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目的探讨和分析我国首例输入性诺氏疟原虫(Plasmodium knowlesi)感染现症病例的诊断和治疗。方法收集患者的临床资料,采集血样制作厚、薄血膜片,吉氏染色后镜检。提取患者血样基因组DNA,通过两轮PCR扩增疟原虫核糖体DNA(r DNA),测序后在Gen Bank数据库进行BLAST分析。结果患者于2014年10月7日从马来西亚的热带雨林旅游1周回国,2014年10月16日在广州市首次发病,出现发热、寒颤和出汗等临床症状。2014年10月26日初步诊断为疟疾并住院治疗。镜检血涂片可见典型的诺氏疟原虫形态,被寄生的红细胞体积略增大,可见大滋养体呈一环、双核,黑褐色疟色素较恶性疟原虫稍大稍粗;裂殖体内可见6~8个裂殖子,有明显的褐色疟色素。PCR扩增出与预期一致的诺氏疟原虫特异性条带,片段长1 099 bp,测序经BLAST分析,其序列与诺氏疟原虫的序列(Gen Bank登录号:AM910985.1、L07560.1和AY580317.1)一致性为99%,确诊为诺氏疟原虫感染。给予患者氯喹和伯氨喹8日治疗,于2014年10月28日出院时,再给予复方双氢青蒿素片治疗。结论根据患者的临床症状、流行病学史、实验室检测结果分析,诊断其为输入性诺氏疟原虫现症感染病例,也是广东省乃至我国首次输入性诺氏疟原虫感染病例报道。
Objective To investigate and analyze the diagnosis and treatment of the first imported case of Plasmodium knowlesi in our country. Methods The clinical data of patients were collected, blood samples were collected to make thick and thin blood films, and microscopic examination was carried out after Ji’s staining. Genomic DNA was extracted from patients’ blood samples and the Plasmodium rDNA was amplified by two rounds of PCR. BLAST analysis was performed on the Gen Bank database after sequencing. Results On October 7, 2014, the patient returned from the tropical rainforest in Malaysia for 1 week. On October 16, 2014, the patient developed his first onset in Guangzhou. He developed fever, shivering and sweating. October 26, 2014 Initial diagnosis of malaria and hospitalization. Microscopic examination of blood smear showed a typical form of Plasmodium of Plasmodium, the volume of parasitized red blood cells increased slightly, showing a trophozoite showed a ring, binuclear, dark brown malaria pigment slightly larger than the Plasmodium falciparum; schizonts visible 6 to 8 merozoites, a significant brown malaria pigment. PCR amplification of the expected consistent with the norepinephrine-specific bands, the fragment length of 1 099 bp, the sequence analysis by BLAST sequence and the sequence of Plasmodium knowles (Gen Bank accession number: AM910985.1, L07560.1 And AY580317.1) was 99% identical and was confirmed as Plasmodium knowlesi infection. Patients were given chloroquine and primaquine on the 8th and were discharged on Oct. 28, 2014, followed by compound dihydroartemisinin. Conclusion According to the patient’s clinical symptoms, epidemiological history and laboratory test results, it is diagnosed as an imported infectious case of Plasmodium knowlesi, which is also the first imported case of Plasmodium knowlesi in Guangdong Province and even China.