获得性免疫缺陷综合征合并感染性葡萄膜炎患者眼内液病原微生物研究

Pathogenic microorganisms in ocular fluid of infectious uveitis patients with acquired immunodeficiency syndrome

目的了解获得性免疫缺陷综合征(AIDS)合并感染性葡萄膜炎患者眼内液病原微生物分布情况。方法回顾性病例研究。2018年6月至2019年12月于上海市公共卫生临床中心住院或门诊就诊的AIDS合并感染性葡萄膜炎患者31例纳入研究。其中,男性30例,女性1例;平均年龄(38.51±11.17)岁。全葡萄膜炎20例,后葡萄膜炎10例,感染性眼内炎1例。同期血清CD4+T淋巴细胞计数(CD4+TC)0~239个/μl。采用二代基因测序技术对采集的眼内液进行检测。31份标本中,房水、玻璃体液分别为27、4份。结果31份标本中,检测到巨细胞病毒(CMV)18份(58.1%,18/31);水痘-带状疱疹病毒(VZV)5份(16.1%,5/31);Epstein-Barr病毒(EBV)9份(29.0%,9/31);人类β疱疹病毒6型(HHV6)3份(9.7%,3/31),人乳头状软疣病毒(HPV)、人多瘤病毒、庚型肝炎病毒各1份(3.2%,1/31),均与其他微生物共存;细环病毒8份(25.8%,8/31);梅毒螺旋体5份(16.1%,5/31);刚地弓形虫和哈蒙哈蒙球虫1份(3.2%,1/31);Synitelium Polycarpum 1份(3.2%,1/31);结核分支杆菌复合群、真菌、微杆菌共存1份(3.2%,1/31)。CMV 18份标本中,基因序列数>1059份(50.0%),104~1055份(27.7%)。VZV 5份标本中,基因序列数>1044份(80.0%)。结核分支杆菌复合群、真菌、微杆菌共存的1份标本,基因序列数均<100。所有标本中读取到的HHV6、HPV、人多瘤病毒、庚型炎病毒、细环病毒基因序列数均较低。31份标本中,检测到病原微生物≥2种15份(48.4%)。结论CMV、VZV是血清CD4+TC<100个/μl AIDS患者感染性葡萄膜炎的主要致病微生物;梅毒螺旋体、刚地弓形虫或其他原虫、结核杆菌、真菌引起的感染性葡萄膜炎更常见于血清CD4+TC>100个/μl的AIDS患者。合并感染性葡萄膜炎的AIDS患者眼内液中可检测到2种或以上微生物共存。

Objective To study the distribution of pathogenic microorganisms in the ocular fluid of patients with acquired immunodeficiency syndrome(AIDS)and infectious uveitis.Methods It was a retrospective case analysis.From June 2018 to December 2019,31 AIDS patients with infectious uveitis who were hospitalized or outpatient at Shanghai Public Health Clinical Center were included in the study.Among them,there were 30 males and 1 female;the average age was 38.51±11.17 years.There were 20 cases of panuveitis,10 cases of posterior uveitis,and 1 case of infectious endophthalmitis.Serum CD4+T lymphocyte count(CD4+TC)were 0-239/μl during the same period.The second-generation gene sequencing technology was used to detect the collected intraocular fluid.Among 31 specimens,aqueous humor and vitreous humor were 27 and 4 respectively.Results Among 31 specimens,18 samples(58.1%,18/31)of cytomegalovirus(CMV)were detected;varicella-zoster virus(VZV)were detected in 5 samples(16.1%,5/31);Epstein-Barr virus were detected in 9 samples(29.0%,9/31);human beta herpes virus type 6(HHV6)were detected in 3 samples(9.7%,3/31),human papillary molluscum virus(HPV),human polyoma virus,type G hepatitis virus were separately detected in 1 sample(3.2%,1/31),all coexisting with other microorganisms.Parvovirus were detedcted in 8 samples(25.8%,8/31);treponema pallidum were detedcted in 5 samples(16.1%,5/31);toxoplasma gondii and Harmon coccidia were detedcted in 1 sample(3.2%,1/31);synitelium Polycarpum were detedcted in 1 sample(3.2%,1/31);mycobacterium tuberculosis complex,fungi,and microbacteria coexist were detedcted in 1 sample(3.2%,1/31).Among the 18 CMV specimens,the number of gene sequences was more than 1059(50.0%),and 104-1055(27.7%).Among the 5 specimens of VZV,the number of gene sequences was>1044(80.0%).In one specimen,the mycobacterium tuberculosis complex,fungi,and microbacteria coexist,and the number of gene sequences were all<100.The number of gene sequences of HHV6,HPV,human polyoma virus,type G virus,and parvovirus in all specimens was small.Among 31 specimens,15(48.4%)of pathogenic microorganisms were detected at least 2 species.Conclusions CMV and VZV are the main pathogenic microorganisms of infective uveitis in patients with serum CD4+TC<100/μl;treponema pallidum,toxoplasma gondii or other protozoa,mycobacterium tuberculosis,and fungi cause more infectious uveitis which are common in AIDS patients with serum CD4+TC>100/μl.The coexistence of two or more microorganisms can be detected in the intraocular fluid of AIDS patients with infectious uveitis.