山东省1例人粒细胞无形体病调查

目的结合1例可疑人粒细胞无形体病病例个案调查,探讨PCR技术在现场流行病学中的应用。方法对1例可疑人粒细胞无形体病病例进行流行病个案调查,采用套式-聚合酶链反应技术检测病例血液中人粒细胞无形体16SrRNA基因。结果DNA检测为阳性,测序分析显示与浙江、吉林野鼠检出的无形体相应序列的同源性在99％以上。结论山东省存在人粒细胞无形体感染病例,进一步开展自然疫源地调查工作十分必要。     

山东省1例人粒细胞无形体病的确认与调查

目的对1例可疑人粒细胞无形体病病例进行病原学实验诊断与流行病学个案调查。方法按照卫生部下发的《人粒细胞无形体病流行病学调查方案(试行)》进行个案调查。采用套式-聚合酶链反应(nested-PCR)技术检测病例血液中人粒细胞无形体16SrRNA基因。结果人粒细胞无形体DNA检测为阳性,测序分析显示与浙江、吉林野鼠检出的无形体相应序列同源性99%以上。结论该病例为山东省2008年疫情网络直报首起人粒细胞无形体病突发公共卫生事件报告病例,并经实验室检测确诊,符合卫生部下发的《人粒细胞无形体病预防控制技术指南(试行)》中的病例诊断标准。证明山东省存在人粒细胞无形体感染病例,进一步开展自然疫源地调查工作十分必要。     

人粒细胞无形体病六例临床分析

人粒细胞无形体病（HGA）是由嗜吞噬细胞无形体（AP）引起的一种经蜱传播的新发自然疫源性疾病。本地于2005年9月先后出现6例不明原因的发热病人,经国家疾病控制中心证实为人粒细胞无形体病。     

山东省人粒细胞无形体病4例报道

2008年泰安市有4例病人被确诊为人粒细胞无形体病,这也是山东省存在人粒细胞无形体病的首次报道。     

人粒细胞无形体病研究进展

人粒细胞无形体病（HGA）是由嗜吞噬细胞无形体侵染人末梢血中性粒细胞，以发热伴白细胞、血小板减少和多脏器功能损害为主要临床表现的蜱传疾病。本病自上世纪九十年代起相继在美国、欧洲被发现。我国在2007年最先由安徽报道，以后的血清学分析及流行病学调查认为，至少从2005年起在我国许多省份就有HGA的发生。     

人粒细胞无形体病

近年来,我国某些省份一些群众被蜱叮后发生无形体感染或疑似无形体感染,为之,特将国内外有关人粒细胞无形体病的调研工作概述如下。     

我国人畜共患无形体病防治面临的挑战——诊断与经验治疗

【摘要】 立克次体可分为立克次体科及无形体科,前者引起恙虫病、斑疹伤寒等传统立克次体病,后者引起人粒细胞无形体病、埃立克体病等新发立克次体病。本文着重对无形体病防治所要面对的挑战即诊断困难和原因进行阐述,提出在临床上高度怀疑本病时,应使用特效药物--四环素类抗生素进行经验治疗。     

中国人粒细胞无形体病流行现状及其影响因素

人粒细胞无形体病是威胁人类健康的新发蜱传自然疫源性疾病。近年来随着原生环境的加速开发以及人口流动加快,人粒细胞无形体病感染数量逐年上升且传播范围不断扩大。为了更有效的预防控制人粒细胞无形体病,本文就我国人粒细胞无形体病流行现状进行概述,并分析生物因素、自然因素、社会因素对人粒细胞无形体病发生和流行的影响。     

人粒细胞无形体病误诊为心肌梗死1例

<正>病例资料患者,男,78岁。因反复胸痛、胸闷、伴发热3 d入院,患者3 d前户外体力劳动后出现发热、胸闷,胸痛、寒战,在当地诊所静脉点滴抗炎治疗无好转,病情加重1 d,并伴有腹泻。为进一步诊治入我院。有种植菜园野外拾粪史。查体:T 37.2℃,P 73次/min,R19次/min,BP 120/80 mmHg。神志尚清,皮肤黏膜无出血点、搔抓痕,浅表淋巴结未触及增大,颈软。双肺听诊未闻及干湿性啰音,肝、脾未触及,腹软,无压痛、反跳痛、双下肢无水肿。查血常规示:WBC3.12×109/L,N 0.70,L 0.55,PLT 73×109/L;天门冬氨酸转氨酶(AST)128 U/L,乳酸脱氢酶(LDH)690 U/L;肌酸激酶(CK)1126 U/L,肌酸激酶同工     

云南省人和家畜立克次体病血清流行病学调查

目的了解云南省正常人及主要家畜立克次体血清流行病学特点。方法按地理位置,选择云南省东北寻甸回族彝族自治县、西北玉龙纳西族自治县及南部的思茅地区3个调查点,以间接免疫荧光法检测莫氏立克次体、黑龙江立克次体、恙虫病东方体、贝氏柯克斯体、横赛巴尔通体、查菲埃立克体及人粒细胞无形体等8种常见立克次体血清IgG或IgM抗体。结果3个调查点237份成人,莫氏立克次体、巴尔通体及贝氏苛克斯体IgG抗体阳性率分别为16．46％、6．33％、9．28％。50岁人群最高（21．74％、9．57％及14．78％）,而4-6岁儿童调查结果显示,英氏立克次体IgG抗体阳性率最高,达12．35％（10／31）,动物8种病原体抗体IgG及IgM抗体均检出,其中莫氏立克次体阳性率最高（61．48％）,且地区间差异无显著意义。结论云南省正常农业人群及家畜存在多种立克次体感染,以莫氏立克次体、巴尔通体及贝氏柯克斯体为多。     

