Kinetics of antigen-specific IgM/IgG/IgA antibody responses during Zika virus natural infection in two patients.

Understanding of kinetics of antibody responses is crucial for developing rapid serological tests and studying the mechanisms of Zika virus (ZIKV) infection. Most of the serological diagnostic assays previously published are based on either IgM or IgG titer, little is known on the level of IgA antibody in saliva and urine. In this study, we investigated the kinetics of IgM/IgG/IgA antibody responses in serum, saliva, and urine obtained from two ZIKV infected individuals from as early as the second day of onset of symptoms to as long as 2 years postinfection. Other than detecting robust early IgM response, long lasting IgG response, we discovered strong early IgA response specific for ZIKV in saliva in both patients. This unique observation provides a novel strategy and scientific basis for the development of noninvasive rapid tests for ZIKV infection.

[Dose of glucocorticosteroids in the treatment of severe acute respiratory syndrome].

OBJECTIVE: To survey the dose of glucocorticosteroids administered in patients with severe acute respiratory syndrome (SARS) and assess the effect of glucocorticosteroid doses in improving the patients' lung function. METHODS: A retrospective analysis was conducted among 225 SARS patients treated in our in 2003. Oxygenation index was used as the effectness index, and the criteria for effectiveness was defiend as increase of the value of OI by 20% or above. RESULTS: Glococoticostecoids were used in 59.56% of the SARS cases. The average value of OI before intravenous use of glucocorticosteroids was 237.08 mmHg, and that after the administration was 335.08 mmHg. The glucocorticosteroid doses that produce better effects were 1-3 mg/kg and 160-240 mg daily, with the total accumulative dose of 1000-2000 mg. The optimal duration of glucocorticosteroid use was 8-14 days. CONCLUSIONS: For SARS treatment, Glucocorticosteroids can effectively ameliorate the SARS patients' lung symptoms and improve the lung function. The appropriate daily dose of glucocorticosteroids is 1-3 mg/kg or 160-240 mg/d for a duration of 8-14 d; the accumulative dose should be controlled around 1500 mg.

[Study of laboratory characteristic of 4 patients with sporadic severe acute respiratory syndrome in 2004].

OBJECTIVE: To analyze the laboratory characteristics of patients with sporadic severe acute respiratory syndrome (SARS) in China. METHODS: The laboratory findings of the 4 cases with SARS occurring in Guangzhou, People's Republic of China, in 2004 were analyzed and compared with that during epidemic. RESULTS: Leukopenia and lymphocytopenia were seen in all the patients. Two patients had slightly decreased peripheral blood T lymphocyte count. Alanine aminotransferase (ALT) and aspartate transaminase (AST) levels increased slightly in 3 patients. No hypoxemia was seen in all the patients. Both SARS-IgM and IgG sero-conversion occurred earlier in all the patients with the titer increased more than 4-fold shortly. Neutralization test was positive in all the patients. SARS coronary virus (SARS-CoV) RNA was detected by polymerase chain reaction (PCR) in pharyngeal swabs only in 1 patient. CONCLUSION: The 4 sporadic SARS patients in 2004 have milder manifestations, shorter course of disease with no complications during an epidemic, compared with patients seen previously. The change in laboratory findings is less than that, which might be attributable to milder virulence of the SARS-CoV. The antibody appears earlier in these patients. The SARS-CoV is eliminated rapidly.

[Study on the damage of liver in patients with SARS].

OBJECTIVE: To study the changes in liver function and histopathology, and investigate the underlying mechanism and clinical significance of damage of liver in patients with severe acute respiratory syndrome (SARS). METHODS: According the clinical diagnostic standard of atypical pneumonia of Ministry of Health P. R. China, liver function was assessed in 110 SARS patients admitted from February 2003 to June 2003. Of them 8 SARS patients died, and the livers were pathologically examined, and their liver function parameters were compared with that of the 35 healthy controls. RESULTS: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), total bilirubin (TBil) of patients with SARS were higher than those of controls, they were (91.61+/-50.53) U/L vs. (32.91+/-10.56) U/L, (78.68+/-33.32) U/L vs. (29.43+/-8.89) U/L, (429.95+/-188.94) U/L vs. (200.83+/-44.86) U/L, (11.67+/-4.26) micromol/L vs. (8.44+/-3.86) micromol/L, all P<0.001. Albumin (ALB) and pro-albumin (PAB) of patients with SARS were lower than those of controls, they were (34.40+/-5.13) g/L vs. (42.09+/-6.79) g/L, (0.20+/-0.06) g/L vs. (0.34+/-0.05) g/L, both P<0.001. Direct reaction bilirubin (DBil), total bile acid (TBA), gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) showed no marked difference between SARS patients and controls, all P>0.05. Non-specific inflammation in the liver was observed in pathological examination in 4 cases. ALT, AST, GGT and LDH were always 4 to 9 times of normal. The ratio of abnormality of ALT, AST and PAB were more than 80.0 percent, the ratio of abnormality of ALB was 42.7 percent, and less than 30.0 percent for other indexes. The average of LDH, ALT, and AST of dead patients were higher than those of the survivors. Histopathology of liver was non-specific hepatitis. CONCLUSION: The patients with SARS are prone to have mild non-specific hepatitis. It seldom causes the typical symptoms of hepatitis and it is easy to be ignored in clinic.

