恙虫病合并慢性血吸虫病发病特点及恙虫病的分型

目的了解恙虫病合并血吸虫病的发病特点以及恙虫病的分型情况。方法收集病例资料并对其进行分析,采用外斐反应和间接免疫荧光方法（IFA）检测患者血清中的恙虫病东方体（Ot）IgG抗体,用巢式PCR法扩增患者血液中的Ot 56kD蛋白基因,并进行核酸序列测定和分析。结果患者有血吸虫肝改变、肝功能受损、脾肿大、焦痂。外斐氏反应检测OXk 1：40,IFA检测Ot IgG抗体Kato型1：160、Karp型1：40,PCR检测Ot 56kD蛋白基因片断阳性,其序列分析结果与PG9、P25、CM438等一些泰国Ot株同源性最高（98%）,与Ot Karp、Gilliam、Kawasaki、TA678、Kato株同源性均在95%以下。结论证实了该患者为恙虫病合并慢性血吸虫病,其Ot血清型可能为Kato＋Karp,遗传进化关系与一些泰国Ot株关系较为密切。     

海南省680例不明原因发热患者恙虫病东方体感染调查

目的 了解海南省不明原因发热患者的恙虫病东方体检感染情况,为不明原因发热患者恙虫病防治提供指导。方法 收集2018—2021年海南医学院第一附属医院、海南医学院第二附属医院、海口市人民医院和琼中黎族苗族自治县人民医院临床诊断为不明原因发热患者血液样本,利用胶体金免疫层析法和PCR方法分别对样本进行恙虫病东方体特异性IgM、IgG抗体和恙虫病东方体56kD型特异性抗原基因检测,同时收集样本的临床及流行病学信息,并进行流行病学分析。结果 共收集临床不明原因发热患者血样680份,恙虫病东方体IgM、IgG抗体和56kD型特异性抗原PCR阳性率分别为23.97%(163/680)、36.62%(249/680)和20.88%(142/680),焦痂或皮疹率为12.06%(82/680)。根据诊断标准,最终诊断为恙虫病的患者为223例,其中男性111例（49.78%）,女性109例（48.88%）,平均年龄（53.14±15.12）岁,其中40～<60岁98例（占43.95%）,感染人群民族中汉族136例（占60.99%）,农民93例（41.70%）,秋季发病114例（51.12%）。临床...     

105例恙虫病疑似患者巢式PCR检测结果分析

目的对泰州市靖江105例恙虫病疑似患者全血进行恙虫病东方体(Ot)检测,分析该地区恙虫病感染情况,为恙虫病预防控制提供科学依据。方法采集靖江市2013年10~11月的105例恙虫病疑似患者全血样品进行巢式PCR检测,并进行个案调查,记录结果,用描述性分析方法对检测结果及个案资料进行分析。结果 105例疑似患者中62例检出恙虫病东方体核酸阳性(阳性率59.0%)。发病人群年龄以50~80岁为主,占69.4%,实验室诊断病例中农民占82.3%,男女性别之比1:1.7。结论靖江市恙虫病发病率较高,应针对流行特征采取综合防制措施。     

重症恙虫病延治致多器官功能衰竭1例

目的 报告临床确诊为重症恙虫病延误治疗致多器官功能衰竭病例1则,结合文献学习,以提高临床医生对重症恙虫病的认识。 方法 报告广州中医药大学第一附属医院1例重症恙虫病患者的临床及实验室检查结果并进行分析,结合文献学习,对重症恙虫病的诊治进行总结。 结果 患者,男,47岁,因反复胸闷半月,加重伴发热、意识障碍2 d入院,查体见全身红色斑丘疹、阴囊处一火山口焦痂,外周血宏基因组新一代测序(mNGS)提示恙虫病东方体。予多西环素抗感染、支持治疗等对症处理后,患者白细胞、中性粒细胞百分比等逐日升高、氧合指数持续下降、凝血功能障碍、心肝肾多器官功能衰竭,病情持续恶化,最终死亡。 结论 恙虫病的预后在于尽早诊治,合理施治。早期诊治,一般预后良好。恙虫病的延误诊治可加重患者的器官损害,增加患者死亡风险。     

