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Research advances in human infection with avian-origin influenza A (H7N9)virus

Haiyan SUN ; Haijiang TONG ; Dawei CUI ; Yu CHEN

Chinese Journal of Clinical Infectious Diseases.2017;10(1):68-75. doi:10.3760/cma.j.issn.1674-2397.2017.01.015

Human avian-origin influenza A (H7N9)virus is a novel subtype of avian influenza A virus,which firstly emerged at the end of March 2013 in Shanghai and Anhui province.It rapidly spread in China within a short time,causing high morbidity and mortality,arousing fear and panic in public,and attracting extensive attention worldwide.The analysis of human H7N9 avian influenza virus gene shows a high affinity for α-2,6-linked sialic acid receptors expressed on human respiratory epithelial cells.At present,the sporadic cases of human H7N9 avian influenza virusare occasionally reported with an epidemic peaksat winter and spring.This article reviews clinical features,epidemiology and genetic characteristics of H7N9 avian influenza virus,proving scientific evidences foreffective prevention and control of H7N9 virus infection.

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Research advances of the effect of commonly used drugs on dendritic cell function and HIV infection

Lijun XU ; Fan HUANG

Chinese Journal of Clinical Infectious Diseases.2017;10(1):63-67. doi:10.3760/cma.j.issn.1674-2397.2017.01.014

Dendritic cells (DCs)can capture HIV from the mucosal site and carry it to the draining lymph nodes to promote CD4 + T cell infection.DC-SIGN(CD209)plays a vital role during this process. Heroin,methamphetamine and cocaine are the most abused drugs used by drug abusers,which can increase the opportunities of HIV infection.Drugs acting on the corresponding receptors activate the downstream signaling pathway and regulate the expression of DC-SIGN on the surface of DCs,weakening the inhibited effects of immune cells on HIV and promoting HIV infection in many aspects.Given the multiplex effects of drugs on immune function,this article reviews the relationship between abused drugs,DCs and HIV infection,particularly in the signal pathway on immune modulation.

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Clinical features and risk factors of cytomegalovirus infection in AIDS patients

Xiaoxia YANG ; Shicheng GAO

Chinese Journal of Clinical Infectious Diseases.2017;10(1):26-30. doi:10.3760/cma.j.issn.1674-2397.2017.01.006

Objective To investigate the clinical features and risk factors of cytomegalovirus (CMV)infection in AIDS patients.Methods A total of 471 AIDS patients,including 173 with CMV infection and 298 without CMV infection were enrolled from Zhongnan Hospital of Wuhan University from June 2015 to August 2016.Multivariate Logistic regression was performed to analyze the risk factors for AIDS patients infected with CMV.Results Among 173 patients co-infected with CMV,103 (59.54%)were diagnosed as CMV viremia,70(40.46%)were CMV end-organ diseases (EOD),in which CMV pneumonia (n =33)and CMV retinitis (n =22)were the most frequent diseases.Univariate analysis showed that sexual transmission,low CD4 +T lymphocyte counts,first visit,tuberculosis,pneumococcal pneumonia (PCP), long hospital stay and septicemia were risk factors of cytomegalovirus infection among patients with AIDS (P <0.05).Multivariate Logistic regression analysis demonstrated that CD4 +T lymphocyte <50 cells/μL (OR =3.897,95%CI 2.354-6.453),concomitant tuberculosis(OR =4.619,95%CI 2.501 -8.529),PCP (OR =4.062,95%CI 2.345-7.038),sepsis (OR =2.553,95%CI 1 .098-5.936)were independent risk factors for CMV infection,while antiretroviral therapy (OR =0.559,95%CI 0.342-0.912)was a protective factor.Conclusions Hospitalized AIDS patients have a high incidence of CMV infection which has a tendency to induce multiple organ damage,and relevant risk factors should be avoid to accentuate disease as much as possible.

