前英国远东战俘中的慢性粪类圆线虫感染

Chronic Strongyloides stercoralis infection in former British Far East prisoners of war.

作者信息

Gill G V, Welch E, Bailey J W, Bell D R, Beeching N J

机构信息

Department of Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool L3 5QA.

出版信息

QJM. 2004 Dec;97(12):789-95. doi: 10.1093/qjmed/hch133.

DOI:10.1093/qjmed/hch133

PMID:15569810

Abstract

BACKGROUND

Chronic infections with the nematode worm Strongyloides stercoralis can occur in former WWII Far East prisoners of war (FEPOWs). The condition may be asymptomatic, but frequently causes a characteristic urticarial 'larva currens' rash. Under conditions of immunosuppression (particularly systemic corticosteroid treatment) potentially fatal dissemination of larvae ('hyperinfection') may occur.

AIM

To review our total experience of strongyloidiasis in former FEPOWs, and investigate its prevalence, characteristics and risk factors.

DESIGN

Retrospective case series.

METHODS

We reviewed 2072 records of all FEPOWs seen at the Liverpool School of Tropical Medicine, 1968-2002. Cases with strongyloidiasis were compared with non-infected controls.

RESULTS

There were 248 (12%) with strongyloidiasis. Diagnostic features included larva currens rash (70%), eosinophilia (66%), positive faecal culture (30%), positive faecal microscopy (26%), and positive serology (64%). Mean (+/-SD) age of cases was 65 +/- 7 years, and as expected, their blood eosinophil counts were significantly higher than controls (775 vs. 238 x 10(6)/l, p < 0.001). Captivity on the Thai-Burma Railway (vs. elsewhere) was significantly associated with strongyloidiasis (78% cases vs. 40% controls, OR 4.19, CI 2.70-6.81, p < 0.001). In terms of prevalence, strongyloidiasis occurred in 166/1032 men imprisoned on the Burma Railway (16.1%). Malaria (88% vs. 69%, p < 0.001) and tropical ulcer (53% vs. 42%, p < 0.02) were more common amongst cases than controls, probably because these diseases were very common on the Burma Railway.

DISCUSSION

S. stercoralis infection is common amongst ex-FEPOWs, particularly those from the Thai-Burma Railway project. It is usually characterized by a 'larva currens' rash and marked eosinophilia. The condition is eminently treatable, and continued diagnostic surveillance is needed, if cases of potentially fatal hyperinfection are to be avoided.

摘要

背景

粪类圆线虫慢性感染可发生于二战时期的远东战俘（FEPOWs）。该病可能无症状，但常引发特征性的荨麻疹样“匐行疹”。在免疫抑制状态下（尤其是全身使用糖皮质激素治疗时），幼虫可能发生致命性播散（“超感染”）。

目的

回顾我们对前远东战俘粪类圆线虫病的总体经验，并调查其患病率、特征及危险因素。

设计

回顾性病例系列研究。

方法

我们查阅了1968年至2002年间在利物浦热带医学院就诊的所有远东战俘的2072份记录。将粪类圆线虫病患者与未感染的对照组进行比较。

结果

有248例（12%）患有粪类圆线虫病。诊断特征包括匐行疹（70%）、嗜酸性粒细胞增多（66%）、粪便培养阳性（30%）,粪便显微镜检查阳性（26%）以及血清学阳性（64%）。患者的平均（±标准差）年龄为65±7岁，正如预期的那样，他们的血液嗜酸性粒细胞计数显著高于对照组（775对238×10⁶/L，p<0.001）。在泰缅铁路被俘（与其他地方相比）与粪类圆线虫病显著相关（78%的病例对40%的对照组，OR 4.19，CI 2.70 - 6.81，p<0.001）。就患病率而言，1032名被囚禁在缅甸铁路的男性中有166例（16.1%）发生粪类圆线虫病。病例组中疟疾（88%对69%，p<0.001）和热带溃疡（53%对42%，p<0.02）比对照组更常见，可能是因为这些疾病在缅甸铁路非常普遍。