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目的对上海市1例三日疟病例进行溯源调查,以明确其传染来源。方法收集该病例的临床、实验室和流行病学资料,并对病例所在居民点进行相关人群的流行病学调查和现场快速诊断试纸条(RDT)检测,以及环境生物媒介调查。结果临床血涂片查见三日疟原虫;骨髓穿刺显示,骨髓增生活跃,粒细胞、红细胞、巨核细胞增生活跃。RDT检测结果为疟原虫阳性;巢式PCR结果显示,患者血样扩增出144 bp特异性条带,与三日疟原虫阳性对照条带大小一致。患者确诊后,服用双氢青蒿素哌喹片2片/次×bid×2 d进行治疗。流行病学溯源调查结果显示,患者发病前3年内无手术史,无输血史,2005年和2013年曾有海南、海门旅行史;患者居住地(上海杨浦区)5年内无本地感染病例。对居民点人群调查结果显示,共调查25户居民,计35人,RDT检测结果均显示阴性,35人在2周内均未出现发热。环境病媒生物调查未查见蚊幼虫孳生。结论患者为长潜伏期三日疟病例,其传染源为外省疫区。
Objective To conduct a retrospective investigation of one case of Plasmodium malaria in Shanghai in order to clarify the source of infection. Methods The clinical, laboratory and epidemiological data of the cases were collected. Epidemiological investigation, rapid test strip test (RDT) and environmental bio-media survey of the affected population were carried out. Results Clinical blood smears were observed in Plasmodium malariae; bone marrow biopsy showed active proliferation of bone marrow, granulocytes, erythrocytes and megakaryocytes hyperplasia. RDT test results were positive for Plasmodium; nested PCR results showed that the patient’s blood samples amplified 144 bp specific bands, and the size of the positive control strip of Plasmodium malariae consistent. Patients diagnosed after taking dihydroartemisinin and piperaquine tablets 2 / times × bid × 2 d for treatment. Epidemiological retrospective survey showed that there was no history of surgery and no blood transfusion in the patients within 3 years before the onset of illness. Travel history of Hainan and Haimen was conducted in 2005 and 2013; there was no local infection within 5 years of the patient’s residence (Yangpu District, Shanghai). The survey of residential population showed that a total of 25 households were surveyed, accounting for 35 people, RDT test results showed negative, 35 were not fever within 2 weeks. Environmental vector bioassay did not check mosquito larvae breeding. Conclusion The patient is a long latency incubation for malaria cases, the source of infection for other provinces infected area.