鼠疫的临床诊治与预防

鼠疫是由鼠疫耶尔森菌感染引起的全身性人畜共患病,人类主要通过被跳蚤叮咬而患病。常见的临床类型为腺鼠疫、败血症型鼠疫和肺鼠疫,早期诊断和及时治疗可明显改善患者预后。治疗首选氨基糖苷类药物,次选四环素类药物。预防措施主要包括防止跳蚤叮咬和直接接触感染动物或患者,接触肺鼠疫患者时还需采取防止飞沫传播的控制措施。     

2010-2015年全球鼠疫流行概况

鼠疫是一种由跳蚤传播、主要侵袭小哺乳动物的细菌性感染.该病的地理分布很局限,偶尔,病原体鼠疫菌通过感染的跳蚤叮咬感染人类.人类鼠疫是一种严重疾病,败血症鼠疫和肺鼠疫.如果不早期治疗,肺鼠疫通常是致命疾病,人与人直接接触传染能引起恐惧的流行.为此,需要及时治疗鼠疫病例,同时积极进行公共卫生应急反应.     

2019年乌干达阻断输入性肺鼠疫传播的干预措施

鼠疫是一种急性人兽共患病，在全球几大洲都存在疫情，可表现为不同的临床形式。 肺鼠疫是高度致命的，可通过传染性飞沫在人与人之间直接传播。 从刚果民主共和国输入到乌干达一个具有高效公共卫生应对能力地区的肺鼠疫，经过当地的迅速应对，及时制止了鼠疫传播。 尽管存在多次高危暴露，但只发生一次传播事件。 在鼠疫地方性流行地区，成立专家组可以快速提供发现及有效应对的措施，减轻疫情传播和降低死亡率。建立跨境协议是有效提高应对能力的举措。     

马达加斯加鼠疫已致94人死亡,世界卫生组织声称正努力防止鼠疫传播

正2017年10月20日路透社Tom Miles:世界卫生组织(WHO)表示,马达加斯加鼠疫已导致94例患者死亡,该病并可能进一步传播。WHO非洲区域突发事件司长Ibrahima Soce Fall在日内瓦宣称,世卫组织正尽力防止鼠疫的流行。鼠疫是马达加斯加地区的流行病,但是自今年8月起疫情突然暴发,导致1 153例疑似病例。这次暴发时间比往年更早,疫情主要侵袭城市地区而非农村,并且主要引起肺鼠疫,这是最致命的     

海原县鼠疫流行因素分析

目的　探讨宁夏回族自治区海原县鼠疫流行特征，为今后鼠疫防治提供科学依据。方法　整理归纳历史上海原县人间鼠疫流行资料，对1963-2007年动物鼠疫调查与监测资料进行描述和分析。结果　海原县历史上发生过2次人间肺鼠疫流行，最近一次是1962年，病例分布在海原县的局部地区，病死率100%；数10年来动物鼠疫发生多次流行，检出鼠疫菌131株，鼠疫阳性血清309份，年度流行曲线呈单峰型。结论　接触疫源动物和肺鼠疫患者，不能及时正确处理是造成人间鼠疫流行的主要原因；控制鼠疫必须根据鼠疫流行因素，采取综合性防治措施。     

1例肺鼠疫患者的护理

鼠疫是由鼠疫杆菌引起的啮齿动物中自然疫源性疾病,在一定条件下通过疫鼠、疫蚤传染人,造成人间鼠.肺鼠疫是鼠疫最严重的一型,发病急、病情重、进展快、传染性强、病死率极高.2009年7月30日我院收住了1例肺鼠疫患者,2009年8月25日治愈出院,现报道如下. 病例介绍 患者,男,32岁,藏族,自述于2009年7月26日接触1例发热、胸痛、咳血的危重患者(该患者在当天送往兴海县医院途中病故,该死者生前4d与一病死的狗有密切接触史),于2009年7月28日出现发热、咳嗽、咳痰、全身肌肉酸痛等症状,在当地卫生院给予静脉注射头孢曲松钠及对症治疗2d,疗效不佳,症状进一步加重,出现胸痛加剧、呼吸急促、痰中带血、腹痛、腹泻稀水样便等症状,于2009年7月30日12:45来我院感染性疾病科就诊,经我院专家组会诊,结合流行病学,初步诊断为"疑似肺鼠疫",立即将患者转送到隔离病区进行临床医学观察,查体:体温39.7℃,脉搏120次/min,呼吸33次/min,血压90/55 mm Hg(1 mm Hg=0.133 kPa),神志清,精神差,呈急性痛苦病容,呼吸急促,口唇及甲床轻度发绀,全身表浅淋巴结无肿大,结膜无充血及水肿,完善相关实验室检查,于2009年8月2日细菌学检查:痰检鼠疫杆菌阳性,血清鼠疫杆菌抗体阳性,结合患者流行病学、症状、体征及上述实验室检查,明确诊断为:肺鼠疫,给予抗感染、抗休克、支持及对症治疗.     

