新生儿肠道病毒感染课件

1、新生儿肠道病毒感染新生儿肠道病毒感染属于小RNA病毒科肠道病毒属，由粪-口，呼吸道、眼部粘膜等途径传播；有4个病毒种，根据交叉中和试验分为67个血清型March, B., et al., Epidemiology of enteroviral meningoencephalitis in neonates and young infants. Journal of Paediatrics and Child Health, 2014. 50(3): p. 216-220.属于小RNA病毒科肠道病毒属，由粪-口，呼吸道、眼部粘膜等途新生儿肠道病毒感染课件Lin, T.Y., et al., Ne

2、onatal enterovirus infections: emphasis on risk factors of severe and fatal infections. Pediatr Infect Dis J, 2003. 22(10): p. 889-94.60%（87例，共146例）的病例发生于夏季（5月-7月）Lin, T.Y., et al., Neonatal en产前产时产后新生儿感染的途径March, B., et al., Epidemiology of enteroviral meningoencephalitis in neonates and young infa

3、nts. Journal of Paediatrics and Child Health, 2014. 50(3): p. 216-220.新生儿感染的途径March, B., et al., Epi146例，从中可以看到EV的高危因素包括 起病早 早产 低体重 低日龄等Lin, T.Y., et al., Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections. Pediatr Infect Dis J, 2003. 22(10): p. 889-94.Abzug MJ,

4、 Levin MJ, Rotbart HA. Profile of enterovirus disease in the first two weeks of life. Pediatr Infect Dis J1993;12:8204.146例，从中可以看到EV的高危因素包括 起病早 早产 低体2011.01-12 584例新生儿2011.01-12 584例新生儿中枢神经系统（50%）心肌炎（25%）败血症样综合症（25%）March, B., et al., Epidemiology of enteroviral meningoencephalitis in neonates and y

5、oung infants. Journal of Paediatrics and Child Health, 2014. 50(3): p. 216-220.中枢神经系统（50%）March, B., et al., 临床症状体征：昏迷、抽搐、易激惹、颈强直，囟门张力增高CSF： 白细胞升高（40-660*106/L） 单核细胞为主 蛋白质、葡萄糖可正常Krajden, S.和.M.P., Enterovirus infections in the neonate. 1983. p. 87-92.Rorabaugh ML, Berlin LE, Heldrich F, et al: Asept

6、ic meningitis in infants younger than 2 years of age: Acute illness and neurologic complications. Pediatrics 92:206-211, 1993.中枢神经系统感染Krajden, S.和.M.P., EnterovirusHaddad J, Messer J, Gut JP, Chaigne D, Christmann D, Willard D.Neonatal echovirus encephalitis with white matter necrosis. Neuropediatri

7、cs1990;21:215217.首次报道一例足月顺产男婴，因艾可病毒感染导致脑炎，MRI提示脑白质损伤，同时头颅B超级CT未提示相关改变。Haddad J, Messer J, Gut JP, ChM. A. Verboon-Maciolek, M.P., et al., White matter damage in neonatal enterovirus meningoencephalitis. NEUROLOGY. 66(2006): p. 12671269报道了6例（3名早产儿，3名足月儿）EV感染引起脑膜脑炎，通过MRI发现轻重不一的脑白质损害，类似于脑白质软化；同时，头颅B超也提

8、示了相似的表现M. A. Verboon-Maciolek, M.P., M. A. Verboon-Maciolek, M.P., et al., White matter damage in neonatal enterovirus meningoencephalitis. NEUROLOGY. 66(2006): p. 12671269在后续的随访中发现，脑白质损害的患儿预后不良，伴有行走困难、癫痫、严重的学习困难等后遗症，其中，随访中未发现后遗症的为足月儿，这可能与发育过程中脑白质对疾病的易感性有关M. A. Verboon-Maciolek, M.P., 发病后6天发病后19天发病后

9、55天一例12天，37周CoxB2所致脑膜脑炎，DWI即提示高信号影，复查MRI证实严重的脑白质损害，提示早期运用DWI的价值。发病后6天发病后19天发病后55天一例12天，37周CoxBHirata等人认为，该病理改变是由于细胞毒性水肿；病变发展累及脑白质，表现为白质软化；小胶质细胞活化，释放氧及活性氮，同时炎症因子的作用，尤其是TNF-，IL-是损伤的主要机制；O. Hirata, N.I.Y.M., A Case of Neonatal Coxsackie B2 Meningo-Encephalitis in which Serial Magnetic Resonance Imaging

10、 Findings Reveal the Development of Lesions. D epartment of Pediatrics, H iroshima University Graduate School of Biomedical Science, H iroshima, J apan, 29(Neuropediatrics 2011;42: 156158).Hirata等人认为，该病理改变是由于细胞毒性水肿；O. HM. A. Verboon-Maciolek, M.P., et al., White matter damage in neonatal enterovirus

11、 meningoencephalitis. NEUROLOGY. 66(2006): p. 12671269Wu, T., et al., Enterovirus infections are associated with white matter damage in neonates. Journal of Paediatrics and Child Health, 2014. 50(10): p. 817-822.收治了12例EV所致脑炎患儿（35-39W），其MRI均提示脑白质损害，类似于早产儿的脑白质软化。其中2名预后不良。M. A. Verboon-Maciolek, M.P., Wu, T., et al., Enterovirus infections are associated with white matter damage in neonates. Journal of Paediatrics and Child Health, 2014. 50(10): p. 817-822.在后续的随访中发现，（生后6月、18月），其中2名仍有不同程度的白质损伤存在另外10