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目的对2015年河南省发生的一起恙虫病暴发疫情进行调查分析,了解其发病特点及流行特征,分析恙虫病感染的影响因素,为制定针对性预防控制措施提供依据。方法采用现场流行病学调查的方法,搜索病例,填写《恙虫病个案调查表》,对病例进行血清学、免疫学以及分子生物学实验。采用病例对照研究的方法,以搜索到的临床诊断病例和确诊病例作为病例组,按1∶2匹配的方式,随机选择与病例所在的同村、年龄相差5岁以内的同性别且无临床症状的村民为对照,收集可疑危险因素。结果本次疫情10月16日至11月20日,共发现病例48例,其中发热≥38.5℃的病例超过83.3%,发现特异性焦痂或溃疡的病例68.7%,有皮疹的病例60.4%,其他临床症状还包括头痛、浅表淋巴结肿大、寒战等。对采集的16份病人标本进行检测,其中血清抗体Ig M阳性15份。外斐氏反应检测OXk血清抗体,抗体滴度>1∶160的13份,最高抗体滴度>1∶640,第二次采集病人恢复期血清有7份抗体呈4倍增高。恙虫病PCR核酸检测,阳性4份。结论本次疫情为一起恙虫病暴发疫情,临床症状上主要表现为发热、特异性焦痂或溃疡、皮疹、头疼等;外斐氏试验可以作为重要诊断依据,PCR核酸检测方法,作为确诊依据之一,具有重要的意义;去参加田间劳动、在屋内堆放柴草或农作物、在家中饲养家禽及在家中饲养宠物为发病的独立影响因素。
Objective To investigate the outbreak of tsutsugamushi disease in Henan Province in 2015, and to understand the characteristics and prevalence characteristics of tsutsugamushi disease. To analyze the influencing factors of tsutsugamushi disease infection and provide evidence for the targeted prevention and control measures. Methods The method of field epidemiological investigation was used to search for cases and fill in the questionnaire of case of scrub typhus. Serological, immunological and molecular biological tests were performed on the cases. A case-control study was used to select the clinically diagnosed cases and the diagnosed cases as case groups. The patients were randomly selected to have the same gender and no clinical symptoms within 5 years Villagers as a control, collecting suspicious risk factors. Results The epidemic ranged from October 16 to November 20, a total of 48 cases were found, of which 83.3% were fever≥38.5 ℃, 68.7% were found with eschar or ulcer, 60.4% with rash, Other clinical symptoms include headache, superficial lymph nodes, chills and more. The collected 16 specimens of patients were tested, of which 15 were Ig M positive serum antibodies. In addition, 13 serum anti-OXK antibodies were detected by external Peijo reaction, with antibody titers> 1:160, the highest antibody titers> 1: 640, and the second antibody collected from patients with convalescent phase showed a 4-fold increase. Scrub typhus PCR nucleic acid detection, 4 were positive. Conclusion The outbreak is a outbreak of scrub typhus, the clinical manifestations of fever, specific eschar or ulcer, rash, headache, etc.; outside the Peijias test can be used as an important basis for diagnosis, PCR nucleic acid detection methods, as the basis for the diagnosis First, it is of great significance to go to work in the field, piling up firewood or crops inside the house, raising poultry at home and keeping pets at home as independent influencing factors.