鼠型斑疹伤寒流行现状及其影响因素

鼠型斑疹伤寒是由斑疹伤寒立克次体引起的一种威胁人类健康的自然疫源性传染病,其主要宿主动物和传播媒介分别是啮齿类动物和蚤类。鼠型斑疹伤寒呈全球性分布,但主要发生在热带、亚热带和温带地区。在国内,鼠型斑疹伤寒发生主要以散发形式存在,局部地区出现小型暴发,但各省（市、区）均有病例报告。随着生态旅游业的发展和原生环境的不断开发,人群与疾病宿主动物和传播媒介的接触机会增多,感染斑疹伤寒立克次体的风险和范围增加。为有效预防和控制鼠型斑疹伤寒的发生和流行,保护人群的生命健康安全,维护和促进旅游经济的稳定发展,本文对鼠型斑疹伤寒的流行现状进行了概述,并简要分析了生物因素、自然因素和社会环境因素对鼠型斑疹伤寒发生和流行的影响。     

A case of murine typhus in Queensland.

OBJECTIVE: To present a case of murine (endemic) typhus, the first to be reported within the last 30 years in Australia. CLINICAL FEATURES: A 17-year-old pregnant woman presented with a viral-like illness and later developed a spotted rash, fever and headache. INVESTIGATION AND OUTCOME: Sera taken on Day 7 and Day 30 of the illness showed seroconversion to Proteus OX19 (Weil-Felix) and to Rickettsia typhi (by immunofluorescence), indicating recent infection with Rickettsia of the typhus group. Her illness was clinically compatible with murine typhus. She responded well to erythromycin and delivered a normal infant at term. CONCLUSION: Infection with Rickettsia typhi (murine typhus) still occurs in Australia. It can be diagnosed by means of specific serological tests for rickettsial disease, which are superior to the non-specific Weil-Felix test.     

Surveillance of Scrub Typhus in the fringe areas around Pune : Potential for Transmission does exist

A field based epidemiological study was undertaken to assess the potential of transmission of scrub typhus in the sylvatic and transitional (fringe) areas at ten different locations around Pune. Parameters studied included rodent trapping and identification, entomological parameters, immunological studies on rodent sera, and rodent organ impression smears. The study revealed that Rattus r rufescence, Rattus meltada, Suncus murinus and Rattus blanfordi were the predominant sylvatic rodent species. All the species showed mild to moderate infestation with trombiculid mite larvae, with Rr rufescence and S murinus showing even higher levels of infestation. Pooled rodent sera showed mild rise of OX2 in 13.9%, OX19 in 5.6% and OXK in 9.8% of the pooled sera. The rise in titres was appreciable among rodents from Lonavala, Khadakvasla, Panchet, Singhgadh and Kondhwa areas. Based on the findings of the study, certain recommendations on prevention, surveillance and epidemic investigations of scrub typhus in the Armed Forces have been submitted.Key Words: Mite, Rodent, Scrub typhus, Weil-Felix     

A serological survey of rickettsial infections in the Gazelle Peninsula, East New Britain and a review of the literature

Of the various rickettsial diseases, only scrub typhus has been well documented in Papua New Guinea. A review of the historical literature confirms this. A serological survey was conducted on 113 antenatal patients presenting to a district hospital in Kokopo, East New Britain. Results suggested that a spotted fever rickettsial infection is common in this area with a seroprevalence of about 17% in young women. There was no evidence of scrub typhus or murine (endemic) typhus in the population sampled. Clinical implications of these findings are discussed.     

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.     

Scrub typhus as a possible aetiology of Guillain–Barré syndrome: two cases

Neurological complications of scrub typhus are reported to be rare. Peripheral nervous system involvement has been reported in only one case. We present two cases of Guillan–Barré syndrome (GBS) associated with scrub typhus. In both cases, the findings of an elevated indirect immunofluorescent antibody titer for Orientia tsutsugamushi and nerve conduction study showing sensory-motor polyneuropathy, have led us to believe that scrub typhus could be one of the antecedent illnesses associated with GBS.     

