BACTERIAL INFECTION IN SCHISTOSOMIASIS CIRRHOSIS

为探讨血吸虫病肝硬化细菌感染的流行程度，我们回顾性地研究了１１１９例血吸虫病肝硬化患者（其中包括４００例血吸虫病肝硬化肝癌患者）的各种细菌感染的发生率。肝硬化病人的细菌感染率为１５．４％，与肝硬化肝癌病人的细菌感染率１５．３％相近，当肝硬化程度按Ｃｈｉｌｄ－Ｐｕｇｈ分级时，肝硬化病人Ａ级感染率为２．３％，Ｂ级为８．０％，Ｃ级为２６．４％；肝硬化肝癌病人Ａ级感染率为３．３％，Ｂ级为１１．１％，Ｃ级为３１．２％。随着肝硬化程度的增加，细菌感染率越高，严重的细菌感染发生在Ｂ级和Ｃ级患者，血吸虫病肝硬化病人的细菌感染率主要与肝硬化有关，与肝癌关系不大。     

我国丙型和戊型肝炎人群流行病学调查及流行因素的研究

为阐明丙型和戊型肝炎在我国的流行严重度和流行规律，采用描述流行病学、血清流行病学和分子流行病学相结合的研究方法，对两型肝炎的流行特征和流行因素进行了研究。结果发现；一般人群调查近９万人丙型肝炎和戊型肝炎的流行率各为２．２％和９．７％，散 生病毒性肝炎感染比率各为２．１５％和１６．４％。丙型肝炎在我国主要经血传播，与血液接触密切人群中ＨＣＶ感染率高达５０－７０％，慢性化比比例高达４０－６０％，目前供     

天祝藏族自治县包虫病流行病学调查报告

１９９０年１０月～１１月，在天祝藏族自治县的三个乡进行了包虫病的血清流行病学调查，共查１９３７人，阳性者６１人，感染率为３．１５％，带包囊者３５人，患病率为１．８１％。土族感染率最高，为５．６％。１０岁以下儿童感染率为０．９５％，随年龄增长，感染率逐渐升高，４１～５０岁最高，达１０．７９％，患病率为７．１９％。调查中发现２例病人，三项化检验查均为阴性，占５．７１％。     

湖南省华支睾吸虫病流行病学的调查

本文报道湖南省从１９７１年至１９９０年开展华支睾吸虫病调查的现状。经证实有涟源等２０个县（市）流行。据永兴等９个县资料分析，共粪检４０５６９人，其感染率为７．５％，感染率范围为２．１％—８５．２％。感染者中年龄最小２岁，最大７５岁；其中１５岁以下儿童和１５岁以上人群的华支睾吸虫感染率分别为１９．８％（１４８／７４９）和３．５％（３２／９２３），两者间差别具有显著意义（χ２＝１１４．２５２５，Ｐ＜０．０１）。男性感染率（１２．９％）高于女性（８．８％），两者间差别具有显著意义（χ２＝７．４７２５，Ｐ＜０．０５）。本省华支睾吸虫第一中间宿主以纹沼螺为主；第二中间宿主以小型淡水鱼类为主，如麦穗鱼、中华鱼，武冈等８县麦穗鱼感染率高达５４．４％。感染方式以食烤鱼、火焙鱼为主。保虫宿主有犬、鼠等。     

四川省黑热病病人死因分析

四川省黑热病病人死因分析吴远祥，李国茹，高斌，陈玉芳，廖昌义（四川省医学科学院寄生虫防治研究所，成都６１００４１）四川省黑热病流行于两北山区，属人、犬共患型黑热病，犬感染率高达３６．８％〔１〕。病人分散，流入区内患者以儿童为主，７岁以下儿童病人占总病...     

