Human Monocytic Ehrlichiosis,Mexico City,Mexico

Little information is available about human infections by the members of the genus Ehrlichia in Mexico. Only 2 species, Ehrlichia canis and E. chaffensis, are known to cause disease in this country. We report a fatal case of human monocytic ehrlichiosis in Mexico City in a man who was homeless.     

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.     

Myocarditis after Trimethoprim/Sulfamethoxazole Treatment for Ehrlichiosis

The manifestations of human monocytic ehrlichiosis range from a mild febrile syndrome to a severe multisystem illness. Myocardial involvement is uncommon. We report a woman, 78 years of age, who was treated with trimethoprim/sulfamethoxazole after a tick bite, in whom myocarditis was subsequently diagnosed. She recovered completely after doxycycline therapy.     

人类埃立克体病综述

目前发现3种埃立克体可致人类埃立克体病,本文就人类埃立克体病的病原体生物学特征及其所致疾病作一个综述。     

Serological investigation of vector-borne disease in dogs from rural areas of China

Objective

To evaluate the Anaplasma phagocytophilum (A. phagocytophilum), Ehrlichia canis (E. canis), Dirofilaria immitis (D. immitis) (canine heartworm), Borrelia burgdorferi (B. burgdorferi) infections in countryside dogs from Yunnan, Hainan and Anhui provinces.

Methods

Serum samples were collected from 26 dogs in Yunnan, Hainan and Anhui provinces. The samples were tested using a commercial ELISA rapid diagnostic assay kit (SNAP^® 4Dx^®; IDEXX Laboratories, Inc. U.S.A.). Meanwhile, indirect immunofluorescence assay (IFA) recommended by WHO was conducted to detect IgG to A. phagocytophilum. Two methods were analyzed and compared.

Results

The number of serologically positive dogs for IgG to A. phagocytophilum was only 2 which was from Hainan province and none of the 26 dogs responded positive for E. canis, D. immitis (canine heartworm), and B. burgdorferi by ELISA rapid diagnostic method. The number of serologically positive dogs for IgG to A. phagocytophilum was 13 (50%) by IFA method. Data of the two methods were analyzed by statistical software and the difference was statistically significant (P=0.002).

Conclusions

It can be concluded that IFA method was more sensitive than ELISA rapid diagnostic method. However, we need conduct further and intensive epidemiology survey on tick-born diseases pathogens including A. phagocytophilum, E. canis, D. immitis (canine heartworm), and B. burgdorferi which have public health significance.     

湖北省随州市蜱携带埃立克体的核酸检测

埃立克体是一类严格细胞内寄生的革兰阴性菌,属无形体科(richettsiaceae),埃立克体属[1].主要寄生在单核细胞、巨噬细胞内,引起人或动物感染埃立克体病[2],蜱是其传播媒介[1].     

逆概率权重法在诊断试验评价证实偏倚中的应用

如何估计和校正筛查或诊断试验中存在的证实偏倚，文中通过宫颈癌筛查实例，采用逆概率权重法R软件CompareTesl：s校诈其灵敏度和特异度，利用随机抽样方法生成新数据，将逆概率权重法计算的灵敏度和特异度，与传统计算方法以及最大似然估计方法计算得到的灵敏度和特异度进行比较。结果表明HPV自检法的真实灵敏度和特异度分别为83.53%(95%CI：74.23～89.93)和85.86%(95%C1：84.23～87.36)。随机抽样结果显示，传统方法计算的灵敏度和特异度分别为90.48%(95%C1：80.74-95.56)和71.96%(95%C1：68.71～75.00)，采用逆概率权重法校正后的灵敏度和特异度分别为82，25%(95%CI：63。11-92.62)和85。80%(95%C1：85。09～86.47)；采用最大似然估计法校正后的灵敏度和特异度分别为80.13%(95%CI：66.81.93.46)和85.80%(95%CI：84.20～87.41)。表明在复杂抽样情况下，逆概率权重法能够有效校正存在证实偏倚的灵敏度和特异度。     

Borrelia,Ehrlichia, and Rickettsia spp. in Ticks Removed from Persons,Texas, USA

Data regarding the type, frequency, and distribution of tick-borne pathogens and bacterial agents are not widely available for many tick species that parasitize persons in the southern United States. We therefore analyzed the frequency and identity of pathogens and bacterial agents in ticks removed from humans and subsequently submitted to the Texas Department of State Health Services, Zoonosis Control Program, from October 1, 2004, through September 30, 2008. The data showed associations of bacterial agents and potential vectors. Tick-related illnesses may pose unidentified health risks in areas such as Texas, where incidence of human disease related to tick bites is low but well above zero and where ticks are not routinely suspected as the cause of disease. Cause, treatment, and prevention strategies can be better addressed through collecting sufficient data to establish baseline assessments of risk.     