云南省齐氏姬鼠体表吸虱性比分析

目的对云南省捕获的1204只齐氏姬鼠体表采集的5323只吸虱进行性比分析。方法应用统计学方法卡方检验及单样本t检验,对数据进行整理。结果优势虱种为锯多板虱(Polyplax serrata)、相关甲胁虱(Hoplopleura affinis)和红姬甲胁虱(Hoplopleura akanezumi),雌/雄吸虱性比均大于1。有吸虱寄生的齐氏姬鼠588只,雌︰雄>1及只有雌虱寄生的齐氏姬鼠共412只,占有虱寄生齐氏姬鼠数量的70.07%。在不同生境齐氏姬鼠体表吸虱性比分布,均呈偏-雌分布。结论齐氏姬鼠体表吸虱性比偏雌分布,是一种普遍现象,其产生机制尚不清楚,有待研究。     

地方性斑疹伤寒早期诊断相关问题的探讨

目的 对地方性斑疹伤寒的临床资料进行分析和探讨,以提高该病早期诊断的水平。方法 搜集15年342例地方性斑疹伤寒住院患者的详细资料,并登记于标准化数据分类表中,以入院和出院作为研究的终末点。结果 342例地方性斑疹伤寒,男266例,女76例(男女比例3.5:1),年龄中位值28岁。;有鼠蚤媒介传播史者64例(18.7％);发病季节秋冬居多(202,59.1％);发热(342,100％)、头痛(331,96.8％)、咽充血(310,90.6％)、球结膜充血(231,67.5％)和皮疹(108,31.6％)为本病的主要症状和体征。258例(75.4％)并发脏器损害:肝脏98例(28.7％),血液系统68例(19.9％),呼吸系统56例(16.4％),心脏17例(5.0％),肾脏16(4.7％),神经系统3例(0.9％);入院时仅有66例(19.3％)首诊为斑疹伤寒。结论 地方性斑疹伤寒的误诊常与忽视流行病学调查、对其早期症状缺乏足够的认识以及缺乏早期实验室检查数据有关。地方性斑疹伤寒全年散发,发病季节后移,临床症状不典型,更趋向于多样化。因此,如何提高地方性斑疹伤寒的早期诊断,仍有待于进一步探讨。     

Clinical and epidemiological observations regarding the 1998 Kauai murine typhus outbreak

Five cases of murine typhus occurring on southwestern Kauai in 1998 are described, following an investigation by the Department of Health. Two cases also had concurrent leptospirosis. Recent habitat changes of peridomestic animals and their fleas may have increased the risk for developing murine typhus. Increased suspicion of typhus by island physicians and more aggressive rodent control activities are recommended.     

人工髋关节置换术后股骨假体周围骨折的治疗

目的总结人工髋关节置换术后股骨假体周围骨折治疗的经验和体会。方法自1996年2月至2004年12月收治人工髋关节置换术股骨假体周围骨折的病人11例，均行手术治疗，包括：单纯行钢丝捆扎的病人2例，普通接骨板固定3例．锁定加压接骨板固定4例．钛缆和接骨板组合应用2例．同时结合植骨3例．石膏外固定1例。结果术后随访6个月-3年．平均10．2个月．10例病人骨折获得骨性愈合．1例出现骨不连．单纯行骨折固定未行股骨柄翻修的病人Harris评分无明显影响，同时行翻修的病人Harris评分明显升高。结论全面术前计划，充分考虑病人骨量丢失，选择合适坚强的内固定，术中仔细操作。     

Murine typhus returns to New South Wales: a case of isolated meningoencephalitis with raised intracranial pressure

Murine typhus (MT) occurs worldwide, but, in Australia, is only regularly diagnosed in south-west Western Australia. Meningoencephalitis is an uncommon complication of MT, often accompanied by rash or systemic involvement. We report a case of MT presenting exclusively with meningoencephalitis, raised intracranial pressure, papilloedema and bilateral 6th cranial nerve palsies. MT should be considered in patients with "aseptic" meningitis or meningoencephalitis, even in the absence of other typical features of a typhus-like illness.     

