一例狂犬病病例的实验室诊断及其启示

Laboratory diagnosis of a human rabies case and its significance

目的通过1例人狂犬病病例的实验室确诊探讨人狂犬病病例实验室诊断的可行性及其对狂犬病防控的意义。方法对存活疑似人狂犬病病例的唾液、脑脊液、血清标本采用反转录-聚合酶链反应(reverse transcription polymerase chain reaction,RT-PCR)、快速荧光灶抑制试验(rapid fluorescent focus inhibition test,RFFIT)进行实验室确诊;通过RFFIT对密切接触个例血清抗狂犬病病毒中和抗体进行检测。结果病例唾液标本用RT-PCR方法检测获得狂犬病病毒核蛋白、RNA聚合酶基因预期扩增片段,序列测定和分析进一步证实为狂犬病病毒。病例血清标本经RFFIT检测抗狂犬病病毒中和抗体阳性。1名病例密切接触者按照狂犬病暴露进行暴露后预防处置,血清抗狂犬病病毒中和抗体检测为阳性。结论 1例疑似人狂犬病病例经实验室诊断确诊为狂犬病病例,实验室检测结果对指导个案处置有现实意义。

Objective To evaluate the feasibility of laboratory diagnosis of human rabies and its significance for prevention and control of rabies. Methods Laboratory diagnosis of a human rabies cases was conducted by using reverse transcription polymerase chain reaction （RT-PCR） and rapid fluorescent focus inhibition test （RFFIT） to detect the saliva, cerebrospinal fluid （CSF）, serum samples collected from the patients. Results The predicted segments of the nucleoprotein （N）, RNA-dependent RNA polymerase （RdRp）/Large protein （L） genes of rabies virus were amplified from the saliva samples with RT-PCR. Sequencing and phylogenetic analysis confirmed the rabies virus infection. Rabies virus neutralizing antibody （RVNP） was detected with RPTIT in the serum sample. One close contact received rabies postexposure prophylaxis （PEP）. The RVNP of the contact was positive. Conclusion A suspected human rabies case was laboratory confirmed. Laboratory test results has important significance for the treatment of rabies cases.