黑热病的临床诊断与鉴别  

Kala azar(Visceral Leishmaniasis):clinical diagnosis and identification

作　　者：谭春艳[1] 闭艺芳[1] 姜烈君[1] 周莹[1] 

机构地区：[1]广西壮族自治区人民医院检验科,广西南宁530021

出　　处：《中华医院感染学杂志》2012年第4期756-757,共2页Chinese Journal of Nosocomiology

摘　　要：目的降低黑热病的误诊率。方法分析2例黑热病确诊病例的临床资料及骨髓中利杜体的形态特点及分布。结果瑞氏-姬姆萨染色骨髓中的利杜体可见1个较大染紫红色的类圆形核,还可见1个比核明显小的呈棒状的动基体;动基体染紫红色,着色明显比核深且结构致密,动基体可在利杜体的任何位置出现,在其中的某些位置也许不甚清楚,但在整张骨髓片中会有大量利杜体可见典型的动基体;利杜体可散在或成簇存在,分布于吞噬细胞内外,位于吞噬细胞内的利杜体更易辨认。结论找到动基体是识别利杜体避免误诊的关键,而利杜体在瑞氏-姬姆萨染色中比单纯瑞氏染色、糖原染色等着色更清晰、更易辨认。OBJECTIVE To reduce the misdiagnosis of kala azar（Visceral Leishmaniasis）.METHODS We analyzed the clinical data from patients with correctly diagnosed kala azar,and their bone marrow smears were analyzed for the morphologic features and distribution of Leishman-Donovan bodies.RESULTS The cell nucleus of Leishman-Donovan body was mauve,round and somewhat big in bone marrow smear with Wright-Giemsa stain.The kinetoplast was more mauve than the cell nucleus.Though some kinetoplasts might be blurry in some Leishman-Donovan bodies,there were always clear ones in others.CONCLUSION To prevent the misdiagnosis of kala azar,finding out the kinetoplast is important for identification of Leishman-Donovan body,which is clearer and more easily identifiable with Wright-Giemsa stain than with Wright＇s stain and periodic acid Schiff stain.

关 键 词：黑热病 利杜体 动基体 瑞氏-姬姆萨染色 

分 类 号：R181.32[医药卫生—流行病学]