上海市1例输入性罗阿丝虫病的临床特征与诊断
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摘要
目的对上海市1例输入性罗阿丝虫病的临床特征与诊治进行分析。方法收集患者临床资料,进行相关流行病学调查;采集患者骨髓及外周血,制作涂片瑞氏染色后镜检;提取患者血样DNA,用丝虫核糖体内转录间隔区1(ITS-1)通用引物PCR进行扩增,对扩增产物进行基因测序检测并进行BLAST比对分析。根据诊断结果给予相应治疗。结果患者,浙江仙居人,2015年5-11月在刚果(金)务工,回国后于2016年1月发现左上肢远端皮肤肿胀,伴皮肤颜色加深。当地医院血检显示嗜酸粒细胞计数升高,核磁共振检查示左前臂部分肌群及腕关节肌腱炎性病变,诊断为"嗜酸性筋膜炎",服用甲泼尼龙片(美卓乐)治疗1年余,无明显效果。2018年2月27日至上海市瑞金医院皮肤科就诊。查体:皮肤黝黑,无皮疹、肿块及淋巴结肿大,其余均无异常。外周血嗜酸粒细胞计数8.2×10~9/L,外周血、骨髓涂片查见微丝蚴,8 ml全血离心浓缩后检出较多微丝蚴。PCR扩增出457 bp的阳性条带,条带序列与罗阿丝虫(Gen Bank登录号:DQ995497)ITS1的相似性为100%。根据微丝蚴形态学和PCR检测结果诊断该病例为罗阿丝虫病,给予伊维菌素150μg/(kg·d)单剂口服,治疗2周后复查,外周血厚、薄血膜中均未查见虫体,8 ml全血离心浓缩后检出12条微丝蚴,外周血嗜酸粒细胞计数为6.39×109/L,伊维菌素治疗有效。结论经病原学和分子生物学检测确诊病例为输入性罗阿丝虫病例。
Objective To analyze the clinical features and diagnosis of an imported loiasis patient in Shang-hai. Methods Epidemiological data were collected and patient 's clinical signs and symptoms were studied. Blood and bone marrow sample smears were prepared and stained with Wright 's solution for parasitological analysis under a light microscope. The internal transcribed spacer 1(ITS-1) region of the parasite was sequenced after PCR amplification and were analyzed using basic local alignment search tool(BLAST) program of Gen Bank. The patient was treated with properly. Result The patient worked in Congo from May to November 2015 and developed with swellings and darkening of the skin in distal left upper extremity after he returned to China in January 2016. He went to a local hospital and in Zhejiang Province the examination results showed elevated number of eosinophiles as well as inflammation in the left upper limb as revealed by magnetic resonance, then was diagonsed as eosinophilic fasciitis. The symptoms were not improved after over 1 year treatment with oral medrol. The patient then went to the dermatology department of Shanghai Ruijin Hospital for further treatment on Febuary 27, 2018. Physical examination concluded dark skin, no swellings, no lumps, no lymphadenopathy or other abnormalities. Eosinophils count was 8.2 × 10~9/L. Microfilariae were found in blood and marrow smears. More microfilariae were found in blood smear of 8 ml peripheral blood after centrifugation. PCR amplification resulted in a band of ~457 bp, sequence of which had 100% homology to that of Loa loa(Gen Bank Accession No: DQ995497). The microfilariae were identified as Loa loa microfilariae by morphological observation and gene sequencing. The patient was diagnosed as loiasis and treated with single oral ivermectin at 150 μg/(kg·d). After 2 weeks of treatment, no microfilaria was found in the peripheral blood, and only 12 microfilariae were found in concentrated blood smear of 8 ml peripheral blood. The number of eosinophils was 6.39 × 10~9/L. These results suggested the effectiveness of ivermection. Conclusion This is an imported loasis case diagnosed by parasitological examination and molecular detection.
