发热伴血小板减少综合征临床误诊3例患者的病原及免疫学检测与鉴定

Pathogenic identification for three misdiagnosed cases of fever with thrombocytopenia syndrome

目的探讨发热伴血小板减少综合征易被误诊的原因。方法采用间接免疫荧光法检测患者急性期与恢复期血清中新布尼亚病毒IgG抗体,荧光RT-PCR检测新布尼亚病毒RNA及S、M、L 3个特异性基因鉴定,新布尼亚病毒核酸测序及比对分析。结果2例误诊患者的血清中IgG抗体效价恢复期较急性期增高4倍以上,3例患者的急性期血清中均能检测到新布尼亚病毒核酸及3个特异性基因,S基因序列比对均为新布尼亚病毒,重症患者与轻症患者的基因序列有一定的差异。结论通过病毒特异性基因鉴定、序列比对分析以及双份血清新布尼亚病毒IgG抗体效价检测,3例临床误诊的患者均为由新布尼亚病毒感染引起的发热伴血小板减少综合征。

Objective To identify the pathogen of misdiagnosed cases of fever with thrombocytopenia syndrome. Methods Blood samples were collected from 3 misdiagnosed cases of fever with thrombocytopenia syndrome in acute and convalesce phases. The serum levels of virus-specific IgG antibody were detected with indirect immunofluorescence assay, and the viral RNA and three segments L（large）, M（medium）, and S（small） was detected with fluorescent reverse-transcription polymerase chain re- action （RT-PCR） assay. The pathogen was characterized by nucleic acid sequencing and comparative analysis. Results The serum IgG antibody titer in convalesce phase was increased more than 4 times than those of acute phase in 2 misdiagnosed cases. The virus nucleic acid and three specific genes were detected in acute phase serum of 3 cases. S gene sequence alignment was confirmed novel Bunia virus; there were some differences in gene sequences between severe cases and mild cases. Conclusion We confirmed that three misdiagnosed cases of fever with thrombocytopenia syndrome were infected with novel Bunia virus.