Kularatne S A M, Edirisingha J S, Gawarammana I B, Urakami H, Chenchittikul M, Kaiho I
Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Trop Med Int Health. 2003 Sep;8(9):803-11. doi: 10.1046/j.1365-3156.2003.01108.x.
To identify different rickettsial infections using a specific immunofluorescent technique in patients clinically diagnosed as 'typhus fever' in the Central Province of Sri Lanka, and to define the clinical picture, assess the severity of infection and to determine the pattern of geographical distribution of the infections of the hospital-based patients.
A specific indirect immunofluorescent antibody technique was used on the sera of two groups of patients in laboratories in Japan and Thailand.
We serodiagnosed infections with Orientia tsutsugamushi, Rickettsia typhi and spotted fever group in 56 of 118 clinically investigated patients. There were eight infections with O. tsutsugamushi, two with R. typhi and 10 spotted fever group patients with IgM antibodies suggestive of acute infection. Nineteen patients had antibodies against these three rickettsial species, suggestive of past exposure, co-infection or cross-reactivity of antigens. Discrete, erythematous maculopapular rash was common to all three types of infection except for five patients who had no rash. Five patients positive for spotted fever antibodies developed fern-leaf type skin necrosis with severe illness. Duration of the febrile period ranged from 4 to 23 days with defervescence occurring after specific antibiotic treatment.
The study has shown the presence of different types of rickettsial infections in the Central Province of Sri Lanka. The characterization of the clinical picture and the severity of infection provide useful information for the proper management of the patients in the future.
采用特定免疫荧光技术，对斯里兰卡中部省份临床诊断为“斑疹伤寒热”的患者进行不同立克次体感染的鉴定，明确临床症状，评估感染严重程度，并确定医院收治患者感染的地理分布模式。
在日本和泰国的实验室，对两组患者的血清采用特定间接免疫荧光抗体技术。
在118例接受临床调查的患者中，我们通过血清学诊断出56例感染恙虫病东方体、伤寒立克次体和斑点热群立克次体。其中8例感染恙虫病东方体，2例感染伤寒立克次体，10例斑点热群患者的IgM抗体提示急性感染。19例患者体内存在针对这三种立克次体的抗体，提示既往接触、合并感染或抗原交叉反应。除5例无皮疹患者外，三种感染类型均常见离散性、红斑性斑丘疹。5例斑点热抗体阳性患者病情严重，出现蕨叶型皮肤坏死。发热期持续时间为4至23天，经特异性抗生素治疗后退热。
该研究表明斯里兰卡中部省份存在不同类型的立克次体感染。临床症状特征及感染严重程度为今后患者的合理治疗提供了有用信息。
