云南省2例婴幼儿输入性内脏利什曼病病例临床分析  

Clinical analysis of two cases of imported visceral leishmaniasis in infants in Yunnan Province

作　　者：世淑兰 李翠英 张倩[1] 李荣杰 奎莉越[1] 樊茂[1] SHI Shulan;LI Cuiying;ZHANG Qian;LI Rongjie;KUI Liyue;FAN Mao(Department of Clinical Laboratory,Kunming Children’s Hospital,Yunnan Children’s Medical Center,Kunming 650228,Yunnan,China;Department of Pathogen Biology and Immunology,Faculty of Basic Medical Science,Kunming Medical University,Kunming 650500,Yunnan,China)

机构地区：[1]昆明市儿童医院检验科,云南省儿童医学中心,云南昆明650228 [2]昆明医科大学基础医学院病原生物学与免疫学系,云南昆明650500

出　　处：《中国寄生虫学与寄生虫病杂志》2024年第5期676-678,683,共4页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：昆明市卫生科技人才培养项目-千工程(2023-SW(后备)-42);昆明市卫生科研项目(2022-11-01-007),昆明市卫生科研项目(2019-06-01-014);昆明市科技局科研项目(2019-1-S-25318000001171)。

摘　　要：回顾性分析2021年1月至2022年12月昆明市儿童医院收治的2例内脏利什曼病患儿的实验室检查及临床病历资料。2例均为云南女性患儿,年龄分别为9个月和2岁,均有内脏利什曼病流行区(分别为甘肃省甘南藏族自治州舟曲县及新疆维吾尔自治区库车市)居住史和白蛉叮咬史。2例患儿均有长期不规则发热,体温39.7~40℃,有皮疹,面色苍白。血常规示白细胞(病例1、病例2分别为3.92×10^(9)/L、3.34×10^(9)/L)、血红蛋白(98 g/L、79 g/L)、血小板(49×10^(9)/L、57×10^(9)/L)减少;超敏C反应蛋白(200 mg/L、58.19 mg/L)、降钙素原(2.29 ng/ml、1.38 ng/ml)、铁蛋白(69 445μg/L、2 800μg/L)升高。rK39抗体均为阳性。骨髓穿刺涂片均检出利什曼原虫无鞭毛体。病例2外周血经全套病原微生物宏基因组高通量测序,检出杜氏利什曼原虫序列32 026条。腹部B超示2例患儿均有肝脏、脾脏肿大。确诊为内脏利什曼病后给予葡萄糖酸锑钠240 mg/kg(均分为6剂),每日静脉注射1次,一个疗程6 d,共3个疗程。2例患儿均治愈,随访半年、1年均未见异常。儿童内脏利什曼病临床症状不典型,若长期不规则发热,临床医师应详细询问内脏利什曼病的流行病学史,结合实验室检查及骨髓穿刺涂片寻找病原体,若骨髓中未找到病原体时,应及时行病原体宏基因组高通量测序等检查,以减少误诊或漏诊。This retrospective analysis reviews the laboratory and clinical data of two infants with visceral leishmaniasis treated at Kunming Children’s Hospital from January 2021 to December 2022.Both patients were female from Yunnan,and 9 months and 2 years old,respectively,with a history of residence in endemic areas (Gannan Tibetan Autonomous Prefecture,Gansu Province,and Kuqa City,Xinjiang Uygur Autonomous Region) and a history of sandfly bites.Symptoms included irregular fever (39.7℃to 40℃),rash,and pallor.Blood routine tests showed decreased white blood cells (3.92×10^(9)/L,3.34×10^(9)/L),hemoglobin (98 g/L,79 g/L),and platelets (49×10^(9)/L,57×10^(9)/L),with elevated C-reactive protein (200 mg/L,58.19 mg/L),procalcitonin (2.29 ng/ml,1.38 ng/ml),and ferritin (69 445μg/L,2 800μg/L).rK39 antibody tests were positive.Bone marrow smears revealed Leishmania amastigotes.The second case,through comprehensive pathogen metagenomic next-generation sequencing,identified 32 026 sequences of Leishmania donovani.Abdominal ultrasound showed hepatosplenomegaly in both patients.After diagnosis,sodium stibogluconate was administered at 240 mg/kg divided into 6 doses,with one intravenous injection per day.It resulted in a cure,with no abnormalities at six months and one year follow-up.Visceral leishmaniasis in children can have atypical symptoms.If there is prolonged irregular fever,clinicians should inquire in detail about the epidemiological history of visceral leishmaniasis.Metagenomic sequencing may be necessary to avoid misdiagnosis or missed diagnosis if no pathogens are found in the bone marrow.

关 键 词：内脏利什曼病 婴幼儿 临床分析 云南省 

分 类 号：R531.6[医药卫生—内科学]