武汉市1例输入性黑热病的诊断及调查分析  

Diagnosis and investigation of an imported case of visceral leishmaniasis in Wuhan City

作　　者：杨燕[1] 周水茂[1] 郭庆 张娟[3] 贾西帅 罗华堂[1] 王帅 刘聪[1] 徐文秀 YANG Yan;ZHOU Shuimao;GUO Qing;ZHANG Juan;JIA Xishuai;LUO Huatang;WANG Shuai;LIU Cong;XU Wenxiu(Wuhan Center for Disease Control and Prevention,Wuhan,Hubei 430024,China;Qiaokou District Center for Disease Control and Prevention,Wuhan,Hubei 430035,China;Hubei Provincial Center for Diseases Control and Prevention,Wuhan,Hubei 430079,China)

机构地区：[1]武汉市疾病预防控制中心,湖北武汉430024 [2]硚口区疾病预防控制中心,湖北武汉430035 [3]湖北省疾病预防控制中心,湖北武汉430079

出　　处：《中国热带医学》2025年第1期127-130,共4页China Tropical Medicine

摘　　要：报道武汉市1例输入性黑热病确诊病例的发现、诊断、治疗及流行病学调查,为提高非流行区医疗卫生机构专业人员对输入性黑热病的认识,减少误诊提供参考经验。患者在山西阳泉务工1年余;2020年返回湖北家乡后开始陆续出现间断发热、全血细胞性贫血、脾脏进行性肿大以及体质量减轻等症状。经骨髓涂片查见利什曼原虫无鞭毛体,rk39快速检测试纸条法检测抗体阳性,环介导等温扩增法(LAMP)和实时荧光定量PCR法(qPCR)核酸检测利什曼原虫阳性。根据流行病学史、临床表现和实验室检查结果,确定为输入性黑热病确诊病例。该病例原虫密度低,伴有类风湿因子增高等自身免疫指标异常,长期被误诊为血液系统、自身免疫系统疾病,未得到有效治疗,离开流行区4年后才得以确诊。建议黑热病非流行区应重视流行病学史的询问,提高医疗卫生机构的诊断意识和诊疗水平,避免延误治疗。This paper reports the discovery,diagnosis,treatment,and epidemiological survey of an imported confirmed visceral leishmaniasis(kala-azar)case in Wuhan City,providing a reference experience for enhancing awareness of imported visceral leishmaniasis among medical professionals in non-endemic healthcare institutions and reducing misdiagnosis.The patient had worked in Yangquan,Shanxi Province,for more than one year.After returning to his hometown in Hubei Province in 2020,he began to show symptoms such as intermittent fever,pancytopenia,progressive splenomegaly,and significant weight loss.Leishmania amastigotes were found in bone marrow smears.The rapid diagnostic test using the rk39 strip was positive for antibodies.Furthermore,both loop-mediated isothermal amplification(LAMP)and quantitative polymerase chain reaction(qPCR)assays confirmed the presence of Leishmania nucleic acid.Based on a comprehensive analysis of the epidemiological history,clinical manifestations,and laboratory test results,the case was confirmed as an imported visceral leishmaniasis case.This case presented with low parasite density and abnormal autoimmune indicators such as increased rheumatoid factor,leading to its prolonged misdiagnosis as a hematologic or autoimmune disease without effective treatment.It was only diagnosed after having left the endemic area for four years.Non-endemic areas should pay attention to the inquiry of epidemiological history and improve healthcare institutions'diagnostic awareness and treatment capabilities related to visceral leishmaniasis to avoid delays in treatment.

关 键 词：黑热病 利什曼原虫 输入性病例 误诊 

分 类 号：R531.6[医药卫生—内科学]