Zhang Lijuan, Liu Yan, Ni Daxin, Li Qun, Yu Yanlin, Yu Xue-jie, Wan Kanglin, Li Dexin, Liang Guodong, Jiang Xiugao, Jing Huaiqi, Run Jing, Luan Mingchun, Fu Xiuping, Zhang Jingshan, Yang Weizhong, Wang Yu, Dumler J Stephen, Feng Zijian, Ren Jun, Xu Jianguo
National Institute of Communicable Disease Control and Prevention, China, CDC, Beijing, China, PO Box 5, Changping, Beijing, China 102206.
JAMA. 2008 Nov 19;300(19):2263-70. doi: 10.1001/jama.2008.626.
Human granulocytic anaplasmosis (HGA) is an emerging tick-borne disease in China. A cluster of cases among health care workers and family members following exposure to a patient with fulminant disease consistent with HGA prompted investigation.
To investigate the origin and transmission of apparent nosocomial cases of febrile illness in the Anhui Province.
DESIGN, SETTING, AND PATIENTS: After exposure to an index patient whose fatal illness was characterized by fever and hemorrhage at a primary care hospital and regional tertiary care hospital's isolation ward, secondary cases with febrile illness who were suspected of being exposed were tested for antibodies against Anaplasma phagocytophilum and by polymerase chain reaction (PCR) and DNA sequencing for A. phagocytophilum DNA. Potential sources of exposure were investigated.
Cases with serological or PCR evidence of HGA were compared with uninfected contacts to define the attack rate, relative risk of illness, and potential risks for exposure during the provision of care to the index patient.
In a regional hospital of Anhui Province, China, between November 9 and 17, 2006, a cluster of 9 febrile patients with leukopenia, thrombocytopenia, and elevated serum aminotransferase levels were diagnosed with HGA by PCR for A. phagocytophilum DNA in peripheral blood and by seroconversion to A. phagocytophilum. No patients had tick bites. All 9 patients had contact with the index patient within 12 hours of her death from suspected fatal HGA while she experienced extensive hemorrhage and underwent endotracheal intubation. The attack rate was 32.1% vs 0% (P = .04) among contacts exposed at 50 cm or closer, 45% vs 0% (P = .001) among those exposed for more than 2 hours, 75% vs 0% (P < .001) among those reporting contact with blood secretions, and 87.5% vs 0% (P = .004) among those reporting contact with respiratory secretions from the index patient.
We report the identification of HGA in China and likely nosocomial transmission of HGA from direct contact with blood or respiratory secretions.
人粒细胞无形体病（HGA）在中国是一种新出现的蜱传疾病。在接触一名患有与HGA相符的暴发性疾病患者后，医护人员和家庭成员中出现了一组病例，促使进行调查。
调查安徽省明显的医院内发热性疾病病例的来源和传播情况。
设计、地点和患者：在一家基层医院和地区三级医院的隔离病房接触了一名以发热和出血为特征的致命疾病的索引患者后，对疑似接触过的发热性疾病继发病例进行了嗜吞噬细胞无形体抗体检测，并通过聚合酶链反应（PCR）和DNA测序检测嗜吞噬细胞无形体DNA。对潜在的暴露源进行了调查。
将有HGA血清学或PCR证据的病例与未感染的接触者进行比较，以确定发病率、患病相对风险以及在为索引患者提供护理期间的潜在暴露风险。
2006年11月9日至17日，在中国安徽省的一家地区医院，一组9名发热患者被诊断为HGA，这些患者白细胞减少、血小板减少且血清转氨酶水平升高，通过对外周血中嗜吞噬细胞无形体DNA进行PCR检测以及对嗜吞噬细胞无形体的血清转化进行诊断。所有患者均无蜱叮咬史。所有9名患者在疑似致命HGA的索引患者死亡前12小时内与其接触，当时该患者出现大量出血并接受了气管插管。在距离50厘米或更近接触的接触者中，发病率为32.1%，而未接触者为0%（P = 0.04）；在接触超过2小时的接触者中，发病率为45%，未接触者为0%（P = 0.001）；在报告接触血液分泌物的接触者中，发病率为75%，未接触者为0%（P < 0.001）；在报告接触索引患者呼吸道分泌物的接触者中，发病率为87.5%，未接触者为0%（P = 0.004）。
我们报告了在中国发现HGA以及可能通过直接接触血液或呼吸道分泌物发生医院内HGA传播的情况。
