致命性黄疸出血型钩端螺旋体病1例

<正>钩端螺旋体病是一种由钩端螺旋体的细菌感染引起的人畜共患疾病。钩端螺旋体病每年有超过100万例病例,是全世界发病率和死亡率最高的人畜共患疾病[1]。尽管进行了积极的治疗和精心的护理,严重钩端螺旋体病的死亡率超过10%[2]。钩端螺旋体病的诊断依赖于血清学检查,早期钩端螺旋体病的临床表现是非特异性的。我们报告一例由黄疸出血型钩端螺旋体引起的休克和严重呼吸衰竭的病例,经气管插管、有创机械通气、抗感染等治疗后,病情好转出院。     

钩端螺旋体病后发脑动脉炎55例分析

1986～1990年,山东省各地医院介绍来我站要求确诊钩端螺旋体病(简称钩体病)后发脑动脉炎(即脑血管钩端螺旋体病)的病人共384例,确诊者55例(占14.3%),现报道如下。一、诊断标准(一) 病人来自钩体病疫区,或有疫水等接触史。(二) 临床表现符合脑血管病变特点,并可排除其他原因引起的病变。(三) 脑血管造影或CT检查有脑动脉     

钩端螺旋体病的早期临床诊断标准探讨一附142例临床分析

钩端螺旋体病（Leptospirosis以下简称钩体病）是农村夏秋季节常见发热性急性传染病，其预后与能否早期诊断有着密切的关系，近年来钩体病的症状体征多不典型，现行的对钩体病的确诊仍有赖于对钩体的培养分离和血清学试验，但费时日，新的钩体DNA检测在一般医院特别是基层医院开展甚少。现就142例住院资料完整的病人作回顾性临床分析，从中找出钩体病的早期临床诊断要点，供参考。     

886例钩端螺旋体病临床分析

８８６例钩端螺旋体病临床分析廖如桂钩端螺旋体病（钩体病）在我县流行始发现于１９６６年的夏天，此后的多年很少发病，１９８５年以来又在我县散发流行，有的村或邻近几个自然村暴发流行。本文总结１９８５年至１９９４年我院住院部收治有病历资料的８８６例，现将临床...     

症状性癫痫患者中脑囊虫病血清学调查研究

症状性癫痫患者中脑囊虫病血清学调查研究安桂珍，顾炳余，米金洪（天津医科大学（天津，３０００７０）天津卫生职工医学院天津静海县医院）脑囊虫病是引起症状性癫痫的常见病因之一。Ａｈｕｊａ（１９８２）报告２９０例迟发性癫痫患者中，脑囊虫病有１３例，占５．１％...     

肺出血型钩端螺旋体病113例X线诊断体会

肺出血型钩端螺旋体病是由钩端螺旋体毒素所致的广泛末梢血管变性,本病起病急,病情重,发展迅速,如不及时治疗常危及患者生命.1989年1月～2008年1月,我院收治肺出血型钩端螺旋体病患者113例,均经X线检查确诊.现报告如下.     

健康人群血清钩端螺旋体抗体调查

钩端螺旋体病（Leptospirosis，简称钩体病），是由致病性钩端螺旋体（Leptospira interrogans，简称钩体）引起的一种分布广泛的自然疫源性疾病，我国是受钩体病危害十分严重的国家。1937年汤择光首次报告3例钩端螺旋体病，1955年本病被列入法定传染病，迄今全国累计发病人数已超过250万。平均病死率约为1％。近年来我校面向全国十几个省市自治区招生，我们曾对本省籍在校学生钩端螺旋体感染情况进行过研究，为了解来自其他省市自治区学生钩端螺旋体感染状况，我们又对本校2003、2004级外省籍学生进行了血清钩端螺旋体抗体检测。     

钩端螺旋体病脑膜脑炎型164例误诊分析

钩端螺旋体病脑膜脑炎型１６４例误诊分析邓文余，吴秀端钩端螺旋体病脑膜脑炎型（钩脑）在国内多见于福建省。我院１９６５～１９９５年的３０年间，共收治钩脑３３６例，以福州市及闽侯县的沿江乡镇发病数居多，其临床表现复杂，被误诊１６４例，误诊率高达４８．８％，...     