32例恙虫病患者肾损害临床分析

目的：探讨恙虫病肾损害的临床特点。方法：从收治的１２８例恙虫病中选取有肾损害的３２例进行临床分析。结果：本组病例除具有恙虫病特征性的临床表现外,均有浮肿、尿少、尿蛋白、尿中红细胞,血压升高,ＵＮ及Ｃｒ升高等肾损害表现,发生率为４０％,使用特效抗菌药物及保肾治疗后,疗效满意。结论：加强对恙虫病肾损害的认识,可减少误诊误治。     

云南洱海周边地带社鼠体表寄生虫的群落组成

目的 社鼠是东洋界种,不仅一直被认为是农林业有害动物.而且被怀疑为滇西北鼠疫疫源地的鼠疫、恙虫病和流行性出血热(汉坦病毒)等病原体的储存宿主.为了了解洱海周边地带社鼠体表寄生虫的多样性,我们研究了89只社鼠体表寄生虫的群落组成.方法 选取云南洱海周边的不同地理方位作为野外抽样调查地点,用鼠笼加食饵诱捕小兽并检获其体表寄生虫.体表寄生虫在显微镜下鉴定寄生虫的种类.用染虫率和虫指数反映体表寄生虫的流行和密度状况,用统计分析中的非参数检验(Non.parametric Mann.Whitney U)分析雌雄小兽宿主间寄生虫数量差异.用Spearman相关分析(Spearman correlation analysis)体表寄生虫数量与宿主身体参数的关系.结果 捕获89只社鼠.其中70只社鼠侵染体表寄生虫,总侵染率为79%.采集到体表寄生虫51种,包括31种恙螨、13种革螨、4种蚤及3种吸虱.攸氏无前恙螨为优势恙螨种,占恙螨总数的66.23%;土尔克厉螨为优势革螨种,占革螨总数的38.48%;绒鼠怪蚤为优势蚤种,占蚤总数的42.86%;太平洋甲胁虱为优势吸虱种,占吸虱总数的80.07%.这51种体表寄生虫中,有11种被证明是人类疾病的主要媒介.U检验表明,体表寄生虫、恙螨、吸虱、蚤类和革螨的个体数量和物种数在雌雄宿主体表间的差异无统计学意义.spearman相关分析表明,体表寄生虫、恙螨、吸虱、蚤类和革螨的个体数量与宿主身体参数(体重)之间无相关性.结论 社鼠的体表寄生虫群落结构复杂,物种多样性高,其中有11种曾经报道与人类疾病有关.社鼠主要的体表寄生虫为吸虱、蚤类、革螨和恙螨,社鼠很可能成为鼠疫、流行性出血热和灌丛斑疹伤寒等病原体的贮存宿主.     

Scrub typhus mimicking the clinical course of infectious mononucleosis: a case report

Objective: Scrub typhus is a relatively common life-threating disease; its symptoms are non-specific and similar to those of other viral infections. Therefore, scrub typhus might be underdiagnosed.Patient: Herein, we report a patient with scrub typhus whose clinical course mimicked that of infectious mononucleosis. A 63-year-old male patient with hypertension presented to our hospital complaining of symptoms including prolonged fever, pharyngeal discomfort, and a mild headache. He showed the appearance of a rash after amoxicillin administration. At the same time, he did not show a crusted rash on his body surface.Results: After a comprehensive examination, Epstein-Barr virus and cytomegalovirus infections were ruled out. We suspected that this patient suffered from scrub typhus on the basis of his usual lifestyle. Finally, polymerase chain reaction analysis showed a positive result for deoxyribonucleic acid of Orientia tsutsugamushi in his blood sample. Fortunately, he recovered naturally with only supportive treatment during his hospitalization.Conclusion: We should observe and monitor patients with infectious mononucleosis-like symptoms and emphasize the importance of a clinical interview.     

开放性胫腓骨骨折的急诊处置(附122例分析)

目的　探讨胫腓骨开放性骨折的急诊处置及固定方式对创面感染的影响。方法　对 12 2例 12 5侧胫腓骨开放性骨折患者的受伤首诊时间、骨折损伤程度、骨折固定方式与术后创面感染之间的关系进行回顾性分析。结果　不同的受伤就诊时间与术后创面感染率差异有高度显著性 (P <0 .0 1) ;不同骨折损伤程度的术后创面感染率差异有高度显著性 (P <0 .0 1) ;不同骨折固定方式与术后创面感染率差异也有高度显著性 (P <0 .0 1)。结论　骨折损伤程度、受伤首诊时间、骨折固定方式对创面感染有重要的影响。提高开放性胫腓骨骨折治疗优良率的关键在于采取正确急诊处置方式。     

TRENCH FEVER A RESUME OF LITERATURE AND A NOTE ON SOME OBSCUP\E PHASES OF THE DISEASE

Although trench tever is now known to be almost worldwide in distribution, it usually exists unrecognized in louse-infested cornm.uni- ties in peace time, and the disease may flare up in epiclemic form in wartime. Inasmuch as phy- sicians are generally unfamiliar with trench fever, the literature on the history, geographic distribution, symptomatology, pathology, etio- logy, immunity, diagnosis, epidemiology, pre- vention and treatment of the diseas.e iS briefly reviewed. Certain obscure phases of trench fe- ver are noted and lines for further studies of the disease suggested. The question is enterta.in- ed whether R rocha-lima, a rickettsia of hitherto undefined status., may represent a variant of R prowazeki acquired by lice feeding on typhus oonvalescent,s living under nat.urall conditions and an intermedia.te stage in the transformation of R prowazeki in the direction of R quintana.     

