我国首例输入性诺氏疟原虫感染现症病例的诊断和治疗  

Diagnosis and Treatment of the First Imported Case of Plasmodium knowlesi Infection in China

作　　者：潘波[1] 裴福全[1] 阮彩文[1] 林荣幸[1] 岑咏珍[1] 刘梦然[1] 邓卓晖[1] 任文峰[2] 廖寅斌[3] 李晓恒[4] 

机构地区：[1]广东省疾病预防控制中心,广州511430 [2]广州市疾病预防控制中心,广州510440 [3]广州市越秀区疾病预防控制中心,广州510055 [4]深圳市疾病预防控制中心,深圳518055

出　　处：《中国寄生虫学与寄生虫病杂志》2016年第6期513-516,共4页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：目的 探讨和分析我国首例输入性诺氏疟原虫（Plasmodium knowlesi）感染现症病例的诊断和治疗。 方法 收集患者的临床资料，采集血样制作厚、薄血膜片，吉氏染色后镜检。提取患者血样基因组DNA，通过两轮PCR扩增疟原虫核糖体DNA（rDNA），测序后在GenBank数据库进行BLAST分析。 结果 患者于2014年10月7日从马来西亚的热带雨林旅游1周回国，2014年10月16日在广州市首次发病，出现发热、寒颤和出汗等临床症状。2014年10月26日初步诊断为疟疾并住院治疗。镜检血涂片可见典型的诺氏疟原虫形态，被寄生的红细胞体积略增大，可见大滋养体呈一环、双核，黑褐色疟色素较恶性疟原虫稍大稍粗；裂殖体内可见6～8个裂殖子，有明显的褐色疟色素。PCR扩增出与预期一致的诺氏疟原虫特异性条带，片段长1 099 bp，测序经BLAST分析，其序列与诺氏疟原虫的序列（GenBank登录号：AM910985.1、L07560.1和AY580317.1）一致性为99%，确诊为诺氏疟原虫感染。给予患者氯喹和伯氨喹8日治疗，于2014年10月28日出院时，再给予复方双氢青蒿素片治疗。 结论 根据患者的临床症状、流行病学史、实验室检测结果分析，诊断其为输入性诺氏疟原虫现症感染病例，也是广东省乃至我国首次输入性诺氏疟原虫感染病例报道。Objective To diagnose and treat the first imported active case of Plasmodium knowlesi infection in China. Methods The clinical information of the patient was collected. Microscopy of blood smear was conducted after Giemsa staining. Genomic DNA was extracted from blood, and PCR was conducted to amplify rDNA. The PCR products were sequenced and analyzed with BLAST. Results The patient returned from a one-week tour in a tropical rain forest in Malaysia. The first disease attack occurred in Guangzhou on Oct. 16, 2014, with fever, shivering and sweating. The patient was initially diagnosed as malaria and hospitalized on Oct. 26, 2014. Microscopic observation revealed typical forms of P. knowlesi in blood smear. The red blood cells became enlarged, with big trophozoites appearing as a ring with dual cores and dark brown malaria pigment. The trophozoites were slightly bigger and thicker than P. falciparum. The schizont had 6-8 merozoites, with obvious brown malaria pigment. PCR resulted in a specific band of 1 099 bp. BLAST analysis showed that the sequence of the PCR product was 99% homologous to P. knowlesi（acession No. AM910985.1, L07560.1 and AY580317.1）. The patient was diagnosed as P. knowlesi infection, and was then given an 8-day treatment with chloroquine and primaquine, together with dihydroartemisinin piperaquine phosphate tablet. The patient was discharged after recovery on Oct. 28, 2014. Conclusion According to the clinical symptoms, epidemiological history and laboratory test, the patient has been confirmed as P. knowlesi infection. It may also be the first active case of knowlesi malaria reported in China.

关 键 词：诺氏疟原虫 诊断 治疗 

分 类 号：R382.31[医药卫生—医学寄生虫学]