{"id":12138,"date":"2020-05-05T23:16:51","date_gmt":"2020-05-05T20:16:51","guid":{"rendered":"https:\/\/www.synevo.ro\/shop\/virusul-encefaliei-de-capusa-tbev-igg-igm-in-lcr-ser\/"},"modified":"2025-02-06T11:49:56","modified_gmt":"2025-02-06T09:49:56","slug":"virusul-encefalitei-de-capusa-tbev-igg-igm-in-lcr-ser","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/virusul-encefalitei-de-capusa-tbev-igg-igm-in-lcr-ser\/","title":{"rendered":"\u0412\u0438\u0440\u0443\u0441 \u043a\u043b\u0435\u0449\u0435\u0432\u043e\u0433\u043e \u044d\u043d\u0446\u0435\u0444\u0430\u043b\u0438\u0442\u0430 (\u0412\u041a\u042d) IgG, IgM \u0432 \u0441\u043f\u0438\u043d\u043d\u043e\u043c\u043e\u0437\u0433\u043e\u0432\u043e\u0439 \u0436\u0438\u0434\u043a\u043e\u0441\u0442\u0438\/\u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0435"},"content":{"rendered":"<p><strong><em>Informa\u021bii generale<\/em><\/strong><\/p>\n<p>Encefalita transmis\u0103 de c\u0103pu\u0219e (TBE) este o infec\u021bie viral\u0103 important\u0103 a sistemului nervos central, \u00een Europa \u0219i \u00een mai multe regiuni din Asia. Este cauzat\u0103 de subtipul Orientului \u00cendep\u0103rtat, siberian \u0219i european al virusului encefalitei transmise prin c\u0103pu\u0219e (TBEV). De\u0219i boala poate fi prevenit\u0103 prin vaccinare, inciden\u021ba a crescut \u00een ultimele decenii \u0219i, \u00een consecin\u021b\u0103, reprezint\u0103 o problem\u0103 de s\u0103n\u0103tate \u00een cre\u0219tere \u00een aproape toate \u021b\u0103rile endemice europene \u0219i asiatice<sup>1<\/sup>.<\/p>\n<p>Dup\u0103 o mu\u0219c\u0103tur\u0103 de c\u0103pu\u0219\u0103 infectat\u0103, replicarea TBEV are loc local. Se presupune c\u0103 celulele dendritice ale pielii (celulele Langerhans) sunt primele celule implicate \u00een replicarea viral\u0103 \u0219i care transport\u0103 virusul c\u0103tre ganglionii limfatici locali. Din acest loc, TBEV\u00a0 disemineaz\u0103 \u00een \u021besuturile extraneurale, \u00een special splina, ficatul \u0219i m\u0103duva osoas\u0103, unde multiplicarea ulterioar\u0103 men\u021bine viremia timp de c\u00e2teva zile. \u00cen timpul fazei viremice (care corespunde clinic fazei ini\u021biale a TBE), virusul ajunge la creier<sup>2,3<\/sup>, \u00eens\u0103 nu este \u00eenc\u0103 cunoscut mecanismul exact prin care TBEV trece bariera hematoencefalic\u0103.<\/p>\n<p>Cele mai multe cazuri apar \u00een perioada cea mai crescut\u0103 de activitate a c\u0103pu\u0219elor, \u00een Europa Central\u0103, \u00een principal din aprilie p\u00e2n\u0103 \u00een noiembrie<sup>4-6<\/sup>. TBE cauzat\u0103 de subtipul virusului european se prezint\u0103 de obicei sub form\u0103 de meningit\u0103 sau meningoencefalit\u0103 \u0219i are un curs bifazic la aproximativ dou\u0103 treimi dintre pacien\u021bi. P\u00e2n\u0103 la 50% dintre pacien\u021bi au sechele pe termen lung<sup>6<\/sup>. Tratamentul se bazeaz\u0103 pe tratarea simptomelor. Cu toate acestea, TBE poate fi prevenit\u0103 cu succes, printr-un vaccin sigur \u0219i extrem de eficient<sup>6<\/sup>.