Diagnosis of tick-borne encephalitis
Diagnosis of tick-borne encephalitis
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DOI：
10.1016/s0264-410x(02)00819-8
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发表时间：
2003-04-01
期刊：
影响因子：
5.5
通讯作者：
Holzmann, H
中科院分区：
文献类型：
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作者：
Holzmann, H
蜱传脑炎（TBE）的实际诊断必须在实验室中建立，因为它呈现非特异性临床特征。选择的方法是通过酶联免疫吸附试验（ELISA）证明特异性IgM和IgG血清抗体，因为这些抗体在住院时几乎在每个病例中都可以检测到。在发病后早期，仅在50%的患者中可在脑脊液中发现特异性抗体，但到发病的第10天，它们几乎总是可检测到。如果感染发生后，尽管暴露后给予特定的免疫球蛋白，血清转换可能会延迟，并可能导致诊断问题。从血液中分离病毒，或通过逆转录酶聚合酶链反应（RT-PCR）检测血液或脑脊液中的特定核酸，通常仅在血清转换前的疾病的第一个病毒血症阶段成功。在致命病例中，病毒可以通过RT-PCR从大脑和其他器官中分离或检测。在TBE病毒感染后或接种疫苗后检测免疫力时，最常用的是IgG ELISA。然而，在其他黄病毒接触的情况下（例如黄热病或日本脑炎疫苗接种;登革热病毒感染），由于黄病毒交叉反应抗体干扰ELISA和血凝抑制（HI）试验，因此需要进行中和试验以评估免疫力。(C)2003爱思唯尔科技有限公司版权所有。
The actual diagnosis of a tick-borne encephalitis (TBE) must be established in the laboratory because of the non-specific clinical features it presents. The method of choice is the demonstration of specific IgM- and IgG-serum antibodies by enzyme-linked immuno-sorbent assay (ELISA), since these antibodies are detectable in practically every case at the time of hospitalization. Early after onset of disease in the cerebrospinal fluid specific antibodies can only be found in 50% of the patients, but by the 10th day of illness they almost invariably become detectable. If an infection occurs after and despite the post-exposure administration of a specific immunoglobulin the seroconversion can be delayed and may cause diagnostic problems. Virusisolation from the blood, or the detection of specific nucleic acid in the blood or the cerebrospinal fluid by reverse-transcriptase polymerase chain reaction (RT-PCR) usually is only successful during the first viremic phase of the disease before seroconversion. In fatal cases, the virus can be isolated or detected by RT-PCR from the brain and other organs. For testing immunity after a TBE virus infection or after vaccination, most often the IgG ELISA is used. However, in cases of other flavivirus contacts (e.g. vaccinations against yellow fever or Japanese encephalitis; dengue virus infections), the performance of a neutralization assay is necessary for assessing immunity due to the interference of flavivirus cross-reactive antibodies in ELISA and hemagglutination inhibition (HI) test. (C) 2003 Elsevier Science Ltd. All rights reserved.