人埃立克体病和无形体病的实验室诊断

人埃立克体病(ehrlichiosis)和无形体病(ana-plasmosis)均为人兽共患的新发传染病。病原体分别为埃立克体(ehrlichiae)和无形体(anaplasma),革兰染色阴性,专性细胞内寄生,可体外培养。主要经蜱叮咬传播。临床表现有发热、不适、头痛、肌痛等一般症状,常有白细胞、血小板减少和A     

一例人粒细胞无形体病的调查与处理

2009年5月,安徽省铜陵市报告发现了1例疑似人粒细胞无形体病。患者发病前是否被蜱叮咬史不详;具有高热、肌肉酸痛、腹股沟淋巴结肿大和周身不适,白细胞和血小板计数进行性下降,尿常规和肝功能异常等典型临床特点,急性期血清嗜吞噬细胞无形体IgG抗体阳性,恢复期血清IgG抗体为呈4倍抗体增高。该病例被确诊为人粒细胞无形体病,通过采取现场流行病调查、隔离治疗、个人防护、消毒等措施,患者得到救治且未出现二代感染与传播病例,疫情得到有效控制。     

3例人粒细胞无形体病的护理

报告了3例人粒细胞无形体病的护理.对3例人粒细胞无形体病患者积极进行病原治疗,密切观察生命体征变化,进行心理护理,同时采取有效的防护隔离.2例患者痊愈出院,1例因消化道大出血死亡,医务人员无感染发生.     

人粒细胞无形体病45例临床分析

目的分析人粒细胞无形体病的流行病学及临床特点。方法对45例人粒细胞无形体病患者进行流行病学调查和实验室检测,对临床表现进行记录分析。确诊患者应用多西环素联合喹诺酮类或头孢类抗生素进行治疗,并根据临床情况进行针对性治疗。结果24例患者经治疗临床痊愈出院;4例分别并发肺部曲霉菌、克雷白杆菌感染、大叶性肺炎,2例并发病毒感染,经积极抗感染等治疗后,临床痊愈出院;3例患者由于经济原因要求转当地治疗,后随访临床痊愈;2例并发肺部曲霉菌、结核杆菌双重感染,治疗症状明显改善,经随访现已治愈;2例合并多器官功能衰竭死亡;8例患者家属放弃治疗,后均死亡。结论人粒细胞无形体病是一类新发的传染疾病,可有多方面临床表现,易被误诊。但早就诊,早治疗,加强防护措施,可以得到有效控制。     

人粒细胞无形体病病人的护理

[目的]探讨人粒细胞无形体病的疾病特点与防治措施.[方法]对20例疑似人粒细胞无形体病病人进行调查,包括发病时间、地点、病情特点、治疗方法、护理与消毒隔离方法、疾病预后等.[结果]治愈12例(60%),好转3例(15%),死亡5例(25%).[结论]人粒细胞无形体病可防可治,加强对病人隔离管理及早期治疗,大多数病人症状可以很快改善并治愈.     

山东省沂源县人粒细胞无形体病现场流行病学调查

目的分析山东省沂源县人粒细胞无形体病发生的危险因素及感染途径。方法对2002-2006年报告的34例可疑人粒细胞无形体病病例进行个案调查,并进行描述性分析,对部分病例进行实验室检测。选择年龄相近、未患过人粒细胞无形体病、同性别、同村居民为对照组,进行1∶2配比的病例对照研究。结果通过单因素分析和非条件logistic回归分析:是否经常从事林间劳动（IOR/I=4.4901,95%ICI/I: 1.4348～14.0518,IP/I0.05）、每日平均劳动时间是否超过1 h （IOR/I=4.0408,95%ICI/I: 1.3083～12.4806,IP/I0.05）、居住院内是否有牲畜圈（IOR/I=3.3707,95%ICI/I: 1.2883～8.8191,IP/I0.05）为沂源县感染人粒细胞无形体病的暴露危险因素。结论根据病例临床资料、现场流行病学调查以及病例对照研究,与牲畜（尤其是羊）接触、林间劳动、接触草地等危险因素为该疾病可能的感染途径。对于人粒细胞无形体病有待于进行更加深入的调查和实验室研究。     

人粒细胞无形体病病人的护理

[目的]探讨人粒细胞无形体病的疾病特点与防治措施。[方法]对20例疑似人粒细胞无形体病病人进行调查,包括发病时间、地点、病情特点、治疗方法、护理与消毒隔离方法、疾病预后等。[结果]治愈12例（60％）,好转3例（15％）,死亡5例（25％）。[结论]人粒细胞无形体病可防可治,加强对病人隔离管理及早期治疗,大多数病人症状可以很快改善并治愈。     