<\/p>\n<p>Confirmarea de rutin\u0103 de laborator a infec\u021biei cu TBEV se bazeaz\u0103 \u00een principal pe demonstrarea existen\u021bei anticorpilor specifici \u00een ser (\u0219i lichidul cefalorahidian), de obicei prin teste imunologice<sup>7,8<\/sup>. La majoritatea pacien\u021bilor, anticorpii IgM \u0219i IgG serici specifici sunt prezen\u021bi la \u00eenceputul fazei meningoencefalitice a bolii. Uneori \u00een prima prob\u0103 de ser se g\u0103sesc numai anticorpii IgM \u00eempotriva TBEV. \u00cen astfel de cazuri, o a doua prob\u0103 de ser trebuie testat\u0103 ulterior, la o distan\u021b\u0103 de 1-2 s\u0103pt\u0103m\u00e2ni, deoarece un singur test pentru depistarea prezen\u021bei anticorpilor IgM nu este suficient pentru diagnostic. Anticorpii TBEV IgM pot fi detecta\u021bi \u00een ser timp de c\u00e2teva luni (p\u00e2n\u0103 la 10 luni sau chiar mai mult) dup\u0103 infec\u021bia acut\u0103, \u00een timp ce anticorpii TBEV IgG persist\u0103 o via\u021b\u0103 \u00eentreag\u0103 \u0219i mediaz\u0103 o imunitate care previne reinfec\u021bia simptomatic\u0103<sup>7,9<\/sup>. \u00cen lichidul cefalorahidian, anticorpii IgM \u0219i IgG specifici sunt detectabili cu c\u00e2teva zile mai t\u00e2rziu dec\u00e2t \u00een \u200b\u200bser \u0219i, \u00een aproape toate cazurile, p\u00e2n\u0103 \u00een ziua 10<sup>10,11<\/sup>.<\/p>\n<p><strong><em>\u00a0<\/em><\/strong><strong><em>Recomand\u0103ri pentru determinarea virusului encefaliei de c\u0103pu\u0219\u0103 IgG \u0219i IgM \u00een ser<sup>1-11<\/sup><\/em><\/strong><\/p>\n<ul>\n<li>Evaluarea celor mai frecvente boli transmise de c\u0103pu\u0219e<\/li>\n<li>Evaluarea pacien\u021bilor cu antecedente sau cu suspiciune de expunere la c\u0103pu\u0219e care prezint\u0103 febr\u0103, mialgie, cefalee, grea\u021b\u0103 \u0219i alte simptome nespecifice<\/li>\n<li>Studii sero-epidemiologice ale prevalen\u021bei infec\u021biei la anumite popula\u021bii<\/li>\n<\/ul>\n<p><strong><em>Specimen recoltat\u00a0<\/em><\/strong>\u2013 s\u00e2nge venos\/ lichid cefalo-rahidian (LCR)<sup>11<\/sup><\/p>\n<p><strong><em>Prelucrare necesar\u0103 dup\u0103 recoltare \u2013\u00a0<\/em><\/strong>Proba se centrifugheaz\u0103 \u0219i se alicoteaz\u0103 serul<sup>12<\/sup>.<\/p>\n<p><strong><em>Volum prob\u0103 \u2013\u00a0<\/em><\/strong>1mL<sup>12<\/sup><\/p>\n<p><strong><em>Cauze de respingere a probei\u00a0<sup>12<\/sup><\/em><\/strong><\/p>\n<ul>\n<li>Specimen hemolizat<\/li>\n<li>Specimen lipemic<\/li>\n<li>Specimen icteric<\/li>\n<li>Specimen transportat necorespunz\u0103tor<\/li>\n<\/ul>\n<p><strong><em>Stabilitate prob\u0103 \u2013\u00a0<\/em><\/strong>serul refrigerat timp de 10 zile<sup>12<\/sup><\/p>\n<p><strong><em>Metod\u0103 \u2013\u00a0<\/em><\/strong>ELISA<sup>12<\/sup><\/p>\n<p><strong><em>Valori de referin\u021b\u0103 -ser<\/em><\/strong><\/p>\n<p>IgG: &lt; 16 RE\/ml<\/p>\n<p>IgM: &lt; 0,8 Ratio<\/p>\n<p><strong><em>Limite \u0219i interferen\u021be<\/em><\/strong><\/p>\n<p>Este necesar\u0103, de asemenea, aten\u021bie la interpretarea serologiei TBE la pacien\u021bii cu meningoencefalit\u0103 sau meningit\u0103 care au fost vaccina\u021bi \u00eempotriva TBE. \u00cen majoritatea cazurilor pacien\u021bilor care au efectuat vaccinul, r\u0103spunsul serologic este diferit de cele g\u0103site la persoanele nevaccinate cu TBE. Aceste cazuri se caracterizeaz\u0103 printr-o dezvoltare \u00eent\u00e2rziat\u0103 a r\u0103spunsului IgM specific (\u00een timpul s\u0103pt\u0103m\u00e2nii ini\u021biale a fazei meningoencefalitice a anticorpilor IgM specifici TBE nu sunt de obicei detectabili) asociat\u0103 cu o cre\u0219tere rapid\u0103 a anticorpilor specifici IgG serici<sup>14,15<\/sup>. Pentru un diagnostic fiabil al TBE la persoanele vaccinate anterior \u00eempotriva TBE, este necesar\u0103 demonstrarea produc\u021biei intratecale de anticorpi TBEV<sup>11<\/sup>.