吉林省孢子丝菌病流行病学调查分析
摘要
孢子丝菌病是一种由申克孢子丝菌感染引起的呈全球性分布的慢性深部真菌病,申克孢子丝菌是存在于自然界中的一种腐生菌,在稻草、芦苇、树皮、昆虫、尘土、动物粪便中广泛存在,由于孢子丝菌不仅侵犯皮肤,而且可以侵犯内脏各器官引起病变,故对人体有较大的危害性。
目的:目前我国孢子丝菌病多发于北方地区,其中吉林省是孢子丝菌病的高发区。为进一步了解吉林省孢子丝菌病的流行病学特点,为今后孢子丝菌病的治疗和预防提供理论及实践依据。
方法:本文对1991—2007年间来我科治疗的孢子丝菌病2305例,进行了回顾性分析。所有患者按性别、年龄、职业、家庭住址、发病时间、发病部位、病程、皮疹类型、真菌培养情况、病理活检结果、治疗情况等方面进行分类并相互对照研究,并用统计学方法分析处理资料。
结果:2305例孢子丝菌病患者中农民占77.27%,其中40～60岁人群发病率高,尤其家庭妇女比例占绝大多数。发病部位以颜面部和上肢等暴露部位为主。临床类型以固定型最多见,其次淋巴管型,播散型少见。地区分布以九台市、农安县、通榆县为多见。碘化钾或与伊曲康唑、特比萘芬联合治疗该病均有显著疗效。
结论:吉林省是孢子丝菌病的高发区,其中九台市、农安县、通榆县为高发;该病近年来发病率有明显上升趋势;大力推广农村玉米秸杆和芦苇的再利用机制,尽量减少腐烂玉米秸杆和芦苇,能降低孢子丝菌病的发病率;对当地村民及基层医务人员加强对该病防治知识的宣教实属必要;碘化钾或与伊曲康唑、特比萘芬联合治疗该病均有显著疗效。
Sporotrichosis, caused by Sporothrix schenckii infection, is a chronic histomycosis. The Sporothrix Shenckii Hektonen and Perkins are widespread in nature, they can be contaminated in soil and Fumu, Bacillus subtilis, reed, corn stalks and other plant corruption. This fungi not only violates the skin, but can cause harm to visceral organs. People who have minor injury are easily infected. Farmers, masonry, paper mill workers, mine workers and gardeners are the susceptible population. In the 1960s, there was an outbreak in a paper mill of Jilin Province, since then on, there is no report of outbreaks but on the dissemination of disease. Recently, the incidence rate is increasing.
Sporotrichosis, which can cause small-scale pandemic in individual area, is a kind of common histomycosis. Once infected, it can not be self-recovered regardless of what type of Sporotrichosis, so it must be treated systimetically or locally. Its damage was particularly prevalent in the skin disease, and less found in mucosa, bone, muscle and the central nervous system, lungs, liver, spleen, eyes and other organs. As for the types of this disease,it can be divided into, lymphatic-type and disseminated. Most of lymphatic damage occurred in exposed parts, such as upper or lower extremity unilateral, especially in the right hand, and most has prior history of trauma. The incubation period of it is from five days to six months, with an average of three weeks. The beginning syndrome is round, quality hardware painless subcutaneous nodules, later the nodules will stick out, holds to the skin, and its colour change from pale red to purplish red, then it gradually soften and break into ulcer. The surface of ulcer has thin secretion, purple black around it, which is called chancre. 1-3 weeks later, the beginning lesion, which is from a few to a few number10, apears along the lymph vessel concentrically, but don't surpass axillary or inguinal lymph node.
At present, it is much seen in the northern area of China, and jilin Province has high incidence rate. Now, with the irregular application of broad-spectrum antibioticsand and widely use of corticosteroids and immunosuppressive drugs in the field of medicine, some skin lesion lack of typical syndrome is easily misdiagnosed or missed. Outside the Skin tissue, it is difficult to get early diagnosis, delaying treatment time often has serious consequences. Thus the early diagnosis of it is critical importance to its treatment and prognosis.