Genotype identification of Orientia tsutsugamushi isolated from Nan Peng Lie Islands in China

目的：为确定我国南澎列岛是否为恙虫病疫源地,对来自该地的８个恙虫病东方体分离株进行基因鉴定。方法;应用套式聚合酶链反应（NPCR）和限制片段长度多态性分析（RFLP）,NPCR的引物来自恙虫病东方体５６kDa蛋白基因,NPCR阳性产物由HincII和PstI消化并产生特异性酶切图谱予以分析。结果;南澎列岛的8个恙虫病东方体分离株属三个型,即Karp,Kato和一新型恙虫病东方体。结论：南澎列岛是恙虫病疫源地。     

广东省硇州岛恙虫病疫源地的证实

目的 我国广东省硇洲岛位于粤西沿海隶属湛江市,为南亚热带气候,恙虫病发病率高,而国内并无该岛屿恙虫病疫源地特征的记载,本研究对该岛屿作为恙虫病疫源地进行全面的调查与研究.方法 疫源地流行病学调查,病原分离与基因检测,宏观预防措施的制定.结果 该地区为南亚热带岛屿型疫源地,主要宿主是褐家鼠,主要媒介为地里纤恙螨.从宿主与媒介分离到的恙虫病东方体经基因鉴定主要流行株为Karp株同时还存在Kato株.血清流行病学调查表明该岛居民恙虫病抗体20.6%阳性,部队人群阳性率2.86%.本研究确立了我国硇洲岛恙虫病疫源地类型,针对海岛特点制定了一套预防措施,全面落实预防措施后发病大大减少,尤其是确保了部队在野营、驻训期间没有病例.结论 我国广东省硇洲岛是恙虫病疫源地,外来人群尤其要做好防护.     

成人恙虫病心电图改变及其临床价值研究

目的 探讨成人恙虫病患者心电图异常情况及其临床价值。方法 回顾性分析233例成人恙虫病病例（恙虫病组）,选取同期220例健康体检者为对照组,对比两组心电图异常情况;收集心电图异常患者临床资料,分析心电图异常与器官损害的关系。结果 恙虫病组心电图异常的患者比例（56.7%,132/233）高于对照组（40.0%,88/220）（P<0.001）。恙虫病组异常心电图发生频率高于对照组的有窦性心动过速（15.5%,36/233）、胸和（或）肢体导联低电压（10.7%,25/233）、房性早搏（6.0%,14/233）、U波改变（2.6%,6/233）（P_均<0.05）。恙虫病组心律失常发生频率（38.2%,89/233）高于对照组（P<0.001）,但两组严重心律失常发生频率均很低且无统计学差异（P=0.659）。低电压患者发生胸膜炎或心脏增大者比例（68.0%,17/25）高于非低电压患者（41.8%,87/208）（P<0.05）,并发器官功能障碍综合征（MODS）比例（20.0%,5/25）亦高于非低电压患者（5.3%,11/208）（P<0.05）。结论 成人恙虫病心电图异常非常普遍,心律失常常见但严重心律失常罕见;低电压患者需注意胸膜或心脏病变,甚至MODS可能,需密切监护和积极治疗。     

2012～2013年广州市人感染恙虫病东方体基因型分析

目的了解广州市人感染恙虫病东方体基因型的分布及特点。方法收集2012~2013年广州市恙虫病临床诊断病人全血,测定型特异性抗原基因部分序列,并进行基因序列同源性及系统进化分析。结果 133份标本中检测到40份阳性,其中Karp型21株,Kato型10株,Gilliam型5株,TA763型3株,未知型别1株。同源性分析显示其传播来源可能与台湾、日本、泰国等有关。结论广州市恙虫病东方体流行型别具多样性,来源复杂,开展更多分子流行病学研究将有助于其防控。     

