新型布尼亚病毒感染的流行病学及诊治进展

近年来,中国部分地区相继发现并报道了以发热伴血小板减少为主要表现的感染性疾病病例,其中少数重症患者因多器官功能损害,救治无效死亡。部分病例为人粒细胞无形体病,但大多数病例不能检测到人粒细胞无形体的核酸和特异性抗体。     

发热伴血小板减少综合征应急监测及控制

发热伴血小板减少综合征原称人粒细胞无形体病,是一种新发传染性疾病,以高热同时伴外周血白细胞、血小板减少为主要临床表现。2006年中国报道了第一例人粒细胞无形体感染确诊病例,此后我国部分地区陆续出现人粒细胞无形体病疫情。我省咸宁、随州、黄冈、     

一起人粒细胞无形体和查菲埃立克体符合感染病例的确认和调查

2010年9月上旬,山东省疾病预防控制中心对4例可疑人粒细胞无形体病进行病原学实验室诊断和流行病学调查发现,该4例病例为山东省2010年疫情网络直报的首起嗜吞噬细胞无形体和查菲埃立克体符合感染病例,并经实验室检测确诊,符合卫生部下发的《人粒细胞无形体病预防控制技术指南(试行)》中的病例诊断标准。     

山东省沂源县人粒细胞无形体病现场流行病学调查

目的分析山东省沂源县人粒细胞无形体病发生的危险因素及感染途径。方法对2002-2006年报告的34例可疑人粒细胞无形体病病例进行个案调查,并进行描述性分析,对部分病例进行实验室检测。选择年龄相近、未患过人粒细胞无形体病、同性别、同村居民为对照组,进行1∶2配比的病例对照研究。结果通过单因素分析和非条件logistic回归分析:是否经常从事林间劳动（IOR/I=4.4901,95%ICI/I: 1.4348～14.0518,IP/I0.05）、每日平均劳动时间是否超过1 h （IOR/I=4.0408,95%ICI/I: 1.3083～12.4806,IP/I0.05）、居住院内是否有牲畜圈（IOR/I=3.3707,95%ICI/I: 1.2883～8.8191,IP/I0.05）为沂源县感染人粒细胞无形体病的暴露危险因素。结论根据病例临床资料、现场流行病学调查以及病例对照研究,与牲畜（尤其是羊）接触、林间劳动、接触草地等危险因素为该疾病可能的感染途径。对于人粒细胞无形体病有待于进行更加深入的调查和实验室研究。     

中国无形体人与人传播院内感染事件引发的公共卫生思考

2008年美国医学会著名杂志JAMA第300期第19卷发表了由中国疾病预防控制中心（CDC）传染病预防控制所等国内外7家专业机构共同发表的研究论文，题目为“中国人粒细胞无形体院内传播感染”。这是世界范围内首次报告的人粒细胞无形体病发生在人与人之间相互传播的事件，也是中国第一次报道的人粒细胞无形体感染确诊病例。同期，     

疑似人粒细胞无形体病12例分析

目的研究人粒细胞无形体病疑似病例的流行病学和临床特点。方法回顾性分析12例人粒细胞无形体病疑似病例的临床资料。结果本组人粒细胞无形体病疑似病例流行地区位于胶东半岛地区,病人均为农民,年龄中位数为57岁,其中2例在起病前1周有明确蜱咬史。常见症状包括发热、腹泻、恶心等,并发症有出血、中毒性脑病、急性肾衰竭等,常见实验室检查指标异常有白细胞、血小板减少,转氨酶升高,尿蛋白、尿潜血,9例行人粒细胞无形体套式PCR检测均为阴性。经过抗生素和对症支持治疗痊愈11例,死亡1例。结论人粒细胞无形体病是一种蜱传急性自然疫源性疾病,可累及多脏器,高龄及有并发症病人易发生严重并发症,预后较差。     