四川省黑热病流行因素的探讨

通过对黑热病流行动态分析，提示在山丘地区黑热病流行因素复杂，犬利什曼病是主要传染源。当犬利什曼病发病较低时，不一定引起人类发病，即使发病也是散在的。犬利什曼病感染率升高时，病人可随之上升，局部爆发流行。白蛉的密度与黑热病关系密切。白蛉的孳生繁殖受海拔高度的制约，海拔１２００米以下和２３００米以上，即使有白蛉，密度很低，也无病人。外来人员发病率较高。     

甘肃省民乐县包虫病流行现状调查分析

目的了解甘肃省民乐县现阶段包虫病的流行和危害程度。方法人群包虫病B超检查、采集儿童血清检测棘球蚴抗体、采集犬粪检测棘球蚴抗原和牲畜剖检。结果人群患病率为0.75%,儿童抗体阳性率2.99%,犬粪抗原阳性率9.22%,牲畜感染率8.00%。结论传染源的持续存在是包虫病发病的根源,手术病人复发率高,药物治疗不规范是包虫病难以根治的主要原因。控制传染源,及时规范地治疗病人是遏制包虫病的有效措施。     

食管静脉曲张密集结扎术和硬化及结扎联合术的疗效对照观察

比较内镜下食管静脉曲张密集结扎术和内镜下硬化及结扎联合术治疗食管静脉曲张破裂出血的疗效。４２例食管静脉曲张破裂出血病情稳定的病人分为两组，２２例患者接受ＤＥＶＬ，２０例病人行ＥＳ＋ＥＶＬ，两组具有可比性（Ｐ＞０．０５）。第１次治疗，ＤＥＶＬ组每个病人平均结扎１１．３２个点，每根曲张静脉平均结扎２．８３个点；ＥＳ＋ＥＶＬ组首先静脉内注射硬化剂，然后行结扎，第１次治疗平均每根曲张静脉注射硬化剂１．０３次（点），结扎１．０１个点。结果：第１次治疗后，ＤＥＶＬ组食管静脉曲张消失率为５０％，ＥＳ＋ＥＶＬ组为３５％，两组比较无统计学意义（Ｐ＞０．０５）；第１、４、１２及２４周的再出血率，ＤＥＶＬ组为４．５％、４．５％、４．５％、４．５％，ＥＳ＋ＥＶＬ组为１０％、１５％、１５％、２５％，两组无显著差别（Ｐ＞０．０５）。ＤＥＶＬ和ＥＳ＋ＥＶＬ均为治疗食管静脉曲张破裂出血、根除食管静脉曲张的有效方法，ＤＥＶＬ的操作较容易、并发症较少、再出血率较低，内镜下食管静脉曲张密集结扎术将取代内镜下硬化剂注射疗法，成为治疗食管静脉曲张破裂出血的首选方法。     

血吸虫病肝硬化的细菌感染

为探讨血吸虫病肝硬化细菌感染的流行程度，我们回顾性地研究了１１１９例血吸虫病肝硬化患者（其中包括４００例血吸虫病肝硬化肝癌患者）的各种细菌感染的发生率。肝硬化病人的细菌感染率为１５．４％，与肝硬化肝癌病人的细菌感染率１５．３％相近，当肝硬化程度按Ｃｈｉｌｄ－Ｐｕｇｈ分级时，肝硬化病人Ａ级感染率为２．３％，Ｂ级为８．０％，Ｃ级为２６．４％，肝硬化肝癌病人Ａ级感染率为３．３％，Ｂ级为１１．１％，Ｃ级为     

汶川县黑热病流行与防治现状

目的 对汶川县30年黑热病的流行情况、防治工作及成效进行分析总结。方法统计黑热病疫情，确定疫点和疫区范围，开展相应的防治工作。结果1972～1986年这一阶段黑热病为散在发病，防治主要针对疫点灭犬灭蛉，保持了疫情的稳定。1987～1990年发病成倍上升，形成大范围的暴发流行，采取大规模的彻底灭犬和3～5年禁养家犬，有效控制了暴发流行，1997～2002年每年仅发病o～2例。发病率下降了98．33％。结论在犬源性黑热病流行区，病犬是主要的传染源，灭犬是控制黑热病流行的重要措施。     

Epidemiology and clinical manifestations of Leishmania donovani infection in two villages in an endemic area in eastern Sudan