南澎列岛恙虫病立克次体血清流行病学调查研究

目的 为了解南澎列岛恙虫病立克次体疫源地情况。方法 本文利用免疫荧光法(IFA),检测了驻岛部队官兵和临时居住岛上的渔民等人群血清抗恙虫病立克次体IgG(抗—Rt.IgG)以及啮齿类动物和鸟畜类动物血清抗RtIgG。结果 岛上人群血清抗RtIgG阳性率为8.5％;鼠血清阳性率为64.8％;鸟畜类血清未检出阳性。被检出的抗恙虫病抗体血清型别有Karp型、Ka-to型和Gilliam型三型,以Karp型为主。生态调查表明,岛上啮齿动物种类以褐家鼠为主,其次是黄胸鼠、白腹鼠、社鼠和臭鼩鼱。褐家鼠的感染率最高,为63.3％。结论 南澎列岛驻岛人群和鼠类存在较高的恙虫病自然感染情况,褐家鼠为主要贮存宿主,在该地恙虫病传播中起重要作用。     

恙虫病东方体Karp株Sta56基因的克隆及序列比较的研究

目的 扩增恙虫病东方体Karp株主要表膜抗原Sta56的开放读码框(ORF)全长，并进行序列比较研究。方法 小鼠接种传代和体外细胞扩增分离恙虫病东方体Karp株，用PCR方法扩增恙虫病东方体Karp株Sta56基因，并采用TA克隆技术构建测序载体，对测序结果进行同源性分析比较。结果 扩增出Sta56的ORF全长，并TA克隆到测序载体pMD18—T vector，测序结果与Karp标准株的同源性为99．4％。结论 Sta56全长ORF克隆扩增成功，为进一步构建表达载体，进行Sta56蛋白表达研究提供基础。     

Molecular epidemic survey on co-prevalence of scrub typhus and marine typhus in Yuxi city, Yunnan province of China

Background Human rickettsioses are worldwide zoonoses and it is not easy to differentiate them from other infectious diseases because of their atypical manifestation. In recent years the number of patients with fever of unknown causes from Hongta District CDC, Yuxi city of Yunnan Province has been increasing significantly in the summer. Diagnosis of scrub typhus was made by local clinicians. In order to ascertain the disease, we undertook a laboratory investigation for such patients from August 18 to 26, 2005.Methods Active surveillance was conducted by Hongta District CDC Yuxi city of Yunnan Province from 2002 to 2004 and basic data were obtained from cases confirmed according to clinical definitions. Average incidences and town-level incidences were calculated during the study periods. Blood samples were analyzed by PCR and serological test. Based on the groEL gene sequences a paired general outer primers (Gro-1 and Gro-2) targeting typhus, spotted fever as well as scrub typhus and two paired inner primers (SF1, SR2 and TF1, TR2) for typhus together with spotted fever and scrub typhus, respectively, were designed to perform a multiplex-nested PCR. Serological assay was carried out by indirect immunofluorescence assay with 7 different rickettsial antigens, i.e., R.mossori, R.sibirica, R.conorii, O.tsutsugamushi, B.quintana, B.henselae and Coxilella burnetii phase II Ag.Results Epidemiological surveillance showed that from 2002 to 2004, the average incidences of the scrub typhus or scrub typhus with murine typhus were 222.1/10(5), 204.3/10(5) and 109.6/10(5), respectively. Of 13 blood samples taken during acute stage of illness, 6 showed the amplified products for scrub typhus and the sequenced products showed 100%, 99%, 99%, 99%, 99%, 99% similarity to O.tsutsugamushi Karp but they shared the same deduced amino acid sequences, which indicated 100% identity with the heat shock protein of the O.tsutsugamushi Karp strain. Five yielded PCR products for murine typhus and their corresponding nucleotide sequences exhibited 100%, 100%, 99%, 99% and 99% similarity to R. mossori Wilmington and the analyses of predicted amino acid sequences indicated 100%, 100%, 98%, 98% and 98% identity with the heat shock protein of R. mossori Wilmington strain. Of the 8 PCR positive patients, 3 showed a co-infection of scrub typhus with murine typhus. All the 13 serum samples from febrile patients were positive against O. tsutsugamushi and 8 of them were positive against R. mossori. All of the 8 paired specimens had four-fold elevation of antibody against O. tsutsugamushi, and seroconversion for typhus was demonstrated in 3 paired serum samples. Another finding in the study was that a high seropositive prevalence (76.9%) of Q fever was detected.Conclusion It’s confirmed that co-prevalence of scrub typhus with murine typhus are occurring in Yuxi city of Yunnan province, China. Other rickettsial diseases also need to be investigated in these areas.     

