Human Enterovirus Infection

人類腸病毒感染

吳文豪(Wen-Hao Wu)

《北市醫學雜誌》 4卷7_S期 (2007/07) Pp. 597-610

https://doi.org/10.6200/TCMJ.2007.4.7.11

摘要

腸病毒屬於單股正價核醣核酸病毒之小RNA病毒種，它們依據外殼蛋白質之抗原性分類為小兒麻痺病毒、依科病毒、科沙奇病毒A型、B型及腸病毒68-71型，新的分類乃依據控管VP1基因分解區所產生之分子資料為A-D之基因族群。人類乃腸病毒之唯一自然界宿主，它在全世界散播，腸病毒藉由糞－口或口－口在人之間傳播，孩童是主要易感族群，全世界至少有13次群突發之報告。台灣於1998年發生129,106例手足口症大流行，其中78例死亡。腸病毒感染之症狀從沒明顯症狀至上呼吸道感染、手足口症、疱疹性咽峽炎、無菌性腦膜炎、腦膜腦炎、胸肌痛、出血性結膜炎、心肌炎、急性無力麻痺症及新生兒多器官衰竭，依臨床症狀分腸病毒感染為4個時期，第三期最嚴重為心肺衰竭。除了臨床診斷外，腸病毒之實驗診斷則需由臨床檢體在合適培養基分離出病毒。使用反轉錄聚合酶連鎖反應之分子分析法可提供快速診斷，並增加敏感度。目前對腸病毒感染無特別治療方式，惟對有併發症之嚴重個案需接受加護照顧，一般而言在非小兒麻痺腸病毒感染之預後都不錯，惟有腸病毒71型群突發時，則為例外。未來，台灣仍需繼續監測腸病毒之感染情形，尤其腸病毒71型，而發展有效腸病毒治療方法和有效之疫苗更是迫在眉睫。

關鍵字

人類 ； 腸病毒臨床分期 ； 腸病毒71型群突發 ； 分子診斷

並列摘要

The enteroviruses belong to a family of single positive stranded RNA viruses named Picornaviridae, they are grouped by their antigenicity on capsid protein into polioviruses, echoviruses, coxsackieviruses A, coxsackieviruses B and enterovirus 68-71. A new classification, based on the molecular data generated from sequencing regions of gene encoding VP1, therefore group the human enteroviruses into four genoproup as A-D. Human beings are the only natural host. Its spread is by fecal-oral and possibly by oral-oral routes between persons. Children are the main susceptible group. Enteroviruses have a worldwide spread and distribution. There have been thirteen large and small reported outbreaks of enterovirus 71 in the world. 129106 cases of hand, foot, and mouth disease and 78 deaths occurred in Taiwan in 1998. Enteroviruses are associated with symptoms ranged from asymptomatic or unapparent infection, mild respiratory illness, or hand, foot, mouth disease, herpangina to the more severe aseptic meningitis, meningoencephalitis, pleurodynia, hemorrhagic conjunctivitis, myocarditis, acute flaccid paralysis and neonatal multi-organ failure. According to the clinical studies, symptomatic enterovirus 71 (EV71) infection can progress into four stages. Most cases stayed at stage 1, some progressed to stage 2, and few might advance to stage 3, the most severe form. Clinical diagnosis relies on season of the year, geographic location, exposure, incubation period, and clinical symptoms. The laboratory diagnosis of enterovirus infection relies on the isolation in cell culture of viruses from clinical samples. Molecular methods using RT-PCR assays provide rapid diagnosis and increased sensitivity. No specific therapy for any enteroviral infection is recognized. Severe enterovirus infection case with complication should be alerted and received intensive care. The prognosis in nonpolioenterovirus infection is excellent in the majority of cases, except instances of enterovirus 71 outbreaks. In the future, it is vey important to continue monitoring enteroviral disease, especially enterovirus 71 and laboratory surveillance in Taiwan, it is urgent to develop effective antiviral management and available vaccine.

並列關鍵字

Human being ； Enterovirus clinical stage ； Enterovirus 71 outbreak ； Molecular diagnosis