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題名 | Rabies Virus Infection: Report of an Autopsy Case with Comprehensive Pathologic, Immounofluorescent, Immunohistochemical and Molecular Studies=狂犬病毒感染:一解剖例作完整病理、免疫螢光、免疫組織化學及分子學研究 |
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作者 | 許永祥; 王立信; 陳立光; 李仁智; 楊惠華; Hsu, Yung-hsiang; Wang, Lih-shinn; Chen, Li-kuang; Lee, Jen-jeh; Yang, Hui-hua; |
期刊 | 慈濟醫學 |
出版日期 | 20050800 |
卷期 | 17:4 民94.08 |
頁次 | 頁219-225+296 |
分類號 | 415.239 |
語文 | eng |
關鍵詞 | 腦炎; 狂犬病; 心肌炎; 間質性肺炎; Encephalitis; Rabies; Myocarditis; Interstitial pneumonitis; |
中文摘要 | 目的:狂犬病在臺灣自1958年已消跡,我們報告一個45歲女性在2002年6月境外移入死亡病例。本研究目的在探討狂犬病毒在體內分布情況,並釐清此病毒致病機轉。材料與方法:以此死亡病例做完整病理檢查、免疫螢光、免疫組織化學染色及分面生物學研究。結果:急性狂犬病腦炎合併有典型的Negri包含體,主要侵犯腦幹及視丘,其次是海馬迴及小腦。發炎細胞以淋巴球為主且圍繞於血管周圍,合併神經元吞噬現象及神經膠結節。狂犬病毒可以從新鮮腦組織分離出來,我們以狂犬病毒單株抗體用免疫螢光染色法偵測到,並且用反轉錄酵素聚合酵素連鎖反應合併基因系列分析得到證實。除了中樞神經的病變外,週邊器官亦有變化,包括:交感神經節及食道黏膜下神經元的神經元神經炎;輕微局部心肌炎;間質性肺炎合併瀰漫性肺泡損傷及肺泡內肉芽組織生成;輕微慢性間質性腎炎及腦下垂體、腎上腺和頷下腺的淋巴球浸潤。以免疫組織化學染色偵測狂犬病毒抗原,可在腦幹、小腦、視丘、海馬迴、交感神經節、食道黏膜下神經元及腎小管上皮細胞發現病毒顆粒蛋白。結論:本研究發現張犬病毒有親神經性,另外此病毒可擴散到週邊器官引發死亡併發症。 |
英文摘要 | Objective: Taiwan has been rabies-free since 1958. Wereport a fatal case of rabies virus infection in a 45-year-old woman from Hu-Nan Province of mainland China which occurred in June 2002. Since knowledge of rabies virus distribution in body organs is limited, the present case study attempted to explore the pathogenesis of infection of this virus. Materials and Methods: We performed a detailed pathologic examination, immunofluorescence. Immunohistochemistry and molecular studies in this case. Results: Acute rabies encephalitis with characteristic Negri inclusion bodies was noted. The brain stem and thalamus were most severely involved. There was mild involvement of the hippocampus and cerebellum. The inflammatory infiltrates consisted of lymphocytes involving primarily the gray matter with perivascular lymphocytic cuffing and ncuronophagia. Rabies virus was isolated from fresh brain tissues and identified in neurons by immunofluoresence stain with specific rabies monoclonal antibody, and confirmed by reverse-transcriptase polymerase chain reaction with sequence analysis. In addition to encephalitis, the following pathologic changes in the peripheral organs were also noted: ganglioneuritis involving the sympathetic and submucosal ganglion of the esophagus; mild focal myocarditis; interstitial pneumonitis with diffuse alveolar damage and granulation tissue formation in the alveolar space; mild interstitial nephritis and lymphocyte infiltration in the pituitary, adrenal, and submandibular glands. Rabies virus antigen was shown with immunohistochemical stain in the brain stem, cerebellum, thalamus, hippocampus, sympathetic ganglion, submucosal ganglion of the esophagus and tubular epithelium of the kidney. Conclusions: These findings demonstrate that in addition to neurotropism, the rabies virus may disseminate into peripheral organs resulting in the development of fatal complications. |
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