上呼吸道感染患儿中柯萨奇病毒A10病例临床特征与分子流行病学分析

Clinical Characteristics and Molecular Epidemiology of Coxsackievirus A10 in Cases with Infection of the Upper Respiratory Tract

为了解上呼吸道感染患儿中柯萨奇病毒A10型(Coxsackievirus A10,CVA10)感染状况及其基因组特征,于2019年10月⁃2022年9月期间收集昆明市儿童医院门诊病例标本,分析CVA10相关病例流行病学特征与临床表现;对45株CVA10分离株进行完整VP1区和3D区逆转录⁃聚合酶链反应扩增和核苷酸序列测定,将测序结果进行同源性分析和系统发生学研究;对25株CVA10分离株进行全基因组序列测定。结果显示,研究期间共在281例(13.32%)上呼吸道感染患儿中检出EV,其中68例鉴定为CVA10,男女比例为1∶1.06;1~5岁年龄组占比较高(67.65%);95.59%患儿伴发热症状;临床诊断以疱疹性咽峡炎(48.53%)为主。CVA10云南株与原型株及云南株之间的核苷酸同源性分别为76.0%~77.1%和90.8%~99.6%。VP1区系统发生学分析显示本地毒株均属于C2亚型,其中有41株属于Cluster 1,4株属于Cluster 3;本地毒株在3D区域各分支间的分布趋势与VP1区大体一致。全基因组序列分析显示,与原型株相比,本研究序列在5'NTR端和VP4区出现了碱基的插入和缺失现象;P1、P2和P3编码区系统发育分析提示部分本地毒株相互间发生了多个型内重组事件。本研究结果丰富了我国上呼吸道感染患者中的CVA10的分子流行病学数据,开展基于呼吸道疾病的肠道病毒监测对于了解其致病谱具有重要的价值。

We wished to determine the prevalence and genetic characteristics of coxsackievirus A10(CVA10)in patients with infection of the upper respiratory tract(IURT).Swab samples from children with IURT were collected in Kunming Children’s Hospital(Kunming,China)from January 2019 to September 2022.Epidemiological and clinical features of the cases associated with CVA10 were described.Homologous and phylogenetic analyses were undertaken to explore the genetical characteristics of CVA10 based on complete VP1 and 3D nucleotide sequences.The complete genome sequences of 25 strains were determined.EVs were detected in 281 cases(13.32%)of IURT,68 of which were identified as CVA10.The sex ratio was 1:1.06 and 67.65%cases belonged to the age group of 1–5 years.Also,95.59%cases had fever and the most common clinical diagnosis was herpangina(48.53%).Yunnan strains had 76.0%to 77.1%VP1 nucleotide similarities with the prototype strain,and 90.8%to 99.6%with each other.Phylogenetic analysis on the VP1 region showed that all CVA10 isolates in our study belonged to subgenotype C2,with 41 strains located in cluster 1 and four strains located in cluster 3.The distribution of isolates in the 3D region was similar with those in the VP1 tree.Sequencing analyses revealed insertion and deletion of bases at 5'NTR and VP4 regions compared with the prototype strain.Phylogenetic analysis of P1,P2,and P3 regions suggested that intra⁃type recombination events occurred among some strains in our study.Our results enrich the molecular⁃epidemiological data of CVA10 in patients with IURT and reflect the value of IURT surveillance in understanding the pathogenic spectrum of EV.