We conducted a longitudinal study in an endemic area for visceral leishmaniasis (VL) in eastern Sudan to compare the epidemiology and clinical spectrum of Leishmania donovani infection in two populations differing in ethnic background and duration of residence in the area. The study took place in two villages from April 1994 to April 1996. In Um-Salala village, which is inhabited by members of the Masaleet tribe, half of the villagers had previous exposure to cutaneous leishmaniasis (Leishmaria major) before moving there. The population of the second village, Mushrau Koka, belong to the Hausa tribe and most were born there. The incidence of VL was 20.4/1000 person-years in 1994/1995 and increased sharply to 38.3/1000 person-years in 1995/1996 in Um-Salala. A rise in the incidence of VL was also observed in Mushrau Koka but with a lower incidence, 3.3/1000 person-years to 4.6/1000 person-years. The incidence rate of confirmed VL reflects only a limited part of the total infection rate which includes various forms of subclinical infection. The ratio of clinical to subclinical infection in Um-Salala was 1.2 : 1 in 1994/1995 compared with 2.6 : 1 in 1995/1996. This ratio was 1 : 11 in 1994/1995 and 1 : 2.5 in 1995/1996 in Mushrau Koka. In both villages the mean age of subclinical cases was higher, but in Mushrau Koka the mean age of subclinical cases also was higher than that of subclinical cases in Um-Salala. The leishmanin skin test (LST) was positive in 56% of individuals in Um-Salala and in 33% in Mushrau Koka. VL only occurred in leishmanin-negative individuals. Post kala-azar dermal leishmaniasis (PKDL) followed in 58% of confirmed VL patients in Um-Salala; the low incidence of VL for Mushrau Koka did not permit to estimate a PKDL rate. The clinical manifestations resulting from exposure to L. donovani range from subclinical infection to VL and PKDL. No firm conclusion as to the difference in incidence of VL between the two villages could be reached but differences in exposure to VL and cutaneous leishmaniasis (CL) as well as other factors such as ethnic background and differences in nutritional status may play a role.     

Serious underreporting of visceral leishmaniasis through passive case reporting in Bihar, India

OBJECTIVES: Visceral leishmaniasis (VL) is a major public health problem in Bihar, India. Unfortunately, accurate data on the incidence or prevalence of the disease are not available. This longitudinal study was undertaken to determine the incidence of VL in a Community Development Block area of the state of Bihar. Survey results were compared with official reports of the disease to assess the extent of underreporting by the Government health system. METHODS: Three health subcentre areas in Kanti Block, consisting of 14 villages with a total population of 26 444, were selected. Active surveillance was performed every month from January 2001 to December 2003 by house to house survey to detect cases of fever for more than 15 days. Patients clinically suspected of suffering from VL were subjected to parasitological examination for confirmation. Analysis of records of the reporting agencies in the district was undertaken to compare and assess the extent of underreporting. RESULTS: A total of 202 cases of VL were identified in 3 years giving an average annual incidence rate of 2.49/1000 population (95% CI = 2.15-2.83). As identification data of patients was not available with the official reporting agencies for 2001 and 2002, extent of underreporting could be assessed for 2003 only. In the study population, 65 cases of VL were detected during 2003 providing an annual incidence rate of 2.36/1000 population. Only eight (12.30%) cases were reported officially, resulting in underreporting by a factor of 8.13. In 2003, the official incidence rate of VL for Kanti Block was 0.31/1000 against the actual rate of 2.36/1000. As the constraints for official reporting at the block and the district levels are similar, the underreporting at district level was also assumed to be similar. This finding has significance in the preparation for elimination programme.     

Central role of interleukin-15 in human immunodeficiency virus (HIV)-infected patients with visceral leishmaniasis

To evaluate clinical and immunological parameters, interleukin (IL)-15 production and outcome of patients with visceral leishmaniasis (VL), including HIV positive patients, we analyzed 48 cases of VL. Clinical manifestations and response to therapy were similar in VL/HIV- and VL/HIV+ patients. However, relapses were more frequent in patients with HIV infection. Low levels of IL-15 concentrations were found in HIV+ patients without VL. These levels were comparable to concentrations obtained in healthy donors. We found a relationship between response to therapy and IL-15 levels. We found increased levels of IL-15 in VL/HIV- and VL/HIV+ patients with clinical and parasitological response to therapy. Our data demonstrate that VL in HIV-infected patients occurs in subjects with severe immunodeficiency and presents high rate of relapses. Low levels of IL-15 in illness patients and restored production in cured persons suggest that this cytokine could play a central role in immune responses during Leishmania/HIV co-infection.     

