1例人感染田鼠巴贝虫的实验室诊断及文献复习  

Laboratory diagnosis of Babesia microti： a case of human babesiosis and literature review

作　　者：陈要朋[1] 彭恒[2] 刘铁牛[1] 黄丽[1] 乔岩[2] 黄贵才[1] 高慧[1] 李孟英[3] 朱淮民[2] 

机构地区：[1]解放军第303医院检验科,南宁530021 [2]第二军医大学病原生物学教研室,上海200433 [3]解放军第303医院感染科,南宁530021

出　　处：《国际医学寄生虫病杂志》2014年第3期143-147,共5页International JOurnal of Medical Parasitic Diseases

基　　金：卫生行业科研专项经费资助项目（201202019）;国家自然科学基金（81141085）

摘　　要：目的 回顾1例反复发热半年,最终确诊为田鼠巴贝虫感染的诊断过程,复习文献,为巴贝虫病的诊断提供参考. 方法 收集患者的临床资料和流行病学资料,采集患者骨髓和外周血涂片镜检,抽提血液基因组DNA,用田鼠巴贝虫特异引物进行巢式PCR扩增,取血清进行间接免疫荧光检测. 结果 骨髓和外周血涂片镜检可见少量红细胞内有环状体,未见其它疟原虫红细胞内期形态.巢式PCR获得阳性条带,经测序证实为田鼠巴贝虫18s rRNA基因;间接免疫荧光抗体试验阳性;经克林霉素、磷酸氯喹片抗巴贝虫治疗2个疗程,患者达到临床治愈. 结论 综合患者临床资料、实验室检查结果、以及抗巴贝虫药物疗效,确诊1例人田鼠巴贝虫感染病例.在病原学检查不典型时,分子生物学和免疫学检查结果是重要的巴贝虫病诊断依据.Objective To present the diagnosis process of a human case with recurrent fever for six months,which eventually diagnosed as Babesia microti infection,combined with the literature review thus to provide reference for the diagnosis of human babesiosis.Methods Clinical and epidemiological information of the case was collected.Bone marrow and peripheral blood samples were collected and examined microscopically.Blood genomic DNA was extracted and then amplified using nest-PCR with Babesia microti specific primers.The amplified products were sequenced and then undergone BLAST analysis.Serum of the patient was collected and tested with indirect immunofluorescence assay （IFA）.Results Ring-formed parasites were observed within and outside of red blood cells of the bone marrow and peripheral blood.No other intraerythrocyte stage of Plasmodium parasites was found.Amplified products were obtained by nested PCR.The fragments sequences were shown of 99％ similarity to 18s rRNA of Babesia microti.The IFA results of patient sera were positive.The patients achieved clinical cure after administration of 2 courses of clindamycin plus chloroquine phosphate.Conclusion The patient was diagnosed as babesiasis microti based on the clinical data,the results of laboratory diagnosis,and efficacy of chemotherapy.The diagnostic process of this case suggested that when the microscopic finding of blood smear is atypical,molecular biology and immunological assay are important support for babesiosis diagnosis.

关 键 词：田鼠巴贝虫 人体感染 实验室诊断 

分 类 号：R446[医药卫生—诊断学]