森林脑炎致呼吸肌麻痹38例临床分析

目的探讨森林脑炎致呼吸肌麻痹的临床特征及治疗原则。方法观察分析38例有呼吸肌麻痹表现的森林脑炎病人的临床特点及治疗效果。结果36例病人在1-6个月恢复与好转,血气分析检测正常,治愈好转率达94.71%。结论森林脑炎可以累及呼吸肌,经抗病毒、丙种球蛋白治疗,以及呼吸机辅助呼吸,效果可靠。     

儿童蜱虫叮咬致感染三例诊治分析并文献复习

目的　探讨儿童蜱虫叮咬后的继发危害、处理及预防。方法　结合文献复习,对2018-07-06、2018-07-19南京医科大学附属儿童医院收治的3例蜱虫叮咬致感染患儿的临床资料（性别、年龄、症状、体征、实验室检查、处理等）进行分析。结果　3例患儿中,男1例,女2例;年龄分别为1岁7个月、5岁3个月、15岁6个月;病程中均有发热,体温最高均超过38.5 ℃。患儿1经外科清除蜱虫,同时局部行清创缝合,治疗效果最好,病程最短,费用最少。患儿2和患儿3为姐弟俩,均未找到明确蜱虫叮咬部位,均因“发热”就诊,经疾病预防控制中心血液检验确诊为“新型布尼亚病毒”感染,其中弟弟常规对症治疗后好转,姐姐病情较重,在常规治疗基础上加用利巴韦林和丙种球蛋白2 g/kg后好转。结论　蜱虫叮咬后及时有效清除虫体效果好,对找不到叮咬部位者,如出现发热,白细胞计数和血小板计数降低,应及时向疾病预防控制中心送检血液,尽早明确病因,早期治疗,减少并发症。     

市售西咪替丁和双嘧达莫抗森林脑炎病毒作用的研究

目的　探讨西咪替丁与双嘧达莫对感染森林脑炎病毒的小鼠的死亡保护作用。方法　将不同浓度的西咪替丁和双嘧达莫经腹腔注射给已感染森林脑炎病毒的小鼠 ,同时设立对照组。结果　西咪替丁与双嘧达莫均可延长感染病毒鼠的平均存活天数 (P均小于 0 .0 5) ,西咪替丁还可降低小鼠的死亡率 (P <0 .0 5) ,但未观察到随西咪替丁浓度的增加有降低死亡率的特点。结论　西咪替丁与双嘧达莫均有抗森林脑炎病毒的作用     

Reactions to argasid tick bites by island residents on the Great Barrier Reef

OBJECTIVE: To attribute a cause and quantify allergic-like symptoms observed among island residents. DESIGN: Skin prick tests and intradermal injections with ultraviolet-irradiated, filtered (0.22 microns) whole-body homogenates of the soft tick, Ornithodoros capensis, were used to reproduce experimentally the symptoms observed. SETTING: Heron Island, Great Barrier Reef, Australia. PARTICIPANTS: Island residents were designated as such after having spent more than 1 month on the island during the summer seabird breeding season. INTERVENTIONS: Control measures were instigated using a residual insecticide, delta-methrin, sprayed inside sleeping quarters. MAIN OUTCOME MEASURES: Acaricide spraying reduced (X2 = 4.42; P less than 0.05) the number of island residents complaining of having been bitten by ticks, yet was considered an inefficient control measure as 67% reported being attacked by ticks after spraying. RESULTS: Among 97 island residents, elevated total IgE levels were associated with reaction to tick bite in 11 cases (X2 = 27.17; P less than 0.001), but were not of reliable diagnostic value. Symptoms included intense pruritus, blistering (a major feature), erythema, weeping lesions, lymphangitis, dull ache, rheumatic pain and general lassitude, and intense discomfort. Sera from two of four volunteers with known reactions to O. capensis and one of four others with reactions to the Australian paralysis tick, Ixodes holocyclus, cross-reacted with antigens from a total of four of six biting/stinging and non-biting arthropods (radioallergosorbent tests). CONCLUSIONS: Symptoms associated with reactions to tick bite peaked in severity at 35-40 hours and thus the response was most likely delayed type IV hypersensitivity.     

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.经过抗生索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.     

Tick infestation in soldiers who were bivouacked in the Perth region

We report observations on infestations with the tick, Amblyomma triguttatum, in soldiers who were bivouacked in two areas near Perth; 34% of 175 persons were infested with varying stages of the ectoparasite. Most persons were infested with only one tick but some troops had multiple infestations. Local skin reactions to tick-bites were frequent; they usually developed 24-48 h after removal of the tick and may indicate delayed hypersensitivity reactions. A small number of persons developed secondary bacterial infections. Management and prevention of these infestations is reviewed briefly.     

