云南省大理州大片形吸虫群体感染26例分析  

Twenty six cases of human Fasciola gigantica infection in Dali, Yunnan province

作　　者：陈木新[1] 艾琳[1] 许学年[1] 吕山[1] 焦建明[2] 苏慧勇 臧伟[1] 诸廷俊[1] 蔡玉春[1] 罗家军 陈家旭[1] 

机构地区：[1]中国疾病预防控制中心寄生虫病预防控制所卫生部寄生虫与病原生物学重点实验室,世界卫生组织疟疾、血吸虫和丝虫病合作中心,上海200025 [2]云南大理学院附属医院内科 [3]大理州人民医院感染科 [4]云南省大理州血吸虫病防治研究所

出　　处：《中国地方病学杂志》2012年第6期595-598,共4页Chinese Jouranl of Endemiology

基　　金：国家科技重大专项（2012ZX10004220、2008ZX10004-011）;国家科技支撑计划项目（2008BA156803）

摘　　要：目的探讨云南省大理州人群感染大片形吸虫的疫情特征，为片形吸虫病预防控制提供科学依据。方法收集疫情资料，了解患者的临床表现和症状。采用酶联免疫吸附法（ELISA）对患者、部分家属及同村的健康人进行血清学大片吸虫可溶性成虫抗原检测和显微镜下粪便虫卵检查，并对检出的虫卵进行测序和PCR扩增。将测序结果进入美国国立生物技术信息中心（NCBI）中的BLAST（basic local alignment search tool）程序进行核酸序列比对，比较二者的相似性。对患者给予三氯苯达唑治疗，治疗剂量为10mg·kg^-1·d^-1，每天1次口服，连续用药2d，服药后留院观察1周。在大理州城镇周边水沟处进行宿主和媒介调查，采集宿主椎实螺，进行压片检查，在有椎实螺分布环境中采集牛粪和羊粪，用水洗沉淀法，在显微镜下检查粪便中的虫卵。结果26例患者均以高热起病。发热持续，嗜酸性粒细胞升高，伴不同程度的恶心、呕吐、腹痛、纳差等消化系统症状；肝肿大、肝区叩痛，肝脏CT均有不同程度损伤，。患者均有生食过鱼腥草等水生植物史，且病程相近，具有相同的流行病学特征。ELISA检测血清大片吸虫可溶性成虫抗原，26例患者阳性率为100．0％（26／26），家属阳性率为31．6％（18／57），同村健康人阳性率为17．1％（6／35）。虫卵经测序和BLAST分析结果显示，与大片形吸虫的相似性为99％～100％。PCR扩增也进一步证实虫卵为大片吸虫虫卵，在约1000bp处出现明显的条带。三氯苯达唑治疗后．患者体温降至正常，自觉症状明显好转。在大理州城镇周边水沟处共采集329只椎实螺，在其中5只螺体内查到吸虫类雷蚴及单尾型尾蚴，初步鉴定为大片形吸虫幼虫。在1份牛粪和1份羊粪中查见大片形吸虫卵。结论生食被大片形吸虫卵感染的水生植物是导致发病的主要原因Objective The aim of the study was to investigate the epidemic situation, climcal symptom, diagnosis and epidemiological characteristics of human Fasciola gigantica infection in Dali, Yunnan province. It will also provide a scientific basis for fasciolosis control and prevention. Methods Epidemic data were collected and patient＇s clinical signs and symptoms were studied. Serum soluble antigen of Fasciola gigantica of patients and part of family members and health people in the same village was detected using enzyme-linked immnnosorbent assay （ELISA） and the eggs of Fasciola gigantica in stool were observed under microscope. Sequencing and PCR amplification of Fasciola gigantica eggs had been done. Sequencing results were analyzed using basic local alignment search tool（BLAST） program of the U.S. National Center for Biotechnology Information（NCBI） and the similarity of the two in the sequence of nucleic acid was compared. Furthermore, patients were experimentally given orally therapeutic doses of Triclabendazole 10 mg·kg^-1·d^-1 daily for 2 days, and kept in the hospital for observation for one week. Moreover, host and vector were investigated in the surrounding ditches of Dali prefecture and Limnaea peregra snail samples were collected. All the snails were squashed by glass sheet in order to detect the cercarie. Cow dung and sheep manure was collected in the Limnaea peregra distribution environment, and the eggs in the feces were checked by microscope after washing and precipitation. Results All the 26 patients had a continued hyperpyrexia with distinct alimentary system symptoms of nausea, vomiting, stomachache, abdominal distension as well as hepatomegaly, sensitive to percussion, different levels of liver damage detected by CT. All the patients had an eaten history of raw Herba Houttuyniae and other aquatic plants, and the course of the disease was similar, with the same epidemiological characteristics. ELISA detection was used in the 26 patients, family members and other healthy population, th

关 键 词：大片形吸虫 流行病学特征 三氯苯达唑 

分 类 号：R532.2[医药卫生—内科学]