人粒细胞无形体病45例临床分析

目的分析人粒细胞无形体病的流行病学及临床特点。方法对45例人粒细胞无形体病患者进行流行病学调查和实验室检测,对临床表现进行记录分析。确诊患者应用多西环素联合喹诺酮类或头孢类抗生素进行治疗,并根据临床情况进行针对性治疗。结果24例患者经治疗临床痊愈出院;4例分别并发肺部曲霉菌、克雷白杆菌感染、大叶性肺炎,2例并发病毒感染,经积极抗感染等治疗后,临床痊愈出院;3例患者由于经济原因要求转当地治疗,后随访临床痊愈;2例并发肺部曲霉菌、结核杆菌双重感染,治疗症状明显改善,经随访现已治愈;2例合并多器官功能衰竭死亡;8例患者家属放弃治疗,后均死亡。结论人粒细胞无形体病是一类新发的传染疾病,可有多方面临床表现,易被误诊。但早就诊,早治疗,加强防护措施,可以得到有效控制。     

河北省首次实验室确诊恙虫病东方体Kawasaki感染病例

目的 对2017年7月13日恙虫病疑似病例进行实验室检测和分析,了解河北省恙虫病基因型的流行情况。 方法 对疑似病例进行流行病学调查,详细询问其病史情况;采集入院时的急性期血清以及2周后的恢复期血清,使用间接免疫荧光法检测血清中的IgG抗体滴度,进行血清抗体滴度分析;提取血液总DNA,采用PCR方法进行基因型鉴定,运用最大似然法构建系统进化树,确定该恙虫病东方体基因型。 结果 病例血清中汉坦病毒、新型布尼亚病毒、登革热病毒、伤寒和副伤寒杆菌、无形体、埃立克体以及立克次体抗体均为阴性;急性期血清中抗恙虫病东方体IgG滴度为1∶64,恢复期血清中的滴度为1∶256; PCR扩增获得目的片段测序比对结果显示与恙虫病东方体Kawasaki型序列相似度最高,达到99%;该毒株与已知恙虫病东方体Kawasaki具有最近亲缘关系。 结论 河北省首次实验室确诊存在恙虫病东方体Kawasaki基因型。      

人粒细胞无形体病病人的护理

[目的]探讨人粒细胞无形体病的疾病特点与防治措施.[方法]对20例疑似人粒细胞无形体病病人进行调查,包括发病时间、地点、病情特点、治疗方法、护理与消毒隔离方法、疾病预后等.[结果]治愈12例(60%),好转3例(15%),死亡5例(25%).[结论]人粒细胞无形体病可防可治,加强对病人隔离管理及早期治疗,大多数病人症状可以很快改善并治愈.     

人粒细胞无形体病16例临床护理

人粒细胞无形体病是一种由蜱传播而引起的发热性疾病.人被蜱叮咬或与携带有蜱的狗、猫接触而被感染.发病季节以4～10月份居多.2008年8月～2009年8月,我院共收治确诊或疑似人粒细胞无形体病患者16例,经精心护理,效果满意.     

Laboratory tests in the diagnosis of feral herd infections

Immunological laboratory tests play an important role in establishing the depth of extent of this or that infectious disease. Scheduled immunological monitoring (serological screening) is made to find out whether there are antibodies (Abs) against the causative agents of individual feral herd infections. The immunological examination is aimed at detecting Abs against the pathogens of infectious diseases of bacterial (Ixodes tick-borne borrelioses, tularemia, leptospiroses, human granulocytic anaplasmosis), viral (hemorrhagic fever with renal syndrome, tick-borne viral encephalitis, West Nile fever), and rickettsial (Q-fever) etiologies. The performed serological screening could yield data on the practically widespread of hemorrhagic fever with renal syndrome in the Ulyanovsk Region and show high rates of Abs to Ixodes tick-borne borrelioses (5.75), coxiellosis (3.7%), and human granulocytic anaplasmosis (4.3%).     

Molecular diagnosis of human granulocytic anaplasmosis

Human granulocytic anaplasmosis, formerly known as human granulocytic ehrlichiosis, is caused by the microorganism Anaplasma phagocytophilum that is transmitted by Ixodes tick bites. The disease state ranges from subclinical to fatal but may be difficult to differentiate from other febrile conditions without specific tests. Rapid and early diagnosis is important since the infection may be fatal and specific antibiotic therapy is required. The bacterium is an obligate intracellular pathogen of neutrophils. Thus, early diagnosis is best achieved by amplification of nucleic acids from the blood. An increasing number of potential gene targets for diagnostic assays have been described and the incipient release of an Anaplasma phagocytophilum genome sequence will not only help to better understand the disease but may facilitate improvements in diagnostic strategies.     

