10例人粒细胞无形体病暴发流行报告

目的 总结我国发现的人粒细胞无形体病(HGA)暴发流行的临床特点,为HGA的防治积累临床经验.方法 对2006年11月发生在皖南医学院弋矶山医院的10例HGA患者的流行病学特点、临床特征及诊治经验进行回顾性分析.结果 10例HGA患者中,除首例发病前有蜱叮咬史外,余9例均有与首发病例密切接触史.潜伏期为6～13 d.除畏寒、发热、头痛,全身酸痛外,多数患者有相对缓脉、表情淡漠及多脏器功能损伤.实验室检查显示,WBC和PLT减少,部分患者出现异型淋巴细胞、蛋白尿、管形尿以及ALT、AST、心肌酶谱升高和部分活化凝血酶原时间延长等.1例患者末梢血HGA包涵体检测阳性.血清学检测结果符合美国疾病预防控制中心(CDC)的HGA诊断标准.首发病例死亡,第2代9例患者均痊愈出院,其中治疗延迟、年龄大、使用免疫抑制剂的患者病情加重.结论 要重视HGA在我国的流行.诊断须重视流行病学资料,HGA传播途径多样,须严密隔离,防止暴发流行.

Outbreak of 10 patients with human granulocytic anapasmosis

Objective To summarize the clinical characteristics of the outbreak of the human granulocytic anapasmosis (HGA) in China for sharing and accumulating clinical experience to prevent and treat the disease. Methods Epidemiological characteristics, clinical features and experiences in diagnosis and treatment of ten HGA patients were reviewed and analyzed. All these cases were admitted in Yijishan Hospital of Wannan Medical College during November 2006. Results Besides the index case showed the history of tick bite, the other nine patients had no evidence of tick bite but close contact with the index patient. The latency varied from 6 to 13 days. Besides chilling, fever, headache and body aches, the common symptoms included relative pulse ease, indifferent expression, and multiple organ dysfunctions. The common laboratory abnormalities included thrombocytopenia and leucocytopenia. Some patients showed heterotypic lymphocyte, proteinuria, urine tube, abnormal alanine amiotransferase (ALT), aspartate transaminase (AST) and myocardial enzymes as well as extended activated partial thromboplastin time (APTT). Inclusion bodies were detected in the peripheral blood samples from one patient. Serological test results were consistent with the diagnosis standard of HGA developed by the United States Centers for Disease Control and Prevention (CDC). The index patient died. The other nine of second generation patients were all cured as a result of early detection and strict isolation for medical treatment. Elder, delayed initiation of treatment and concomitant use of immunosuppressive drugs were all factors contributing to exacerbation. Conclusions Attention should be paid to the prevalence of HGA in China. As the transmission routes of HGA are diverse, epidemiological data are very important for diagnosis. Patients with HGA must be strictly isolated to prevent the outbreak.