[Lancet Infect Dis发表论文]：中国新发脾媒虾夷病毒感染系列病例：主动监测与基因组分析

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2025年04月11日 ⁄ 时讯速递, 进展交流 ⁄ 已关闭评论

Summary

Background

Yezo virus (YEZV) is an emerging tick-borne pathogen, which was initially reported in Japan in 2021. Only one patient had been reported in China so far. We aimed to describe the epidemiological, clinical, and laboratory findings of a series of patients, and to characterise the viral genomes of YEZV.

背景：虾夷病毒（YEZV）是一种新发蜱媒病原体，最初于 2021 年在日本报告。迄今为止中国仅报告了一例患者。我们旨在描述系列病例的流行病学、临床和实验室结果，并描述 YEZV 基因组特征。

Methods

In this active surveillance and genomic analysis, we conducted active surveillance at Mudanjiang Forestry Central Hospital, Heilongjiang Province of northeast China. Participants were eligible for inclusion if they sought medical care for a recent tick bite between May 1 and July 31, in 2022 and 2023, and between May 1 and July 10, in 2024. We collected sera from participants to detect YEZV infection by meta-transcriptomic sequencing, real-time RT-PCR, and indirect immunofluorescence assay. We isolated YEZV by cell culture and characterised the pathogen by morphological and phylogenetic analyses.

方法：在中国东北黑龙江省的牡丹江林业中心医院进行主动监测和基因组分析。参与者纳入标准为 2022 和 2023 年 5 月 1 日至 7 月 31 日以及 2024 年 5 月1 日至 7 月 10 日期间，因近期被蜱叮咬而就诊者。我们采集参与者的血清，通过宏转录组测序、实时 RT-PCR 和间接免疫荧光试验检测 YEZV 感染。通过细胞培养分离 YEZV，并进行该病原体的形态学和系统发育特征分析。

Findings

A series of 18 patients with YEZV infection (12 male and six female; median age 53 years, IQR 45–60) were identified among 988 participants. The patients presented with fever (18 patients, 100%), headache (ten patients, 56%), dizziness (nine patients, 50%), malaise (three patients, 17%), lumbago (three patients, 17%), and cough (three patients, 17%). Nine (50%) patients had rash around the tick bite site and four (22%) had lymphadenopathy. Nine (50%) patients had gastrointestinal symptoms, and five (28%) had neurological symptoms. We observed leukopenia in ten (63%) and thrombocytopenia in five (31%) of 16 assessed patients. Elevated hepatic transaminase concentrations were identified in 13 (72%) of all 18 patients, lactate dehydrogenase or α-hydroxybutyric dehydrogenase in nine (50%), serum amyloid protein A in 13 (72%), and hypersensitive C-reactive protein in ten (56%). Eight (7%) of 119 Ixodes persulcatus ticks removed from participants were positive for YEZV. Three YEZV strains were isolated from the sera of patients. Ten viral genomes were obtained from five patients, a blood-sucking I persulcatus removed from a participant, and four host-questing tick samples collected in the areas where patients were identified or in the adjacent region. Phylogenetic analyses revealed that YEZVs in either patients or ticks were divided into two clades, each with distinct mutations.

发现：在 988 名参与者中发现了 18 例 YEZV 感染患者（12 名男性和 6 名女性；年龄中位数为 53 岁，四分位数在 45–60 岁之间）。患者表现出发热（18例，100%）、头痛（10 例，56%）、头晕（9 例，50%）、乏力（3 例，17%）、腰痛（3 例，17%）和咳嗽（3 例，17%）。9 名患者（50%）在蜱咬处出现皮疹，4 名患者（22%）有淋巴结肿大。9 名患者（50%）出现胃肠症状，5 名患者（28%）有神经系统症状。在 16 名有血常规检测结果的患者中，10 名（63%）出现白细胞减少，5 名（31%）出现血小板减少。全部 18 名患者中，13 名（72%）肝转氨酶升高，9 名（50%）乳酸脱氢酶或 α-羟基丁酸脱氢酶升高，13名（72%）血清淀粉样蛋白 A 升高，10 名（56%）超敏 C 反应蛋白升高。从参与者身上摘取的正在吸血的 119 只全沟硬蜱中，8 只（7%）YEZV 阳性。从患者血清中分离到 3 株 YEZV，并获得了 10 套病毒全基因组序列，其中 5 套来自病人、1 套来自从参与者身上摘取的正在吸血的蜱、4 套来自从患者居住地域及周边地区采集的游离蜱。系统发育分析显示，患者或蜱中的 YEZV 分为两个进化分枝，每个分枝具有独特的突变位点。