2001年广西伤寒监测结果分析

目的 及时全面了解、掌握广西伤寒主要流行菌型变化动态和传染源。方法 在广西桂林市及其辖区7个县开展伤寒监测,对发热疑似病人进行病原学、血清学检测;并对密切接触者、病人病后带菌调查;水体及疫点环境调查。选取桂林市10家医院作为哨点医院。结果 2001年8个监测点发病数为2889例,占广西病例总数的52．28％,发病率为80.55／10万。哨点医院病原学监测．阳性率22．28％,甲型副伤寒沙门氏菌占95．34％,伤寒沙门氏菌仅占4．66％。监测点血培养阳性率15．64％,甲型副伤寒沙门氏菌占92．69％,伤寒沙门氏菌占7．31％。结论 我区目前流行的主要菌型以甲型副伤寒沙门氏菌为主,传染源仍广泛存在,防治形势不容乐观。加强监测和有效降低医疗费用,是管理、控制传染源的重要措施。     

云南省伤寒副伤寒空间分布特征及其气候影响因素研究

目的 分析云南省2001-2007年伤寒副伤寒发病的空间分布特征以及气象因素与伤寒副伤寒流行的关联性.方法 收集2001-2007年云南省以县为单位的伤寒副伤寒发病数据,应用空间聚类、面板数据模型等方法分析伤寒副伤寒的分布特征,以及伤寒副伤寒流行与气温、降水、相对湿度等气象因素的关系.结果 2001-2007年云南省伤寒副伤寒的年均发病率为23.11/10万,病例主要分布于夏秋季.空间聚类分析发现两个伤寒副伤寒的高发聚集区:玉溪地区(7年平均发病率207.45/10万)及该省与缅甸、老挝交界地区.多因素面板数据分析显示,云南省伤寒副伤寒发病增加与气温升高、降水量增多和湿度增加等气候因素相关:月平均气温升高10℃,IRR=1.30(95%CI:1.24～1136);湿度增加10%,IRR=1.07(95%CI:1.05～1.09);月降水量增多100 mm,IRR=1.02(95%CI:1.00～1.03);前1个月的气温升高10℃,IRR=1.73(95%CI:1.64～1.82);P＜0.05.结论 云南省伤寒副伤寒发病存在聚集区,相对湿度等气候因素在流行中发挥了一定的作用.

Abstract：

Objective To characterize the spatial distribution of typhoid and paratyphoid fever(TPF)in Yunnan province, China and to determine the effectiveness of meteorological factors on the epidemics of TPE Methods Data of reported TPF cases in Yunnan province(2001 -2007)from the China Information System for Diseases Control and Prevention was applied to GIS-based spatial analyses to detect their spatial distribution and clustering of TPF incidence at the county level.Panel data analysis was used to identify the relationships between the TPF incidence and meteorological factors including monthly average temperature, monthly cumulative precipitation and monthly average relative humidity. Results During the study period, the average incidence of TPF in Yunnan province was 23.11/100 000, with majority of the TPF cases emerged in summer and autumn. Although widely distributed, two TPF clusters were detected in Yunnan province based on the spatial analysis:one area around Yuxi city with the average annual incidence as 207.45/100 000 and another at the junctions of Yunnan province with Burma and Laos. Based on results from panel data analysis, the incidence of TFP was shown to be associated with meteorological factors such as temperature,precipitation, relative humidity and one month lag of temperature increase [10 ℃ increase in the monthly average temperature:IRR=1.30(95%CI: 1.24-1.36);10% increase in monthly average relative humidity:IRR= 1.07(95%CI: 1.05-1.09); 100 mm rise in monthly cumulative precipitation:IRR=1.02(95%CI: 1.00-1.03); and 10 ℃ average temperature increase, the last month: IRR=1.73(95%CI: 1.64-1.82)]. Conclusion Areas with high TPF incidence were detected in this study,which indicated the key areas for TPF control in Yunnan province. Meteorological factors such as temperature, precipitation and humidity played a role in the incidence of TPF.     

云南省伤寒副伤寒空间分布特征及其气候影响因素研究

Objective To characterize the spatial distribution of typhoid and paratyphoid fever(TPF)in Yunnan province, China and to determine the effectiveness of meteorological factors on the epidemics of TPE Methods Data of reported TPF cases in Yunnan province(2001 -2007)from the China Information System for Diseases Control and Prevention was applied to GIS-based spatial analyses to detect their spatial distribution and clustering of TPF incidence at the county level.Panel data analysis was used to identify the relationships between the TPF incidence and meteorological factors including monthly average temperature, monthly cumulative precipitation and monthly average relative humidity. Results During the study period, the average incidence of TPF in Yunnan province was 23.11/100 000, with majority of the TPF cases emerged in summer and autumn. Although widely distributed, two TPF clusters were detected in Yunnan province based on the spatial analysis:one area around Yuxi city with the average annual incidence as 207.45/100 000 and another at the junctions of Yunnan province with Burma and Laos. Based on results from panel data analysis, the incidence of TFP was shown to be associated with meteorological factors such as temperature,precipitation, relative humidity and one month lag of temperature increase [10 ℃ increase in the monthly average temperature:IRR=1.30(95%CI: 1.24-1.36);10% increase in monthly average relative humidity:IRR= 1.07(95%CI: 1.05-1.09); 100 mm rise in monthly cumulative precipitation:IRR=1.02(95%CI: 1.00-1.03); and 10 ℃ average temperature increase, the last month: IRR=1.73(95%CI: 1.64-1.82)]. Conclusion Areas with high TPF incidence were detected in this study,which indicated the key areas for TPF control in Yunnan province. Meteorological factors such as temperature, precipitation and humidity played a role in the incidence of TPF.     

