中国 48 例“嗜吞噬细胞无形体”感染的流行病学、临床和实验室特征：一项描述性研究。

Epidemiological, clinical, and laboratory characteristics of 48 cases of "Babesia venatorum" infection in China: a descriptive study.

机构信息

State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.

Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China.

出版信息

Lancet Infect Dis. 2015 Feb;15(2):196-203. doi: 10.1016/S1473-3099(14)71046-1. Epub 2014 Dec 22.

DOI:10.1016/S1473-3099(14)71046-1

PMID:25539588

Abstract

BACKGROUND

Human babesiosis is an emerging zoonosis. "Babesia venatorum" has been identified in only four asplenic men and a child so far. We aimed to describe the epidemiological, clinical, and laboratory characteristics of a series of cases with "B venatorum" infection identified in a sentinel hospital in China.

METHODS

We recruited participants with a recent tick bite at Mudanjiang Forestry Central Hospital, Heilongjiang province, China. Cases were diagnosed through PCR followed by sequencing, microscopic identification, or isolation by animal inoculation, or both.

FINDINGS

48 individuals (30 women or girls; median age 45 years, range 7 months to 75 years) with "B venatorum" infection were identified. 32 of these individuals were confirmed cases and 16 were probable cases. None of the 48 cases had received a blood transfusion or had a splenectomy. Geographically, cases were distributed diffusely throughout the hospital catchment area. Of the 32 confirmed cases, 21 (66%) presented with a fever, 13 (41%) with a headache, 12 (38%) with myalgia or arthralgia, and three (9%) with chills. 14 (44%) patients had fatigue, eight (25%) had dizziness, and eight (25%) had hypersomnia. Six (19%) patients had an erythematous non-pruritic rash around the tick-bite site and two (6%) had lymphadenopathy. Seven (22%) and four (13%) patients had anaemia and thrombocytopenia, respectively, and seven (50%) of 14 patients with confirmed infection had increased hepatic transaminase concentrations. In the confirmed cases, concentrations of intercellular adhesion molecule 3 (p<0·001), P-selectin (p<0·05), and platelet endothelial cell adhesion molecule 1 (p<0·001) were significantly reduced, whereas tumour necrosis factor α (p<0·01) and vascular cell adhesion molecule 1 (p<0·001) were significantly increased.

INTERPRETATION

"B venatorum" infection should be included in the differential diagnosis of patients with a tick-exposure history in areas where this pathogen has previously been identified in ticks or people.

FUNDING

Natural Science Foundation of China and Mega-Project for Infectious Diseases.

摘要

背景

人体巴贝虫病是一种新出现的人畜共患病。到目前为止，仅在 4 名无脾男性和 1 名儿童中发现了“巴贝虫猎手”。我们旨在描述在中国一家哨点医院发现的一系列“B venatorum”感染病例的流行病学、临床和实验室特征。

方法

我们招募了在中国黑龙江省牡丹江市林业中心医院有近期蜱叮咬史的参与者。通过 PCR 后测序、显微镜鉴定或动物接种或两者结合来诊断病例。

结果

共发现 48 例“B venatorum”感染患者（30 名女性或女孩；中位年龄 45 岁，范围 7 个月至 75 岁）。其中 32 例为确诊病例，16 例为疑似病例。48 例患者均未接受过输血或脾切除术。从地理上看，病例分布在医院整个收容区。在 32 例确诊病例中，21 例（66%）有发热，13 例（41%）有头痛，12 例（38%）有肌痛或关节痛，3 例（9%）有寒战。14 例（44%）患者有乏力，8 例（25%）有头晕，8 例（25%）有嗜睡。6 例（19%）患者在蜱叮咬部位周围有红斑性非瘙痒性皮疹，2 例（6%）有淋巴结病。7 例（22%）和 4 例（13%）患者分别有贫血和血小板减少症，14 例确诊感染患者中有 7 例（50%）肝转氨酶浓度升高。在确诊病例中，细胞间黏附分子 3（p<0·001）、P 选择素（p<0·05）和血小板内皮细胞黏附分子 1（p<0·001）浓度显著降低，而肿瘤坏死因子α（p<0·01）和血管细胞黏附分子 1（p<0·001）浓度显著升高。