人粒细胞无形体病误诊为流行性出血热

目的分析人粒细胞无形体病(human granulocytic anaplasmosis,HGA)的临床特点和误诊原因,加强对本病认识。方法 分析我院2010年7月收治的1例HGA临床资料。患者因发热、头痛、腰痛伴胸闷入院。查查白细胞、血小板减少。诊断为流行性出血热?给予丹参、左氧氟沙星等药物治疗,病情无好转且心、肝功能损害加重。结果患者于入院第5天突然抽搐、口鼻出血,血压90/60 mmHg。急查淋巴细胞0.52(异型淋巴细胞0.34),血小板73×109/L;酶学指标升高,凝血功能检查异常。入院第6天患者突然心搏停止,抢救无效死亡。采集血液标本经血清学检测证实为HGA。结论以发热伴白细胞、血小板减少和多脏器功能损伤为主要表现的病例,应考虑到HGA的可能,及时检测嗜粒细胞包涵体或抗体等,以避免误诊。     

中国首例埃立克体病病例报告

1引言埃立克体病（Ehrlichiosis）是由埃立克体（Ehrlichia）所致的一类人畜共患的自然疫源派性疾病。该病原体为专性细胞内寄生,周立克次体科、埃立克体属,但与立克欢体不同,埃立克体并非游离在白细胞的胞浆内,而是被包裹在胞浆的空泡中。目前国外已经报道的引起人类埃立克体病的病原体主要包括腺热埃立克体[1]、查菲埃立克体[2]、人粒细胞埃立克体［3］。腺热埃立克体主要存在日本、马来西亚等地;自1986年美国首先发现查菲埃立克体病以来,在美洲、欧洲、非洲国家相继有病例报遣,人粒细胞埃立克体病主要发生在美国。我国尚未见埃立…     

以疑似人粒细胞无形体病发病的肠病型T细胞淋巴瘤1例

报告1例以疑似人粒细胞无形体病发病的肠病型T细胞淋巴瘤患者的救治体会如下.1 病历简介1.1一般情况:患者女性,58岁,因发热、肝功能损害3d,入院3d前于传染病医院住院治疗.半天前无明显诱因出现便血约1000 ml,伴乏力、头晕、心慌、口渴、恶心,呕吐胃内容物,到外院给予止血、补液等治疗,病情无好转而入本院.既往有高血压病史2年,有阑尾切除、子宫切除、右膝关节置换病史.     

Survival of Ehrlichia chaffeensis in refrigerated, ADSOL-treated RBCs

BACKGROUND: The purpose of this study was to investigate the persistence of viable Ehrlichia chaffeensis in ADSOL-treated RBCs stored at 4 to 6 degrees C. STUDY DESIGN AND METHODS: The continuous monocytic cell lines THP-1 and DH82 were infected with E. chaffeensis (St. Vincent isolate). Packed RBC units were inoculated in separate experiments with E. chaffeensis-infected cells as final concentrations of 8.02 x 10(4) (DH82) and 1.43 x 10(4) (THP-1) infected cells per mL. Aliquots were stored at 4 to 6 degrees C for 1 to 42 days. At selected intervals, nucleated cells from the RBC aliquots were obtained by using a ficoll-isopaque separation procedure. Uninfected DH82 cell cultures were inoculated with the harvested nucleated cells or supernatant. The cell cultures were evaluated for infection by weekly examination of Wright's (Diff-Quik) stained cytocentrifuged slides. PCR amplification was also used to test the harvested nucleated cells or supernatant for the presence of E. chaffeensis DNA. RESULTS: In both types of infected cell lines, E. chaffeensis was reisolated in DH82 cells for as long as 11 days from the cellular fraction and for up to 5 days from the supernatant fraction. PCR results were positive throughout the 42-day testing period. CONCLUSION: Cell-associated E. chaffeensis remains viable in ADSOL-treated RBCs stored at 4 to 6 degrees C for at least 11 days. These data suggest that transfusion-acquired infection is possible. Successful reisolation was achieved from the supernatant fraction, which suggests that RBC products treated with a WBC-reduction procedure may still present a risk for transfusion transmission. No correlation between PCR positivity and viability of bacteria was noted.     

Current management of human granulocytic anaplasmosis,human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis

Anaplasma phagocytophilum, Ehrlichia chaffeensis and Ehrlichia ewingii are emerging tick-borne pathogens and are the causative agents of human granulocytic anaplasmosis, human monocytic ehrlichiosis and E. ewingii ehrlichiosis, respectively. Collectively, these are referred to as human ehrlichioses. These obligate intracellular bacterial pathogens of the family Anaplasmataceae are transmitted by Ixodes spp. or Amblyomma americanum ticks and infect peripherally circulating leukocytes to cause infections that range in clinical spectra from asymptomatic seroconversion to mild, severe or, in rare instances, fatal disease. This review describes: the ecology of each pathogen; the epidemiology, clinical signs and symptoms of the human diseases that each causes; the choice methods for diagnosing and treating human ehrlichioses; recommendations for patient management; and is concluded with suggestions for potential future research.     

