江西省本地儿童肺细粒棘球蚴感染1例报告分析
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摘要
为了解江西省新余市1例临床确诊新发肺细粒棘球蚴感染患儿的临床及流行病学特点,收集患儿的临床、影像、病理、免疫学检测和流行病学调查资料。资料分析结果显示,患儿临床诊断为肺囊肿合并寄生虫感染,血清免疫学猪囊尾蚴和棘球蚴抗体IgG阳性,病理切片鉴定为细粒棘球蚴感染,经囊肿切除术后给予阿苯达唑片0.2 g×2次/d,连续3个月,治疗后未复发。流行病学调查结果显示,患儿未去过棘球蚴病流行区,也未接触过来自棘球蚴病流行区的人或物品。疫源地追踪调查结果显示, 204名居民腹部B超检查均未发现棘球蚴病疑似病例,血清学检测结果显示棘球蚴抗体阳性率为4.04%(8/198);调查问卷显示,低龄儿童大多数与家犬有密切接触史; 9份犬粪棘球绦虫抗原均为阴性。因此本病例确诊为本地感染病例,也提示当地存在本地棘球蚴病传播的可能。
To better understand the clinical and epidemiological characteristics of pulmonary echinococcosis recently diagnosed in a child with 6 years old in Xinyu, Jiangxi Province, the related clinical manifestations and examinations(imaging, pathological, immunological results) and epidemiological data were collected and analyzed. Data analysis showed that the clinical diagnosis of the child was pulmonary cyst with parasitic infection. The serological test showed the antibody IgG positive to Cysticercus cellulosae antigen and Echinococcus antigen. The pathological biopsy identified Echinococcus granulosus parasite in the lung tissue. After removal of the pulmonary cyst by surgery, the child was treated with 0.2 g albendazole tablet twice a day for 3 consecutive months. The child was totally recovered with no relapse. The epidemiological investigation showed that the child had no history traveling to any endemic area of hydatid disease or exposing to any people or objects from endemic areas. Further investigation on 204 local residents living with the child identified no any sign of hydatid disease by abdominal ultrasonography.However, the serological test demonstrated that the positive rate of anti-Echinococcus antibody was 4.04%(8/198).The questionnaire survey showed that most of the children with low age usually had close contact with the dogs around. Fecal samples were collected from 9 dogs in the village and none of them had been detected with Echinococcus antigen. Based on the clinical and epidemiological data the child was diagnosed as a local infection of E. granulosus, suggesting the possibility of local transmission of local hydatid disease in this village.
To better understand the clinical and epidemiological characteristics of pulmonary echinococcosis recently diagnosed in a child with 6 years old in Xinyu, Jiangxi Province, the related clinical manifestations and examinations(imaging, pathological, immunological results) and epidemiological data were collected and analyzed. Data analysis showed that the clinical diagnosis of the child was pulmonary cyst with parasitic infection. The serological test showed the antibody IgG positive to Cysticercus cellulosae antigen and Echinococcus antigen. The pathological biopsy identified Echinococcus granulosus parasite in the lung tissue. After removal of the pulmonary cyst by surgery, the child was treated with 0.2 g albendazole tablet twice a day for 3 consecutive months. The child was totally recovered with no relapse. The epidemiological investigation showed that the child had no history traveling to any endemic area of hydatid disease or exposing to any people or objects from endemic areas. Further investigation on 204 local residents living with the child identified no any sign of hydatid disease by abdominal ultrasonography.However, the serological test demonstrated that the positive rate of anti-Echinococcus antibody was 4.04%(8/198).The questionnaire survey showed that most of the children with low age usually had close contact with the dogs around. Fecal samples were collected from 9 dogs in the village and none of them had been detected with Echinococcus antigen. Based on the clinical and epidemiological data the child was diagnosed as a local infection of E. granulosus, suggesting the possibility of local transmission of local hydatid disease in this village.
引文
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[5] Bakal U, Simsek S, Kazez A. Surgical and molecular evaluation of pediatric hydatid cyst cases in Eastern Turkey[J]. Korean J Parasitol, 2015, 53(6):785-788.
[6] Berberian G, Rosanova T, Inda L, et al. Echinococcosis in children:experience in a tertiary care hospital outside the endemic area[J]. Arch Argent Pediatr, 2017, 115(3):282-286.
[7]韩诚,邓彦超,朱辉.儿童肺棘球蚴病93例临床分析[J].中华外科杂志, 2011, 49(2):150-153.
[8]马立公,李文方,乔颖.等.肝包虫的CT诊断[J].临床放射学杂志, 1998, 17(6):347-349.
[9]梁东,傅振超,张永恒,等. 3126例肝细粒棘球蚴病外科治疗[J].中国寄生虫学与寄生虫病杂志, 2004, 22(5):320.
[10]阿达来提·托留汉,漫格库丽·哈提木拉提,阿合里江·卡依多拉,等.新疆塔城地区棘球蚴病流行现状调查[J].中国寄生虫学与寄生虫病杂志, 2018, 36(6):1-6.
[11]陈新华,温浩,张朝霞,等.包虫病免疫误诊的原因分析[J].中国寄生虫学与寄生虫病杂志, 2002, 20(2):121-122.
[2] Velasco-Tirado V, Romero-Alegría魣, Belhassen-García M, et al.Recurrence of cystic echinococcosis in an endemic area:a retrospective study[J]. BMC Infect Dis, 2017, 17(1):455.
[3]叶尔江·苏里唐,江莉.我国棘球蚴病防治研究进展[J].中国寄生虫学寄生虫病杂志, 2000, 18(3):179-181.
[4] Sanaei Dashti A, Kadivar MR, Alborzi A, et al. Analysis of hospital records of children with hydatid cyst in south of Iran[J]. J Parasit Dis, 2017, 41(4):1044-1048.
[5] Bakal U, Simsek S, Kazez A. Surgical and molecular evaluation of pediatric hydatid cyst cases in Eastern Turkey[J]. Korean J Parasitol, 2015, 53(6):785-788.
[6] Berberian G, Rosanova T, Inda L, et al. Echinococcosis in children:experience in a tertiary care hospital outside the endemic area[J]. Arch Argent Pediatr, 2017, 115(3):282-286.
[7]韩诚,邓彦超,朱辉.儿童肺棘球蚴病93例临床分析[J].中华外科杂志, 2011, 49(2):150-153.
[8]马立公,李文方,乔颖.等.肝包虫的CT诊断[J].临床放射学杂志, 1998, 17(6):347-349.
[9]梁东,傅振超,张永恒,等. 3126例肝细粒棘球蚴病外科治疗[J].中国寄生虫学与寄生虫病杂志, 2004, 22(5):320.
[10]阿达来提·托留汉,漫格库丽·哈提木拉提,阿合里江·卡依多拉,等.新疆塔城地区棘球蚴病流行现状调查[J].中国寄生虫学与寄生虫病杂志, 2018, 36(6):1-6.
[11]陈新华,温浩,张朝霞,等.包虫病免疫误诊的原因分析[J].中国寄生虫学与寄生虫病杂志, 2002, 20(2):121-122.