To further understand the epidemiological characteristics of the disease and its treatment and prevention, this research selects 2,342 cases with out-patient and in-patient treatment from Dermatology in the second hospital of Jilin university. Now, only 2,305 cases belong to jilin province would be retrospectively analized and made conclusion. Research will be carried out with classification and mutual-control study, according to patients sex, age, occupation, home address, onset time, the location, type of skin rash, fungal culture, biopsy results, the treatment of the situation in different areas .All materials are analized and prossed with statistical methods. Results: among 2,305 cases ,famers accounted for 77.27%, of which the age of high incidence rate is between 30 and 60, especially the percentage of women accounted for the vast majority of families. As for the location, it mainly violate exposed parts such as face or upper limbs. As for Clinical types, it is seen most by the stationary type, next by lymphatic type and disseminated type is rare. As for Geographical distribution, it is widespread in Jilin Province, of which it is most common in Jiutai City, Nong`an County and Tongyu County. This fungus exist in the vegetation and soil, farmers ,who contact frequently with soil ,the old rotting corn straw and reeds have high incidence rate, and because of the right hand work habits, infection percentage increases relatively. From the morbidity age observation, it occurs more on children from 2 to 10 year-old , which is considered to be relation with children`s immune status and with playing mud grass daily. In addition, with the worse primary medical conditions or insufficient understanding to clinical manifestations of this disease and because of diversity lesions of stationary type, and the low rate of positive direct examination, it is easily misdiagnosed as verrucous skin Tuberculosis, the proliferation of pyoderma, sarcoidosis, squamous cell skin cancer, such as basal cell carcinoma. It must be done mycology and pathological examination early, once suspected, in order not to delay treatment. From the treatment perspective, the potassium iodide is easy tobe accepted by patients because of effective and inexpensive. However, treatment should be sufficient and should be continued even if the rash has been disapeared for four weeks. To prevent recrudescence is the key to success of treatment. However ,what is worth proposing is that it can cause clock frequency, runny nose, tears, shortness of breath, dizziness, gastrointestinal reactions, or even a dysfunction of the thyroid and other adverse reactions by taken orally. So its clinical application is limited.
Analysis of the reasons for increasing incidence rate:
1. With the enhancement of living standard and the increasing consciousness of medical examination, the population of people who go to see a doctor increases.
2. With the development of mycology and the innovation medical examination method, the diagnosis rate of Sporotrichosis enhances.
3. Due to the enhancement of overall medical personnel`s diagnosis and treatment level, the misdiagnosis rate of Sporotrichosis reduces obviously.
4. Widely use of corticosteroids and immunosuppressive drugs decrease the body's immunity and easy to cause fungal infection.
5. There is suitable environment for fungus, such as rural old, rotten, moldy corn straw, reeds but no timely and complete treatment.
6. local villagers and medical personnel lack of understanding to this disease and do not know how to protect wound fter injured, which is also main reason to cause it.
Conclusion:
1, There is high incidence rate in Jilin Province, of which it is more seen in Jiutai City, Nong`an County and Tongyu County.
2. Male, female disease incidence rate: Female > male, and most is the working women who is engaged in the housework.
3. Morbidity spot: mainly exposed spots such as face, both hands or four limbs.
4. Morbidity season: winter and spring.
5. Morbidity age: various ages have the occurrence, most between 40~60 years old.
6. Morbidity tendency: there is obviously increasing incidence rate from 2004.
7. Clinical type: it is seen most by the stationary type, next by lymphatic type and disseminated type is rare.
8. Treatment: Uniting treatment is important, which can effect more quickly than purely using the potassium iodide treatment. At the same time it can reduce treatment course and side effect of medicine as far as possible.
9. Promoting the reuse of rural corn straw and reed to minimize rotting corn straw and reed, which can reduce its incidence rate.
10. It is very important to prevent this disease by preventing skin wound .Once injured, it is necessary to maintain the wound clean, in order to avoid being infected by Sporothrix. The surgical dressing of patients should be promptly burnt down, in order to avoid causing the pollution of the environment, and infect other people.
