entrovirus是小核糖核酸病毒家族的一员,依靠一种完全不同的进化策略,它变得不可见,而我们可以准确地识别鼻病毒。影响人类的小核糖核酸病毒科最重要的成员是有一百多种血清型的鼻病毒,而内病毒的数量要少得多.
在它们与自然宿主人类一起进化的过程中,鼻病毒已经成功地对宿主造成了一些损害,但仍在复制,在必要时迅速改变,即使有一定的因果关系,也很容易传播,找到新的易感宿主。因此,它们已经到达了病毒前厅。
它们的亲戚肠病毒发生了什么?由于肠道病毒可引起广泛的临床病症,从普通感冒、疱疹性咽炎和rush(大多数是良性的儿科疾病)到更为严重的心肌炎,无论是在儿科人群中,还是在成年人中,偶尔在老年人中,肠道病毒似乎已经忘记了疾病是意外事件,是可能杀死微生物和宿主的突发事件;这两个不受欢迎的。上述所有疾病都可能由许多其他病毒和/或细菌病原体引起,与患者的年龄和免疫能力有关。感染史可以很容易地回忆起罗斯福总统在他的晚年患有复杂的脊髓灰质炎。没有人知道从那以后,有多少类似的病例发生在由肠道病毒家族的其他成员引起的老年患者中,有多少人被误诊为脑血管事件,多发性硬化症(MS),这在某些患者群体中确实更为普遍,与很少危及生命的病毒感染相反。从专利中获得良好的病史是容易识别这些肠道病毒相关的神经系统和其他疾病的线索。它们有两期病程,与急性脑血管事件相反,以发热开始。不幸的是,多发性硬化症有时会出现双相病程,因此会被误诊。研究表明,一些患有ms样疾病的患者自发康复,而不是发展到典型的慢性波动危及生命的神经系统疾病,这并不罕见。 What is going on nowadays with poliovirus relatives? A few years ago, an unusual outbreak of polio-like disease was described among Californian children attending a kindergarten, caused by Enterovirus 68. Similar episodesare most probably everyday routine occurrence in many children clinics and hospitals, but they come and go unrecognized. The same applies to many immunocompetent and immunocompromised children and adults who suffer strange neurologic conditions, including aseptic meningitis and/or encephalitis, or even militias, also etiologically undiagnosed, since these usually undertook a benign self limited course. Neurologist and infectious diseases specialists have forgotten that the easiest way to come to the conclusion and diagnosis is to test patients stool in order to detect enteroviral RNA, using PCR technique, which is feasible, even though not standardised and commercially available always and everywhere. In many instances this is much more accurate then more non-specific an expensive CT, MRI, and/or PET scans. A good history, physical examination and few easy to perform laboratory analyses, along with ordinary neuroimmaging techniques are feasible and mostly available to rule out serious diseases over those with more benign and often self-limited course. This kind of approach to patients and diseases is easy and is cost effective in terms of both money and health resources.
目前,最有趣的熵病毒相关疾病是一种新生儿败血症样疾病,它总是危及生命,很难与更常见的新生儿疾病区分开来,这可能是由几种细菌病原体引起的,包括大肠杆菌,Lysteria monocytogenes,B群链球菌,它们都是出生通道的居民,还有2型单纯疱疹病毒。所有这些微生物,至少是其中的大部分,会在最初健康的新生儿中引起危及生命的多器官功能障碍综合征(MODS),因为所有这些微生物都有相当长的潜伏期,某些病原体需要相当长的潜伏期才能在呼吸道或胃肠道粘膜上复制,达到RES,并最终导致最终器官疾病。
参考文献
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