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Survival analysis of HIV/AIDS patients receiving antiretroviral therapy in Hangzhou from 2004 to 2014

Xiting LI ; Yan LUO ; Jie CHENG ; Ke XU ; Jie JIN ; Xingliang ZHANG ; Jinlei ZHENG

Chinese Journal of Clinical Infectious Diseases.2017;10(1):20-25. doi:10.3760/cma.j.issn.1674-2397.2017.01.005

Objective To analyze the survival rate of HIV /AIDS patients receiving highly active antiretroviral therapy(HAART)since the implementation of the national Four Free and One Carepolicy against HIV in Hangzhou.Methods Clinical data of 2370 AIDS patients were collected from National AIDS Comprehensive Treatment Information System Treatment Library from 2004 to 2014.The data, including basic information,viral load,CD4 +T lymphocyte counts,starting time of treatment,WHO clinical stage,infection pathways and follow-up were respectively analyzed.Kaplan-Meier and Cox proportional hazards models were used to analyze the survival rate and the factors affecting survival.Results The total follow-up time was 3968.14 person years and 57 patients died in 2370 patients with a mortality rate of 1 .44 /100 person years (57 /3968.14).Kaplan-Meier method showed that the cumulative survival rates of the first,third and fifth year were 98.08%,96.20% and 95.24%,respectively.The overall mortality rate fell from 6.06 /100 person years in 2006 to 1 .44 /100 person years in 2014.The mortality rate of AIDS-related disease declined from 1 .10 /100 person years in 2009 to 0.90 /100 person years in 2014.Multivariate Cox regression analysis showed that the risk of death for patients with CD4 +T 200-349 cells/μL was 0.466 times(95%CI 0.246-0.882)as that for patients with CD4 +T cells <200 /μL.The risk of death was 3.408 times(95%CI 1 .365-8.506)in patients aged≥ 50 years,3.788 times(95%CI 1 .645-8.718)in patients aged 40 to <50 years,and 2.593 times(95%CI 1 .139-5.905)in patients aged 30 to 40 years as that in patients aged <30 years.The mortality risk for patients with baseline WHO stage Ⅲ and Ⅳ was 1 .960 times as patients with WHO stage Ⅰ and Ⅱ (95% CI 1 .117-3.439 ).Conclusions Patients with increased age,low CD4 +T counts and baseline WHO stage Ⅲ or Ⅳ are main risk factors affecting survival rate of HIV /AIDS patients,early antiviral therapy is the key for improving the survival rate of patients.

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Non-nucleoside reverse transcriptase inhibitors (NNRTIs)resistance-related gene mutations among AIDS patients with antiviral treatment failure in Guangdong province 2015

Yun LAN ; Weiping CAI ; Linghua LI ; Xiaoli CAI ; Yan HE ; Xiaoping TANG ; Fengyu HU ; Junbin LI ; Weilie CHEN ; Liya LI

Chinese Journal of Clinical Infectious Diseases.2017;10(1):14-19. doi:10.3760/cma.j.issn.1674-2397.2017.01.004

Objective To investigate the prevalence and characteristics of non-nucleoside reverse transcriptase inhibitors (NNRTIs)resistance-related gene mutations among the AIDS patients with virological suppression failure in Guangdong Province 2015.Methods Plasma samples from AIDS patients receiving highly active antiretroviral therapy for more than one year with viral loads > 1000 copies/mL from Guangdong province (except Shenzhen)were collected from January to December 2015.Total 612 HIV-1 gene fragments were amplified from plasma samples using self-developed lab method.Sub-genotypes were determined by phylogenetic tree according to the sequences,NNRTIs resistance-related mutations were determined in Stanford University HIV-1 Drug Resistance Database. The NNRTIs-resistance, the relationships of NNRTIs resistance-related mutations with baseline CD4 +T lymphocyte counts,transmission routes,antiviral regimens and HIV-1 genotypes were analyzed.SPSS 17.0 software was used to analyze the data.Results In 612 patients with virological suppression failure,the main NNRTIs resistance-related mutations were K103 (26.80%),Y181 (14.71 %),V179 (13.73%),G190 (11 .44%) and V106 (10.62%).The susceptibility rate of 310 patients (50.65%)to NNRTIs had changed,the highly resistant rate to nevirapine was 49.51 %,which was higher than that of efavirenz (43.14%),etravirine (5.56%) and rilpivirine (12.25%),respectively,and the differences were statistically significant (χ2 =5.00,296.3 and 198.0,all P <0.05).The incidence rate of drug resistance in patients with baseline CD4 +T lymphocyte counts >200 cells/μL was lower than that in those with baseline CD4 +T lymphocyte counts <200 cells/μL (χ2 =17.93,P <0.01 );the incidence rate of drug resistance was lower in intravenous drug abusers than that of sexually transmitted patients (χ2 =44.21 ,P <0.01 );while the incidence of drug resistance in patients receiving NVP-containing regimens was higher than that in those receiving EFV-containing regimens (χ2 =8.93,P <0.01 ),and the incidence rate was higher in patients with CRF01 _AE than that in those with CRF07_BC and CRF08 _BC (χ2 =8.46 and 8.47,P <0.01 ).Conclusions The results suggest that compliance education and follow-up should be strengthened in patients with high baseline CD4 +T lymphocyte counts and intravenous drug users,and patients with liver diseases should avoid using drugs containing NVP regimens.

