Ambroise-Thomas P, Goullier A, Grillot R, Lascaud D, Rivoire L, Perrin Y
Acta Trop. 1975;32(4):365-70.
We had the opportunity of studying an epidemic of autochthonous amoebiasis occurring in the autumn of 1974 in a small town of 4000 inhabitants 30 km from Grenoble. Attention was originally attracted by the occurrence in this town of two cases of hepatic amoebiasis and one of intestinal amoebiasis identified by rectoscopy. Systematic investigations (coproctic examinations and serological tests for amoebiasis by indirect antibody fluorescence) were then carried out on everyone in the locality with digestive disorders which were possibly referable to amoebiasis, and on the other members of their families. A total number of 148 coproctic examinations were made and in two cases revealed the presence of vegetative forms of Entamoeba histolytica. In both cases the infestation provoked few symptoms (asthenia, vague abdominal discomfort, intermittent and apparently banal diarrhoea). On the other hand 20 out of 94 serological tests revealed positive results, 14 of which were equal to or greater than a titre of 1/100, a level at which all risks of non-specificity are virtually ruled out under our experimental conditions. Material reasons made it impossible to subject these cases to repeated faecal checks, but in two of them at least the rectoscopic appearances were very suggestive of subacute intestinal amoebiasis. Moreover, amoebic disease appears to be well confirmed by the results obtained among the patients as a whole by treatment with Metroinidazole. A variety of hypotheses on the origin of this epidemic have been put forward and then abandoned (market garden produce, receipt by certain families of exotic frut from overseas). In actual fact water seems to be the point of departure, for, although specimens of water taken at 7 different levels in the water supply system failed to reveal the presence of a single amoeba, bacteriological analyses during autumn 1974 showed signs of faecal contamination. The locality, which is situated at the foot of the Chartreuse massif, receives its water solely from springs but there is a holiday camp for the staff of an international airline situated above the main water catchment.
1974年秋，我们有机会对一起本地阿米巴病流行情况进行研究，此次流行发生在距格勒诺布尔30公里、有4000居民的一个小镇。最初，该小镇出现的两例肝阿米巴病和一例经直肠镜检查确诊的肠阿米巴病引起了人们的关注。随后，对当地每一位可能患有阿米巴病的消化系统疾病患者及其家庭成员进行了系统调查（粪便检查以及通过间接抗体荧光法进行的阿米巴病血清学检测）。共进行了148次粪便检查，其中两例发现了溶组织内阿米巴的滋养体。这两例感染引发的症状都很轻微（乏力、腹部隐痛、间歇性且看似平常的腹泻）。另一方面，94次血清学检测中有20例呈阳性结果，其中14例滴度等于或高于1/100，在我们的实验条件下，这一水平几乎排除了所有非特异性反应的风险。由于实际原因，无法对这些病例进行重复粪便检查，但其中至少两例的直肠镜检查结果强烈提示为亚急性肠阿米巴病。此外，甲硝唑治疗全体患者所取得的结果似乎充分证实了阿米巴病的存在。关于此次疫情的起源，人们提出了各种假设，随后又都放弃了（如菜园产品、某些家庭收到来自海外的异国水果）。实际上，水似乎是源头，因为尽管在供水系统的7个不同层面采集的水样均未发现任何阿米巴，但1974年秋季的细菌学分析显示存在粪便污染迹象。该地区位于沙特尔山脉脚下，其用水完全取自泉水，但在主要集水区上方有一个国际航空公司员工的度假营地。