医学之“最”

△疾病之“最”感冒是世界上最常见的传染病。世界上传染性最强的疾病是肺型鼠疫,传染性最弱的是麻风病。世界上最先消灭的传染病是天花。世界上最为罕见的疾病是库鲁病(Kuyu)或称笑病。这个病只在新几内亚东部的一个部族里发生过,其死亡率为百分之百。     

鼠疫菌基因组“默认编码序列”数据库的建立与初步研究

目的对8株鼠疫耶尔森菌全基因组间编码序列进行比对,寻找鼠疫菌中最普遍存在的编码序列,建立"默认编码序列"数据库。方法应用Blast软件、Perl编程及Excel软件等,对8株已测序全基因组编码序列进行比对和统计。结果建立了"默认编码序列"数据库,共有4271个编码序列。其中8株鼠疫菌核苷酸(氨基酸)完全一致的编码序列为1176个;对应的编码序列只存在1种"默认编码序列"的是2465个;存在2种"默认编码序列"的是630个。结论 "默认编码序列"数据库是鼠疫菌中最普遍存在的编码序列集合,为进一步深入研究鼠疫菌的遗传特征提供了可靠信息。     

2005-2017年云南省玉龙鼠疫自然疫源地鼠疫流行病学分析

目的分析2005 — 2017年云南省丽江市玉龙野鼠鼠疫自然疫源地鼠疫流行态势，为制定该疫源地鼠疫防制对策提供依据。方法采用描述流行病学方法，对2005 — 2017年玉龙县及古城区动物及人间鼠疫的三间分布和流行状况进行分析。结果玉龙鼠疫自然疫源地动物鼠疫流行异常活跃，主要地区分布在玉龙县黄山镇南溪村委会鹿子村及古城区七河镇后山村委会木梳村，流行季节及高峰期主要为4 — 5月。 13年间发生鼠疫疫情8年次13个疫点。 其中，2005年 发生人间鼠疫1起，确诊肺鼠疫病例5例，死亡2例，其他年次均为动物间鼠疫。结论玉龙鼠疫自然疫源地自证实以来动物间鼠疫始终处于活跃状态，疫情连续不断。 应加强疫情监测，及时处置动物间疫情，严防波及人间。     

全球麻风病(1999年9月)

鼠疫是最早被人类识别的一种疾病 ,现在仍是热带、亚热带及温带国家的较热地区许多自然疫源地的地方病。鼠疫实际上是野生啮齿动物的疾病 ,经体外寄生物蚤传播 ,并可由感染蚤的叮咬或接触感染宿主而传染到人。最近的暴发表明 ,在一些长期不受传播影响的地区 ,可重新发生鼠疫。该病如不治疗 ,死亡率很高 ,尤其是肺鼠疫 ;如迅速确诊并及时用链霉素、四环素等抗菌素治疗 ,可有效地控制 ;死亡率可从 6 0 %下降到 15%以下。然而 ,最近在马达加斯加分离到的一株鼠疫耶尔森菌 (Ｙｅｒｓｉｎｉａｐｅｓｔｉｓ) ,表现出了对抗菌素的多重抗药性 ,这是…     

Yersinia pestis: still a plague in the 21st century.

Yersinia pestis, the causative agent of plague, is an aerobic, non-motile, gram-negative bacillus belonging to the family Enterobacteriacea. It is a zoonotic infection transmitted to humans via the bite of a flea. Three clinical forms of human plague exist: bubonic, pneumonic, and septicemic. Many important virulence factors associated with this organism are responsible for its extreme pathogenicity and high mortality rates. The bubonic form of plague is usually not transmitted human to human but the pneumonic form is--through inhalation of contaminated aerosol droplets. The pneumonic plague would be the form most likely implicated in the event of an intentional attack. Inhalation of aerosols can cause devastating consequences resulting in many casualties. Unless antibiotics are administered within 24 hours of the initial symptoms, death is inevitable. Its potential for use as a biological weapon is of major concern to public health officials.     

Cethromycin-mediated protection against the plague pathogen Yersinia pestis in a rat model of infection and comparison with levofloxacin

The Gram-negative plague bacterium, Yersinia pestis, has historically been regarded as one of the deadliest pathogens known to mankind, having caused three major pandemics. After being transmitted by the bite of an infected flea arthropod vector, Y. pestis can cause three forms of human plague: bubonic, septicemic, and pneumonic, with the latter two having very high mortality rates. With increased threats of bioterrorism, it is likely that a multidrug-resistant Y. pestis strain would be employed, and, as such, conventional antibiotics typically used to treat Y. pestis (e.g., streptomycin, tetracycline, and gentamicin) would be ineffective. In this study, cethromycin (a ketolide antibiotic which inhibits bacterial protein synthesis and is currently in clinical trials for respiratory tract infections) was evaluated for antiplague activity in a rat model of pneumonic infection and compared with levofloxacin, which operates via inhibition of bacterial topoisomerase and DNA gyrase. Following a respiratory challenge of 24 to 30 times the 50% lethal dose of the highly virulent Y. pestis CO92 strain, 70 mg of cethromycin per kg of body weight (orally administered twice daily 24 h postinfection for a period of 7 days) provided complete protection to animals against mortality without any toxic effects. Further, no detectable plague bacilli were cultured from infected animals' blood and spleens following cethromycin treatment. The antibiotic was most effective when administered to rats 24 h postinfection, as the animals succumbed to infection if treatment was further delayed. All cethromycin-treated survivors tolerated 2 subsequent exposures to even higher lethal Y. pestis doses without further antibiotic treatment, which was related, in part, to the development of specific antibodies to the capsular and low-calcium-response V antigens of Y. pestis. These data demonstrate that cethromycin is a potent antiplague drug that can be used to treat pneumonic plague.     

