2006年1至8月份我国克雅病监测病例分析

目的了解我国克雅病（Creutzfeldt-Jakob disease，CJD）的发病情况及分布特征。方法对2006年1至8月份我国克雅病监测网络获得的可疑CJD病例的l临床及流行病学资料进行分析；收集患者脑脊液及血液样品，利用Western Blot方法对脑脊液中14—3—3蛋白进行检测；利用PCR及测序方法对脚基因进行序列分析。结果共发现CJD临床诊断病例10例，疑似诊断病例8例。均为散发型CJD病例，病例的地理分布及职业没有明显的聚集性。发病年龄平均为60岁，男女比例接近1：1。首发症状中以快速进行性痴呆所占比例最多，占44％。临床诊断病例比疑似诊断病例出现更多的典型临床表现。结论我国监测到的CJD病例主要以散发型为主，地理、职业、男女比例以及平均年龄均符合散发型CJD的分布特点。     

Incidence,prevalence and geographic distribution of human alveolar echinococcosis in Austria from 1854 to 1990

Since the second half of the last century it has been known that Austria — like southern Germany, eastern France and Switzerland — is a part of the Central European area of distribution ofEchinococcus multilocularis (Em), the causative organism of alveolar echinococcosis (AE). Up until October 1990, 128 human AE cases were documented in Austria; personal anamnestic and clinical data on the majority of these patients are available. Based on these data, epidemiological parameters (incidence, prevalence, geographic distribution, sex and age distribution, occupation) were evaluated so as to obtain information on the past and recent history of alveolar echinococcosis in Austria. The (retrospective) study led to the following results and conclusions: (a) the (documented) incidence (presently two cases/year) of AE in Austria is rather low; (b) the main endemic Em areas are situated in the western (Tyrol, Vorarlberg) and southern (Carinthia) provinces; (c) a new focus could be detected in Lower Austria (outside the Alps); (d) the sex ratio (M:F) of AE patients was 1.3:1; (e) the average age of men and women at the time of diagnosis was 44 and 47 years, respectively; (f) 98% of Austrian AE patients exhibited Em lesions in the liver; and (g)>50% of AE patients were (or had been) farmers.Dedicated to Prof. Dr. J. Eckert (Zürich) on the occasion of his 60th birthday     

Drug-induced hepatitis: histologic clues to a difficult diagnosis

Drug-induced liver injury (DILI) results from two chief mechanisms of action: idiosyncratic hepatotoxicity, which typically manifests with prominent inflammation, and intrinsic hepatotoxicity, which demonstrates necrosis with negligible inflammation. Clinically, DILI is classified into hepatitic, cholestatic, or mixed presentations based on the pattern of liver enzyme elevation. As many etiologic factors can result in abnormal liver enzymes, the clinical clue to diagnosing DILI is symptomatic and biochemical improvement upon withdrawal of the offending agent. Histologically, DILI manifests in four main patterns of injury: i) inflammation-predominant acute hepatitis, ii) necrosis-predominant acute hepatitis, iii) resolving hepatitis, and iv) syncytial giant cell hepatitis. In contrast to the characteristic features of both acute hepatitis and syncytial giant cell hepatitis, resolving drug-induced hepatitis lacks specific histologic features and may mimic other mild forms of chronic hepatitis. Ultimately, the presence of sinusoidal PASD + Kupffer cell aggregates – in the absence of significant hepatocellular inflammation or injury – is the histologic hallmark of resolving drug-induced hepatitis.     

Incidence of AIDS-defining cancers after AIDS diagnosis among people with AIDS in Italy, 1986-1998

A record linkage was carried out between the Italian National Registry of AIDS and 19 cancer registries. The aim was to evaluate the 1986 through 1998 trends in incidence rate (IR) of AIDS-defining cancers (ADCs) among persons with AIDS (PWA) in Italy overall and according to various characteristics. A steady decrease in IRs was found for Kaposi sarcoma (KS) in men between 1986-1992 (2.5 per 100 person-years [py]) and 1997-1998 (1.0 per 100 py). Conversely, the first decrease in IRs of KS in women (from 0.9 to 0.6 per 100 py) and of non-Hodgkin lymphoma in both genders (from 1.7 to 0.7 per 100 py) was seen between 1993-1996 and 1997-1998, thus pointing to a favorable impact of highly active antiretroviral therapies. The decline was consistent across different age and HIV transmission groups, but it was more marked in PWA with a CD4 count >50 cells/microL than in PWA with more severe immune suppression. As a proportion of AIDS cases, invasive cervical cancer increased from 1.5% in 1993-1996 to 2.4% in 1997-1998, but IRs after AIDS could not be evaluated. On account of the marked decline of KS in men in 1997-1998, the overall burden of ADCs in Italy became similar in both genders.     

Time trends and seasonal variations in hospital admissions for childhood asthma in Taiwan from 1990 to 1998.