超声对伤寒的腹部声像图特征价值的探讨

目的:探讨超声对伤寒的腹部超声特征的价值,证实腹部超声在伤寒诊断中的有效性。方法:对我院收治发热3天内疑似伤寒的239例患者进行腹部超声检查,并在7天、14天、21天对该病例进行随访观察。并对86例肥大试验及沙门氏菌培养阳性患者超声表现进行回顾性分析。结果:超声表现:脾大(73例,84.9%);肠管壁增厚(69例,80.2%);回盲部淋巴结肿大(72例,83.7%);阑尾肿大(32例,37.2%);肝肿大(26例,30.2%);胆囊炎症性改变(31例,36%)。结论:脾、肝肿大、回盲部肠壁增厚、肠系膜淋巴结肿大、胆囊改变和阑尾肿大是早期伤寒的特征性超声表现,超声对血清学检查可疑及培养阴性的伤寒病例的诊断具有很高的敏感性。     

台州地区伤寒副伤寒的流行状况及防控对策

目的 了解和掌握台州地区伤寒副伤寒流行病学和病原分子生物学特征,分析其流行因素,探讨防控对策.方法 对全市伤寒副伤寒疫情资料进行描述流行病学分析,结合实验研究对采取的防控措施进行科学评价.结果 台州市伤寒副伤寒疫情从2001年开始逐年抬升,发病率从2001年的22.83/10万上升到2004年的61.55/10万,2007年降到9.02/10万;优势病原菌由伤寒杆菌转变为甲型副伤寒杆菌,后者又以X2基因为主.发病季节提前,发病点多面广相对集中,临床表现极不典型,各年龄组均有发病,10～59岁之间的占报告病例总数的90.34%,男女发病之比为1.31∶1,以民工、农民、学生为主;饮用水污染和生食或半生食贝类食品为发病的主要危险因素.结论 针对流行病学和病原学病因采取综合性防控措施,推进饮用水安全卫生与改厕无害化建设、落实健康教育与健康促进等是控制伤寒副伤寒流行的根本性措施.     

上海地区1990～1999年儿童伤寒临床特点分析

目的　了解上海地区 2 0世纪 90年代儿童伤寒的特点。方法　回顾性分析 1990年 1月至 1999年 12月 2 5 1例临床确诊为伤寒的住院儿童的临床资料。结果　所有患儿均有发热 ,伴随消化道症状 136例(5 4 18% ) ,其次可伴呼吸道等症状 ,193例 (76 89% )患儿肝脏肿大 ,73例 (2 9 0 8% )肝脾均肿大。 10 9例(43 4 3% )患儿出现并发症 ,并发伤寒肝炎 6 1例 (5 5 96 % )、心肌炎 5 2例 (47 71% ) ,肠出血、肠穿孔很少见。白细胞在正常范围 198例 (78 88% ) ,嗜酸粒细胞绝对计数为零者 2 2 2例 (88 4 5 % )。药敏报告显示伤寒杆菌对氯霉素的耐药性明显下降 ,对氨基糖苷类抗生素几乎不耐药 ,而对氨苄青霉素尤其是复方新诺明耐药较多 ,几乎所有菌株对第 3代头孢菌素、氟喹诺酮类敏感。结论　上海地区儿童伤寒全年散发 ,夏秋季多发 ,6岁以上学龄儿童为主要患病人群。临床表现不典型且复杂。嗜酸性粒细胞为零仍是儿童伤寒的一个特点。治疗儿童伤寒以第3代头孢菌素、氟喹诺酮类药物疗效好。     

重组（人）白细胞介素2对伤寒Vi荚膜多糖菌苗的免疫佐剂效应的实验研究

采用改良溶血空斑试验和间接血球凝集试验研究了重组人白细胞介素２（ｒｈＩＬ－２）对伤寒Ｖｉ荚膜多糖菌苗（简称Ｖｉ菌苗）免疫小鼠的特异性抗Ｖｉ菌苗抗体应答的影响及其与免疫保护作用的关系。结果表明：ｒｈＩＬ－２能增强Ｖｉ菌苗免疫小鼠的特异性抗体应答，具有明显的佐剂效应；且特异性抗体的水平与用伤寒菌株（Ｔｙ２５００９８）攻击的小鼠的免疫保护力呈正相关关系。提示ｒｈＩＬ－２可用做Ｖｉ菌苗的免疫佐剂以提高接种人群抗伤寒感染的免疫保护力。     

Benigen cecal ulcer

Summary Benign cecal ulceration, generally presenting as a right lower abdominal mass or lower gastrointestinal bleeding in older patients, is often associated with typhoid fever, cytomegalovirus, and ingestion of nonsteroidal anti-inflammatory drugs. Diagnosis is generally made during surgery, but conservative treatment often leads to complete healing. In elective patients, repeated X-ray examinations of the colon, especially with air contrast barium enema and colonoscopy, are recommended to distinguish benign cecal ulceration from a malignancy.