海南省澄迈县新发斑点热流行病学调查  

Epidemiologyical investigation of emerging spotted fever in Chengmai county,Hainan province

作　　者：金玉明[1] 张丽娟[2] 孙莲英[1] 老世军[1] 寒江 黄昌和[1] 王誓闻[2] 曾昭长[1] 王圆圆 朱建华[1] 黄芳[1] 贾鹏本[1] 苏新元[1] 吴维学[1] 

机构地区：[1]海南省疾病预防控制中心,海南海口570000 [2]中国疾病预防控制中心传染病预防控制所

出　　处：《疾病监测》2011年第1期18-22,共5页Disease Surveillance

基　　金：国家基础研究项目-973计划(No.2010CB530200; 2010CB530206);国家传染病防治科技重大专项(No.2008ZX10004 -008;2009ZX10004 -203)~~

摘　　要：目的对海南省澄迈县进行斑点热自然疫源地现场调查。方法以病原学证实的首发患儿居住村外延收集可疑病例并采集当地野生啮齿动物抗凝血,用现代Shellvial培养技术进行立克次体病原分离,对分离株进行16S rRNA、gltA、ompA、17kD蛋白基因及groEL基因扩增并测序分析。以WHO立克次体协作中心推荐间接免疫荧光试验检测患者、全县10村812名农业人群、18只家犬及44只野生啮齿动物血清斑点热群立克次体抗体。巢式PCR扩增患者、家犬、野生啮齿动物、媒介蜱、螨及蚤标本groEL基因并测序分析。分析斑点热群立克次体优势流行株及可能的媒介及宿主种类以及人群及家畜对当地斑点热群立克次体优势流行株抗体阳性率。结果从调查的21例可疑立克次体患者血液标本中分离到11株斑点热群立克次体,从15只野生针毛鼠血液标本中分离到7株斑点热群立克次体,遗传学分析证实分离株与黑龙江立克次体及广东野鼠斑点热群立克次体分离株关系密切,但血清表型不同黑龙江立克次体。犬血、媒介蜱、螨及蚤PCR扩增groEL基因及测序结果支持病原学证据并且序列分析结果显示与病原分离株为同一流行株。血清学结果提示当地人群对该流行株IgG抗体总阳性率为46.1%,家犬88.9%,鼠11.4%。发热可疑患者强力霉素经验治疗痊愈。结论正常人群、发热患者、媒介及宿主等病原学、分子生物学及血清学调查结果证实海南省存在新发斑点热疫源地,加强临床诊断及鉴别诊断,进一步监测其他蜱传立克次体病,消杀农户家居及家畜体表媒介蜱,防止叮咬是当地防治该病的关键。Objective To investigation natural focus of spotted fever in Chengmai county,Hainan Province. MethodsRickettsia cultrue from probable patients＇ blood and mouse＇ blood samples by modern Shell vial methods were performed and identification of isolates were conducted by PCR amplifying and sequencing of 16S rRNA,gltA,ompA,17 kD and groEL genes. Specific IgG antibody against the emerging spotted fever group rickettsiae was detected on 812 serums from healthy farmer population collected from 10 villages in Chengmai county,18 dogs,and 44 mice by IFA. Rickettsiae groEL genes were directly amplified and sequenced on patients＇ blood,mouse blood and dog blood DNAs and vectors including ticks,mites and fleas. Results A total of 11 isolates of novel spotted group rickettsiae from patients and 7 isolates from Rattus fulvescens were isolated. Genetic analysis showed that these isolates were closely related to R.heilongjiangensis genetically However,isolate have different phentype based on the assasy. The sequences of 16S rRNA,gltA,ompA,groEL and 17 kD genes demonstrated all isolates were the same epidemiological clone. The evidences of amplifying and sequencing of groEL genes from patients,mouse and dogs blood DNA and vectors including ticks,mites and fleas demonstrated 100% homologies with that of the isolates from the patients and mice. The prevalence of IgG antibody against the epidemiological spotted fever group rickettsia for control adult population,domestic dogs and mice were 46.1%,88.9% and 11.4% respectively. Doxycycline was effective for curing probable patients experimentally. Conclusion An emerging spotted fever is prevalence in Chenmai county,Hainan province. Diagnose and differential diagnose between spotted fever and others febrile diseases should be emphasized in clinics. Killing ticks in farmer＇s houses and bodies of domestic animals and prevention from tike biting should be propagated in the endemic areas. Further investigation of other tickborn rickettsiosis should be performed.

关 键 词：新发斑点热 斑点热群立克次体 自然疫源地 

分 类 号：R181.3[医药卫生—流行病学] R513[医药卫生—公共卫生与预防医学]