斯里兰卡伴有神经表现的斑点热立克次体病的病例系列。

A case series of spotted fever rickettsiosis with neurological manifestations in Sri Lanka.

机构信息

Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.

出版信息

Int J Infect Dis. 2012 Jul;16(7):e514-7. doi: 10.1016/j.ijid.2012.02.016. Epub 2012 Apr 26.

DOI:10.1016/j.ijid.2012.02.016

PMID:22541336

Abstract

BACKGROUND

Spotted fever group (SFG) rickettsial infections are increasingly detected in Sri Lanka. We describe 17 patients with SFG who developed neurological manifestations.

METHODS

The cases were studied prospectively from 2008 at the Teaching Hospital, Peradeniya. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis.

RESULTS

All had an IFA IgG titer ranging from 1/64 to 1/4096 and a positive IFA IgM titer against Rickettsia conorii antigen; in 10 (59%) cases the IgG titers were ≥ 1/256 (definitive cases). The median age of the patients was 62 years (range 26-82 years); 10 were male and seven female. The median duration of fever was 12 days (range 4-35 days). Neurological manifestations on admission were drowsiness or confusion in 14 (82%) and a semi-comatose state in three (18%). Rigidity of the limbs occurred in 14 (82%), bradykinesia and resting tremors in 12 (71%), which persisted after defervescence, neck stiffness in seven (42%), weakness of the limbs in five (29%), deafness in two (12%), and stupor in three (18%). Electroencephalograms in three (18%) showed generalized slow waves. Cerebrospinal fluid examination showed a cellular reaction, predominantly lymphocytes, in three cases. Two patients died (fatality rate 12%).

CONCLUSION

We have documented for the first time the neurological features of SFG rickettsioses in the Central Province, Sri Lanka. These were predominantly extrapyramidal features in patients of older age.

摘要

背景

在斯里兰卡，越来越多的斑点热群（SFG）立克次体感染被检测到。我们描述了 17 例出现神经系统表现的 SFG 患者。

方法

这些病例是 2008 年在佩拉德尼亚教学医院进行前瞻性研究的。采用免疫荧光抗体检测（IFA）来确诊。

结果

所有患者的 IFA IgG 滴度范围为 1/64 至 1/4096，对康氏立克次体抗原的 IFA IgM 滴度均为阳性；10 例（59%）患者的 IgG 滴度≥1/256（确诊病例）。患者的中位年龄为 62 岁（范围 26-82 岁）；10 例为男性，7 例为女性。发热的中位持续时间为 12 天（范围 4-35 天）。入院时的神经系统表现为 14 例（82%）的嗜睡或意识模糊和 3 例（18%）的半昏迷状态。四肢僵硬发生于 14 例（82%），12 例（71%）存在运动徐缓和静止性震颤，这些症状在退热后仍持续存在，7 例（42%）存在颈项强直，5 例（29%）存在四肢无力，2 例（12%）存在耳聋，3 例（18%）存在昏迷。3 例（18%）的脑电图显示为弥漫性慢波。3 例患者的脑脊液检查显示以淋巴细胞为主的细胞反应。2 例患者死亡（病死率 12%）。