Nishise S, Fujishima T, Kobayashi S, Otani K, Nishise Y, Takeda H, Kawata S
Department of Gastroenterology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
Ann Trop Med Parasitol. 2010 Jul;104(5):383-90. doi: 10.1179/136485910X12743554760388.
After two cases of amoebic colitis were detected at an institution for the mentally retarded in the Yamagata prefecture of Japan, the prevalence and epidemiology of Entamoeba histolytica infection at the institution were investigated. When the 76 residents with mental retardation were checked by serology and stool examinations, 40 (53%) showed evidence of infection with E. histolytica (i.e. E. histolytica-specific antibodies in their serum, Entamoeba cysts in their stools, and/or E. histolytica-specific antigens in their stools). The cysts were all assumed to be those of E. histolytica since all nine of the 18 cyst-positive stool samples investigated using a PCR (that distinguishes E. histolytica from E. dispar) were found positive for this species. The E. histolytica found in the institution in Yamagata appears to have been brought into the institution, from a similar institution in Kanagawa prefecture, by a mentally retarded individual who relocated from Kanagawa to Yamagata. Isolates of E. histolytica recovered during an outbreak in the institution in Kanagawa appear genotypically identical to the genotyped isolates collected in the outbreak investigated in the present study. The 40 infected individuals in Yamagata were each treated for 10 days with metronidazole or diloxanide furoate. The residents and staff of the institution were encouraged to wash their hands more frequently and more thoroughly, and the staff were asked to clip residents' fingernails and to improve the cleanliness/sterilization of the surfaces in the institution that were most likely to be contaminated with E. histolytica (lavatories, handrails, doors, doorknobs, washrooms, clothing etc). In the last 5 years of follow-up since the instigation of these and other infection-control measures, and the last treatments, no cases of E. histolytica infection have been found in the institution. This encouraging result offers hope and guidance to those attempting to control outbreaks of E. histolytica infection in other institutions.
在日本山形县一所智障机构检测出两例阿米巴性结肠炎病例后，对该机构内溶组织内阿米巴感染的患病率和流行病学情况进行了调查。对76名智障居民进行血清学和粪便检查时，40人（53%）显示有溶组织内阿米巴感染迹象（即血清中有溶组织内阿米巴特异性抗体、粪便中有溶组织内阿米巴包囊和/或粪便中有溶组织内阿米巴特异性抗原）。由于使用聚合酶链反应（区分溶组织内阿米巴和迪氏内阿米巴）对18份包囊阳性粪便样本中的9份进行检测，均发现为该物种阳性，所以所有包囊都被认定为溶组织内阿米巴的包囊。山形县该机构发现的溶组织内阿米巴似乎是由一名从神奈川县迁至山形县的智障人士从神奈川县的类似机构带入该机构的。神奈川县该机构疫情期间分离出的溶组织内阿米巴菌株在基因分型上似乎与本研究调查的疫情中收集的基因分型菌株相同。山形县的40名感染者均接受了为期10天的甲硝唑或糠酸二氯尼特治疗。鼓励该机构的居民和工作人员更频繁、更彻底地洗手，并要求工作人员修剪居民的指甲，改善该机构内最有可能被溶组织内阿米巴污染的表面（厕所、扶手、门、门把手、洗手间、衣物等）的清洁/消毒情况。自采取这些及其他感染控制措施和最后一次治疗以来的5年随访中，该机构未发现溶组织内阿米巴感染病例。这一令人鼓舞的结果为那些试图控制其他机构中溶组织内阿米巴感染疫情的人带来了希望和指导。
