CAJ | 학술논문

目的分析安徽省滁州地区一起恙虫病暴发的流行病学特点及临床特征,了解我国恙虫病疫源地的某些新变化.方法采用现场流行病学调查、临床特征分析、胶体金免疫色谱法和外斐反应检测恙虫病立克次体特异性抗体相结合的策略诊断恙虫病,并对新疫源地的地貌及气候特征进行调查.结果本次暴发季节为2007年10至11月份,疫源地为偏潮湿山区丛林地带,昼夜气温20～4℃.共发现恙虫病患者19例,其中9例住院治疗,9例在院外已基本恢复并通过血清学试验获得诊断,1例有典型临床表现但因故未获得血清学诊断.19例患者的主要临床特征为:畏寒14例,发热19例,头痛15例;9例住院患者中,淋巴结大8例,皮疹7例,脾大4例,体表焦痂和溃疡7例,抗OXκ斐反应阳性4例;18例检测恙虫病立克次体特异性抗体均为阳性.所有患者均无严重并发症.在首例患者确诊前,所有其他患者均未得到及时和正确的诊断,也未得到抗生素治疗.9例住院患者予多西环素治疗后迅速康复.结论安徽省本次恙虫病暴发系过渡型疫源地秋季型恙虫病.皖北地区存在恙虫病疫源地.多西环素治疗恙虫病快速有效.
목적 분석안휘성저주지구일기양충병폭발적류행병학특점급림상특정,료해아국양충병역원지적모사신변화.방법 채용현장류행병학조사、림상특정분석、효체금면역색보법화외비반응검측양충병립극차체특이성항체상결합적책략진단양충병,병대신역원지적지모급기후특정진행조사.결과 본차폭발계절위2007년10지11월빈,역원지위편조습산구총임지대,주야기온20～4℃.공발현양충병환자19례,기중9례주원치료,9례재원외이기본회복병통과혈청학시험획득진단,1례유전형림상표현단인고미획득혈청학진단.19례환자적주요림상특정위:외한14례,발열19례,두통15례;9례주원환자중,림파결대8례,피진7례,비대4례,체표초가화궤양7례,항OXκ비반응양성4례;18례검측양충병립극차체특이성항체균위양성.소유환자균무엄중병발증.재수례환자학진전,소유기타환자균미득도급시화정학적진단,야미득도항생소치료.9례주원환자여다서배소치료후신속강복.결론 안휘성본차양충병폭발계과도형역원지추계형양충병.환북지구존재양충병역원지.다서배소치료양충병쾌속유효.
Objective To investigate the epidemiological and clinical characteristics of an outbreak of tsutsugamushi disease in Chuzhou region, Anhui Province, and to clarify the new changes of epidemic focus of tsutsugamushi disease in China. Methods Field epidemiological investigation and analysis of clinical features were done. The detections of specific antibodies against Rickettsia tsutsugamushi were conducted to diagnose tsutsugamushi disease using colloidal gold immunochromatography assay combined with Well-Felix reaction. The geomorphic and climatic characteristics of the new epidemic focus were investigated. Results The outbreak occurred from October to November, 2007. The epidemic focus located on mountainous brushland regions, and the air temperature fluctuated from 20-4 ℃. Nineteen cases of tsutsugamushi disease in the new-found epidemic focus were finally diagnosed, 9 cases out of them were hospitalized, another 9 had recovered when diagnosed by serological tests; the remaining one had classical manifestations of tsutsugamushi disease but did not receive the serological test for certain cause. The main clinical symptoms were chilly in 14 cases, fever in 19 cases, headache in 15 cases; among the 9 hospitalized patients, the symptoms were lymphadenectasis in 8 inpatients, skin rash in 7 inpatients, splenomegaly in 4 inpatients and skin eschar and ulcer in 7 inpatients and Weil-Felix reaction by OXκantigen positive in 4 cases; the specific antibodies against Rickettsia tsutsugarnushi of 18 tested cases were all positive. No severe complications occurred in all patients. Before the first case was identified, all other cases were not diagnosed in time and did not receive correct antibiotic treatment. Nine hospitalized patients recovered rapidly with the treatment of doxycycline. Conclusions The outbreak of tsutsugamushi disease in Anhui Province in 2007 is type of emerged in autumn and transitional epidemic focus. There is epidemic focus of tsutsugamushi disease in northern region of Anhui Province. Doxycycline is rapid and effective for the treatment of tsutsugamushi disease.