螺旋体传染病

flaB—PCR在钩端螺旋体病检测中应用，钩端螺旋体致病机制的研究进展（综述），钩端螺旋体病26例临床分析，钩端螺旋体疫苗的过去、现在和未来，     

犬钩端螺旋体病3例报告

目的探究钩端螺旋体病的发病规律和诊疗方法。方法对2015年8月至11月在中国农业大学动物医院确诊的3只钩端螺旋体病犬的发病和诊疗情况进行回顾分析。结果病犬均出现精神沉郁、黄疸、厌食和呕吐等症状,其中2例有体温升高病史,并且在发病前接触过外界水源。实验室检查3只病犬均存在肝肾损伤和贫血。依据尿液PCR检测结果为阳性确诊病犬患钩端螺旋体病。在诊疗过程中3只病犬有1只死亡,其余2只经抗菌素和对症治疗后康复。结论犬感染钩端螺旋体和接触疫水相关,尿液PCR检测可作为该病的确诊方法,治疗上推荐使用青霉素和多西环素等四环素类药物。     

临床标体中钩端螺旋体及其L型的检测与鉴定

目的　为探讨钩体 Ｌ 型在钩体病患者体内是否存在及是否具有致病作用。方法　对患者血、 Ｃ Ｓ Ｆ 进行 Ｍ Ａ Ｔ；对患者血、 Ｃ Ｓ Ｆ 及尿液进行钩体及其 Ｌ 型培养； 对培养出的钩体 Ｌ 型进行免疫酶染色、免疫荧光染色、 Ｓ Ｄ Ｓ－ Ｐ Ａ Ｇ Ｅ、 Ｄ Ｉ Ｂ Ａ及电镜等方法鉴定。结果　 Ｍ Ａ Ｔ 阳性率为１９１７ ％ （６０３１３） ； 钩体普通培养阳性率１１８８ ％ （４１３４５） ； 钩体 Ｌ 型阳性率２４９３ ％ （８６３４５） 。培养出的 Ｌ 型经上述方法鉴定为钩体 Ｌ 型。结论　钩体 Ｌ 型培养应与 Ｍ Ａ Ｔ 及钩体普通培养同时进行，以防漏诊。     

山东省猪带绦虫病和囊尾蚴病流行病学调查

目的　调查山东省猪带绦虫病和囊尾蚴病流行现状。　方法　采用现场访问、粪便检查及血清学检测等方法对猪带绦虫病和囊尾蚴病人群的感染流行状况、猪囊尾蚴感染情况及有关流行因素进行调查分析。　结果　全省人群猪带绦虫病和囊尾蚴病平均患病率分别为 0 .0 4 8%和 0 .0 5 7% ,抗囊尾蚴特异性 Ig G4 抗体阳性率平均为 1.91%。各地区流行程度不同 ,性别及城乡人群患病率均无显著性差异。流行因素调查结果表明 ,居民普遍存在不卫生习惯 ,如 :切菜刀、板生熟不分 ,饭前便后不洗手等。“连茅圈”养猪占 92 .3% ,粪便管理及生活环境卫生均较差。囊尾蚴病猪检出率平均为 0 .0 6 % ,囊尾蚴抗体阳性率平均为 1.99%。　结论　山东省绦虫病和囊尾蚴病患病率呈下降趋势 ,但流行范围扩大 ,各地区流行程度不同 ,各种流行因素远未得到控制     

应用斑点酶联免疫结合试验检测弓形体血清抗体

以弓形体可溶性抗原进行斑点免疫结合试验(Dot-Immunobinding Assay,DIA),检测16份弓形体病人血清,结果全部阳性。检查山东省精神病院精神病人血清417份,阳性率为4.32％。此法与囊虫病、旋毛虫病、血吸虫病等均无交叉反应,表明对弓形体有较高的特异性。在同一批血样中,此法检出的阳性结果比常规ELISA和IHA均高,初步证实了DIA优于常规ELISA和IHA,具有简、快、敏、特等优点。     

Musculocutaneous and visceral cysticercosis: a rare disease?]