<\/p>\n<p><strong><em>\u00a0<\/em><\/strong><\/p>\n<p><strong><em>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/em><\/strong><\/p>\n<ol>\n<li>S\u00fcss J. (2011). Tick-borne encephalitis 2010: epidemiology, risk areas, and virus strains in Europe and Asia-an overview. Ticks and tick-borne diseases, 2(1), 2\u201315.\u00a0https:\/\/doi.org\/10.1016\/j.ttbdis.2010.10.007<\/li>\n<li>R\u016f\u017eek, D., Dobler, G., &amp; Donoso Mantke, O. (2010). Tick-borne encephalitis: pathogenesis and clinical implications. Travel medicine and infectious disease, 8(4), 223\u2013232.\u00a0https:\/\/doi.org\/10.1016\/j.tmaid.2010.06.004<\/li>\n<li>Mandl C. W. (2005). Steps of the tick-borne encephalitis virus replication cycle that affect neuropathogenesis. Virus research, 111(2), 161\u2013174.\u00a0https:\/\/doi.org\/10.1016\/j.virusres.2005.04.007<\/li>\n<li>Mansfield, K. L., Johnson, N., Phipps, L. P., Stephenson, J. R., Fooks, A. R., &amp; Solomon, T. (2009). Tick-borne encephalitis virus \u2013 a review of an emerging zoonosis. The Journal of general virology, 90(Pt 8), 1781\u20131794.\u00a0https:\/\/doi.org\/10.1099\/vir.0.011437-0<\/li>\n<li>Lindquist, L., &amp; Vapalahti, O. (2008). Tick-borne encephalitis. Lancet (London, England), 371(9627), 1861\u20131871.\u00a0https:\/\/doi.org\/10.1016\/S0140-6736(08)60800-4<\/li>\n<li>Kaiser R. (2008). Tick-borne encephalitis. Infectious disease clinics of North America, 22(3), 561\u2013x.\u00a0https:\/\/doi.org\/10.1016\/j.idc.2008.03.013<\/li>\n<li>Saksida, A., Duh, D., Lotric-Furlan, S., Strle, F., Petrovec, M., &amp; Avsic-Zupanc, T. (2005). The importance of tick-borne encephalitis virus RNA detection for early differential diagnosis of tick-borne encephalitis. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 33(4), 331\u2013335.\u00a0https:\/\/doi.org\/10.1016\/j.jcv.2004.07.014<\/li>\n<li>Ludolfs, D., Reinholz, M., &amp; Schmitz, H. (2009). Highly specific detection of antibodies to tick-borne encephalitis (TBE) virus in humans using a domain III antigen and a sensitive immune complex (IC) ELISA. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 45(2), 125\u2013128.\u00a0https:\/\/doi.org\/10.1016\/j.jcv.2009.03.016<\/li>\n<li>Hofmann, H., Kunz, C., Heinz, F. X., &amp; Dippe, H. (1983). Detectability of IgM antibodies against TBE virus after natural infection and after vaccination. Infection, 11(3), 164\u2013166.\u00a0https:\/\/doi.org\/10.1007\/BF01641297<\/li>\n<li>G\u00fcnther, G., Haglund, M., Lindquist, L., Sk\u00f6ldenberg, B., &amp; Forsgren, M. (1997). Intrathecal IgM, IgA and IgG antibody response in tick-borne encephalitis. Long-term follow-up related to clinical course and outcome. Clinical and diagnostic virology, 8(1), 17\u201329.