CAJ | 학술논문

目的探讨云南省大理州人群感染大片形吸虫的疫情特征,为片形吸虫病预防控制提供科学依据.方法收集疫情资料,了解患者的临床表现和症状.采用酶联免疫吸附法(ELISA)对患者、部分家属及同村的健康人进行血清学大片吸虫可溶性成虫抗原检测和显微镜下粪便虫卵检查,并对检出的虫卵进行测序和PCR扩增.将测序结果进入美国国立生物技术信息中心(NCBI)中的BLAST(basic local alignment search tool)程序进行核酸序列比对,比较二者的相似性.对患者给予三氯苯达唑治疗,治疗剂量为10 mg·kg-1·d-1,每天1次口服,连续用药2d,服药后留院观察1周.在大理州城镇周边水沟处进行宿主和媒介调查,采集宿主椎实螺,进行压片检查,在有椎实螺分布环境中采集牛粪和羊粪,用水洗沉淀法,在显微镜下检查粪便中的虫卵.结果 26例患者均以高热起病,发热持续,嗜酸性粒细胞升高,伴不同程度的恶心、呕吐、腹痛、纳差等消化系统症状；肝肿大、肝区叩痛,肝脏CT均有不同程度损伤,.患者均有生食过鱼腥草等水生植物史,且病程相近,具有相同的流行病学特征.ELISA检测血清大片吸虫可溶性成虫抗原,26例患者阳性率为100.0％(26/26),家属阳性率为31.6％(18/57),同村健康人阳性率为17.1％(6/35).虫卵经测序和BLAST分析结果显示,与大片形吸虫的相似性为99％～ 100％.PCR扩增也进一步证实虫卵为大片吸虫虫卵,在约1000 bp处出现明显的条带.三氯苯达唑治疗后,患者体温降至正常,自觉症状明显好转.在大理州城镇周边水沟处共采集329只椎实螺,在其中5只螺体内查到吸虫类雷蚴及单尾型尾蚴,初步鉴定为大片形吸虫幼虫.在1份牛粪和1份羊粪中查见大片形吸虫卵.结论生食被大片形吸虫卵感染的水生植物是导致发病的主要原因,三氯苯达唑治疗大片形吸虫的首选药物,政府和疾病预防控制部门应加强对当地居民健康教育,了解生食水生植物的潜在危害,预防本病的发生. 目的探討雲南省大理州人群感染大片形吸蟲的疫情特徵,為片形吸蟲病預防控製提供科學依據.方法收集疫情資料,瞭解患者的臨床錶現和癥狀.採用酶聯免疫吸附法(ELISA)對患者、部分傢屬及同村的健康人進行血清學大片吸蟲可溶性成蟲抗原檢測和顯微鏡下糞便蟲卵檢查,併對檢齣的蟲卵進行測序和PCR擴增.將測序結果進入美國國立生物技術信息中心(NCBI)中的BLAST(basic local alignment search tool)程序進行覈痠序列比對,比較二者的相似性.對患者給予三氯苯達唑治療,治療劑量為10 mg·kg-1·d-1,每天1次口服,連續用藥2d,服藥後留院觀察1週.在大理州城鎮週邊水溝處進行宿主和媒介調查,採集宿主椎實螺,進行壓片檢查,在有椎實螺分佈環境中採集牛糞和羊糞,用水洗沉澱法,在顯微鏡下檢查糞便中的蟲卵.結果 26例患者均以高熱起病,髮熱持續,嗜痠性粒細胞升高,伴不同程度的噁心、嘔吐、腹痛、納差等消化繫統癥狀；肝腫大、肝區叩痛,肝髒CT均有不同程度損傷,.患者均有生食過魚腥草等水生植物史,且病程相近,具有相同的流行病學特徵.ELISA檢測血清大片吸蟲可溶性成蟲抗原,26例患者暘性率為100.0％(26/26),傢屬暘性率為31.6％(18/57),同村健康人暘性率為17.1％(6/35).蟲卵經測序和BLAST分析結果顯示,與大片形吸蟲的相似性為99％～ 100％.PCR擴增也進一步證實蟲卵為大片吸蟲蟲卵,在約1000 bp處齣現明顯的條帶.三氯苯達唑治療後,患者體溫降至正常,自覺癥狀明顯好轉.在大理州城鎮週邊水溝處共採集329隻椎實螺,在其中5隻螺體內查到吸蟲類雷蚴及單尾型尾蚴,初步鑒定為大片形吸蟲幼蟲.在1份牛糞和1份羊糞中查見大片形吸蟲卵.結論生食被大片形吸蟲卵感染的水生植物是導緻髮病的主要原因,三氯苯達唑治療大片形吸蟲的首選藥物,政府和疾病預防控製部門應加彊對噹地居民健康教育,瞭解生食水生植物的潛在危害,預防本病的髮生.