浙江省羊体内无形体DNA的PCR检测及序列分析

目的了解浙江省羊自然感染无形体的情况。方法在浙江省采集100份羊血标本,应用巢式PCR对羊血标本进行嗜吞噬细胞无形体属16SrRNA基因扩增、测序,并将所测序列与GenBank中注册的基因序列进行相似性比较。结果检出46份阳性,总阳性率为46%,其中山羊的阳性率为48.9%（44/90）,绵羊的阳性率为20.0%（2/10）;测序后与GenBank中注册序列比对分析,41份山羊和2份绵羊血标本与牛无形体相同基因区接近,3份山羊血标本与嗜吞噬细胞无形体相同基因区接近;不同地区的羊均感染羊无形体,不同地区感染率差异有统计学意义（χ2=15.36,P〈0.01）。结论该地区家畜动物中存在较高的牛无形体的自然感染,且山羊为嗜吞噬细胞无形体储存宿主之一,该地区是人粒细胞无形体病的潜在疫源地。     

Evaluation of antibiotic susceptibilities of Ehrlichia canis, Ehrlichia chaffeensis, and Anaplasma phagocytophilum by real-time PCR

We determined MICs of antibiotics against Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Ehrlichia canis by real-time quantitative PCR. The doubling times of the organisms were established: 19 h for E. chaffeensis, 26 h for A. phagocytophilum, and 28 h for E. canis. In comparison to the reference method for determining sensitivities, which uses Diff-Quick staining, our PCR assay was very sensitive and specific. We confirmed that doxycycline and rifampin are highly active against these bacteria and found variable susceptibilities to fluoroquinolones; A. phagocytophilum was susceptible, but E. canis and E. chaffeensis were only partly susceptible. Beta-lactam compounds, cotrimoxazole, macrolide compounds, and telithromycin showed no activity against any of the three organisms. Thiamphenicol was found to be more active than chloramphenicol. For the first time, we showed that these three species have numerous point mutations in their 23S RNA genes, with those at positions 754, 2057, 2058, 2059, and 2611 (Escherichia coli numbering) known to confer resistance to macrolide compounds in other bacteria. The role of each of these mutations in resistance to these drugs should be investigated in the future. Our study confirms previous reports that quantitative PCR is a reliable method for determining antibiotic susceptibility; therefore, it might be useful for screening new drugs.     

A real-time combined polymerase chain reaction assay for the rapid detection and differentiation of Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Ehrlichia ewingii

A rapid real-time polymerase chain reaction (PCR) assay capable of the simultaneous detection and differentiation of Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Ehrlichia ewingii was developed using the LightCyclertrade mark instrument (Roche Applied Sciences, Indianapolis, IN). The assay targets the operon groEL of the heat shock protein. Base pair mismatches in amplified DNA in regions of detection probe hybridization allowed organism differentiation by melting curve analysis. The analytical sensitivity was at least 10 copies per reaction. DNA extracts from 59 specimens previously confirmed positive for A. phagocytophilum (n = 37), E. chaffeensis (n = 19), or E. ewingii (n = 3) were used to evaluate the assay. All of the specimens positive for 1 of the 3 organisms by conventional PCR were likewise positive by the LightCycler method. Sensitivity and specificity were at least 100% compared with conventional PCR. This assay provides a rapid method for the detection and differentiation of the causative agents of human ehrlichiosis in the United States.     

中国嗜吞噬细胞无形体及无形体病研究进展

无形体病是严重威胁人畜健康的新发蜱传人兽共患病。2006年,我国某医院发生无形体病院内感染事件,引起卫生部、临床及疾病监测组织的高度重视。2008年和2009年,卫生部先后下发文件要求认真做好无形体病的防治工作。本研究就近年我国无形体病的监测、临床防治及基础研究等作一综述。     

First detection and molecular identification of Anaplasma phagocytophilum in an introduced population of Reeve's muntjac (Muntiacus reevesi) in United Kingdom

In the present study, we investigated blood samples of 196 invasive Reeve's muntjac (Muntiacus reevesi) and 91 native roe deer (Capreolus capreolus) originating from the same area in Thetford Forest in Eastern England for the occurrence of blood pathogens such as Anaplasmatacae, Rickettsiales and Piroplasmida (Babesia spp., Theileria spp.) by using PCR. Babesia spp., Rickettsia spp. and Theileria spp. were not detected. Only two male (1%) Reeve's muntjacs and six (6.6%) roe deer were positive for Anaplasma phagocytophilum with 100% identity among their sequences. However, it is not clear whether Reeve's muntjac is less susceptible to infection, less susceptible to infestation by I. ricinus, or an infection in Reeve's muntjac is more lethal and therefore less positive animals are taken during hunting events.