热带真杆菌菌血症伴发热于西非农村。

Tropheryma whipplei bacteremia during fever in rural West Africa.

机构信息

Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Université de la Méditerranée, Faculté de Médecine, 1Marseille, France.

出版信息

Clin Infect Dis. 2010 Sep 1;51(5):515-21. doi: 10.1086/655677.

DOI:10.1086/655677

PMID:20658941

Abstract

BACKGROUND

Tropheryma whipplei not only causes Whipple disease but also is an emerging pathogen associated with gastroenteritis and pneumonia that is commonly detected in stool samples in rural West Africa. We investigated the role of T. whipplei in febrile patients from rural Senegal who had a negative test result for malaria.

METHODS

From November 2008 through July 2009, we conducted a prospective study in 2 Senegalese villages; 204 blood specimens from febrile patients were collected. DNA extraction of whole-blood samples collected by finger pricks with a lancet stick was performed in Senegal; elution and quantitative polymerase chain reaction assays for T. whipplei were performed in France. In April 2009, we conducted a screening to look for the presence of T. whipplei in the saliva and stools of the overall population. Blood from French patients with chronic T. whipplei in stool samples was also analyzed.

RESULTS

The presence of T. whipplei DNA was detected in blood from 13 (6.4%) of 204 tested patients, mostly in children and in December and January. None of the French carriers tested positive. The patients with T. whipplei bacteremia presented with fever (13 patients), cough (10), thirst (8), fatigue (7), rhinorrhea (6), and sleep disorders (5). Cough and sleep disorders were significantly more frequent in febrile carriers than in the 191 febrile episodes without T. whipplei bacteremia (P = .002 and .005, respectively). No correlation was observed between the presence of T. whipplei in the stools and saliva and bacteremia.

CONCLUSIONS

Our findings suggest that T. whipplei is an agent of unexplained cold season fever with cough in rural West Africa.

摘要

背景

特罗斐姆·惠利菌不仅会引起惠利病，还是一种与肠胃炎和肺炎有关的新兴病原体，在西非农村的粪便样本中经常被检测到。我们调查了特罗斐姆·惠利菌在塞内加尔农村发热但疟疾检测结果为阴性的患者中的作用。

方法

2008 年 11 月至 2009 年 7 月，我们在塞内加尔的两个村庄进行了一项前瞻性研究；采集了 204 份发热患者的血样。用刺血针从手指采集全血样本，在塞内加尔进行 DNA 提取；在法国进行洗脱和定量聚合酶链反应检测特罗斐姆·惠利菌。2009 年 4 月，我们进行了一项筛查，以寻找特罗斐姆·惠利菌在总人口中的唾液和粪便中的存在情况。还分析了来自法国慢性特罗斐姆·惠利菌粪便样本携带者的血液。

结果

在 204 名检测患者中，有 13 名（6.4%）的血液中检测到特罗斐姆·惠利菌 DNA，主要是儿童和 12 月和 1 月。没有法国携带者检测呈阳性。特罗斐姆·惠利菌菌血症患者出现发热（13 例）、咳嗽（10 例）、口渴（8 例）、乏力（7 例）、流涕（6 例）和睡眠障碍（5 例）。咳嗽和睡眠障碍在发热携带者中比在 191 例无特罗斐姆·惠利菌菌血症的发热发作中更为常见（分别为 P=0.002 和 0.005）。未发现特罗斐姆·惠利菌在粪便和唾液中的存在与菌血症之间存在相关性。