The aims of the present study were to measure the frequency of cutaneous, muscular and visceral forms of cysticercosis in anatomopathological examinations and necropsies in the Federal District and to study the clinical aspects of this disease. In 64.911 protocols of anatomopathological examinations reviewed, 30 (0.05%) had the diagnosis of cysticercosis, 90% had cysticerci in the subcutaneous tissue, skeletal muscle or mucous membrane, 3.3% in lymph node and 6.7% in the central nervous system. Two (7.4%) patients had cysticerci in the tongue. In 1520 autopsies protocols reviewed, 25 (1.6%) autopsies with cysticercosis were found. 96% had cysticerci in the central nervous system, 8% in the heart, 8% in the skeletal muscle and 4% in the liver, either isolated or associated with cysticerci in other viscera. 1122 people were also examined. Indirect immunofluorescence and ELISA were the serological tests used in all patients for the diagnosis of cysticercosis. The radiological investigation of the skull and soft tissues was also performed. 59 (5.3%) patients had both serological tests positive (10 had also biopsies with the diagnosis of cysticercosis). The muscular form was found in 42.4%, subcutaneous cysts were present in 20.3% and the visceral form was found in 3.4% of cases. In patients with visceral cysticercosis, the cysts were localized in the heart, pleura, kidney and ovary. Calcifications in the skull and/or soft tissues were demonstrated radiologically in 32 (2.8%) patients with negative serological tests for cysticercosis. The present study suggests a high frequency of subcutaneous and muscular forms of cysticercosis in the Federal District. The visceral form of the disease is also found in various organs, without clinical manifestations of importance.     

非典型脑囊尾蚴病的诊断研究

目的 分析非典型脑囊尾蚴病患者血清免疫学检查和脑CT影像学检查特点,为该病诊断提供参考。方法 以446例疑似脑囊尾蚴病患者作为研究对象,所有患者均给予吡喹酮实验性治疗,根据治疗效果及脑CT 或MRI复查结果确诊非典型脑囊尾蚴病。同时,采用间接ELISA 法检测患者血清和脑脊液抗囊尾蚴特异性IgG抗体,采用McAb?ELISA法检测患者血清和脑脊液抗囊尾蚴特异性IgG4抗体,采用PEG?ELISA法测定囊尾蚴循环抗原（CAg）,并进行间接血凝试验（IHA）及脑CT检查。计算上述免疫学检测及脑CT检查的检测效能。结果 446例疑似脑囊尾蚴病患者经吡喹酮实验性治疗后,315例临床症状显著好转,被确诊为非典型脑囊尾蚴病。血清特异IgG、IgG4抗体及囊尾蚴CAg检测阳性率分别为15.47%、15.02%、11.21%, IHA试验阳性率为28.47%,差异有统计学意义（[χ2] ＝ 52.45,P＜0.01）。脑CT检查有疑似囊尾蚴病灶者353例,占79.14%。ELISA、McAb?ELISA、PEG?ELISA、IHA和脑CT诊断非典型脑囊尾蚴病的灵敏度为15.36%～96.82%,特异度为63.36%～99.24%,阳性预测值为86.40%～98.52%,阴性预测值为32.83%～98.25%,阳性似然比为2.64～27.86,阴性似然比为0.05～0.81,OR值7.16～52.80;5项检查合并后其OR值为108.00,较CT检查的OR值提高1倍。结论 非典型脑囊尾蚴病主要通过评价实验性抗囊尾蚴治疗效果而确诊,血清免疫学检测及脑CT检查亦具有重要参考价值。     

Neurocysticercosis in Spain. Apropos 4 cases seen in immigrant patients from endemic countries

Neurocysticercosis is a helminthiasis of the central nervous system produced by the encysted larvae of the pork tapeworm Taenia solium. We report 4 cases of neurocysticercosis observed in immigrants from endemic areas (India and Latin America). Three of the patients were diagnosed because of new onset of seizures, all of the no received anthelmintic therapy with favourable outcome. The fourth case was a form known as racemose cysticercosis. She was admitted because of CNS sensorial symptoms with later development of severe intracranial hypertension that required surgical treatment. All the cases had a positive result in the ELISA test for cysticercosis. In only one patient chronic epilepsy persisted thus needing long-term anticonvulsant therapy as a sequelae. Our report helps to familiarize clinicians with the characteristic radiological findings from cysticercosis and em s the fact that epidemiological suspicion and serological data are usually enough to get the diagnosis and avoid unnecessary probes.     