大兴安岭林区人群莱姆病螺旋体感染危险因素及防蜱措施调查

为探讨当地人群莱姆病螺旋体感染的主要危险因素。分析当地人群防蜱意识。对205 份被调查者进行菜姆病螺旋体抗体水平检测,并进行防蜱措施、防蜱意识等调查,对可能影响人感染蜱传疾病的流行因素进行分析。结果表明,蜱咬和职业是人群感染莱姆病螺旋体的主要危险因素(OR=3.62和OR=0.27)。另外,当地人群防蜱意识较差,缺乏合理的防蜱措施。防止蜱咬,保护重点职业人群是该地控制莱姆病螺旋体感染的关键措施。     

内蒙古包头市牛场寄生蜱的调查

蜱类刺吸家畜的血液,除了传播多种病原体外,还会引起牛的产奶量、产肉量下降。调查内蒙古包头地区17家牛场蜱虫的感染情况、蜱虫染蜱率、染蜱指数、体表寄生蜱的分布及蜱的季节消长规律,结果显示包头地区牛场蜱虫感染率偏低,仅有1家肉牛场有微小牛蜱感染。肉牛体表寄生此蜱主要集中在腹部鬃毛密集处,颈部肉垂处,次为两前腿和两后腿区间,占总数的85%以上。该蜱活动时间4~11月,高峰期是5月上旬、8月上旬和9月下旬。并针对蜱虫成虫活动高峰时间应采取防治措施,用1%敌百虫溶液、0.02%蜱虱敌溶液对牛体表及畜舍寄生的蜱进行喷洒杀灭,两种药物均可有效地杀灭微小牛蜱,动物健康也未见异常,可用于包头地区动物体表及圈舍蜱的杀灭药物。     

Paralysis with Ixodes cornuatus envenomation

Ixodes cornuatus is a tick that is widely distributed in Victoria, Tasmania and southern New South Wales. Serious human envenomation has not been reported previously. The clinical syndrome that results from envenomation by Ixodes cornuatus in a three-year-old boy is presented. Bulbar palsy and respiratory failure necessitated endotracheal intubation and mechanical ventilation for five days. Canine tick antivenom was administered.     

Report of nine cases of Crimean-Congo haemorrhagic fever From Iran

Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries around the world. It is transmitted to humans by the bite of an infected tick and by direct contact with blood or tissue from infected humans and livestock. In the following, we report nine cases of CCHF disease. This paper reported nine human CCHF cases, two in Tabas and Bandar Abbas and seven in Yazd. They were 21-, 33-, 28-, 29-, 61, 34, 35, 36 and 52 year-old men. The first, second and third patients were butchers and other patients were farmers. CCHF should be investigated in the patients with fever, bleeding and low platelet counts.     

6例人感染新型布尼亚病毒病的临床特征和流行病学调查分析

目的:分析溧水县2011年确诊的6例人感染新型布尼亚病毒病的临床特征和流行病学特征,为制定预防控制措施提供参考。方法:采用卫生部统一的诊断标准和流行病学个案调查表对病例进行调查。结果:发病率为1.42/10万,死亡率0.24/10万,病死率为16.67%。临床表现主要为发热(6例)、乏力(6例)、食欲减退(6例)、全身酸痛(5例)、腹泻(5例)、恶心(4例);临床实验室检查有血小板计数减少和白细胞计数减少(6例),门冬氨酸氨基转移酶(6例)、磷酸肌酸激酶(6例)、乳酸脱氢酶(6例)、α-羟丁酸脱氢酶(5例)、肌酸激酶同工酶(5例)、胱抑素C(5例)水平升高。病例均来自丘陵村镇,为中老年农民,发病时间集中于4～7月份,部分病例发病前有明确的蜱叮咬史。结论:新型布尼亚病毒感染病例发病初期临床症状不典型,发病有地域特征,高度散发,在丘陵地区生活、生产的居民有较高的感染风险。     

