HIV).
Stool and serum specimens were obtained from HIV-infected patients enrolled in a longitudinal study in Atlanta. Fecal specimens from patients with diarrhea and from control patients without diarrhea were screened by electron microscopy, polyacrylamide-gel electrophoresis, and enzyme immunoassays for rotaviruses, enteric adenoviruses, caliciviruses, picobirnaviruses, and astroviruses. Paired serum samples were tested for antibody responses to Norwalk virus and picobirnavirus.
Viruses were detected in 35 percent of 109 fecal specimens from patients with diarrhea but in only 12 percent of 113 specimens from those without diarrhea (P < 0.001). Specimens from patients with diarrhea were more likely than those from patients without diarrhea to have astrovirus (12 percent vs. 2 percent, P = 0.003); picobirnavirus (9 percent vs. 2 percent, P = 0.017); caliciviruses, including small round structured viruses (6 percent vs. 1 percent, P = 0.062); and adenoviruses (9 percent vs. 3 percent, P = 0.047). They were also more likely to have a mixed viral infection (6 percent vs. 0 percent, P = 0.006). With the use of polyacrylamide-gel electrophoresis to analyze concentrated RNA extracts from stool, picobirnavirus was detected in fecal specimens from 6 of the 65 patients with diarrhea and was associated with prolonged viral shedding and chronic diarrhea. No rotaviruses, enteric adenoviruses, or instances of seroconversion to positivity for Norwalk virus were observed.
Novel enteric viruses such as astrovirus and picobirnavirus may be more important etiologic agents of diarrhea in HIV-infected patients than previously recognized and may be more common than either bacterial or parasitic enteropathogens.
腹泻在获得性免疫缺陷综合征患者中频繁发生，但病因往往不明。我们使用一组诊断检测方法来确定哪些病毒是一组感染人类免疫缺陷病毒（HIV）患者腹泻的病原体。
从亚特兰大一项纵向研究中纳入的HIV感染患者获取粪便和血清标本。通过电子显微镜、聚丙烯酰胺凝胶电泳和酶免疫测定法，对腹泻患者和无腹泻对照患者的粪便标本进行轮状病毒、肠道腺病毒、杯状病毒、微小双股RNA病毒和星状病毒的筛查。对配对的血清样本检测针对诺如病毒和微小双股RNA病毒的抗体反应。
在109份腹泻患者的粪便标本中，35%检测到病毒，而在113份无腹泻患者的标本中仅12%检测到病毒（P<0.001）。腹泻患者的标本比无腹泻患者的标本更有可能检测到星状病毒（12%对2%，P=0.003）；微小双股RNA病毒（9%对2%，P=0.017）；杯状病毒，包括小圆结构病毒（6%对1%，P=0.062）；以及腺病毒（9%对3%，P=0.047）。腹泻患者也更有可能发生混合病毒感染（6%对0%，P=0.006）。使用聚丙烯酰胺凝胶电泳分析粪便中浓缩的RNA提取物，在65例腹泻患者中的6例粪便标本中检测到微小双股RNA病毒，且与病毒长期排出和慢性腹泻相关。未观察到轮状病毒、肠道腺病毒或诺如病毒血清转化为阳性的情况。
星状病毒和微小双股RNA病毒等新型肠道病毒可能是HIV感染患者腹泻比以往认识到的更重要的病原体，并且可能比细菌或寄生虫肠道病原体更常见。