Taenia solium taeniasis and cysticercosis in three communities in north Vietnam

OBJECTIVES: (1) To investigate the response to a serum antigen-detecting ELISA for cysticercosis and a stool coproantigen test for taeniasis in two rural communities (mountainous and coastal areas) and one group of (peri-)urban factory workers; and (2) to examine clinical features of human cysticercosis in northern Vietnam. METHODS: Villagers and factory workers and their families were informed and invited to participate in the study. Blood and faecal samples were collected from the participants and a simple questionnaire on taeniasis/cysticercosis completed. Serum was examined for the presence of circulating cysticercus antigen by a monoclonal-based sandwich ELISA. Ag-ELISA positive persons underwent a clinical examination and a computed tomography (CT) scan. Stool samples were examined microscopically for the presence of Taenia eggs and for copro-antigens. Tapeworms were identified following therapeutic expulsion using morphology and PCR-RFLP. RESULTS: Circulating cysticercus antigens, suggesting active infection, were detected in 5.3% (16/303), 0.6% (1/175) and 0.0% (0/229) of the sampled individuals from the mountainous, coastal and urban regions, respectively. Clinical examination and CT scan of the cysticercus antigen positive persons showed that active cysticercosis did not cause severe disease in most cases. Taenia copro-antigens were found in 0.3% (1/297), 1.8% (3/166) and 0.0% (0/228) of the stool samples from the mountainous, coastal and urban communities, respectively. Three tapeworms were expelled after treatment: two Taenia solium and one Taenia saginata. CONCLUSION: This survey points to a focal distribution of taeniasis/cysticercosis and suggests that human cysticercosis is rather acquired due to close contact with a T. solium carrier and self-infection, than through infection from the environment.     

钩端螺旋体L型感染与钩端螺旋体脑动脉炎的关系

目的　探讨钩端螺旋体 Ｌ型感染与钩体脑动脉炎发病的可能关系。方法　对７４ 例钩体脑动脉炎患者血液及脑脊液进行钩端螺旋体普通培养、 Ｌ 型培养， 患者血清做显微镜凝集试验， 用免疫荧光染色确定钩体 Ｌ 型及其原菌型。结果　钩体脑动脉炎患者钩体 Ｌ型培养、普通培养、钩体 Ｍ Ａ Ｔ的阳性率分别为： ４７３ ％ 、１８９ ％ 、７０３ ％ 。分离出的钩体 Ｌ 型呈多形性。结论　钩端螺旋体 Ｌ 型感染与钩体脑动脉炎的发病关系密切。     

聚合酶链反应检测弓形虫的实验研究

目的建立敏感、特异、稳定的聚合酶链反应（ＰＣＲ）法,以检测弓形虫感染。方法建立ＰＣＲ法,确定最佳扩增条件;用ＰＣＲ法检测实验感染家兔血液中ＤＮＡ的动态变化,并与ＥＬＩＳＡ法检测ＣＡｇ进行比较。结果兔感染弓形虫后第２ｄ,ＰＣＲ开始出现阳性,阳性率为７６．９％（１０／１３）,总检出率达１００％。与ＥＬＩＳＡ法查ＣＡｇ进行平行检测,前者出现阳性时间早,且阳性率明显高于后者。该法敏感性高,可检测到１０ｆｇＤＮＡ含量;特异性强,对其它９种寄生虫和微生物ＤＮＡ均无交叉现象;稳定性好,对阳、阴性同一样品重复５次,结果一致。结论提示本法可用于临床诊断,在一定范围内替代病原学和免疫学检测。