海南地区血红扇头蜱的生物学特性及对宿主的影响

目的 对野外采集的蜱进行形态学与分子生物学鉴定,确定种属并完成该蜱的实验室人工饲养,研究该蜱虫的生物学特性及其对宿主的影响。方法 在体视镜显微镜下观察蜱的形态学特征,并结合分子生物学的方法扩增蜱虫线粒体16srRNA目的基因,进一步确定蜱的种属;利用改进的实验室人工蜱喂养系统在新西兰白兔体表寄生蜱虫,分析其各时期的形态学变化和生活史特性,最后用全自动血细胞分析仪测定寄生与未寄生新西兰白兔血液的14项血常规指标。结果 根据蜱形态学分析,雌雄蜱的假头基呈六角扇形,腹部肛沟明显,雌蜱腹部可看到明显的生殖孔和肛门,具有明显的缘垛;PCR扩增16srRNA 1.5%琼脂糖凝胶在约460 bp处有目的条带,确定野外采集蜱为血红扇头蜱（Rhipicephalus sanguineus）。在相对温度28℃,相对湿度（90±5）%的实验室环境下,血红扇头蜱发育1个完整的世代需要61～83 d,并表现出宿主单一性,即在不更换宿主的情况下,幼蜱、若蜱和成蜱均在新西兰白兔上寄生;新西兰白兔寄生蜱6次后,体质量和体温降低,白细胞数（WBC）、淋巴细胞百分比率（LYM）等升高。结论 在相对温度28℃,相对湿度（9...     

Tick exposure and Lyme disease at a summer camp in Maryland

After investigating an outbreak of Lyme Disease among counselors at a summer camp in Kent County, Maryland in 1994, we wanted to determine the incidence of Lyme Disease (LD) at the camp the following summer and identify risk factors for tick exposure. Any ticks that were detected on campers' skin or clothing were collected by the camp nurse and we studied them for infection with Borrelia burgdorferi. In addition, we sent detailed questionnaires home with the 1,623 campers. A total of 537 campers returned the questionnaire and 200 had found ticks on their skin or clothing while at camp. Risks were analyzed using logistic regression models. Participation in the ropes-course, night-trip and camp-out events significantly increased the risk of tick exposure (OR 1.6 to 2.3). Six cases of LD were identified among campers, which was an estimated incidence of 3.3 per 1,000 campers/10-14 day camp session, and two counselors had LD. Of the 238 ticks collected mainly in June-July 1995, 19% were identified as Ixodes scapularis larvae and nymphs; 11% of the latter were infected with B. burgdorferi. The risk for LD in campers and staff was much higher than that of the general population despite the use of tick-exposure precautions. Focused interventions need to be put in place in summer camps to prevent transmission of LD.     

Tick Bites and Lyme Disease in an Endemic Setting: Problematic Use of Serologic Testing and Prophylactic Antibiotic Therapy

Context.— The use of serologic testing to diagnose Lyme disease (LD) is a source of controversy. Expert recommendations also discourage the routine use of antibiotic therapy for prophylaxis of LD following tick bites, but the extent to which physicians in endemic areas have adopted these recommendations is not known. Objective.— To assess the pattern of use of serologic testing and antibiotic therapy for tick bites and LD and associated charges for management in an endemic area. Design.— Active surveillance of patient-physician encounters for tick bites and LD. Setting.— Primary care practices on the Eastern Shore of Maryland. Patients.— Consecutive sample of 232 patients with tick bites, LD (defined by physician diagnosis in medical record), and suspected LD (physician notation of possible, but not definite LD) seen in 1995. Main Outcome Measures.— Serologic testing for LD, test results, antibiotic therapy, and direct costs of management. Results.— Surveillance identified 142 patients (61.2%) with diagnoses of tick bites, 40 patients (17.2%) with LD, and 50 patients (21.6%) with suspected LD. Of the 142 patients seen for tick bites, 95 (67%) underwent serologic testing for LD. Of these, 93 patients had initial negative or equivocal results; 24 (26%) of the 93 had convalescent testing, with 1 seroconversion. Seventy-eight patients (55%) with a diagnosis of tick bite received antibiotic therapy. No patients with tick bite developed clinical LD. Serologic testing for LD was performed for 36 patients (90%) with a diagnosis of LD and 46 patients (92%) with suspected LD. In most cases, antibiotics were prescribed before serologic test results became available. Convalescent testing was not performed for 37 (86%) of the 43 patients with suspected LD who had initial negative or equivocal results. Of these 37 patients, 25 (68%) did not receive antibiotic therapy. Direct charges for treatment of these 232 patients totaled $47595, one third of which was attributable to serologic testing. A total of 32% of direct charges were for patients with tick bites, 48% were for patients with LD, and 20% were for patients with suspected LD. Conclusions.— In this setting, most patients consulting physicians for tick bites received prophylactic antibiotic therapy of unproven efficacy and underwent unnecessary, costly serologic testing. Despite almost universal use in this study, serologic testing for LD did not appear to influence treatment of patients diagnosed as having LD.      

