组织胞浆菌病误诊黑热病1例

1临床资料 患者,男,17岁,20d前无明显诱因出现畏寒、发热,体温为40.0℃,血象示三系减少,可见"组织细胞".考虑恶性组织细胞病,来我院进一步明确诊断.查体:贫血貌,皮肤无黄疸和出血点,双侧颌下、颈部、腹股沟可以触及米粒至黄豆大小的淋巴结,无压痛,质中,肝肋下8 cm,脾肋下5 cm质中,无压痛.     

Deaths in visceral leishmaniasis (Kala-azar) during treatment

Twenty-seven out of five hundred and fifty three patients hospitalized for visceral leishmaniasis (Kala-azar) died during treatment with sodium antimony gluconate. Data from these patients were evaluated to find out the cause of death. Eight patients had associated diseases such as pulmonary tuberculosis (3), severe malnutrition (1), acute gastroenteritis (1), spleenic infarction (1), acute renal failure (1) and atrial septal defect (1) which could be attributed to death. Twelve patients developed spontaneous haemorrhages from nose, gums and gastrointestinal tract and died, despite of adequate supportive measures. Seven other patients who were improving slowly with antimony therapy died unexpectedly. Though, cause of death could be explained in some patients with associated disease conditions, it could not be explained in others as significant clinical manifestations, haematological, biochemical and electrocardiographic alterations were not evident prior to death. Our impression is that mortality in Kala-azar patients during standard antimonial therapy is more related to the drug rather than the disease process.     

Kala-azar (Visceral Leishmaniasis) from Khotang

Kala-azar is a chronic infection of reticuloendothelial system caused by flagellated protozoan, leishmania donovani injected into human host by the bite of the sand fly (phlebotomous) previously infected by biting and sucking the blood of a patient of leishmaniasis. It is characterized by irregular fever of long duration, large spleen and liver, anaemia, leucopenia and progressive emaciation. This article reports a case of a 10year old girl from Khotang, a nonendemic zone for Kala-azar, who presented with long history of abdominal distension for 11months, fever for 9months, cough for a week and weight loss. Clinical examination revealed pallor, enlarged liver and huge splenomegaly. Investigations confirmed the diagnosis of kala-azar by the presence of L.D bodies in bone marrow smear. The patient is being treated with i.v Amphotericin B in Infectious Disease Hospital, Teku. Key words: Abdominal distension, fever, pallor, splenomegaly, L.D bodies.     

Alteration of serum copper in Kala-azar patients during SAG therapy

We conducted an analytic case-control study in Kala-azar patients during Sodium Antimony Gluconate (SAG) therapy to assess the changes in serum copper. A total of 89 subjects were included in the study. Diagnosed patients of Kala-azar with parasitological evidence of Leishmania Donovani (LD) bodies in bone marrow, were selected as cases (n=54). They were selected from Medicine and Paediatric wards of Mymensingh Medical College Hospital, Mymensingh and nearby Fulbaria upazila of Mymensingh district. Physically healthy volunteers of similar age, sex and body mass index (BMI) as cases, were included in control group (n=35). The study period was from July 2003 to June 2004. SAG was given intramuscularly (20 mg/kg/day) to Kala-azar patients for 30 days. Blood samples were collected from controls, Kala-azar cases before therapy and same cases during 15-20 days of SAG therapy. Serum copper was higher in cases before therapy than those of controls (p<0.001). However, serum copper reduced significantly (p<0.001) during SAG therapy. So biochemical monitoring may be considered in the management of the disease.     

新疆巴楚垦区黑热病流行病学调查

本文报告了新疆巴楚垦区1975～1980年黑热病流行病学调查结果。患者多集中在夏河营及毛拉公社,人群利什曼素皮内试验阳性率分别为81.8％和33.6％。经过一个白蛉季节的婴儿皮内试验阳性率为7.31％。病人以婴幼儿为主,各病例间无任何流行病学联系。媒介昆虫为硕大白蛉吴氏亚种。鼠类和家犬不是主要保虫宿主,其它动物保虫宿主待查。根据流行病学特征,该地黑热病在分型上属于荒漠型。该垦区为黑热病自然疫源地。     

Diagnostic efficacy of Aldehyde test in late cases of Kala-azar

This case control study was carried out in the Paediatric wards of Mymensingh Medical College Hospital for a period of one year from April 2002 to March 2003 to determine the sensitivity, specificity and predictive values of Aldehyde test in the diagnosis of Kala-azar. A total of seventy five febrile cases of Kala-azar from Paediatric wards were enrolled in the study and Seventy five controls having splenomegaly with or without fever were also included from the same source. Aldehyde test was done in both cases and controls. Diagnosis of Kala-azar was confirmed by demonstration of Leish-man-Don-o-van body (LD) in bone marrow or splenic aspirates. Out of 75 parasitologically proven cases of Kala-azar, AT was positive in 56 cases. The sensitivity irrespective of duration of illness was 74.6%. We found sensitivity of AT increases with the duration of illness where AT was sensitive in 34.7% cases having fever for less than 3 months, 90.90% with fever for 3 months to less than 6 months and 100% with fever for 6 months or more in duration. Specificity of AT was calculated as 96% with positive and negative predictive values of 94.9% and 79.1% respectively. So AT is a very sensitive and specific test with high positive and negative predictive values. Considering the cost, availability, simplicity, sensitivity, and specificity we would recommend the Aldehyde test as an important diagnostic tool for field diagnosis of Kala-azar especially after three months of febrile illness.     

Family planning in Gujarat (1974-75).

Targets for family planning were exceeded in the Gujarat State of India in 1974-1975. The Gujarat experience is reviewed with the hope that others may use it as an example. Factors in the family planning recruitment success were: 1) advance planning taking local factors into account; 2) use of high financial incentives, with the money raised mostly through private sources; 3) recognition of effective recruiters; 4) use of various types of family planning camps; 5) support by local governments and voluntary organizations; 6) intensification of the pregnancy termination program; 7) combination of child innoculation prog rams with family planning services; 8) operational plans based on field experience; and 9) the interest and support of government officials.     

引入临床案例分析的黑热病教学实践

目的探讨将临床案例分析引入黑热病教学以提高人体寄生虫学的教学水平.方法从分析当前黑热病流行现状入手,建立病例库,融合应用PBL和多媒体教学方法,加强教师课堂教学实践,改革考核方法等.结果在黑热病教学活动中引入临床案例分析的PBL教学,增强了学生兴趣,取得了较好教学效果.调查结果显示,学生评价等级优(90~100分)、良(80~89分)、中(60~79分)、差(<60分)所占比例分别为89.3%,7.04%,3.0%,0.66%.学生对引入临床案例分析的黑热病教学实践课的教学质量评价总体较好.结论临床病例教学法可激发学生学习兴趣,提高学生临床综合分析能力,教学效果优于传统教学法.