内蒙古大兴安岭林区人埃立克体病自然疫源地的调查

目的人粒细胞埃立克体病和人单核细胞埃立克体病都是近10年来发现的2种经蜱传播的自然疫源性疾病。这2种病的公共卫生学意义已受到了许多国家的关注。由于病原体是专性细胞内寄生菌,直接培养和纯化较为困难。我们根据这2种埃立克体的16S rRNA基因序列,构建了一系列PCR引物对,对采自我国大兴安岭等北方地区的蜱、动物脏器和人血标本进行PCR扩增,并对扩增出的产物进行DNA序列分析,以期查清有可疑蜱媒地区是否存在埃立克体感染,并通过这次调查为今后进一步开展系统研究提供参考。方法与结果本研究采用半巢式PCR检测蜱标本2种埃立克体的带菌率。结果首次从内蒙古大兴安岭采集的全沟硬蜱和森林革蜱,新疆精河采集的全沟硬蜱和草原革蜱中扩增出390bp的特异和人单核细胞埃立克体16S rRNA基因片段;同时检测的大兴安岭的嗜群血蜱和北京灵山采集的长角血蜱均未扩增出相应的片段。大兴安岭莫尔道嘎林业局采集的全沟硬蜱携带此基因的阳性率为39.06％(25/64),森林革蜱为 10.00％(7/70),2种蜱的带菌率有显著差异(x~2=15.53,P<0.01)。新疆精河采集的蜱携带EC率也是全沟硬蜱(11组/190,最小阳性率为5.79％)高于森林革蜱(1组/60,最小阳性率为1.67％),但差别不显著(x~2=1.30,P>0.25)。还从大兴安岭林区捕捉的一只大林姬鼠的脏器中检测到这一16S rRNA基因片段。对一只从莫尔道嘎采集的全沟硬蜱蜱标本进行近1500bp的人单核细胞埃立克体 16S rRNA全基因扩增与序列分析,结果扩增出的序列与美国一株人单核细胞埃立克体(GenBank注册号U23503)的相应序列完全相同。同样应用半巢式PCR和序列分析技术,从蜱标本中扩增出441bp的特异的人粒细胞埃立克体16SrRNA基因片段。内蒙古大兴安岭莫尔道嘎采集的全沟硬蜱和森林革蜱人粒细胞埃立克体的阳性率分别是 6.25%(4/64)和 2.86%(2/70);内蒙古大兴安岭乌尔旗汗采集的全沟硬蜱和嗜群血蜱的阳性率分别为3.81％(最小阳性率,8组/210)和2%(1/50);新疆精河采集的全沟硬蜱和草原革蜱最小阳性率分别为3.16％(6组/190)和1.67%(1组/60)。这是首次在亚洲从蜱标本中检测到人粒细胞埃立克体。同时检测的北京灵山采集的长角血蜱未扩增出相应的片段。对一只从莫尔道嘎采集的全沟硬蜱标本进行近1500bp的人粒细胞埃立克体 16S rRNA全基因分析,结果扩增出的序列与美国一株人粒细胞埃立克体(GenBank注册号U02125)的相应序列完全相同,一个碱基不差。另外还从内蒙古大兴安岭采集的森林工人血标本中扩增出特异的EC和人粒细胞埃立克体16SrRNA基因片段。这是首次在亚洲从人血中扩增出人埃立克体DNA。对一份人血标本进行近1500bp的人粒细胞埃立克体 16S rRNA全基因分析,结果仅在第81位与美国这株人粒细胞埃立克体差一个碱基,相差的位置正好位于高变区。结论根据检测结果,本研究建立的系列半巢式PCR扩增方法可以快速、灵敏地检测蜱、脏器、血等标本中的EC和人粒细胞埃立克体,并能较快地分析出其16S rRNA全基因。据报道,莱姆病的流行区往往也是人埃立克体病的流行区。为此我们在大兴安岭林区进行了人埃立克体病和莱姆病的流行病学调查。血样检测发现了人粒细胞埃立克体和 EC 16S rRNA基因阳性的病例共6名,病例均有近期蜱咬史,有埃立克体病的临床表现,潜伏期也相符;血清抗体检测发现检测人群中有HGE阳性抗体。2种病例的发现均为亚洲之首次。通过莱姆病螺旋体感染流行因素的单因素和多因素Logistic回归分析,发现在调查的流行因素中,职业和蜱咬史是影响该疫区人群感染莱姆病螺旋体的主要危险因素。这一调查结果也为该地区人埃立克体病和其他蜱传病的防治提供了参考。     

山东省首例实验室诊断人单核细胞埃立克体病调查

目的 报告山东省首例人单核细胞埃立克体病的发现、诊治经过及其实验室检测.方法 对该疑似病例开展流行病学调查并填写个案调查表,采集其血标本,套式-PCR技术检测血液中嗜吞噬细胞无形体和查菲埃立克体特异性16S rRNA基因.结果 患者为不明原因发热,伴WBC和PLT减少.嗜吞噬细胞无形体特异性核酸检测阴性,查菲埃立克体特异性核酸检测阳性.PCR扩增阳性产物进行测序并与GenBank中注册的已知序列进行比较分析,显示与查菲埃立克体的同源性＞99％.结论 山东省存在查菲埃立克体感染病例,进一步开展自然疫源地调查十分必要.