中国西部蜱类的分布及防制对策

蜱类是重要的医学媒介动物,传播多种人畜疾病,对畜牧业、野生动物和人类健康造成极大危害。本文分析了中国西部蜱类的分布,计有１１属９１种,占中国蜱类总数的８５．０４％;其中硬蜱科９属８５种,软蜱科２属６种。同时,对西部９省（自治区）的蜱种进行了分析。在此基础上,提出了蜱类防制的对策。     

莱姆病在我国的首次报告

1986年作者在黑龙江省林区观察到莱姆病162例,此病又名伯格多费里疏螺旋体病,系由硬蜱传播,可引起人体多器官病变,早期皮肤病变是慢性游走性红斑,以后可有头痛、颈项强直、面瘫等神经系统症状和心脏、关节损害。免疫学检查发现恢复期病人血清中有高度特异性抗体。对部分现症病人青霉素治疗取得明显疗效。本病例报告系莱姆病在我国的首次报告。     

某部驻区蜱类种群构成与密度调查

目的了解某部驻区蜱类的种群构成、密度与分布情况,为做好蜱媒传染病预防工作提供依据。方法采用人工布旗小时法进行蜱密度的调查,在部队营区内草丛中及部队驻地附近小道旁边的草丛和周围林区中人员经常涉足的地方进行调查,连续调查3 d;寄生蜱从当地居民饲养的羊和营区的军犬体表采集。将采集的蜱收集于含75%酒精的小瓶中带回实验室鉴定。结果所捕获的蜱均为长角血蜱,蜱密度为16只/布旗人工小时;捕获的497只蜱中寄生蜱449只、游离蜱48只,雌性210只、雄性287只,成虫478只、若虫19只,饱血状态117只、未饱血380只。在当地的12只羊体表采集到393只寄生蜱,平均每只羊体表寄生32.75只蜱;在营区中的2条军犬体表采到56只蜱。结论调查区域存在长角血蜱,且家畜和军犬体表寄生蜱较多;提出了开展蜱类调查时的注意事项。     

Study on 40 cases of rickettsia

Rickettsia is emerging in the subcontinent and clinically presents as non-specific febrile illness. At present there is no cheap & easily available diagnostic tool in our hand. Beside this, Weil-Felix test is becoming abandoned. So, high index of clinical suspicions is essential to diagnose rickettsia at early stage and to prevent mortality & morbidity. 40 cases were recorded among the admitted febrile patients in MMCH since 2003 to 2005. Cases were selected by clinical suspicions; exclusions of other common febrile illness & thereafter supported by lab. Investigations, specially by positive Weil-felix test. Cases were distributed through out the year but 19 (47.5%) cases were detected in March to May. 12 (30%) cases were found in August to October. The remaining 9 cases were detected in the rest 6 months. All (40) cases were presented with fever (100%), headache was present in 33 (82.5%) cases, rashes were present in 15 (37.5%) cases, isolated splenomegaly was found in 15 (37.5%) cases & hepatosplenomegaly in 12 (30%) cases, arthralgia in 13 (32.5%) cases, lymphadenopathy in 5 (12.5%) cases; 2 (5%) cases attended with unconsciousness & epistaxis in 1 (2.25%) case. Scrub typhus were 19 (47.5%), Indian tick typhus 16 (40%), 5 (12.5%) cases were with dual pathology and were associated with enteric fever. 15 (37.5%) cases were treated with tetracycline only. 20 (50%) cases with only doxyclycline & 5 (12.5%) cases with tetracycline and ceftriaxone as these cases were associated with enteric fever. All patients (100%) cured with treatment.     

Unexplained febrile illnesses after exposure to ticks. Infection with an Ehrlichia?

The Ehrlichia are tick-borne rickettsial organisms that cause disease in animals throughout the world but that have been previously recognized as human pathogens only in Asia. We have identified six patients with serological evidence of recent infection with an Ehrlichia: a fourfold or greater rise or fall in titer to Ehrlichia canis. All of the patients reported recent tick bites. Rigors, myalgia, headache, nausea, and anorexia were each reported by five patients. Fever was present in all patients and was accompanied by relative bradycardia and leukopenia in five patients, thrombocytopenia and abnormal liver function test results in four, and anemia in three. Five of the six patients were treated with tetracycline hydrochloride, and all recovered. Infection with Ehrlichia should be considered in patients with unexplained febrile illnesses after tick exposure.     

A typhus-like illness caused by acute HIV seroconversion

A patient is described in whom an acute human immunodeficiency virus seroconversion illness occurred following a trip to southern Africa. The presentation was strikingly similar to that of African tick typhus and could only be distinguished by serological testing.