美国军队中的寄生虫感染：从类圆线虫病到血吸虫病。
Helminth infections in the US military: from strongyloidiasis to schistosomiasis.
机构信息
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.
Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
出版信息
J Travel Med. 2021 Aug 27;28(6). doi: 10.1093/jtm/taab004.
BACKGROUND
Helminth infections caused by parasitic worms, including nematodes (roundworms), cestodes (tapeworms) and trematodes (flukes), can cause chronic symptoms and serious clinical outcomes if left untreated. The US military frequently conducts activities in helminth-endemic regions, particularly Africa, the Middle East and Southeast Asia. However, the military does not currently screen for these infections, and to date, no comprehensive surveillance studies have been completed to assess the frequency of helminth diagnoses in the military personnel and their families.
METHODS
To determine the burden of helminth infections in the US Military Health System (MHS), we conducted a retrospective analysis of International Classification of Diseases (ICD)-9/10 diagnosis codes from all medical encounters in the MHS Data Repository (MDR) from fiscal years (FY) 2012 to 2018. Chart reviews were conducted to assign ICD diagnoses as incorrect, suspected, probable or confirmed based on the laboratory results and symptoms.
RESULTS
Abstraction of MHS data revealed over 50 000 helminth diagnoses between FY 2012 and FY 2018. Of these, 38 445 of diagnoses were amongst unique subjects. After chart review, we found there were 34 425 validated helminth infections diagnosed amongst the unique subjects of US military personnel, retirees and dependents. Nearly 4000 of these cases represented infections other than enterobiasis. There were 351 validated strongyloidiasis diagnoses, 317 schistosomiasis diagnoses and 191 diagnoses of cysticercosis during the study period. Incidence of intestinal nematode infection diagnoses showed an upward trend, whilst the incidence of cestode infection diagnoses decreased.
CONCLUSIONS
The results of this study demonstrate that helminth infections capable of causing severe morbidity are often diagnosed in the US military. As helminth infections are often asymptomatic or go undiagnosed, the true burden of helminth infections in US military personnel and dependents may be higher than observed here. Prospective studies of US military personnel deployed to helminth-endemic areas may be indicated to determine if post-deployment screening and/or empirical treatment are warranted.
背景
寄生虫引起的蠕虫感染，包括线虫（圆虫）、绦虫（带绦虫）和吸虫（吸虫），如果不治疗，可能会导致慢性症状和严重的临床后果。美国军方经常在蠕虫流行地区开展活动，特别是在非洲、中东和东南亚。然而，军方目前并没有对这些感染进行筛查，迄今为止，也没有完成全面的监测研究来评估军事人员及其家属中蠕虫诊断的频率。
方法
为了确定美国军事卫生系统（MHS）中蠕虫感染的负担，我们对 MHS 数据仓库（MDR）中 2012 财年至 2018 财年所有医疗记录的国际疾病分类（ICD）9/10 诊断代码进行了回顾性分析。根据实验室结果和症状，进行图表审查以将 ICD 诊断分配为不正确、疑似、可能或确诊。
结果
从 MHS 数据中提取的数据显示，在 2012 财年至 2018 财年期间，有超过 50000 例蠕虫诊断。其中，38445 例诊断是在独特的主题中。经过图表审查，我们发现在美军人员、退休人员和家属的独特人群中诊断出 34425 例经证实的蠕虫感染。其中近 4000 例为肠道蠕虫感染以外的感染。在研究期间，有 351 例经证实的旋毛虫病诊断，317 例血吸虫病诊断和 191 例囊虫病诊断。肠道线虫感染诊断的发病率呈上升趋势，而绦虫感染诊断的发病率则下降。
结论
本研究结果表明，能够引起严重发病率的蠕虫感染在美国军队中经常被诊断出来。由于蠕虫感染通常无症状或未被诊断，因此美国军事人员及其家属中蠕虫感染的真实负担可能高于这里观察到的。可能需要对派往蠕虫流行地区的美国军事人员进行前瞻性研究，以确定是否需要进行部署后筛查和/或经验性治疗。
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