\u00a0https:\/\/doi.org\/10.1016\/s0928-0197(97)00273-0<\/li>\n<li>Bogovic, P., &amp; Strle, F. (2015). Tick-borne encephalitis: A review of epidemiology, clinical characteristics, and management. World journal of clinical cases, 3(5), 430\u2013441.\u00a0https:\/\/doi.org\/10.12998\/wjcc.v3.i5.430<\/li>\n<li>Barp, N., Trentini, A., Di Nuzzo, M., Mondardini, V., Francavilla, E., &amp; Contini, C. (2020). Clinical and laboratory findings in tick-borne encephalitis virus infection. Parasite epidemiology and control, 10, e00160.\u00a0https:\/\/doi.org\/10.1016\/j.parepi.2020.e00160<\/li>\n<li>Stiasny, K., Aberle, J. H., Chmelik, V., Karrer, U., Holzmann, H., &amp; Heinz, F. X. (2012). Quantitative determination of IgM antibodies reduces the pitfalls in the serodiagnosis of tick-borne encephalitis. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 54(2), 115\u2013120.\u00a0https:\/\/doi.org\/10.1016\/j.jcv.2012.02.016<\/li>\n<li>Stiasny, K., Holzmann, H., &amp; Heinz, F. X. (2009). Characteristics of antibody responses in tick-borne encephalitis vaccination breakthroughs. Vaccine, 27(50), 7021\u20137026.\u00a0https:\/\/doi.org\/10.1016\/j.vaccine.2009.09.069<\/li>\n<li>Andersson, C. R., Vene, S., Insulander, M., Lindquist, L., Lundkvist, A., &amp; G\u00fcnther, G. (2010). Vaccine failures after active immunisation against tick-borne encephalitis.\u00a0<em>Vaccine<\/em>,\u00a0<em>28<\/em>(16), 2827\u20132831. https:\/\/doi.org\/10.1016\/j.vaccine.2010.02.001<\/li>\n<\/ol>","protected":false},"excerpt":{"rendered":"<p>\u041a\u043b\u0435\u0449\u0435\u0432\u043e\u0439 \u044d\u043d\u0446\u0435\u0444\u0430\u043b\u0438\u0442 \u2013 \u044d\u0442\u043e \u0441\u0435\u0437\u043e\u043d\u043d\u043e\u0435 (\u0432\u0435\u0441\u0435\u043d\u043d\u0435-\u043b\u0435\u0442\u043d\u0435\u0435) \u0432\u0438\u0440\u0443\u0441\u043d\u043e\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0435, \u043f\u0435\u0440\u0435\u0434\u0430\u044e\u0449\u0435\u0435\u0441\u044f \u0432 \u043e\u0441\u043d\u043e\u0432\u043d\u043e\u043c \u0441 \u0443\u043a\u0443\u0441\u043e\u043c \u043a\u043b\u0435\u0449\u0435\u0439; \u043f\u043e\u0440\u0430\u0436\u0430\u0435\u0442 \u043f\u0440\u0435\u0438\u043c\u0443\u0449\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u043e 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\u0441\u0438\u0431\u0438\u0440\u0441\u043a\u0438\u0439. \u041e\u0441\u043d\u043e\u0432\u043d\u043e\u0439 \u043f\u0435\u0440\u0435\u043d\u043e\u0441\u0447\u0438\u043a \u044d\u043d\u0446\u0435\u0444\u0430\u043b\u0438\u0442\u0430 \u2013 \u0438\u043a\u0441\u043e\u0434\u043e\u0432\u044b\u0435 \u043a\u043b\u0435\u0449\u0438. \u041a\u0440\u043e\u043c\u0435 \u0442\u043e\u0433\u043e, \u043e\u043d \u043f\u0435\u0440\u0435\u0434\u0430\u0435\u0442\u0441\u044f \u0447\u0435\u0440\u0435\u0437 \u043f\u0442\u0438\u0446, \u0433\u0440\u044b\u0437\u0443\u043d\u043e\u0432 \u0438 \u0445\u0438\u0449\u043d\u0438\u043a\u043e\u0432. \u0418\u043d\u043a\u0443\u0431\u0430\u0446\u0438\u043e\u043d\u043d\u044b\u0439 \u043f\u0435\u0440\u0438\u043e\u0434 \u0432 \u0441\u0440\u0435\u0434\u043d\u0435\u043c \u0441\u043e\u0441\u0442\u0430\u0432\u043b\u044f\u0435\u0442 3-7 \u0441\u0443\u0442\u043e\u043a. \u041a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0435 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