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Research progress on direct-acting antiviral agents(DAAs)in treatment of hepatitis C

Yilin MA

Chinese Journal of Clinical Infectious Diseases.2017;10(1):8-13. doi:10.3760/cma.j.issn.1674-2397.2017.01.003

In recent years,great progress has been made in treatment of patients with HCV infection with direct-acting antiviral agents (DAAs).Up to now,twelve kinds of oral DAAs and three kinds of combination regimens have been approved by the U.S.Food and Drug Administration and European Medicines Agency to treat chronic HCV infection.This article reviews the research progress of DAAs in treatment of hepatitis C,including the name of DAAs,drug targets,therapy regimen,clinical efficacy and adverse effects.

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Clinical and laboratory features of severe cases of hand, foot and mouth diseases in Wenzhou

Suhua LI ; Jie CHEN ; Hongjiao WANG ; Junya CHEN ; Zhiwei XU ; Yiping CHEN

Chinese Journal of Clinical Infectious Diseases.2010;03(6):337-339. doi:10.3760/cma.j.issn.1674-2397.2010.06.005

Objective To investigate the clinical and laboratory features of severe cases of hand,foot and mouth disease (HFMD) in Wenzhou, Zhejiang Province. Methods Clinical data of 107 children with HFMD, including 97 severe and 10 critical cases treated in Children' s Hospital Affiliated to Wenzhou Medical College during January and May 2010 were retrospectively analyzed. One hundred and fifty children with mild HFMD were also selected as the controls. Clinical features and laboratory results were compared between the two groups. Results Fever, rash and infection in central nervous system were observed in all patients with severe HFMD, and symptoms on respiratory, digestive and cardiovascular systems were more serious than those of mild HFMD cases. White blood cell counts (WBC) were higher in severe group than those in controls (t = 12.72, P ＜0.01). Hyperglycemia (9. 2 mmol/L) and abnormal troponin (0. 3 -9. 0 ng/mL) were presented in all the critical patients. Cerebrospinal fluid WBC counts were raised in 97 severe HFMD patients (98.5 × 106/L for average) with predominance of lymphocytes. Among 107 severe patients, EV71 was positive in 70, including all 10 critical cases. Conclusion Involvement of nervous,respiratory and digestive symptoms is common in severe cases of HFMD, and EV71 is the predominant pathogen.

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Drug-resistance and genotyping of methicillin-resistant Staphylococcus aureus isolated from intensive care unit

Zhijun ZHAO ; Wei JIA ; Zhiyun SHI ; Gang LI ; Nan ZHANG ; Shuai ZONG ; Jun WEI

Chinese Journal of Clinical Infectious Diseases.2010;03(6):321-324. doi:10.3760/cma.j.issn.1674-2397.2010.06.001

Objective To investigate drug resistance and genotypes of methicillin-resistant Staphylococcus aureus (MRSA) isolated from intensive care unit (ICU). Methods MRSA strains were isolated from patients, medical staff and environment of hospital ICUs. Disk diffusion (K-B method) was used for drug resistance testing; Staphylococcal cassette chromosome mec (SCCmec) and Staphylococcal protein A (spa) typing methods were used for genotyping and identifying the homology. Results There were 78 strains of Staphylococcus aureus isolated including 62 isolates of MRSA, which were mainly from the burn ICU (22, 35.48%). Among 62 MRSA strains, 50 were hospital acquired strains, in which 43 isolates were of SCCmec Ⅲ, 4 of SCCmec Ⅰ and 3 of SCCmec Ⅱ. Twelve isolates could not be typed. Twenty-eight out of 37 hospital acquired isolates were typed by spa typing as SCCmec Ⅲ-t030, which belonged to the same clone. Conclusion MRSA in ICU is multi-drug resistant and SCCmec Ⅲ-t030 is the most prevalent genotype, which indicates that clinical MRSA strains and environmental MRSA strains may be homologous.

