感染途径不明的恙虫病1例

1临床资料 患者，女，36岁。发热、头痛2d就诊。查体：体温39．5℃，急性病容，球结膜充血，咽部充血，扁桃体无肿大，浅表淋巴结无肿大，心率110次／min，律齐、各瓣膜无病理杂音，两肺呼吸音啰、无干湿音。腹软无压痛，肝脾肋下未触及。     

恙虫病的声像图表现

本文对45例恙虫病患者作超声检查，结果表明患者心脏、胸腔、肝、脾、肾及睾丸等脏器声像图均有异常改变，同时发现声像图恢复较临床表现消失缓慢。如并发心肌炎、肾炎，则临床预后较差。     

粤北山区域恙虫病自然疫源地的研究

目的 了解粤北山区域是否存在恙虫病自然疫源地. 方法 采用分子生物学诊断技术结合间接免疫荧光方法调查粤北山区发热人群、宿主动物感染状况;采用荧光定量PCR技术对粤北山区域恙虫病病人的标本检测Ot-Sta56kDa基因片段,对阳性标本进行基因分型和序列分析,并与巢式PCR检测结果相比较. 结果 在660份发热人群血清标本...     

山东南部再次发生恙虫病流行的调查

为了对肥城坡庄管区发生恙虫病临床病例而开展流行病学调查。采用微量补体结合试验方法检测患者血清、鼠血 ,同时解剖鼠取肝、脾、肾进行病原体分离试验。结果 :采集 18份病人血 ,阳性 15份 ,阳性率 83.33%。捕鼠 7只 ,其中褐家鼠 5只 ,黑线姬鼠、小家鼠各 1只。对 3只褐家鼠采血进行补体结合试验 ,阳性 1份。病原体分离试验仍在进行。结果 :确定了当地发生了一起恙虫病流行 ,当地存在恙虫病自然疫源地。     

Surveillance, recognition, and reporting of Tsutsugamushi disease (scrub typhus) and Japanese spotted fever by general practice clinics in Miyazaki Prefecture, determined by questionnaire survey in 2007

In June 2007, a questionnaire survey related to the surveillance, recognition, and reporting of Tsutsugamushi disease (TD) and Japanese spotted fever (JSF) — diseases considered endemic in Miyazaki Prefecture — was distributed to general practice clinics in the prefecture. The response rate was 40.9% (232/567). While 75.5% of the responding clinics knew TD to be a notifiable disease, only 41.8% knew JSF was notifiable. The recognition level of JSF surveillance was lower in the low-incidence areas of JSF within Miyazaki Prefecture. In 2006, 25 cases were clinically suspected as TD by the responding clinics; of the 25 cases, 9 were confirmed and 8 of these were reported to the National Epidemiological Surveillance of Infectious Diseases (NESID). Only 1 of 6 clinically suspected JSF cases from the responding clinics was confirmed in 2006, and it was not reported to NESID. The clinics located in the high-incidence areas for TD tended not to perform laboratory confirmation of the clinically suspected cases of either of the diseases. Considering that NESID requires laboratory confirmation of the reported cases of these diseases, their extent may be underestimated, especially in the high-incidence areas. For clinics in Miyazaki Prefecture, we need to publicize the existence of JSF surveillance and inform clinics about the laboratories available for confirmation of JSF and TD in the prefecture.     

沂蒙山区秋冬季型恙虫病236例临床资料综合分析

１９８６～１９８９年，每年秋冬季节，山东沂蒙山区有恙虫病发生，作者对２３６例恙虫病临床资料进行了分析。所有病例均发热３８℃～４１℃之间，皮疹１９９例（８４．３％），淋巴结肿大２０４例（８６．４％），出现溃疡或焦痂１６７例（７０．８％）。发热、皮疹、淋巴结肿大、溃疡或焦痂四种主要症状同时出现者１５０例（６３．６％）。半数病例白细胞增加，最高达１９．８×１０９／Ｌ，最低２．７８×１０９／Ｌ。１４份病人血液做酶标检测均阳性，最高滴度ＩｇＧ１:５１２０，ＩｇＭ１:２０４８０；１２份病人血液做免疫荧光阳性１１份；并从病人血液、黑线姬鼠，小盾纤恙螨分离出恙虫病立克次体，属Ｇｉｌｌｉａｍ血清型。     

Myocardial disease in inherited disease

To detect cardiac Fabry's disease, plasma alpha-galactosidase activity was measured in 230 male patients with left ventricular hypertrophy (LVH). Seven patients were diagnosed as having cardiac Fabry's disease. They did not have typical clinical manifestations of Fabry's disease. All seven had symmetric LVH. Endomyocardial biopsies revealed marked sarcoplasmic vacuolization in all five patients examined. Typical lysosomal inclusions with a concentric lamellar configuration were observed. Two novel mutations, A20P in exon 1 and M296I in exon 6, were detected in two patients, respectively. The remaining five had no mutations in the coding region for the alpha-galactosidase gene, and had marked decreases in the amount of alpha-galactosidase mRNA. Cardiac Fabry's disease should be considered as one of the cause of LVH.