盐城市2006-2010年恙虫病流行病学研究

目的研究2006-2010年盐城市恙虫病流行病学及病原学特点,探讨防制对策。方法系统收集恙虫病疫情,检测病人血液中恙虫病东方体及进行相关分子生物学研究,开展人群及动物恙虫病血清流行病学调查。结果盐城市2006-2010年共报告399例恙虫病病例,各县(市)均有疫情发生。每年疫情始于10月,11月为高峰,终于12月。病人以中老年为主。从1例病人血液中分离出恙虫病东方体,经分子技术测定及目的基因同源性比较,基因型别属Kawasaki。15岁以上人群血清抗恙虫病东方体IgG阳性率为1.85%,牛的血清阳线率为3.40%。结论盐城市各县(市)均发现恙虫病疫源地,疫情将持续流行,病原体基因型别未发生变化。     

恙虫病东方体Karp株Sta22抗原基因原核表达载体的构建及鉴定

目的:构建恙虫病东方体Karp株Sta22抗原基因原核表达载体,为表达该基因奠定基础。方法:以恙虫病东方体Karp株基因组为模板,通过PCR方法扩增Sta22抗原基因,并将其克隆到表达载体pEASY-E2上,通过PCR方法及核苷酸测序进行鉴定。结果:所构建的原核表达载体携带Sta22基因,基因序列与GenBank上所公布的信息完全一致。结论:成功构建了Sta22抗原基因的原核表达载体,为研制和开发新型的恙虫病疫苗及临床诊断试剂奠定理论基础及物质保障。     

海南岛立克次体血清学和病原学调查报告

目的:调查海南岛立克次体的群别及其分布。方法:应用微量免疫荧光检测法(mIFA)对人群血清进行恙虫病、斑疹伤寒和斑点热3种立克次体IgM、IgC抗体检测。应用L929单层细胞进行立克次体分离培养。立克次体用特异性抗体进行mIFA鉴定。结果:恙虫病、斑疹伤寒和斑点热3种立克次体ISC抗体阳性率分别是13.55％(76/561),18.77％(101/538),30.83％(164/532)。其中IgM和IgC抗体均≥1:80者,斑疹伤寒为32.08％,斑点热为46.30％。立克次体分离培养结果,20份不明原因发热或疑似立克次体病患者血液标本分离出12株立克次体,免疫血清mIFA鉴定及聚合酶链反应(PCR)技术检测立克次体特异性DNA等方法鉴定出3株恙虫病立克次体、2株斑疹伤寒立克次体和7株斑点热群立克次体。结论:海南岛确有恙虫病、斑疹伤寒、斑点热病存在,该岛的中、西部感染率较高,南、北部较低。     

Scrub typhus--one case report

Scrub typhus (tsutsugamushi disease) is an acute infectious disease caused by Rickettsia tsutsugamushi transmitted through the bite of larvae of certain trombiculid mites. Geographical distribution in Asian-Pacific region is much of the roughly triangular area bounded by Japan, Pakistan and Australia. It is an endemic illness in the Pescadores Islands, but has scarcely been reported in central Taiwan. An eleven-year-old boy was admitted to Changhua Christian Hospital with the chief complaints of fever, lethargy and skin rash for seven days. On physical examination, he was found to have painless eschar, conjunctivitis, meningoencephalitis, pneumonitis, ascites, jaundice, hepatomegaly, liver function impairment and thrombocytopenia. His Proteus OX-K agglutinin titer increased from 1:160 in the acute sera to 1:640 in the convalescent sera. A greater than four-fold rise (greater than 1:640) in antibody titers to Karp, Gilliam, Kato strains of R. tsutsugamushi between acute and convalescent sera were demonstrated by immunofluorescent antibody. The patient was treated with minocycline and chloramphenicol and was completely recovered.