海南省680例不明原因发热患者恙虫病东方体感染调查  

Epidemiology and clinical characteristics of scrub typhus based on 680 unexplained fever patients in Hainan

作　　者：薛莉颖 谢晓菲 王高玉 黄艺 张丽媛 何昌华[5] 贾毅博 文书 杜江 尹飞飞[1,2,3] XUE Li-ying;XIE Xiao-fei;WANG Gao-yu;HUANG Yi;ZHANG Li-yuan;HE Chang-hua;JIA Yi-bo;WEN Shu;DU Jiang;YIN Fei-fei(Key Laboratory of Tropical Translational Medicine of Ministry of Education,Hainan Medical University,Haikou,Hainan 571199,China;Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases,Hainan Medical University,Haikou,Hainan 571199,China;Department of Pathogen Biology,Hainan Medical University,Haikou,Hainan 571199,China;Department of Infectious Diseases,Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570216,China;Hainan Center for Disease Control and Prevention,Haikou,Hainan 570203,China;Department of Clinical Laboratory,People's Hospital of Qiongzhong Li Miao Autonomous County,Qiongzhong,Hainan 572900,China)

机构地区：[1]海南医学院,海南医学院热带病转化医学教育部重点实验室,海南海口571199 [2]海南医学院,海南医学院-香港大学热带传染病联合实验室,海南海口571199 [3]海南医学院,海南医学院病原生物学教研室,海南海口571199 [4]海南医学院第二附属医院热带病科,海南海口570216 [5]海南省疾病预防控制中心,海南海口570203 [6]琼中黎族苗族自治县人民医院检验科,海南琼中572900

出　　处：《中国热带医学》2022年第10期930-934,共5页China Tropical Medicine

基　　金：海南省重大科技计划项目(No.ZDKJ202003);海南省重点研发计划(No.ZDYF2022SHFZ085,No.ZDYF2022SHFZ098);海南省自然科学基金项目(No.820QN267,No.820RC628,No.822MS076,No.819QN360);海南医学院培育基金(No.HYPY201919)。

摘　　要：目的了解海南省不明原因发热患者的恙虫病东方体检感染情况,为不明原因发热患者恙虫病防治提供指导。方法收集2018—2021年海南医学院第一附属医院、海南医学院第二附属医院、海口市人民医院和琼中黎族苗族自治县人民医院临床诊断为不明原因发热患者血液样本,利用胶体金免疫层析法和PCR方法分别对样本进行恙虫病东方体特异性IgM、IgG抗体和恙虫病东方体56kD型特异性抗原基因检测,同时收集样本的临床及流行病学信息,并进行流行病学分析。结果共收集临床不明原因发热患者血样680份,恙虫病东方体IgM、IgG抗体和56kD型特异性抗原PCR阳性率分别为23.97%(163/680)、36.62%(249/680)和20.88%(142/680),焦痂或皮疹率为12.06%(82/680)。根据诊断标准,最终诊断为恙虫病的患者为223例,其中男性111例(49.78%),女性109例(48.88%),平均年龄(53.14±15.12)岁,其中40~<60岁98例(占43.95%),感染人群民族中汉族136例(占60.99%),农民93例(41.70%),秋季发病114例(51.12%)。临床表现以非特异性症状与体征为主,36.77%患者出现皮肤特异性溃疡或焦痂。结论海南省是恙虫病的疫源地,流行时间有明显的季节性,预防重点应是秋季的农村地区,临床特征以高热和焦痂或溃疡为主。Objective To analyze the epidemiological characteristics of scrub typhus in 680 patients with unexplained fever in Hainan Island and provide guidance for local scrub typhus prevention and control.Methods Blood samples from patients with clinically diagnosed unexplained fever in the First Affiliated Hospital of Hainan Medical University,Second Affiliated Hospital of Hainan Medical University,Haikou Municipal People's Hospital and Central South University Xiangya Medical College Affiliated Hospital,People's Hospital of Qiongzhong Li Miao Autonomous County were collected between 2018 and 2021,then samples were tested for Orientia tsutsugamushi specific IgM,IgG antibodies and Orientia tsutsugamushi 56kD-specific antigen genes using colloidal gold immunochromatography and PCR methods.The clinical and epidemiological information of the samples were also collected.Epidemiological analysis was carried out on the obtained sample information and test results.Results A total of 680 samples from patients with clinically unknown fever were collected.The positive rates of scrub typhus IgM antibody,IgG antibody,PCR were 23.97%(163/680),36.62%(249/680),20.88%(142/680),respectively,and eschar or rash was observed in 12.06%(82/680)of all patients.According to the diagnostic criteria,223 patients were finally diagnosed with scrub typhus.Among them,there were 111 males(49.78%)and 109 females(48.88%);the average age was(53.14±15.12)years old,and the 40-<60 years old was the main incidence group(98 cases,accounting for 43.95%).The ethnicity of the patient with scrub typhus was mainly Han ethnicity(136 cases,accounting for 60.99%).Farmers were the main morbidity group(93 cases,41.70%).The patient with scrub typhus distributed throughout the island except for Sanya and Wuzhishan,with Haikou and Qiongzhong show the highest number of cases.The number of cases in autumn was the highest(114 cases,51.12%).The clinical manifestations of infected patients were mainly non-specific symptoms and signs,36.77%of patients developed skin-specific ul

关 键 词：恙虫病 不明原因发热 恙虫病东方体56kD型特异性抗原 流行病特征 

分 类 号：R513.2[医药卫生—内科学]