[Study on the myocardiac injury in patients with severe acute respiratory syndrome].

OBJECTIVE: To explore the myocardiac injury in patients with severe acute respiratory syndrome (SARS) and its clinical significance. METHODS: 37 SARS patients fulfilled the Guangdong provincial diagnostic criteria for infectious atypical pneumonia and 35 health controls were investigated. The serum levels of creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), troponin I (TnI), creatine kinase-MB (CK-MB) and myoglobin (MYO) were measured. RESULTS: CK, LDH and AST levels in patients were higher than those of control group (P < 0.01); furthermore, among patients the levels were higher in fatal cases than in survivors. The positive rates of TnI, CK-MB and MYO in patients were higher than those in controls (P < 0.05). CONCLUSION: The patients with SARS are subject to complicating myocardiac injury. Therefore, careful monitoring of the myocardiac enzyme profiles is of great importance in reducing the complications and mortality in patients with SARS.

[Changes of liver function in patients with serious acute respiratory syndrome].

OBJECTIVES: To investigate the changes of liver function during the course of serious acute respiratory syndrome (SARS) and to explore its possible influence factors. METHODS: There were 91 patients with common SARS, and 23 patients with severe SARS, and 61 common pneumonia patients served as the controls. The liver functions of all the patients were measured. RESULTS: The rate of anomaly liver function in the common SARS patients group was 68.1%, which was higher than that in the common pneumonia patients group (24.6%), chi2=27.7, P<0.01. The changes mainly existed in the mild to moderate elevation of alanine aminotransferase and aspartate aminotransferase. The severe SARS patients were older and the changing rate of liver function was as high as 95.7%. CONCLUSIONS: The damage possibility of liver function in SARS patients is higher than that in common pneumonia patients. The damage is light and related to SARS itself. The damage of liver function in the severe SARS patients may have close relationship with age.

[Clinical analysis of 190 cases of outbreak with atypical pneumonia in Guangzhou in spring, 2003].

OBJECTIVE: To study methods of diagnosis and treatment for atypical pneumonia (Severe Acute Respiratory Syndrome), outbreak of the illness in Guangzhou during Jan. - Mar., 2003. METHODS: 190 cases with atypical pneumonia were analyzed, and the cases were admitted in Guangzhou municipal First Hospital and Guangzhou municipal Eighth Hospital. RESULTS: Patients were infected by close quarters contacting each other. All patients manifest high fever, and accompany by dyspnea, cough, palpitate, weakness, headache and swirl. Other 46 cases were accompanied by diarrhea. Most of patients, manifestation of lungs was negative. Chest X-ray, shadow of lungs were light in beginning, and change to severity slowly or suddenly during 5 - 10 days. Of these cases, 36 cases develop to ARDS and 11 cases died with severity ARDS. Using general antibiotic was of no effect for the illness. Continual positive airway pressure (CPAP) and glucocorticoid was required that can control deprivation of the disease when toxicosis symptom of patients was severity and shadow of lungs diffuse more and more. CONCLUSION: Infectivity of the illness is evidence and spread by airway. Using general antibiotic was of no effect for the illness. Continual positive airway pressure (CPAP) and glucocorticoid are effective for control of the disease.

[Measurement of subsets of blood T lymphocyte in 93 patients with severe acute respiratory syndrome and its clinical significance].

OBJECTIVE: To investigate the changes of subsets of blood T lymphocyte in patients with severe acute respiratory syndrome (SARS) and their clinical significance. METHODS: Subsets of blood T lymphocyte in 93 patients with SARS were detected by flow cytometer. The patients comprised 40 men and 53 women, aged 17 - 88 years (average 44 years). The results detected in 64 normal subjects and 50 patients with AIDS served as controls. RESULTS: The numbers of CD(3)(+), CD(4)(+), and CD(8)(+) lymphocytes all significantly decreased in acute phase of SARS patients compared with those in normal persons. Their findings was different from what we observed in patients with AIDS who had decreased CD(4)(+), but increased CD(8)(+) counts. The counts of CD(3)(+), CD(4)(+), and CD(8)(+) lymphocytes decreased more apparently in patients with critical SARS. All the five patients who died had CD(4)(+) counts less than 200/microl. As the patients' conditions improved, the counts of CD(3)(+), CD(4)(+), and CD(8)(+) gradually returned to normal. CONCLUSION: The patients with SARS were found having damage of cellular immunity markedly.

[Analysis of acute physiology and chronic health evaluation III in the 54 patients with severe acute respiratory syndrome].

OBJECTIVE: To evaluate the acute physiology and chronic health evaluation III (APACHE III) in the severe acute respiratory syndrome (SARS) patients and its significance in prognosis. METHODS: The clinical data of 54 SARS patients, including survivors (43 cases) and nonsurvivors (11 cases) were collected and evaluated with APACHE III scoring system. The correlation of scores and prognosis was evaluated. RESULTS: The scores of the nonsurvivors were higher remarkably than those of the surviving group(P<00.01). The scores of the acute physiology score (APS) and year score (YS) in the death group were higher obviously than those of the surviving group(both P<0.01). Elderly patients with severe disease had a high mortality. The scores of APACHE III had positive correlation with the over all fatality rate. When the scores of APACHE III was higher than 60, the fatality rate increased obviously. CONCLUSION: The scores of APACHE III in the SARS are correlated with the patient's condition and prognosis.