新疆克拉至依皮肤利什曼病传播媒介的研究

１９９４年的研究表明，在克拉玛依从皮肤利什曼病患者皮肤损害部位和从硕大白蛉吴氏亚种消化道内分离出来的利什曼原虫，经ＤＮＡ基因型的分析，证实与婴儿利什曼原虫同源。本文报道，在皮肤利什曼病流行区区硕大白蛉吴氏亚种的数量颇大，亲人性强，在野外和居民点内该蛉的前鞭毛体自然感染率分别为５．９％和２．９％，前鞭毛体在该蛉的消化道内能大量繁殖并可移行至咽及喙部；而在非流行区，该蛉的数量很少或无，也未查见前鞭毛体     

新疆克拉玛依地区的利什曼原虫及其与皮肤利什曼病的关系

应用多学科的手段，包括形态度量，对宿主的致病性和病理，组织化学，单克隆抗体检测，ＤＮＡ杂交，酶电泳分析等，从细胞水平到分子水平的不同层次，对新疆克拉玛依地区大沙鼠体内的利什曼原虫进行了研究；首次证实了我国新疆境内的大沙鼠耳组织有都兰利什曼原虫的寄生。用生态学，寄生虫与昆虫宿主的相容性等方法，确定了都兰利什曼原虫的传播媒介为蒙古白蛉和安氏白蛉，并从硕大白蛉吴氏亚种体内查见婴儿利什原虫，本文初步讨论了     

复发性皮肤利什曼病时原虫持续存在的作用

在免疫抑制者中，作为机会感染的利什曼病例报告日益增多，病人体内持续存在的利什曼原虫的重新激活可能是这些病人发病的原因。本文综述了人体和鼠模型的利什曼原虫持续的深入研究将对探测此病复发的可能性、对复发病人新疗法的评价及抗利什曼原虫疫苗的研制设计等方面可能有重要的意义。     

深圳市首例输入性内脏利什曼病报道

本文报道1例主要临床表现为发热、畏寒、伴全血细胞减少的患者。为查明病因,采集患者外周血,应用宏基因组二代测序筛查病原体,检出杜氏利什曼原虫序列;患者骨髓涂片见利什曼原虫无鞭毛体,确诊为内脏利什曼病。给予两性霉素B脂质体治疗14 d,患者痊愈出院。该病例为深圳市自1979年建市以来报道的首例输入性内脏利什曼病病例。     

炎症皮肤趋化因子在皮肤利什曼病中的差异表达

趋化因子是一类分子量较小的(8～10kDa)趋化细胞因子。依照N端最先出现的两个保守半胱氨酸残基排列方式的不同，趋化因子可分成两大类：CXC和CC。在CXC亚类两个半胱氨酸问插入了另一个氨基酸。在CC亚类两个半胱氨酸紧邻排列。趋化因子能触发整合素激活，并有助于在流动情况下捕获白细胞，而在脾脏有助于引导淋巴细胞进驻次级淋巴器官。     

新疆克拉玛依皮肤利什曼病病原生物学的研究

从新疆克拉玛依地区皮肤利 曼病患者皮损内分离的３株婴儿利什曼原虫，接种至草原名词行鼠或背纹仓鼠的腹腔／睾丸内后，引起内脏感染。习的病理变化与内脏利什曼病人体内分离出来的婴儿利什曼原虫／杜氏利什曼原虫引起的一致。     

液氮冷冻治疗皮肤利什曼病的效果观察

任灏远等曾用液氮冷冻法治疗皮肤利什曼病（ＣＬ），据云有良好疗效［１］。１９９２—１９９３年，我们用该法对克拉玛依小拐农场的１０例ＣＬ患者进行治疗，结果如下。有２个以上皮肤损害的病例作为治疗对象，取１个皮损作涂片或组织切片以确定诊断，其余的均用液氮冷冻...     

洛阳市1起输入性皮肤利什曼病疫情流行病学 筛查报告

目的　了解中国石油天然气第一建设公司乌兹别克斯坦务工归国员工中利什曼原虫感染情况,并及时采取相关防控措施,防止疫情扩大。方法　设计调查问卷采集筛查对象相关信息,由内科医生触诊肝、脾及浅表淋巴结,皮肤科医生检查皮肤经常暴露处皮肤损害情况,对筛查对象行B超检查肝脾大小,采集筛查对象血清,应用内脏利什曼病快速检测试纸条（rK39）检测,对于筛查中发现的有皮肤损害者,采集皮损处组织镜检利什曼原虫,病原学检测阳性组织用分子生物学方法鉴定虫种。结果　共181人接受筛查,内科检查中6人颈部可触及肿大淋巴结,皮肤科检查中12人有皮肤损害表现,B超检查提示5人肝脾肿大,rK39试纸条检测血清显示3人结果呈阳性。共采集2人份典型皮损处组织,其中1份组织病原学检测发现利什曼原虫;提取前鞭毛体DNA,用利什曼原虫属特异性引物K13A/K13B和L5.8S/LITSR分别扩增出120 bp和350 bp的片段,片段序列与硕大利什曼原虫相应序列（GenBank登录号：EU370906.1、FN677342.1）同源性分别为90%和98%。结论　筛查发现6例皮肤利什曼病患者,其中2例尚未痊愈。1例未痊愈者确诊为由硕大利什曼原虫感染引起的输入性皮肤利什曼病。     