临沧城区地方性斑疹伤寒的调查研究

采用补体结合试验对临沧城区健康人群、各种病人、鼠血清进行了检测；同时对鼠、蚤标本进行了病原学检查。结果：阳性率分别为５５％、６６１５％、６６２％；４６６％。病原体分离鉴定证明该病原微生物属莫氏立克次体。提示城区有相当数量人群感染过本病，鼠间有明显流行，主要传播媒介是印鼠客蚤     

南宁市职业人群布鲁菌感染状况调查

目的了解南宁市职业人群布鲁菌感染状况,为开展科学防治工作提供依据。方法采用试管凝集试验对南宁市南、北2大奶场的饲养员、挤奶工和农贸市场的生畜肉的销售员进行3年的布鲁菌抗体血清学跟踪检测。结果636人份血清中检出阳性37份,阳性率为5．81％,南边奶场和农贸市场畜肉类销售员均为阴性。阳性感染者集中在北边奶场。且数量呈逐年递增趋势。检测和回访中发现阳性感染者血清抗体滴度以1：100～200者占97．30％（36／37）,达到1：400仅1份,感染者未见有临床症状或有不适。结论本市职业人群布鲁菌感染者的抗体阳性滴度不高,几乎均无临床症状。控制家畜布鲁菌病的流行是降低人群布鲁菌感染率的关键,同时应继续关注并跟踪隐性感染者的健康状况。     

恙虫病并发多器官损害32例临床分析

目的:探讨恙虫病并发多器官损害的临床表现及治疗转归,提高临床诊治水平。方法:回顾性分析收治的32例恙虫病并发多器官损害患者的临床资料,对临床诊断和治疗进行分析。结果:32例患者经上述治疗后病情均好转,29例患者用药后24 h内体温恢复正常,其余3例患者用药后48 h内体温恢复正常;32例患者住院时间4～15 d,平均8.7 d;所有患者均临床治愈出院。对所有患者进行为期6个月的随访观察,除3例患者遗留轻微胃肠道反应外,无其他并发症发生。结论:恙虫病并发多器官损害临床表现多样,临床诊治需及时,该病预后良好。     

海南省琼中黎族苗族自治县2019年恙虫病东方体分子流行病学及遗传进化分析

目的 通过分析海南省琼中黎族苗族自治县（简称“琼中”）98例不明原因发热患者的恙虫病流行特点,了解该地区恙虫病东方体菌株流行的情况,为该地区制定恙虫病防治策略和控制措施提供科学依据。方法 收集2019年 1月1日至2019年12月31日琼中黎族苗族自治县人民医院诊断为疑似恙虫病和不明原因发热患者血液样本,利用胶体金免疫层析法和巢式PCR方法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,同时使用预先设计的样本信息表收集患者的临床表现及流行病学信息。针对巢式PCR检测结果为阳性的样本,进行克隆及Sanger测序。对获得的患者临床信息及检测结果进行流行病学分析,将测序得到的序列进行基因遗传进化分析。结果 98例样本中,恙虫病IgM抗体阳性率为24.49%（24/98）,恙虫病IgG抗体阳性率为46.94%（46/98）,恙虫病PCR阳性率26.53%（26/98）,焦痂或皮疹13.27%（13/98）。根据诊断标准,最终诊断为恙虫病的患者为33例。感染人群主要以31~50岁的青壮年为主,职业主要为农民。该地区恙虫病的流行以营根镇、长征镇和红毛镇为主并涉及9个乡镇。流行时间有明细的季节性,以7月和11月为主要高发期。流行的基因型主要为Karp型和Gilliam型。结论 琼中为恙虫病的自然疫源地,该地区流行的恙虫病东方体基因型主要为Karp和Gilliam型,具有基因多态性。