内脏利什曼病治疗后64年复发1例  

Relapse of visceral leishmaniasis in a cured case after 64 years

作　　者：张爱平[1] 梁曼曼[1] 朱玲玲 盛皓宇[1] 杨江华[1] ZHANG Ai-ping;LIANG Man-man;ZHU Ling-ling;SHENG Hao-yu;YANG Jiang-hua(Department of Infectious Diseases,Yijishan Hospital,Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院感染性疾病科,芜湖241001

出　　处：《中国寄生虫学与寄生虫病杂志》2022年第2期266-268,F0003,共4页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：患者,74岁,日照莒县人,1957年在山东省莒县当地医院诊断为内脏利什曼病,予以五价锑治疗6 d后好转。1964年移居安徽省马鞍山市,2014年10月回日照莒县省亲半个月后返回马鞍山市,2020年7月移居安徽省亳州市,期间均否认白岭叮咬,家中无养犬,无内脏利什曼病患者及病犬接触史。2020年7月出现不明原因的消瘦、乏力,2021年4月出现头晕症状,2021年6月无明显诱因突发高热,乏力及头晕加重。患者骨髓涂片查见利什曼原虫无鞭毛体;骨髓病原微生物高通量基因检测,检出利什曼原虫属序列30366条,其中杜氏利什曼原虫种序列128条;血清rk39免疫层析试条检测结果阳性。结合流行病学史和实验室检测结果,确诊患者为内脏利什曼病复发。予五价锑(0.6 g/d,肌内注射,总量6 g,疗程10 d)治疗后好转出院。出院后电话随访,患者无发热症状,但未遵医嘱到医院复查。A 74-year-old patient from Juxian County,Rizhao,Shandong Province was diagnosed with visceral leishmaniasis and treated with pentavalent antimony for 6 d in the local hospital of Juxian in 1957.In 1964,the pa-tient migrated to Ma’anshan City,Anhui Province.In October 2014,He travelled back to Juxian County for two weeks before returning to Ma’anshan City.In July 2020,he migrated to Bozhou City,Anhui Province.The patient denied any history of being bitten by sandfly,living with a dog at home during this period.The patient had no contact history of visceral leishmaniasis patients or Leishmannia infected dogs.The patient presented unexplained emaciation and fatigue from July 2020,and dizziness from April 2021.The patient had a sudden high fever without obvious inducement and aggravated fatigue and dizziness in June 2021.Bone marrow smear examination revealed Leishmania parasite flagellate body.The metagenomic analysis of the bone marrow pathogenic microorganisms revealed 30366 sequences of the Leishmania genus,including 128 sequences of Leishmania donovani.Serum rk39 immunochromatographic strip showed a positive result.Combining the epidemiological history and labortory test results,a recurrent visceral leishmaniasis diagnosis was made.The patient was discharged after treatment with pentavalent antimony(0.6 g/d,intra-muscular injection,6 g,one course of 10 days).The patient was followed up by telephone after discharge,and showed no fever but did not go to the hospital for review.

关 键 词：内脏利什曼病 利什曼原虫 复发感染 

分 类 号：R531.6[医药卫生—内科学]