洛阳市1起输入性皮肤利什曼病疫情流行病学 筛查报告

目的　了解中国石油天然气第一建设公司乌兹别克斯坦务工归国员工中利什曼原虫感染情况，并及时采取相关防控措施，防止疫情扩大。方法　设计调查问卷采集筛查对象相关信息，由内科医生触诊肝、脾及浅表淋巴结，皮肤科医生检查皮肤经常暴露处皮肤损害情况，对筛查对象行B超检查肝脾大小，采集筛查对象血清，应用内脏利什曼病快速检测试纸条（rK39）检测，对于筛查中发现的有皮肤损害者，采集皮损处组织镜检利什曼原虫，病原学检测阳性组织用分子生物学方法鉴定虫种。结果　共181人接受筛查，内科检查中6人颈部可触及肿大淋巴结，皮肤科检查中12人有皮肤损害表现，B超检查提示5人肝脾肿大，rK39试纸条检测血清显示3人结果呈阳性。共采集2人份典型皮损处组织，其中1份组织病原学检测发现利什曼原虫；提取前鞭毛体DNA，用利什曼原虫属特异性引物K13A/K13B和L5.8S/LITSR分别扩增出120 bp和350 bp的片段，片段序列与硕大利什曼原虫相应序列（GenBank登录号：EU370906.1、FN677342.1）同源性分别为90%和98%。结论　筛查发现6例皮肤利什曼病患者，其中2例尚未痊愈。1例未痊愈者确诊为由硕大利什曼原虫感染引起的输入性皮肤利什曼病。     

First Case of Visceral Leishmaniasis Caused by Leishmania martiniquensis

We report the first case of visceral leishmaniasis (VL) caused by Leishmania martiniquensis in the Caribbean, which until now, was known only to cause cutaneous leishmaniasis. The disease presented with fatigue, anemia, and hepatosplenomegaly in a 61-year-old man with human immunodeficiency virus (HIV) infection who was receiving antiretroviral therapy. Diagnosis was made by bone marrow biopsy. VL is life-threatening, and its emergence in the Caribbean is of concern.     

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。     

四川省犬源性黑热病临床特征与诊断方法探讨

通过文献复习以及作者的工作实践,对四川省黑热病患者临床资料进行回顾性分析,探讨犬源性黑热病的临床特点、诊断方法,并介绍了国内在这些方面的经验和体会,以供临床诊断和防治利什曼病的参考,提高本病的诊断率,减少误诊。黑热病均为白蛉季节有疫区居住史的患者,临床特点为反复不规则发热、脾肿大或肝脾均肿大、全血细胞减少及血浆球蛋白增高。易误诊为肝硬化、再生障碍性贫血、白血病、伤寒和结核病等。非疫区医疗机构未能结合流行病学史、尽早做病原学或免疫学检查是误诊主要原因。对来自疫区的患者应加强对本病的防范意识和提高诊断水平,掌握黑热病的流行病学资料、临床特点,尽早作病原学检查或血清学检测是避免误诊的关键。     

Case Report: First Cases of Cutaneous Leishmaniasis Caused by Leishmania (Viannia) naiffi Infection in Surinam

Cutaneous leishmaniasis in Surinam is generally caused by infection by Leishmania guyanensis. We report three cases of infection with Leishmania (Viannia) naiffi, a Leishmania species not described from Surinam before. Treatment with pentamidine proved to be effective.     

四川省地震灾后黑热病流行动态与防治现状

目的了解地震灾害后黑热病流行动态和防治现状,为制定灾后黑热病防治策略提供依据。方法收集地震前、后各级医疗卫生机构黑热病病历资料和网络直报疫情报告,核实后进行资料处理;了解各受灾黑热病疫区发病和防治措施实施情况。结果全省黑热病病例地震前的2006、2007年分别发病49和78例;地震灾害的2008年发病56例,发病数较地震前有所减少;2009年发病62例;2010年发病65例,其中疫区居民和非疫区流动人群各发病28、37例,分别比2009年下降13.85%和上升19.36%。2010年汶川县居民发病4例,省内和省外非疫区流动人员在当地感染发病9和3例,当地居民和流动人口发病出现回升。结论地震灾后疫区当年居民发病人数有所减少,其后2年局部疫区居民和流动人口发病人数增多,存在黑热病局部暴发风险,应加强相应的防治对策。     

