上海市1例输血性三日疟病例的实验室检测分析与诊断  

Laboratory analysis and diagnosis of one transfusion-transmitted quartan malaria case in Shanghai City

作　　者：王真瑜[1] 张耀光[1] 江莉[1] 李美[2] 朱民[1] 蔡黎[1] 

机构地区：[1]上海市疾病预防控制中心,上海200336 [2]中国疾病预防控制中心寄生虫病预防控制所

出　　处：《中国血吸虫病防治杂志》2015年第4期362-366,共5页Chinese Journal of Schistosomiasis Control

基　　金：上海市卫生局科研项目(20134349)

摘　　要：目的对1例感染源不明的三日疟病例进行实验室检测分析并确诊。方法收集该病例的临床资料,并进行流行病学调查。对患者及其供血者的血样进行血涂片病原学检查、疟疾快速诊断检测(RDT)和巢式PCR检测,并对阳性结果进行测序比对。结果该患者无疟疾流行区居留史和既往疟疾感染史,有外科手术时大量输血史。外周血涂片镜检查见三日疟原虫。流行病学调查显示,该患者接受了3位供血者的血液,但3位供血者血样经血涂片镜检、RDT和巢式PCR检测均未查见疟原虫,后经改进的巢式-多重PCR检测及结果测序比对后显示,与其中1名非洲籍留学生供血者的阳性扩增条带具100%同源性。结论该病例因输血而感染三日疟。实验室检测疟疾疑难病例需经多方法验证方可确诊,改进的巢式-多重PCR方法对低密度疟原虫感染有较好的检测效果。Objective To diagnose a case of quartan malaria with unknown origin by laboratory detection. Methods The clinical data of the case were collected and the epidemiological survey was conducted. The blood samples of the patient and the blood donor were detected by microscopy,rapid diagnostic test（RDT）and nested PCR,and the positive results were sequenced. Results The patient did not visit malaria endemic areas and have no history of malaria infection,but have history of massive blood transfusion in surgical operation. The patient was confirmed as quartan malaria by microscopy with peripheral blood smears. The patient was transfused from three donors whose peripheral blood was none of malaria infection by microscopy,RDT and nested PCR. But sequence analysis showed that the amplified band of one donor was 100% homology to the patient＇s with the improved nest-multi PCR examination. Conclusion This patient is confirmed of Plasmodium malariae infection via blood transfusion. Laboratory analysis and diagnosis of undefined malaria cases require multiple methods,and the improved nest-multi PCR could effectively detect the low parasitized malaria infection.

关 键 词：疟疾 输血 三日疟 血涂片 检测 快速诊断 巢式PCR 巢式-多重PCR 

分 类 号：R531.3[医药卫生—内科学]