肝脏寄生虫感染48例临床分析

目的分析48例肝脏寄生虫感染患者的临床特征,提高临床诊断水平和指导治疗。方法搜集2010年4～7月在四川省人民医院感染科住院治疗的肝脏寄生虫感染患者资料,对其流行病学、临床表现、病原学、免疫学、腹部CT影像资料以及治疗进行分析。结果患者均有进食生泥鳅的病史、主要临床表现包括发热、乏力、食欲减退、上腹不适、腹痛、腹泻、肩颈腰背部和四肢酸痛,嗜酸性粒细胞显著升高,腹部增强CT肝包膜下、肝实质内低密度片状影或结节影。泥鳅肌肉组织查见囊蚴;患者血清中囊虫、包虫、肺吸虫、肝吸虫或血吸虫抗体1项或多项阳性。3例粪便自然沉淀法查见类似姜片虫虫卵。口服吡喹酮治疗全部治愈,随访1月以上无复发。结论生食泥鳅可引起肝脏寄生虫感染,本次感染的病原学以肝片吸虫可能性大,结合流行病学、临床、实验室和CT表现可以诊断,吡喹酮治疗安全、有效。

CHnical analysis of 48 cases with parasitic infection of liver.

Objective To analyze clinical characteristics of 48 cases with parasitic infection of liver,facilitate clinical diagnosis and therapy.Methods Clinical data of 48 cases hospitalized in department of Infectious Diseases,People′s Hospital of Sichuan Province in April 2010 to July 2010 were collected,investigated epidemiology,clinical manifestation,pathogen,lab examinations,abdominal CT images and therapy.Results All patients ever had uncooked loach.Symptoms include fever,fatigue,upper quadrant abdominal discomfort and pain,malaise,myalgia,diarrhea,mild elevated aminotransferase,mild to severe hypereosinophilia and multiple hypodense lesions seen on computed tomography(CT) scan.The metacercariae were found in muscles of loach.One or several serum antibody of bladder worm,hydatid,paragonimiasis,liver flukes and schistosome were positive in patients.Eggs were found in 3 cases,which similar to those of Fasciolopsis buski.All cases were cured by oral praziquantel.No case was recurrence in follow-up at least 1 month.Conclusion To eat uncooked loach may be caused parasitic infection of liver similar to Fascioliasis.Diagnosis is based on epidemiology,clinical manifestation,lab examinations and abdominal CT images.Oral praziquantel is safe and efficacious.