Rare case of severe rhabdomyolysis secondary to human granulocytic anaplasmosis

Anaplasma phagocytophilum (AP) is the causative agent of human granulocytic anaplasmosis (HGA), a tick-borne illness with highest incidence in north-eastern regions of the United States. This condition presents with vague constitutional symptoms and has been associated with laboratory derangements such as leukopenia, thrombocytopenia and transaminitis1. Rhabdomyolysis, however, is not one of these associations. We report a case of confirmed HGA associated with severe rhabdomyolysis, where no other cause was identified. The etiology of rhabdomyolysis secondary to AP infection is still unknown. A presumptive diagnosis of HGA can be made in the presence of fever, non-specific symptoms such as myalgias, laboratory derangements such as leukopenia and thrombocytopenia in an individual residing in an endemic area3. Serological confirmation should not delay treatment, given the rapid progression of this dangerous infection. Rhabdomyolysis should also be considered as part of supporting data in the diagnostic consideration for HGA.     

Thrombotic thrombocytopenic purpura and its look-alikes: A single institution experience

At presentation, variant or “look-alike” conditions can resemble TTP. We reviewed charts of 26 consecutive patients treated for presumed TTP. Of 15 classic TTP patients, 11 were tested for ADAMTS13; all showed severe deficiency, and inhibitor levels correlated with probability of relapse. The variant TMA group consisted of 8 patients who had active clinical disorders which overlapped with TTP. Variant TMA patients had higher creatinine and worse prognosis than classic TTP patients. “Look-alike” disorders included ITP with intravascular hemolysis following administration of WinRho™, and human granulocytic anaplasmosis. These conditions had not been previously described as TTP look-alikes.     

Tick-borne encephalitis in children: an update on epidemiology and diagnosis

Tick-borne encephalitis is an infection of the CNS caused by a tick-borne encephalitis virus transmitted by ticks. It is more common in adults than in children. During the last 30 years, the incidence of the disease increased continuously in almost all endemic European countries except Austria. Many factors are responsible for the increased incidence. However, in Austria, the incidence of tick-borne encephalitis decreased dramatically since the introduction of a well-organized vaccination campaign against tick-borne encephalitis. The diagnosis of tick-borne encephalitis is based on clinical criteria and laboratory confirmation of infection. Other tick-borne diseases, such as Lyme borreliosis and human granulocytic anaplasmosis, should be considered in children with tick-borne encephalitis since endemic areas for all three diseases overlap.     

Human granulocytic anaplasmosis in eastern France: clinical presentation and laboratory diagnosis

Human granulocytic anaplasmosis (HGA) is a tick-borne infection characterised by an acute, nonspecific febrile illness. To date, few clinical cases have been supported by both a positive polymerase chain reaction (PCR) assay and subsequent seroconversion against Anaplasma phagocytophilum antigen all over Europe. We report here 3 consecutive cases of HGA that occurred during the summer of 2009 which fulfilled the epidemiologic, clinical, and biological criteria for HGA. These data highlight PCR assay on ethylenediaminetetraacetic acid blood rather than serology as the diagnostic test of choice during the acute phase of the disease. In endemic areas, HGA should be investigated in patients presenting an undifferentiated febrile illness with cytopenia, elevated rates of liver enzymes, and increased C-reactive protein values.     

Current management of human granulocytic anaplasmosis,human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis

Anaplasma phagocytophilum, Ehrlichia chaffeensis and Ehrlichia ewingii are emerging tick-borne pathogens and are the causative agents of human granulocytic anaplasmosis, human monocytic ehrlichiosis and E. ewingii ehrlichiosis, respectively. Collectively, these are referred to as human ehrlichioses. These obligate intracellular bacterial pathogens of the family Anaplasmataceae are transmitted by Ixodes spp. or Amblyomma americanum ticks and infect peripherally circulating leukocytes to cause infections that range in clinical spectra from asymptomatic seroconversion to mild, severe or, in rare instances, fatal disease. This review describes: the ecology of each pathogen; the epidemiology, clinical signs and symptoms of the human diseases that each causes; the choice methods for diagnosing and treating human ehrlichioses; recommendations for patient management; and is concluded with suggestions for potential future research.