11. It is necessary for the local villagers and medical staff to strengthen the knowledge of its preventionand treatment.
目的:目前我国孢子丝菌病多发于北方地区,其中吉林省是孢子丝菌病的高发区。为进一步了解吉林省孢子丝菌病的流行病学特点,为今后孢子丝菌病的治疗和预防提供理论及实践依据。
方法:本文对1991—2007年间来我科治疗的孢子丝菌病2305例,进行了回顾性分析。所有患者按性别、年龄、职业、家庭住址、发病时间、发病部位、病程、皮疹类型、真菌培养情况、病理活检结果、治疗情况等方面进行分类并相互对照研究,并用统计学方法分析处理资料。
结果:2305例孢子丝菌病患者中农民占77.27%,其中40～60岁人群发病率高,尤其家庭妇女比例占绝大多数。发病部位以颜面部和上肢等暴露部位为主。临床类型以固定型最多见,其次淋巴管型,播散型少见。地区分布以九台市、农安县、通榆县为多见。碘化钾或与伊曲康唑、特比萘芬联合治疗该病均有显著疗效。
结论:吉林省是孢子丝菌病的高发区,其中九台市、农安县、通榆县为高发;该病近年来发病率有明显上升趋势;大力推广农村玉米秸杆和芦苇的再利用机制,尽量减少腐烂玉米秸杆和芦苇,能降低孢子丝菌病的发病率;对当地村民及基层医务人员加强对该病防治知识的宣教实属必要;碘化钾或与伊曲康唑、特比萘芬联合治疗该病均有显著疗效。
Sporotrichosis, caused by Sporothrix schenckii infection, is a chronic histomycosis. The Sporothrix Shenckii Hektonen and Perkins are widespread in nature, they can be contaminated in soil and Fumu, Bacillus subtilis, reed, corn stalks and other plant corruption. This fungi not only violates the skin, but can cause harm to visceral organs. People who have minor injury are easily infected. Farmers, masonry, paper mill workers, mine workers and gardeners are the susceptible population. In the 1960s, there was an outbreak in a paper mill of Jilin Province, since then on, there is no report of outbreaks but on the dissemination of disease. Recently, the incidence rate is increasing.
Sporotrichosis, which can cause small-scale pandemic in individual area, is a kind of common histomycosis. Once infected, it can not be self-recovered regardless of what type of Sporotrichosis, so it must be treated systimetically or locally. Its damage was particularly prevalent in the skin disease, and less found in mucosa, bone, muscle and the central nervous system, lungs, liver, spleen, eyes and other organs. As for the types of this disease,it can be divided into, lymphatic-type and disseminated. Most of lymphatic damage occurred in exposed parts, such as upper or lower extremity unilateral, especially in the right hand, and most has prior history of trauma. The incubation period of it is from five days to six months, with an average of three weeks. The beginning syndrome is round, quality hardware painless subcutaneous nodules, later the nodules will stick out, holds to the skin, and its colour change from pale red to purplish red, then it gradually soften and break into ulcer. The surface of ulcer has thin secretion, purple black around it, which is called chancre. 1-3 weeks later, the beginning lesion, which is from a few to a few number10, apears along the lymph vessel concentrically, but don't surpass axillary or inguinal lymph node.
At present, it is much seen in the northern area of China, and jilin Province has high incidence rate. Now, with the irregular application of broad-spectrum antibioticsand and widely use of corticosteroids and immunosuppressive drugs in the field of medicine, some skin lesion lack of typical syndrome is easily misdiagnosed or missed. Outside the Skin tissue, it is difficult to get early diagnosis, delaying treatment time often has serious consequences. Thus the early diagnosis of it is critical importance to its treatment and prognosis.