Antibiotic Treatment of Experimental Pneumonic Plague in Mice

A mouse model was developed to evaluate the efficacy of antibiotic treatment of pneumonic plague; streptomycin was compared to antibiotics with which there is little or no clinical experience. Infection was induced by inhalation of aerosolized Yersinia pestis organisms. Antibiotics were administered by intraperitoneal injection every 6 hours for 5 days, at doses that produced levels of drug in serum comparable to those observed in humans treated for other serious infections. These studies compared in vitro to in vivo activity and evaluated the efficacy of antibiotics started at different times after exposure. Early treatment (started 24 h after challenge, when 0 of 10 mice tested had positive blood cultures) with netilmicin, ciprofloxacin, ofloxacin, ceftriaxone, ceftazidime, aztreonam, ampicillin, and rifampin (but not cefazolin, cefotetan, or ceftizoxime) demonstrated efficacy comparable to streptomycin. Late treatment (started 42 h after exposure, when five of five mice tested had positive blood cultures) with netilmicin, ciprofloxacin, ofloxacin, and a high dose (20 mg/kg of body weight every 6 h) of gentamicin produced survival rates comparable to that with streptomycin, while all of the beta-lactam antibiotics (cefazolin, cefotetan, ceftriaxone, ceftazidime, aztreonam, and ampicillin) and rifampin were significantly inferior to streptomycin. In fact, all groups of mice treated late with beta-lactam antibiotics experienced accelerated mortality rates compared to normal-saline-treated control mice. These studies indicate that netilmicin, gentamicin, ciprofloxacin, and ofloxacin may be alternatives for the treatment of pneumonic plague in humans. However, the beta-lactam antibiotics are not recommended, based upon poor efficacy in this mouse model of pneumonic plague, particularly when pneumonic plague may be associated with bacteremia.     

Yersinia pestis (plague) vaccines

Live attenuated and killed whole cell vaccines against disease caused by Yersinia pestis have been available since the early part of the last century. Although these vaccines indicate the feasibility of protecting against disease, they have a number of shortcomings. The live attenuated vaccine is highly reactogenic and is not licensed for use in humans. The killed whole cell vaccine, also reactogenic, provides poor protection against pneumonic plague and immunisation requires multiple doses of the vaccine. Against this background, a range of candidate vaccines, including rationally attenuated mutants, subunit vaccines and naked DNA vaccines have been described. Of these, an injected subunit vaccine is likely to offer the best near-term solution to the provision of a vaccine that protects against both bubonic and pneumonic plague.     

Generation of protective immune responses to plague by mucosal administration of microsphere coencapsulated recombinant subunits.

We have investigated noninvasive immunization to plague. Recombinant subunit antigens, F1 and V from Yersinia pestis, were coencapsulated in biodegradable poly(L100 LD(50's) inhalational challenge with virulent Y. pestis. These data expand on previous findings from our laboratories, providing further insight into the mechanics of safeguarding mice from plague through nasal immunization. Further, these results demonstrate that in a murine model, solid protection from pneumonic plague can be engendered by two intranasal administrations of appropriately formulated recombinant proteins.     

Clinical and pathologic differential diagnosis of selected potential bioterrorism agents of interest to pediatric health care providers

The early recognition of potential bioterrorism agents has been of increasing concern in recent years. The Centers for Disease Control and Prevention has categorized and listed biological terrorism agents. Although any or all of the highest risk biological agents (including inhalation anthrax, pneumonic plague, smallpox, tularemia, botulism, and viral hemorrhagic fevers) can be seen in the pediatric patient, several agents might closely resemble--at least in their initial stages-some of the more common childhood illnesses. The awareness of these similarities and, more importantly,their differences, are critical for all health care professionals. Selected examples of some typical childhood illnesses are presented and then compared with three of the most virulent biological agents (smallpox, anthrax and plague) that might be used in a bioterrorism attack.     

震惊世界的苏拉特鼠疫流行及其教训

苏拉特的鼠疫流行导致了一场名副其实的鼠疫恐慌，对印度的经济和她的国际形象带来了严重的损害。究其根源，这场悲剧来自一种理论上的错误导向，它使印度在鼠疫监测和控制方面出现了重大的决策失误，导致印度的政府和卫生当局疏于对鼠疫的防范工作。也造成了在鼠疫袭来时，对鼠疫病人的诊断及隔离措施失当和人民群众的惊慌失措。苏拉特事件表明，印度在鼠疫控制方面还面临着巨大的任务。这次事件对我国的疾病防制工作也不无教益，我国需要在疾病控制的组织，投入，队伍建设和研究方面做出重大努力，才能避免苏拉特事件一类的悲剧在我国重演。