北京地区输入性人粒细胞无形体病患者一例  

A case report of imported human granulocytic anaplasmosis in Beijing

作　　者：王鹤[1] 胡岚[1] 方媚 栗绍刚 王超[1] 齐文杰[1] Wang He;Hu Lan;Fang Mei;Li Shaogang;Wang Chao;Qi Wenjie(Department of Infection Medicine,Beijing 100050,China;Beijing Tropical Medicine Research Institute,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院感染内科,北京100050 [2]首都医科大学附属北京友谊医院北京热带医学研究所热带病防治研究北京市重点实验室,北京100050

出　　处：《中华实验和临床感染病杂志（电子版）》2022年第1期60-64,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：首都卫生发展科研专项(No.首发2016-3-2023)。

摘　　要：目的:探讨人粒细胞无形体病(HGA)的临床特征、实验室检查及治疗方法。方法:回顾性分析首都医科大学附属北京友谊医院感染内科2020年11月收治的1例输入性HGA患者的临床资料及诊疗过程。结果:患者系一名考古学家,长期于野外作业,入院前从青海都兰古墓考古回京,随后出现发热、口渴、血尿、尿潴留同时伴有白细胞、血小板计数进行性下降,于外院治疗效果不佳转至本院,血二代测序(NGS)结果为阴性,骨髓涂片可见粒细胞包涵体,高度可疑HGA,及时给予米诺环素1天余体温正常,2周后症状消失出院,出院2周后患者再次出发考古并于四川当地门诊复查血液各项指标均正常,未再出现发热。结论:HGA病情进展迅速,严重者可引起多脏器损害,甚至死亡,而引起一过性尿潴留较为罕见,本病例首次报告HGA并发尿潴留症状,但HGA与尿潴留是否直接相关有待进一步研究。同时野外作业是HGA的高危因素。NGS对HGA诊断价值有限,及时行血涂片或骨髓涂片,以及经验性治疗是挽救生命的关键。Objective To investigate the clinical features,laboratory indexes,and treatment of human granulocytic anaplasmosis(HGA).Methods Data of a patient with imported HGA admitted to the Department of Infectious Medicine,Beijing Friendship Hospital,Capital Medical University in November 2020 was reviewed.Results The patient was an archaeologist who worked in the field for a long time.Before admission,he returned to Beijing from the ancient tomb of Dulan,Qinghai.He subsequently developed fever,thirst,hematuria,and urinary retention,accompanied by a progressive decline in white blood cell and platelet counts.The treatment effect in the other hospital was poor,he was transferred to our hospital.The next-generation sequencing(NGS)of blood was negative.The bone marrow smear showed granulocyte inclusion bodies and highly suspicious HGA.Minocycline was given in time for one day and the body temperature returned normal.After two weeks,the symptoms disappeared and the patient was discharged.During the archaeology,he took re-examination in the local outpatient clinic in Sichuan,all blood indicators were normal,and fever did not reappear.Conclusions HGA progresses rapidly.For severe cases,it can cause multiple organ damage and even death.This case is the first to report HGA complicating urinary retention.However,whether HGA is directly related to urinary retention needs further study.At the same time,field work is a high risk factor for HGA.NGS was of limited value in the diagnosis of HGA,and timely blood smear or bone marrow smear and empirical treatment are the keys to saving lives.

关 键 词：人粒细胞无形体病 嗜吞噬细胞无形体 尿潴留 发热待查 

分 类 号：R512[医药卫生—内科学]