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尼帕和亨德拉病毒性脑炎

Authors
Adeeba Kamarulzaman, MBBS, FRACP
Khean Jin Goh, MBBS, FRCP
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH
Translators
吕志勤, 主任医师

引言

尼帕和亨德拉病毒是两种有相关性的、出现在亚太地区的动物源性病原体。在1998至1999年间，尼帕病毒曾在马来西亚和新加坡导致了一次猪和人类的感染暴发，自2001年以来，尼帕病毒造成孟加拉国和印度西孟加拉邦反复发生了多次人类感染暴发[1-8]。自1994年以后，在澳大利亚已经发生过由亨德拉病毒导致的马和人类感染[9-12]。两种病毒都是属于副黏病毒科的RNA病毒。它们具有相同的抗原、血清学及超微结构特征，并且不同于其他副黏病毒，因此目前被归类于亨尼帕病毒属(henipavirus)[13-16]。

尼帕病毒

尼帕病毒最初是在马来西亚养猪农民暴发病毒性脑炎时被发现的。该病毒是以一个感染患者所住的马来西亚村庄命名的。此外，在孟加拉国多个地区以及相邻的印度西里古里区域，也发生过几次急性尼帕病毒性脑炎暴发[8,17]。

尼帕病毒感染的流行病学 — 最初认为马来西亚的脑炎暴发是在亚洲流行的日本脑炎(Japanese encephalitis, JE)。然而，一些特征不符合该诊断：脑炎发生在成年，而非儿童；病例集中于同一家庭中；感染农民所养的猪有疾病史[2,4]。此外，大量患者之前曾接种过日本脑炎疫苗[2,4]。 (参见“虫媒性脑炎”，关于‘日本脑炎病毒’一节)

动物宿主 — 亨尼帕病毒的主要动物宿主为狐蝠属的蝙蝠[18-23]。在来自孟加拉国和马来西亚的蝙蝠体内发现了抗尼帕病毒抗原的抗体，此外，从栖息在马来西亚东海岸的小狐蝠(P. hypomelanus)尿液中分离出了该病毒[5,18,22]。自此以后，在中国云南和海南岛、柬埔寨、泰国、印度、马达加斯加以及西非加纳等广泛传播地区，已在10个属23个种的蝙蝠体内发现尼帕病毒感染的血清学证据[23]。

与日本脑炎不同，感染尼帕病毒的猪有临床疾病，表现为神经系统和呼吸道症状[24,25]。在猪之间的传播模式可能为直接接触感染的液体，例如尿液、唾液、咽及支气管分泌物。其他家养宠物(如猫和狗)也已被发现存在尼帕病毒血清学阳性的情况[4]。

                 

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Literature review current through: 2017-06 . | This topic last updated: 2016-05-02.
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