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Correlation of T-lymphocytes expressing HLA-DR antigen with serum HBV DNA and HBeAg levels in chronic hepatitis B

Songping ZHANG ; Yongle ZHANG ; Mingli ZHU ; Yijian PAN ; Ying WANG ; Gongying CHENG

Chinese Journal of Clinical Infectious Diseases.2010;03(6):333-336. doi:10.3760/cma.j.issn.1674-2397.2010.06.004

Objective To investigate the correlation of T-lymphocyte expressing HLA-DR with serum HBV DNA and HBeAg contents in chronic hepatitis B. Methods Totally 134 chronic hepatitis B patients and 36 healthy blood donors were enrolled in the study. The T-lymphocytes (CD3 + HLA-DR + ,CD4 + HLA-DR+ and CD8 + HLA-DR+ T) expressing HLA-DR were detected by flow cytometry, the serum HBV viral loads were detected by the real-time quantitative PCR and HBeAg was detected by chemiluminescence method. According to serum HBV DNA viral loads patients were defined as HBV DNA negative (≤ 103 copies/mL), low (＞ 103 - 105 copies/mL), medium (＞ 105 - 107 copies/mL) and high groups (＞ 107 - 109 copies/mL) ; according to serum HBeAg levels, patients were defined as HBeAg negative (≤1 PEIU/mL), low (＞ 1 - 100 PEIU/mL), medium (＞ 100-1 000 PEIU/mL) and high groups (＞ 1 000-10 000 PEIU/mL). T test and one-way ANOVA were performed. Results With HBV DNA loads, HBeAg levels increased, the percentage of CD3 + HLA-DR + , CD4 + HLA-DR + and CD8 + HLA-DR +decreased, especially CD8 + HLA-DR +. Compared with HBV DNA negative group, the percentages of CD3 +HLA-DR + , CD4 + HLA-DR + and CD8 + HLA-DR + were significantly reduced in high group (t = 3. 686,4. 592 and 3. 216, P ＜ 0. 0l); the percentages of CD4 + HLA-DR + and CD8 + HLA-DR + were also reduced in medium group (t = 3. 761 and 2.862, P ＜ 0.01); while in low group, only the percentage of CD8 + HLA-DR + was reduced (t = 2.215, P ＜ 0.05). Compared with HBeAg negative group, the percentages of CD3 +HLA-DR+, CD4 + HLA-DR+ and CD8 + HLA-DR+ were significantly reduced in medium and high groups (thigher =3. 144, 2.222 and 4.035; tmiddle =3.311, 2.362 and 3.374, P ＜0.05), while in the low group,only the percentage of CD8+HLA-DR+ was reduced (t=2.029, P＜0. 05). Conclusion The combined measurement of HBV DNA, HBeAg and T-lymphocytes expressing HLA-DR in chronic hepatitis B patients may not only help to evaluate the immune status of patients, but also can predict the disease progression and clinical outcomes.

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Drug resistance and genotype of methicillin-resistant Staphylococcus in Tianjin

Shujiong CHEN ; Shangwei WU ; Rong WANG ; Wei GAO ; Jie XIA ; Wei GUAN ; Yunde LIU

Chinese Journal of Clinical Infectious Diseases.2010;03(6):328-332. doi:10.3760/cma.j.issn.1674-2397.2010.06.003

Objective To investigate the drug resistance and genotype of methicillin-resistant Staphylococcus (MRS), and to study the epidemiology of drug resistance in Staphylococcus. Methods Drug susceptibility tests were performed for 138 Staphylococcus strains clinically isolated, and mecA gene was detected with PCR. For mecA positive strains, Staphylococcal cassette chromosome mec (SCCmec) gene was detected by two multiplex PCR assays. Results Seven (10.8%) out of 65 Staphylococcus aureus strains were methicillin-resistant Staphylococcus aureus (MRSA) strains, and 44 (60.3%) out of 73 coagulase negative Staphylococcus strains were methicillin-resistant coagulase negative Staphylococcus (MRCNS)strains. There was statistical significance on the difference of isolation rates (x2 = 37. 05, P ＜0.01). No vancomycin or nitrofurantoin resistant strain was found. There were 52 (52/138, 37.7%) mecA positive strains, including 16 SCCmec type Ⅰ strains, 1 type Ⅱ strain, 13 type Ⅲ strains, 9 type Ⅳ strains and 4 type Ⅴ strains. Conclusions Drug resistance in MRS is increasingly serious. MRCNS strains are more popular than MRSA in clinic, and SCCmec Ⅰ and Ⅲ may account for most infections.

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