The aim of the study was to determine the trends and seasonal variations in hospital admissions for childhood asthma in a tertiary medical center since 1990. Data were collected according to the age and sex of patients and obtained from hospital registries between 1990 and 1998. Children between 2 and 14 years of age admitted with the diagnosis of asthma, or asthmatic bronchitis (ICD-9 code 493) were included. Age-specific and sex-specific hospital admission rates for asthma were calculated for each calendar year. The asthma admission rates were defined as the number of asthma admissions divided by the total number of all pediatric admissions in a year. Seasonal admission rates were calculated in a similar fashion. In addition, the number of readmissions was also calculated during the study period with comparisons of sex and age differences. The asthma admission rates showed a significant upward trend throughout the period studied, particularly among the 2-4 years of age group (relative risk = 2.08; p = 0.0001). Seasonal admission rates revealed a statistically significant increase during the October-December period, peaking in November or December of each calendar year (relative risk = 1.84; p = 0.0001). There was a male predominance in both age categories during the 9-year period. Comparisons of readmissions for asthma (at least three admissions) disclosed that girls were far more likely to be readmitted than boys among the 5-14 years of age group (p = 0.01). Our results indicate 1) an increased prevalence and severity of childhood asthma in Taiwan; 2) boys and younger children aged 2-4 years with asthma had increased risks of admission for asthma (relative risks were 1.22 and 1.96, respectively) and 3) girls among the older children with asthma tend to present with greater severity than boys owing to higher relative risks of readmission for asthma.     

Incidence and case-fatality rates resulting from the 1998 enterovirus 71 outbreak in Taiwan

In 1998, an epidemic of hand-foot-and-mouth disease and herpangina caused by enterovirus 71 occurred in Taiwan, leaving many fatalities and severely handicapped survivors in its wake. The reasons this rather common pathogen would cause such a large-scale epidemic remain unknown. A seroepidemiological survey to elucidate the epidemiological characteristics of this outbreak, including its incidence and case-fatality rates was undertaken. Microneutralization tests for antibodies against enterovirus 71 were used to screen four collections of serum samples: 1) 202 specimens taken from individuals > or = 4 years old in 1994; 2) 245 specimens collected from individuals of all ages in 1997; 3) 1,258 specimens collected from individuals of all ages in 1999; and 4) sera samples from a birth cohort of 81 children who had yearly blood samples taken from 1988-98. After the maternal antibody had declined, the seropositive rates began to increase with age. Approximately half of all children aged 6 years or older were enterovirus 71 seropositive. Significantly higher seropositive rates were noted in 1999 than in 1997, in children aged 0.5-3 years. The incidence of enterovirus 71 infection during the epidemic was estimated to be 13-22%, with the higher rates in younger children. The case-fatality rate was highest (96.96 per 100,000) in infants aged 6-11 months, and declined in older children. The results showed that enterovirus 71 is endemic in Taiwan. The apparent lack of large-scale enterovirus 71 activity in the 3 years before 1998 might have been the prelude to the epidemic's appearance in 1998, and might suggest that enterovirus 71 infection will reappear every few years. The lack of a protective antibody in younger children may account for the high incidence and case-fatality rate in this age group.     

Incidence of hay fever in a North London practice

A practice in North west London consisting of about 6,000 patients, 30 per cent of whom are immigrant, yielded a sample of 77 patients who could be considered to be suffering from hay fever. These were questioned and skin tested.

The disease was found to be more prevalent in the immigrant West Indian section of the practice. These patients had not suffered from the disease before arrival in this country but had developed their symptoms after an interval of up to 14 years with an average of about five years. Most of the patients had arrived in this country as adults, and some differences in the pattern of disease from that encountered in the indigenous population were observed. The tendency is for the disease to begin between the age of five and 15 for the indigenous patient, although extreme cases with ages of onset of two and 74 years were found. However, in the immigrant West Indian group the age of onset tended to be between 25 and 45. In addition, the older an immigrant was on arrival in this country the longer hay fever took to develop. It was found that May was stated to be the month of onset of the disease for the indigenous group whereas June tended to be the month of onset for the immigrant group.

The sample proved too small to detect any existing patterns in personal or family history, but sex links were found in both response to grass pollen and a personal history of asthma, in that men showed less tendency to asthma whilst proportionately less women than men responded to grass pollen skin tests only.

We suggest that a diagnosis of hay fever should be considered in both the young and the elderly who present with recurrent symptoms occurring only in the summer months, of one or more of the following: sneezing, lacrimation, nasal drip, nasal blockage, wheezing, dry throat, or itchy eyes. The diagnosis can readily be confirmed by simple skin testing.

     

Incidence of listeriosis in Barcelona,Spain, in 1990

A population-based register of cases of listeriosis admitted to acute-care hospitals has been established in Barcelona, Spain, in order to estimate the basal incidence of sporadic cases and to facilitate epidemiological surveillance of potential epidemics. Eleven acute-care hospitals reported all cases of listeriosis to a central unit following a standardized protocol. During 1990, 31 patients with listeriosis were identified, 18 of whom were residents of the city, resulting in an annual incidence of 10.95 cases per million inhabitants. Twelve of the 31 cases occurred in the period from July to September 1990, ten of them being community-acquired. The incidence of listeriosis was higher in elderly ( 65 years) and immunosuppressed persons. Forty-two percent of the cases were considered to be nosocomial infections. The overall mortality rate was 51.6 %. The incidence of listeriosis in the present study is one of the highest reported in the literature. A high sensitivity of the reporting system with good case identification techniques, or demographic and environmental characteristics related toListeria monocytogenes infection in our area, might be possible reasons for this geographic variation.C. Balado, Department of Microbiology, Hospital de la Creu Roja; J. Bosch, Department of Microbiology, Hospital de la Maternitat; J.M. Campos, Department of Microbiology, Hospital Sant Joan de Deu, Esplugues de Llobregat; G. Domingo, Intensive Care Unit, Hospital Militar; E. Gimeno, Department of Microbiology, Institut d'Urologia i Andrologia; M. Morta, Department of Microbiology, Laboratori Municipal; L. Viñas, Department of Microbiology, Institut Universitari Dexeus.