To further understand the epidemiological characteristics of the disease and its treatment and prevention, this research selects 2,342 cases with out-patient and in-patient treatment from Dermatology in the second hospital of Jilin university. Now, only 2,305 cases belong to jilin province would be retrospectively analized and made conclusion. Research will be carried out with classification and mutual-control study, according to patients sex, age, occupation, home address, onset time, the location, type of skin rash, fungal culture, biopsy results, the treatment of the situation in different areas .All materials are analized and prossed with statistical methods. Results: among 2,305 cases ,famers accounted for 77.27%, of which the age of high incidence rate is between 30 and 60, especially the percentage of women accounted for the vast majority of families. As for the location, it mainly violate exposed parts such as face or upper limbs. As for Clinical types, it is seen most by the stationary type, next by lymphatic type and disseminated type is rare. As for Geographical distribution, it is widespread in Jilin Province, of which it is most common in Jiutai City, Nong`an County and Tongyu County. This fungus exist in the vegetation and soil, farmers ,who contact frequently with soil ,the old rotting corn straw and reeds have high incidence rate, and because of the right hand work habits, infection percentage increases relatively. From the morbidity age observation, it occurs more on children from 2 to 10 year-old , which is considered to be relation with children`s immune status and with playing mud grass daily. In addition, with the worse primary medical conditions or insufficient understanding to clinical manifestations of this disease and because of diversity lesions of stationary type, and the low rate of positive direct examination, it is easily misdiagnosed as verrucous skin Tuberculosis, the proliferation of pyoderma, sarcoidosis, squamous cell skin cancer, such as basal cell carcinoma. It must be done mycology and pathological examination early, once suspected, in order not to delay treatment. From the treatment perspective, the potassium iodide is easy tobe accepted by patients because of effective and inexpensive. However, treatment should be sufficient and should be continued even if the rash has been disapeared for four weeks. To prevent recrudescence is the key to success of treatment. However ,what is worth proposing is that it can cause clock frequency, runny nose, tears, shortness of breath, dizziness, gastrointestinal reactions, or even a dysfunction of the thyroid and other adverse reactions by taken orally. So its clinical application is limited.
Analysis of the reasons for increasing incidence rate:
1. With the enhancement of living standard and the increasing consciousness of medical examination, the population of people who go to see a doctor increases.
2. With the development of mycology and the innovation medical examination method, the diagnosis rate of Sporotrichosis enhances.
3. Due to the enhancement of overall medical personnel`s diagnosis and treatment level, the misdiagnosis rate of Sporotrichosis reduces obviously.
4. Widely use of corticosteroids and immunosuppressive drugs decrease the body's immunity and easy to cause fungal infection.
5. There is suitable environment for fungus, such as rural old, rotten, moldy corn straw, reeds but no timely and complete treatment.
6. local villagers and medical personnel lack of understanding to this disease and do not know how to protect wound fter injured, which is also main reason to cause it.
Conclusion:
1, There is high incidence rate in Jilin Province, of which it is more seen in Jiutai City, Nong`an County and Tongyu County.
2. Male, female disease incidence rate: Female > male, and most is the working women who is engaged in the housework.
3. Morbidity spot: mainly exposed spots such as face, both hands or four limbs.
4. Morbidity season: winter and spring.
5. Morbidity age: various ages have the occurrence, most between 40~60 years old.
6. Morbidity tendency: there is obviously increasing incidence rate from 2004.
7. Clinical type: it is seen most by the stationary type, next by lymphatic type and disseminated type is rare.
8. Treatment: Uniting treatment is important, which can effect more quickly than purely using the potassium iodide treatment. At the same time it can reduce treatment course and side effect of medicine as far as possible.
9. Promoting the reuse of rural corn straw and reed to minimize rotting corn straw and reed, which can reduce its incidence rate.
10. It is very important to prevent this disease by preventing skin wound .Once injured, it is necessary to maintain the wound clean, in order to avoid being infected by Sporothrix. The surgical dressing of patients should be promptly burnt down, in order to avoid causing the pollution of the environment, and infect other people.
11. It is necessary for the local villagers and medical staff to strengthen the knowledge of its preventionand treatment.
引文
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