Yeni bir viral tehdit: Enterovirüs D68

Year 2016, Volume: 73 Issue: 3, 293 - 302, 01.09.2016

Mustafa Altındiş Tuba Dal

Abstract

Enterovirüs D68 EV-D68 genellikle solunum yolu infeksiyonlarından sorumlu olan zarfsız, tek zincirli, pozitif polariteli bir RNA virüsüdür. Picornaviridae ailesi içinde sınıflandırılır. Solunum yollarında diğer enterovirüslerin reseptörü olan α2-3 siyalik asit yerine α2-6 siyalik aside bağlanır. Özellikle çocuklarda üst solunum yolu ve alt solunum yolu infeksiyonlarının yanısıra sinir sistemi infeksiyonlarından da sorumlu olabilir. Polio benzeri felçlerle ilişkilidir. Virüs enfekte kişilerin tükürük, balgam, mukus gibi salgılarıyla bulaşır. Altta yatan solunum hastalığı ve astımı olan bebek ve çocuklarda, immunsupresif hastalarda ciddi komplikasyonlar ile ilişkilidir. Amerika Birleşik Devletleri ve Kanada’da 2014 yılında geniş çaplı bir salgın gerçekleşmiştir. Ardından Avrupa, Tayland, Çin, Yeni Zellanda ve bazı Afrika ülkelerinde salgınlara yol açmıştır. EV-D68, 33°C’de üreyebilmesi ve aside toleransının düşük olması nedeniyle atipik bir EV olarak kabul edilir. Bu nedenle EV-D68 infeksiyonlarının mevsimsel dağılımı sonbaharın başlangıcı ve kış aylarıdır. Virüs, hücre kültürlerinde üretilebilir ancak tanıda genellikle moleküler yöntemlerden yararlanılır. Tanı için, solunum yolu örnekleri, bazen de beyin omurilik sıvısı ve kan örnekleri kullanılır. Enterovirüs D68 virüsüne yönelik henüz özel bir aşı ve ilaç bulunmamaktadır. Hafif ve orta dereceli vakalar için destekleyici tedavi yeterli olabilmektedir. Ağır vakalar ise hastaneye yatış ve yoğun bakım gerektirir. Korunma için, enfekte hastaların yediklerini, içtiklerini paylaşmaktan, bu hastaları öpmek ve sarılmaktan kaçınılması ve el hijyenine dikkat edilmesi önerilmektedir.Bu derlemede, literatür eşliğinde, EV-D68 infeksiyonlarının güncel epidemiyolojik, patojenik, klinik ve tanısal özelliklerinin özetlenmesi amaçlandı. Türkiye’de virüsün neden olduğu infeksiyonlara yönelik yeterince veri bulunmamaktadır. Sunduğumuz derleme, ülkemizde EV-D68 ile ilgili çalışmalara ışık tutacak, olası bir salgın durumunda EV-D68 infeksiyonunun erken tanısında ve yönetiminde yarar sağlayacaktır

Keywords

Enterovirüs D68 (EV-D68), solunum yolu infeksiyonu, salgın

A new viral threat: Enterovirus D68

Abstract

Enterovirus D68 EV-D68 is a non-enveloped singlestranded RNA virus with positive polarity that usually leads to respiratory tract infections. It is classified in the Picornaviridae family. It binds to α2-6 sialic acid instead of α2-3 sialic acid which is an EV receptor in respiratory tract. It may be responsible for the central nervous system infections especially in children, as well as the upper respiratory tract, and lower respiratory tract infections. It is associated with poliolike paralysis. The virus is transmitted by secretions of infected people such as saliva, sputum, and mucus. It is associated with serious complications in infants and children with the underlying respiratory disease and asthma, and immunosuppressive patients. In United States and Canada, in 2014, a large-scale outbreak occurred. Then, it led to outbreak in Europe, Thailand, China, New Zealand and in some African countries. EVD68, due to reproduce at 33 °C and the low tolerance to the acid is considered an atypical EV. Therefore, seasonal distribution of EV-D68 infection is beginning of the autumn and winter months. The virus can be isolated in cell culture, but the diagnosis is often based on molecular methods. For diagnosis, respiratory samples, and sometimes cerebrospinal fluid and blood samples can be used. Currently, there is no specific vaccine and drug for EV-D68. Supportive treatment may be sufficient for mild and moderate cases. Severe cases require hospitalization and intensive care. For protection, it is recommended to avoid to share foods or drinks with infected patients and avoid to kiss them and to pay attention to hand hygiene. The aim of this review was to summarise the current epidemiological, pathogenic, clinical, diagnostic features of EV-D68 infections. There was no available data for infections caused by this virus in Turkey. This review will lead the studies on EV-D68 and it will provide benefits for early diagnosis and management of infections in a possible outbreak.

Keywords

Enterovirus D68 (EV-D68), respiratory tract infection, outbreak

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