목적 탐토운남성대리주인군감염대편형흡충적역정특정,위편형흡충병예방공제제공과학의거.방법 수집역정자료,료해환자적림상표현화증상.채용매련면역흡부법(ELISA)대환자、부분가속급동촌적건강인진행혈청학대편흡충가용성성충항원검측화현미경하분편충란검사,병대검출적충란진행측서화PCR확증.장측서결과진입미국국립생물기술신식중심(NCBI)중적BLAST(basic local alignment search tool)정서진행핵산서렬비대,비교이자적상사성.대환자급여삼록분체서치료,치료제량위10 mg·kg-1·d-1,매천1차구복,련속용약2d,복약후류원관찰1주.재대리주성진주변수구처진행숙주화매개조사,채집숙주추실라,진행압편검사,재유추실라분포배경중채집우분화양분,용수세침정법,재현미경하검사분편중적충란.결과 26례환자균이고열기병,발열지속,기산성립세포승고,반불동정도적악심、구토、복통、납차등소화계통증상；간종대、간구고통,간장CT균유불동정도손상,.환자균유생식과어성초등수생식물사,차병정상근,구유상동적류행병학특정.ELISA검측혈청대편흡충가용성성충항원,26례환자양성솔위100.0％(26/26),가속양성솔위31.6％(18/57),동촌건강인양성솔위17.1％(6/35).충란경측서화BLAST분석결과현시,여대편형흡충적상사성위99％～ 100％.PCR확증야진일보증실충란위대편흡충충란,재약1000 bp처출현명현적조대.삼록분체서치료후,환자체온강지정상,자각증상명현호전.재대리주성진주변수구처공채집329지추실라,재기중5지라체내사도흡충류뢰유급단미형미유,초보감정위대편형흡충유충.재1빈우분화1빈양분중사견대편형흡충란.결론 생식피대편형흡충란감염적수생식물시도치발병적주요원인,삼록분체서치료대편형흡충적수선약물,정부화질병예방공제부문응가강대당지거민건강교육,료해생식수생식물적잠재위해,예방본병적발생.
Objective The aim of the study was to investigate the epidemic situation,clinical symptom,diagnosis and epidemiological characteristics of human Fasciola gigantica infection in Dali,Yunnan province.It will also provide a scientific basis for fasciolosis control and prevention.Methods Epidemic data were collected and patient's clinical signs and symptoms were studied.Serum soluble antigen of Fasciola gigantica of patients and part of family members and health people in the same village was detected using enzyme-linked immunosorbent assay (ELISA) and the eggs of Fasciola gigantica in stool were observed under microscope.Sequencing and PCR amplification of Fasciola gigantica eggs had been done.Sequencing results were analyzed using basic local alignment search tool (BLAST) program of the U.S.National Center for Biotechnology Information (NCBI) and the similarity of the two in the sequence of nucleic acid was compared.Furthermore,patients were experimentally given orally therapeutic doses of Triclabendazole 10 mg·kg-1·d-1 daily for 2 days,and kept in the hospital for observation for one week.Moreover,host and vector were investigated in the surrounding ditches of Dali prefecture and Limnaea peregra snail samples were collected.All the snails were squashed by glass sheet in order to detect the cercarie.Cow dung and sheep manure was collected in the Limnaea peregra distribution environment,and the eggs in the feces were checked by microscope after washing and precipitation.Results All the 26 patients had a continued hyperpyrexia with distinct alimentary system symptoms of nausea,vomiting,stomachache,abdominal distension as well as hepatomegaly,sensitive to percussion,different levels of liver damage detected by CT.All the patients had an eaten history of raw Herba Houttuyniae and other aquatic plants,and the course of the disease was similar,with the same epidemiological characteristics.ELISA detection was used in the 26 patients,family members and other healthy population,the results of all the 26 patients were positive(100.0％,26/26) ; the positive rates of the 57 family members and other health people of the same village were 31.6％ (18/57) and 17.1％ (6/35),respectively.The results of sequencing and BLAST program showed that the pathogen was Fasciola gigantica with the similarity between 99％-100％.PCR amplification also confirmed that the eggs were Fasciola gigantica eggs with an approximately 1000 bp band on agarose gel.After treatment with Triclabendazole,body temperature of the patients dropped to normal and symptoms improved markedly.Moreover,329 Limnaea peregra snails were collected including 5 ones with redia and one-tailed cercariae which were preliminary identified as the larva of Fasciola gigantica.There were also eggs of Fasciola gigantica detected in one stool of cattle and one of goat.Conclusions Eating raw food is the leading cause of the onset of the disease.Triclabendazole is the drug of choice to treat Fasciolasis.Health education should be strengthened by government and disease prevention and control departments in order to make the local residents to understand the potential hazard of eating raw aquatic vegetable and drinking unboiled water,which is the key to prevent the occurrence of the disease.