Preventing Zoonotic Canine Leishmaniasis in Northeastern Brazil: Pet Attachment and Adoption of Community Leishmania Prevention

Visceral leishmaniasis (VL), caused by Leishmania infantum chagasi (L.i. chagasi syn. infantum) in northeastern Brazil, was responsible for 51,000 new VL cases from 1980 to 2003. Household presence of L. infantum-infected dogs is a major risk factor for human infection. Despite culling of dogs based on seropositivity, canine L. infantum seroprevalence remains near 20%, suggesting that dog culling is ineffective for preventing VL spread. We administered a cross-sectional survey to 224 households within 300 m of the homes of VL human patients diagnosed within the last year. The goal was to develop a model for voluntary preventative use based on characteristics and motivations of dog owners. We identified that owner knowledge deficiencies regarding canine transmission of L. infantum associated with increased risk of dog infection (odds ratio [OR] = 3.681, confidence interval [CI] = 1.223, 11.08). Higher owner education was associated with decreased levels of dog seropositivity (OR = 0.40, CI = 0.20, 0.81). Pet attachment (P = 0.036) and perception of risk/disease knowledge (P = 0.040) were significantly associated with willingness to voluntarily purchase canine VL prevention. These results highlight the importance of owner attachment to their pet in implementing reservoir-targeted zoonotic VL prevention.     

The impact of highly active antiretroviral therapy (HAART) on visceral leishmaniasis in Spanish patients who are co-infected with HIV

Clinicians in Madrid have been observing and treating HIV-positive patients with visceral leishmaniasis (VL) for over a decade. As their records cover some of the co-infection cases that occurred before and after highly active antiretroviral therapy (HAART) was introduced into Spain, retrospective analysis of the records has allowed some of the effects of HAART on local VL to be determined. Encouragingly, HAART appears to have decreased the annual incidence of VL among local AIDS cases, from 4.81 cases/100 to just 0.8 case/100 (P <0.0005), a first episode of VL now appearing only when there is obvious HAART failure. Unfortunately, it does not seem to be very good at preventing VL relapses; within 24 months of antileishmanial treatment, 70% of patients who were receiving HAART had such relapses. The mean time between antileishmanial treatment and VL relapse was, however, longer when HAART was used than when it was not (20 v. 13 months). In those receiving HAART, relapses of the VL often occurred despite increasing CD4+ cell counts and undetectable HIV loads, indicating that successful treatment of the viral infection is insufficient to prevent the relapse of the leishmaniasis. These results are in general agreement with other observations made in Spain. VL relapses are possible and even frequent in HIV-positives who have no more than 200 CD4+ cells/microl, but secondary prophylaxis to prevent VL relapses may be safely suspended if a CD4+ count of >200 cells/microl can be maintained using HAART. VL also seems to hamper the immunological recovery of the HIV-positive, although HAART appears to have little effect on the clinical manifestations of VL.     

Infection rates with Leishmania donovani and Mycobacterium tuberculosis in a village in eastern Sudan

BACKGROUND: Leishmania-tuberculosis co-infection is not uncommon in clinical practice in East Africa, but little is known about the epidemiology of this problem at population level. A cross-sectional household survey was carried out in an active visceral leishmaniasis (VL) focus in Eastern Sudan in February 2002. METHODS: All inhabitants of Marbata village in Atbara River Area, Gedarif State, who gave informed consent, underwent both a leishmanin skin test (LST) and a tuberculin test for infection with L. donovani and Mycobacterium tuberculosis. All subjects were clinically screened for VL and tuberculosis (TB). RESULTS: About 66% (252 of 382) were LST-positive, 26% (100 of 382) were tuberculin-positive and 20% (77 of 382) were positive for both tests. By the age of 15, more than 60% of inhabitants were LST-positive, but <20% were tuberculin-positive. By the age of 30, these percentages increased to 100 and 50%. No association was found at the individual level between leishmanial and tuberculous infection after controlling for age. CONCLUSION: In this community study, we found no association between the risk of infection with L. donovani and M. tuberculosis. However, the progression to active VL disease might be different in M. tuberculosis-infected than in non-infected persons and vice versa. Prospective studies are needed to document the prognosis of TB/VL co-infection.     