Objective To analyze the clinical features and diagnosis of an imported loiasis patient in Shang-hai. Methods Epidemiological data were collected and patient 's clinical signs and symptoms were studied. Blood and bone marrow sample smears were prepared and stained with Wright 's solution for parasitological analysis under a light microscope. The internal transcribed spacer 1(ITS-1) region of the parasite was sequenced after PCR amplification and were analyzed using basic local alignment search tool(BLAST) program of Gen Bank. The patient was treated with properly. Result The patient worked in Congo from May to November 2015 and developed with swellings and darkening of the skin in distal left upper extremity after he returned to China in January 2016. He went to a local hospital and in Zhejiang Province the examination results showed elevated number of eosinophiles as well as inflammation in the left upper limb as revealed by magnetic resonance, then was diagonsed as eosinophilic fasciitis. The symptoms were not improved after over 1 year treatment with oral medrol. The patient then went to the dermatology department of Shanghai Ruijin Hospital for further treatment on Febuary 27, 2018. Physical examination concluded dark skin, no swellings, no lumps, no lymphadenopathy or other abnormalities. Eosinophils count was 8.2 × 10~9/L. Microfilariae were found in blood and marrow smears. More microfilariae were found in blood smear of 8 ml peripheral blood after centrifugation. PCR amplification resulted in a band of ~457 bp, sequence of which had 100% homology to that of Loa loa(Gen Bank Accession No: DQ995497). The microfilariae were identified as Loa loa microfilariae by morphological observation and gene sequencing. The patient was diagnosed as loiasis and treated with single oral ivermectin at 150 μg/(kg·d). After 2 weeks of treatment, no microfilaria was found in the peripheral blood, and only 12 microfilariae were found in concentrated blood smear of 8 ml peripheral blood. The number of eosinophils was 6.39 × 10~9/L. These results suggested the effectiveness of ivermection. Conclusion This is an imported loasis case diagnosed by parasitological examination and molecular detection.
引文
[1]ZouréHG,Wanji S,Noma M,et al.The geographic distribution of Loa loa in Africa:results of large-scale implementation of the rapid assessment procedure for loiasis(RAPLOA)[J].PLo S Negl Trop Dis,2011,5(6):e1210.
[2]黄建荣,恩加惠·艾里.罗阿丝虫病25例临床分析[J].浙江预防医学,2002,14(5):60.
[3]何战英,王小梅,李锡太,等.北京市5例输入性罗阿丝虫病流行病学特征分析[J].热带病与寄生虫学,2006,14(2):74-76.
[4]许翔,姚立农,章金阳,等.输入性罗阿丝虫病1例报告[J].中国病原生物学杂志,2008,3(12):926.
[5]翁永夫,张行钦.舟山市定海区首例输入性罗阿丝虫病调查分析[J].中国预防医学杂志,2010,11(2):205.
[6]Nuchprayoon S,Junpee A,Poovorawan Y,et al.Detection and differentiation of filarial parasites by universal primers and polymerase chain reaction-restriction fragment length polymorphism analysis[J].Am J Trop Med Hyg,2005,73(5):895-900.
[7]Boussinesq M,Gardon J,Gardon-Wendel N,et al.Clinical picture,epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon[J].Filaria J,2003,2(Suppl 1):s4.
[8]World Health Organization.Guidelines for rapid assessment of Loa Loa.TDR/IDE/RAPLOA/02[M].Geneva:UNDP/World bank/WHO Special Programme for Research and Training in Tropical Diseases,2002:4-6.
[9]Mischlinger J,Veletzky L,Tazemda-Kuitsouc GB,et al.Behavioural and clinical predictors for Loiasis[J].J Glob Health,2018,8(1):010413.
[10]Klion AD,Ottesen EA,Nutman TB.Effectiveness of diethylcarbamazine in treating loiasis acquired by expatriate visitors to endemic regions:long-term follow-up[J].J Infect Dis,1994,169(3):604-610.
[11]Nutman TB,Miller KD,Mulligan M,et al.Diethylcarbamazine prophylaxis for human loiasis.Results of a double-blind study[J].N Engl J Med,1988,319(12):752-756.
[12]史宗俊,孙德建,王兆俊,等.中国阻断淋巴丝虫病传播的策略和技术措施的研究成果简介[J].中国寄生虫学与寄生虫病杂志,2001,19(2):110-112.
[13]段绩辉,罗亨桥.丝虫病传播阻断后残存传染源的微丝蚴密度消长及传播作用[J].中国寄生虫学与寄生虫病杂志,2007,25(6):457-461.