糖尿病酮症酸中毒的急救与临床护理

酮症酸中毒是糖尿病的一种急性并发症,如果患者没有得到及早发现和及早治疗与护理,严重威胁患者的生命安全,糖尿病酮症酸中毒患者的急救与临床护理极为重要。在临床护理过程中,应根据护理评估结果,采取补充血容量、合理应用胰岛素、补钾、纠正酸中毒等急救和护理措施,采用心理护理、基础护理、密切观察病情和预防感染等临床护理措施,配合积极的治疗,可以提高救治成功率,降低病死率。控制糖尿病酮症酸中毒病情的关键是尽快恢复机体胰岛素浓度,维持有效循环血量与肾脏功能是治疗糖尿病酮症酸中毒的又一关键措施。     

Case Report: Leishmaniasis in the Tongue of an Immunocompetent Man

A 49-year-old immunocompetent white man had a painful ulcer (1.5 cm in diameter) on the left ventrolateral surface of a grossly enlarged tongue. The ulcer was present for two months. Impaired swallowing resulted in substantial weight loss and fatigue. Histopathologic analysis of a punch biopsy specimen indicated numerous Leishman Donovan bodies within macrophages. A polymerase chain reaction confirmed the presence of L. donovani. Therapy with two cycles of liposomal amphotericin B over a three-month period was administered. Four months after discharge, the ulcer had healed completely and the tongue returned to its normal size and function.Leishmaniasis directly affects 1.5–2 million patients per year, and more than 350 million persons are at risk worldwide for contracting this disease.¹ It is a vector-borne disease caused by Leishmania, obligate intramacrophage protozoa. Human infection occurs through the bite of female phlebotomine sand flies. Non-vector transmission is possible, but is rarely reported. Leishmaniasis is classified into cutaneous, mucocutaneuous, and visceral (kala-azar) forms and shows a wide spectrum of clinical manifestations.² Oral involvement is unusual and typically appears as mucosal ulcerations, mainly in the nasopharyngeal region.³A 49-year-old white man was admitted to the Medical University of Vienna Hospital for the evaluation of a painful ulcer in a grossly enlarged tongue (Figure 1A and ​andB).B). The ulcer was present for two months. He reported a burning sensation, accompanied by the development of a small vesicle, which resulted in the persistent ulcer. Because of difficulties in swallowing, the patient had substantial weight loss and fatigue.Open in a separate windowFigure 1.Tongue of the patient before (A and B) and after (C and D) treatment with liposomal amphotericin B. This figure appears in color at www.ajtmh.org.Clinical examination diagnosed an ulcer 1.5 cm in diameter on the left ventrolateral surface of the tongue. Mandibular lymph nodes on the left side were enlarged, non-tender, and relocatable. Clinical differential diagnosis included malignomas, eosinophilic granuloma, primary syphilis, infection with herpes zoster, and tuberculosis.Routine laboratory investigations show negative results for infection with human immunodeficiency virus and elevated levels of cholesterol (225 mg/dL), gamma-glutamyl transferase (102 U/L), aspartate aminotransferase (42 U/L), and alanine aminotransferase (105 U/L). Ultrasonic testing of the abdomen showed slight signs of steatosis hepatis. A computed tomography scan of the paranasal sinuses did not show any pathologic changes except for chronic inflammations in the area of four teeth. Fibrotic changes in the mediastinum, with a single enlarged pre-aortal lymph node and numerous minimally increased mediastinal lymph nodes were illustrated by a computed tomography scan of the lungs and mediastinum. T2-weighted magnetic resonance imaging of the mouth and tongue indicated residual hyperintensities of the tip of the tongue, which extended ventrally to the left side.Histopathologic analysis of a Giemsa-stained punch biopsy specimen of the tongue identified granulomatous changes (Figure 2A) and numerous Leishman-Donovan bodies within macrophages (Figure 2B). Results of parasitologic and serologic-tests presented borderline values (Leishmania sp. indirect immunofluorescence test titer = 1:40 and Leishmania sp. enzyme-linked immunosorbent assay optical density = 0.39). A subsequent polymerase chain reaction identified Leishmania donovani complex DNA (Figure 2C). A detailed travel history indicated that the patient had taken a trip to the island of Rab in Croatia four weeks before the onset of his symptoms.Open in a separate windowFigure 2.Histopathologic analysis of a Giemsa-stained punch biopsy specimen from the tongue of the patient, showing A, granulomatous changes and B, numerous leishman donovan bodies within macrophages. C, A subsequent polymerase chain reaction confirmed the presence of Leishmania donovani complex DNA. This figure appears in color at www.ajtmh.org.Treatment with parenteral application of liposomal amphotericin B (3 mg/kg/day) for 5 consecutive days was initiated. The medication was well tolerated and the patient did not have any discernible adverse reactions. Three months after therapy, his tongue was still swollen and had a palpable nodular infiltrate. Therefore, a second treatment cycle with liposomal amphotericin B (3 mg/kg/day) for 5 days was initiated. Four months later, his tongue returned to its normal size and shape (Figure 1C and ​andDD).Leishmaniasis in humans is a diverse and complex disease. It is divided into three major clinical types: cutaneous, mucocutaneous, and visceral. There are approximately 24 infective Leishmania spp. Each species can produce more than one clinical form of the disease, and each form of the disease can be caused by multiple species.⁴ Mucosal involvement in leishmaniasis caused by L. donovani is uncommon and results from hematogenous or lymphatic dissemination of amastigotes from the skin to the nasopharyngeal mucosa.³ Such metastatic spread occurs more often with species belonging to the subgenus L. viannia of New World Leishmania. These parasites are localized in tropical forests of Central and South America. They usually affect the upper respiratory tract and show a predilection for the nose and larynx, often after an initial cutaneous lesion, which was not found in our patient.Leishmaniasis of the tongue is a rare occurrence and is usually observed in immunodeficient patients. To our knowledge, there have been only two reported cases of lingual leishmaniasis, one in an immunocompetent man from Iran.^5,6 Cutaneous leishmaniasis caused by Old World parasites may be manifested as nodular or ulcerating skin lesions, depending on the age of the lesions and the response of the host. Leishmania major and L. tropica cause most of these cases. Mucosal involvement is rare.At the time of onset of the disease, our patient was healthy and had no signs of immunodeficiency or any previous infections. Confirmation of infection with L. donovani by polymerase chain reaction is an unusual finding because L. donovani usually causes a visceral form of leishmaniasis. The liver test results for our patient may have indicated visceral disease caused by L. donovani. However, an alternative explanation for these findings was a family history of hypercholesterolemia and recreational drinking.This rare case of lingual leishmaniasis caused by L. donovani proves that a strict separation of different types of leishmaniasis and the species that cause them is not always possible or appropriate for diagnosis. This conclusion is supported by several observations, such as a patient in India, where L. donovani was reported as the cause of mucocutaneous and cutaneous leishmaniasis.^7,8Tourism has resulted in increased reports of leishmaniasis in non-endemic areas such as northern Europe and North America. The areas endemic for L. donovani (the Mediterranean, South America, eastern Africa, and central and southeast Asia) are contingent with the travel history of our patient. The island of Rab, which is a frequent tourist attraction, is situated at the northern border of Dalmatia, a region on the eastern coast of the Adriatic Sea.⁹ Therefore, we emphasize that specific guidelines should be provided for leishmaniasis-endemic areas to ensure that travelers are aware of prevention methods, clinical manifestations, and the necessity for early diagnosis and timely treatment.     

