南美洲疫区旅行或工作史、啮齿动物或其排泄物接触史以及出现出血症状是诊断南美出血热的关键。
患病第一周经常出现非特异性流感样或登革热样症状;约 20%-30% 的患者在第二周继续进展至出现出血性或神经系统症状,常常导致多器官功能衰竭和死亡。
医务工作者应使用全套个人防护用品,并确保实验室样本经妥善贴签标注和运输。
通过逆转录聚合酶链反应 (reverse transcription-polymerase chain reaction, RT-PCR) 确诊。
所有有症状患者的主要治疗均为支持性治疗。
南美出血热(South American haemorrhagic fevers, SAHF)属于病毒感染,可能导致出血和器官功能障碍,经常导致死亡。病毒感染由新世界沙粒病毒 B 进化枝(沙粒病毒科哺乳动物沙粒病毒属)引起,其自然感染啮齿动物,但主要通过受感染啮齿动物分泌物和排泄物的气溶胶和黏膜接触传播给人类。虽不常见,但这些病毒可通过接触被感染的体液(如唾液、尿液、粪便、血液)在人与人之间传播。关于医源性传播和实验室传播也已有报道。[1]Patterson M, Grant A, Paessler S. Epidemiology and pathogenesis of Bolivian hemorrhagic fever. Curr Opin Virol. 2014;5:82-90.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028408/
http://www.ncbi.nlm.nih.gov/pubmed/24636947?tool=bestpractice.com
[2]Gómez RM, Jaquenod de Giusti C, Sanchez Vallduvi MM, et al. Junín virus. A XXI century update. Microbes Infect. 2011;13:303-311.
http://www.ncbi.nlm.nih.gov/pubmed/21238601?tool=bestpractice.com
[3]Enria DA, Briggiler AM, Sánchez Z. Treatment of Argentine hemorrhagic fever. Antiviral Res. 2008;78:132-139.
http://www.ncbi.nlm.nih.gov/pubmed/18054395?tool=bestpractice.com
[4]Enria DA, Briggiler AM, Feuillade MR. An overview of the epidemiological, ecological and preventive hallmarks of Argentine haemorrhagic fever (Junin virus). Bulletin Institut Pasteur. 1998;96:103-114.[5]de Manzione N, Salas RA, Paredes H, et al. Venezuelan hemorrhagic fever: clinical and epidemiological studies of 165 cases. Clin Infect Dis. 1998;26:308-313.
http://cid.oxfordjournals.org/content/26/2/308.long
http://www.ncbi.nlm.nih.gov/pubmed/9502447?tool=bestpractice.com
SAHF 发生在玻利维亚、阿根廷、委内瑞拉和巴西。在这些国家中,致病病毒性病原体不同;例如,在玻利维亚是查帕雷病毒和马秋博病毒,在委内瑞拉是瓜纳瑞托病毒,在阿根廷是胡宁病毒,在巴西是沙比亚病毒。[1]Patterson M, Grant A, Paessler S. Epidemiology and pathogenesis of Bolivian hemorrhagic fever. Curr Opin Virol. 2014;5:82-90.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028408/
http://www.ncbi.nlm.nih.gov/pubmed/24636947?tool=bestpractice.com
[2]Gómez RM, Jaquenod de Giusti C, Sanchez Vallduvi MM, et al. Junín virus. A XXI century update. Microbes Infect. 2011;13:303-311.
http://www.ncbi.nlm.nih.gov/pubmed/21238601?tool=bestpractice.com
[3]Enria DA, Briggiler AM, Sánchez Z. Treatment of Argentine hemorrhagic fever. Antiviral Res. 2008;78:132-139.
http://www.ncbi.nlm.nih.gov/pubmed/18054395?tool=bestpractice.com
[4]Enria DA, Briggiler AM, Feuillade MR. An overview of the epidemiological, ecological and preventive hallmarks of Argentine haemorrhagic fever (Junin virus). Bulletin Institut Pasteur. 1998;96:103-114.[5]de Manzione N, Salas RA, Paredes H, et al. Venezuelan hemorrhagic fever: clinical and epidemiological studies of 165 cases. Clin Infect Dis. 1998;26:308-313.
http://cid.oxfordjournals.org/content/26/2/308.long
http://www.ncbi.nlm.nih.gov/pubmed/9502447?tool=bestpractice.com
[6]Delgado S, Erickson BR, Agudo R, et al. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia. PLoS Pathog. 2008;4:e1000047.
http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1000047
http://www.ncbi.nlm.nih.gov/pubmed/18421377?tool=bestpractice.com
[7]Barry M, Russi M, Armstrong L, et al. Brief report: treatment of a laboratory-acquired Sabiá virus infection. N Engl J Med. 1995;333:294-296.
http://www.nejm.org/doi/full/10.1056/NEJM199508033330505
http://www.ncbi.nlm.nih.gov/pubmed/7596373?tool=bestpractice.com
这是由于每个国家的啮齿动物媒介不同。
现据报道,引起人类临床疾病的其他新世界沙粒病毒包括弗莱克索病毒(巴西)和塔卡里伯病毒(特立尼达);然而,并不将其视为病毒性出血热病毒。此外,报告的病例极少,且全部由实验室暴露引起。[8]Centers for Disease Control and Prevention. Viral hemorrhagic fevers (VHFs): Old World/New World arenaviruses. June 2013 [internet publication].
http://www.cdc.gov/vhf/virus-families/arenaviruses.html
BMJ talk medicine podcast: South American haemorrhagic fevers, with Prof Thomas Ksiazek
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