[14]吴凯,王重新.武汉市2009年遗留慢性丝虫病患者现状调查报告[J].公共卫生与预防医学,2010,21(4):75.
[15]龚艳凤,李志宏.江西省慢性丝虫病现状调查[J].中国血吸虫病防治杂志,2008,20(6):477-478.
[16]朱民,蔡黎.2006年上海市慢性丝虫病病人随访结果分析[J].中国热带医学,2007,7(8):1305-1307.
[17]张小萍,朱民,蔡黎,等.上海市消除丝虫病后慢性丝虫病流行病学调查[J].中国血吸虫病防治杂志,2007,19(4):299-303.
[18]曹汉钧,孙凤华.江苏省慢性丝虫病现状调查[J].中国病原生物学杂,2006,1(3):214-216.
[19]李继良,吴成果.重庆市慢性丝虫病现状调查[J].热带医学杂志,2006,6(1):45-48.
[2]黄建荣,恩加惠·艾里.罗阿丝虫病25例临床分析[J].浙江预防医学,2002,14(5):60.
[3]何战英,王小梅,李锡太,等.北京市5例输入性罗阿丝虫病流行病学特征分析[J].热带病与寄生虫学,2006,14(2):74-76.
[4]许翔,姚立农,章金阳,等.输入性罗阿丝虫病1例报告[J].中国病原生物学杂志,2008,3(12):926.
[5]翁永夫,张行钦.舟山市定海区首例输入性罗阿丝虫病调查分析[J].中国预防医学杂志,2010,11(2):205.
[6]Nuchprayoon S,Junpee A,Poovorawan Y,et al.Detection and differentiation of filarial parasites by universal primers and polymerase chain reaction-restriction fragment length polymorphism analysis[J].Am J Trop Med Hyg,2005,73(5):895-900.
[7]Boussinesq M,Gardon J,Gardon-Wendel N,et al.Clinical picture,epidemiology and outcome of Loa-associated serious adverse events related to mass ivermectin treatment of onchocerciasis in Cameroon[J].Filaria J,2003,2(Suppl 1):s4.
[8]World Health Organization.Guidelines for rapid assessment of Loa Loa.TDR/IDE/RAPLOA/02[M].Geneva:UNDP/World bank/WHO Special Programme for Research and Training in Tropical Diseases,2002:4-6.
[9]Mischlinger J,Veletzky L,Tazemda-Kuitsouc GB,et al.Behavioural and clinical predictors for Loiasis[J].J Glob Health,2018,8(1):010413.
[10]Klion AD,Ottesen EA,Nutman TB.Effectiveness of diethylcarbamazine in treating loiasis acquired by expatriate visitors to endemic regions:long-term follow-up[J].J Infect Dis,1994,169(3):604-610.
[11]Nutman TB,Miller KD,Mulligan M,et al.Diethylcarbamazine prophylaxis for human loiasis.Results of a double-blind study[J].N Engl J Med,1988,319(12):752-756.
[12]史宗俊,孙德建,王兆俊,等.中国阻断淋巴丝虫病传播的策略和技术措施的研究成果简介[J].中国寄生虫学与寄生虫病杂志,2001,19(2):110-112.
[13]段绩辉,罗亨桥.丝虫病传播阻断后残存传染源的微丝蚴密度消长及传播作用[J].中国寄生虫学与寄生虫病杂志,2007,25(6):457-461.
[14]吴凯,王重新.武汉市2009年遗留慢性丝虫病患者现状调查报告[J].公共卫生与预防医学,2010,21(4):75.
[15]龚艳凤,李志宏.江西省慢性丝虫病现状调查[J].中国血吸虫病防治杂志,2008,20(6):477-478.
[16]朱民,蔡黎.2006年上海市慢性丝虫病病人随访结果分析[J].中国热带医学,2007,7(8):1305-1307.
[17]张小萍,朱民,蔡黎,等.上海市消除丝虫病后慢性丝虫病流行病学调查[J].中国血吸虫病防治杂志,2007,19(4):299-303.
[18]曹汉钧,孙凤华.江苏省慢性丝虫病现状调查[J].中国病原生物学杂,2006,1(3):214-216.
[19]李继良,吴成果.重庆市慢性丝虫病现状调查[J].热带医学杂志,2006,6(1):45-48.