山西省1例新发内脏利什曼病病例调查

2011年9月,山西省长治市疾病预防控制中心通过传染病网络直报系统报告1例幼儿内脏利什曼病新发病例。围绕该病例展开了相关的临床个案和现场流行病学调查。患儿,2岁,山西省长治市黄碾镇人。临床检查示患儿肝脾肿大,血常规检查示全血细胞呈持续性降低,骨髓病理涂片发现利杜体,rK39免疫诊断试条检测示强阳性,确诊为内脏利什曼病。患儿经葡萄糖酸锑钠治疗1个疗程(总剂量为150～200 mg/kg,分6 d注射,1次/d)后,症状明显好转。现场调查该病例所在地区无内脏利什曼病既往病例。居民家中犬和家养动物的数量较多。采用rK39免疫诊断试条对周围人群(17人)及部分家养动物(3只犬、1头羊和1只猫)血样进行检测,结果均为阴性。推测该地区存在内脏利什曼病潜在流行风险。     

广州管圆线虫病外地感染四川发病首例报道

目的 报道人群因生食凉拌福寿螺肉感染广州管圆线虫的病例,提示该病对人群的危害与加强该病防治的重要性.方法 根据患者典型的症状与体征,应用流行病学调查,对患者进行临床检查与诊断,采用阿苯达唑驱虫治疗、对症处理、营养补充及卧床休息的防治方案.结果 经上述方法处置的第10d,患者症状、体征基本消失,治疗后的1月、4月的随访,患者已痊愈.结论 应重视广州管圆线虫病对人群的健康危害,加强本病的健康教育与防治,提高自我保护意识,杜绝生食与半生食福寿螺肉及其他传播广州管圆线虫的媒介,提高广大医务人员对本病的重视与诊治水平、处置能力,对患者尽量做到早发现、早诊断、早治疗.