螺类宿主感染钩棘单睾吸虫尾蚴的调查与感染实验

本文对钩棘单睾吸虫的第一中间螺蛳宿主自然感染情况进行调查，显示了一年中该虫尾蚴感染率随季节呈动态变化，10月份瘤拟黑螺感染率高达5.42％。各地瘤拟黑螺与纹沼螺平均感染率分别为2.45％（38／1548）与0.73％（20／2726），表明前者为本吸虫更为适宜的第一中间宿主。感染实验结果表明，该虫尾蚴侵染鱼类宿主后须经25d囊蚴发育完全成熟，而囊蚴感染终未宿主仅4d即可发育为成虫并产卵，其发育迅速为吸虫类所罕见。     

A survey on canine leishmaniasis in western Turkey by parasite, DNA and antibody detection assays

Human visceral leishmaniasis (VL) caused by Leishmania infantum is found throughout the Mediterranean Region, including Turkey, where dogs are considered to be the main reservoir host for this parasite. In the district of Manisa, western Turkey, 37 human VL cases were reported from June 1993-August 1997. Twenty-four villages in this district were chosen for a survey of disease prevalence in dogs. The dogs, 490 in total, were examined using either the indirect immunofluoresence assay (IFAT) or direct agglutination test (DAT). Anti-Leishmania antibodies were found by at least one test in 5.3% (26/490) of the dogs. Infections were confirmed by parasitological examination of or polymerase chain reaction (PCR) on lymph node aspirates in 65% (13/20) and 76.4% (13/17) of the seropositive dogs tested, respectively. The confirmation rate was 85% by combining the results of PCR and microscopy. Our results demonstrate that canine VL is wide spread in western Turkey where human VL is endemic, and that serodiagnosis is a valuable tool for monitoring the infection.     

1996-2006年新疆喀什市伯什克然木乡内脏利什曼病的流行概况

目的 回顾1996-2006年问新疆维吾尔自治区喀什市伯什克然木乡黑热病的流行情况,了解人群感染,以便采取相应的防治对策. 方法 收集汇总1996-2006年的"黑热病病人报告表",资料采用EPI DATA 2.1b和EPI INFO 2002录入和分析. 结果 1996-2006年喀什市伯什克然木乡有黑热病患者722例.全乡21个村中17个村有流行,主要集中在其中的2个村,其余呈散发状态,该病在性别间的分布差异无统计学意义(χ2=16.5126,P＞0.05);0～5岁年龄组和6～10岁年龄组人群的病例数最多,分别占发病人数的30.06%和28.95%,随年龄的增大病例数呈减少趋势;自1996年起患者数呈逐年增多趋势,2002年达到最高峰,其后逐年下降. 结论 喀什市伯什克然木乡仍然是黑热病流行的高发区,需采取有效控制措施.     

The high sensitivity of a PCR-ELISA in the diagnosis of cutaneous and visceral leishmaniasis caused by Leishmania infantum

In general, the conventional techniques available for the diagnosis of leishmaniasis have relatively low sensitivity. This means that parasite-rich samples (which can usually only be collected by very invasive methods, such as bone-marrow aspiration) must be employed. This problem has not yet been solved even by use of the PCR-based techniques currently available. However, a new PCR-ELISA has been developed for the diagnosis of cutaneous (CL) and visceral leishmaniasis (VL) caused by Leishmania infantum. This assay appears to have sufficient sensitivity to be effective in the diagnosis of VL not only when bone-marrow aspirates are investigated but also when the samples are of peripheral blood. Overall, the ability of the PCR-ELISA to detect Leishmania, in 76 samples (22 of peripheral blood, 36 bone-marrow aspirates and 18 skin samples) from 72 patients living in a endemic region, was better than that of culture or the examination of Giemsa-stained smears. For example, L. infantum kDNA was detected by PCR-ELISA in 15 (83%) of the 18 skin samples from suspected cases of CL, whereas the combined use of several classical techniques only confirmed the presence of amastigotes in five (28%) of these samples. Similarly, only 21 individuals were diagnosed as having VL by conventional techniques whereas 30 were found Leishmania-positive in the PCR-ELISA. The new PCR-ELISA also appears to be a suitable technique for detecting leishmanial kDNA in samples of peripheral blood from cases of L. infantum-HIV co-infection. The assay is more sensitive than the combined use of several conventional techniques in the diagnosis of subclinical VL, probably because those with subclinical infection have relatively low parasitic loads that are generally undetectable using the other techniques.