2021年湖北省一例疑似福氏耐格里原虫感染所致死亡病例的个案调查分析

目的 通过调查核实诊断2021年8月湖北省荆州市某医院首次报告的1例疑似福氏耐格里原虫感染脑膜脑炎病例,查找感染来源,并提出防控建议。方法 通过访谈病例家属、医生及同村居民,查阅病历,现场实地查看等方式了解病例的发病就诊经过、临床特征及发病前可疑暴露史等情况,进行环境调查和采样检测,分析感染来源。结果 病例为男性货运司机,47岁,居住在荆州市的农村地区,2021年8月1—7日清理屋前池塘水草,9日出现发热、头痛等,11日出现昏迷、言语模糊,15日深昏迷后经机械泵维持生命体征,16日高通量测序技术检测脑脊液考虑福氏耐格里原虫感染,当日湖北省荆州市疾病预防控制中心接到报告开展调查,17日病例出院后死亡。病例清理水草的池塘水样中发现疑似福氏耐格里原虫包囊结构。当地相关部门在可疑危险水体设置警示牌,向周围居民宣传相关健康知识。结论 本例病例是1例疑似福氏耐格里原虫感染引发的原发性阿米巴性脑膜脑炎病例（PAM）,发病9 d后死亡,可能与清理池塘水草有关。在报告过PAM病例的地区开展外环境水体监测及后续病例监测,并加强人群的宣教,普及相关防治知识。

An investigation of one death case probably caused by Naegleria fowleri infection in Hubei, 2021

  Objective  To identify the infection source of a primary amoebic meningoencephalitis case probably caused by Naegleria fowleri infection reported for the first time by a hospital in Jingzhou of Hubei provice in August 2021 and provide evidence for the prevention and control of such infection.   Methods  The information about case’s disease onset, exposure history and clinical characteristics were collected from family member, doctor and villagers and field investigation was conducted to identify the infection source.   Results  The case was a 47 years old men who lived in rural area of Jingzhou, He cleaned waterweeds in a pond in front of his home from 1st August to 7th August, 2021. The case had fever and headache on 9th August, slipped into a coma with alalia on 11th August, and mechanical pump was used to maintain his life on 15th August after a deep coma. Naegleria fowleri infection was considered after the testing of case's cerebral spinal fluid by high throughput sequencing on 16th August, local CDC received the report and immediately began an investigation on the same day. The case died after the discharge on 17th August. A suspected cyst of Naegleria fowleri was found in water sample from the pond. Warning signs were set around the pond to prevent others contact with the pond water, and health education was conducted in the village.   Conclusion  The primary amoebic meningoencephalitis case, who died 9 days later after onset, was probably caused by Naegleria fowleri infection after contact with the pond water. It is necessary to strengthen the disease and environment surveillances in areas where primary amoebic meningoencephalitis has occurred and improve the health education in local people.