湖北省随州市羊携带嗜吞噬细胞无形体的调查

目的调查湖北省随州市羊携带嗜吞噬细胞无形体的状况。方法运用聚合酶链反应方法对湖北随州市采集的羊血标本进行嗜吞噬细胞无形体16SrRNA基因片段进行扩增和序列分析,将扩增序列与GenBank相应基因序列进行同源性比较和进化分析。结果共检测羊血标本29份,阳性标本25份,嗜吞噬细胞无形体阳性感染率为86．2％;所检出的嗜吞噬细胞无形体16SrRNA基因（1442bp）与GenBank中收录的部分嗜吞噬细胞无形体16srRNA基因序列的同源性高达97．1％～99．8％,进化分析显示与嗜吞噬细胞无形体同在一个分支上。结论湖北随州地区山羊存在嗜吞噬细胞无形体的感染。     

湖北省长角血蜱携带嗜吞噬细胞无形体的调查

目的调查湖北省长角血蜱是否携带嗜吞噬细胞无形体。方法运用聚合酶链反应方法对湖北随州地区采集的蜱标本进行嗜吞噬细胞无形体16S rRNA基因片段进行扩增和序列分析,将扩增序列与GenBank注册的基因序列进行比较。结果共检测游离蜱72只,蜱种鉴定均为长角血蜱,嗜吞噬细胞无形体最小感染率为4.22%;所检出的嗜吞噬细胞无形体16S rRNA基因与我国已在GenBank注册的24个相对应序列同源性100%。结论湖北省长角血蜱携带嗜吞噬细胞无形体。     

北京东北部山区人群嗜吞噬细胞无形体血清流行病学调查

目的 了解北京东北部山区人群嗜吞噬细胞无形体的感染状况,为制定相应的防控策略提供依据。方法 在北京密云与怀柔区采集人群血清,采用间接免疫荧光法检测嗜吞噬细胞无形体IgG抗体,进行血清流行病学调查。结果 801份血清中嗜吞噬细胞无形体IgG抗体阳性者106份,阳性率13.23%,其中密云区为13.48%,怀柔区为12.70%,差异无统计学意义(P>0.05)。结论 北京密云与怀柔区正常人群中均有嗜吞噬细胞无形体感染的存在,应加强人粒细胞无形体病的监测和防控工作。     

Increasing incidence of Ehrlichia chaffeensis and Anaplasma phagocytophilum in the United States, 2000-2007

Ehrlichia chaffeensis causes human monocytic ehrlichiosis, and Anaplasma phagocytophilum causes human granulocytic anaplasmosis. These related tick-borne rickettsial organisms can cause severe and fatal illness. During 2000-2007, the reported incidence rate of E. chaffeensis increased from 0.80 to 3.0 cases/million persons/year. The case-fatality rate was 1.9%, and the hospitalization rate was 49%. During 2000-2007, the reported incidence of A. phagocytophilum increased from 1.4 to 3.0 cases/million persons/year. The case-fatality rate was 0.6%, and the hospitalization rate was 36%. Rates among female patients were lower than among male patients for ehrlichiosis (rate ratio = 0.68) and anaplasmosis (rate ratio = 0.70). Most (80%) ehrlichiosis and anaplasmosis cases met only a probable case definition, although, use of a polymerase chain reaction to confirm infections increased during 2000-2007. Heightened reporting of these diseases will likely continue with improving recognition, changing surveillance practices, and appropriate application of diagnostic assays.     

吉林省林区蜱粒细胞无形体感染的调查

目的调查吉林省蜱粒细胞无形体感染。方法运用聚合酶链反应方法对吉林延边地区采集的蜱标本粒细胞无形体16S rRNA和gltA基因片段进行扩增及序列分析,将扩增序列与GenBank注册的基因序列进行比较,构建粒细胞无形体gltA基因进化树。结果共检测游离蜱427只,其中全沟硬蜱100只,森林革蜱327只,粒细胞无形体感染阳性率分别为4.00%和0.00%。寄生蜱感染阳性率2.9%。寄生蜱与游离蜱感染率差别无显著性。16S rRNA序列与我国已在GenBank注册的AF205140序列一致,与国外粒细胞无形体16S rRNA序列存在不同程度的差异,相似性为97%～99%;gltA基因与GenBank的粒细胞无形体gltA基因片段比较,相似性为87%～97%,推导的氨基酸序列相似性为84%～99%。结论我国吉林省林区存在蜱粒细胞无形体感染。     

福建部分地区人和动物嗜吞噬细胞无形体基因检测和序列分析

目的 了解福建省人和动物嗜吞噬细胞无形体的感染状况以及基因特征.方法 收集永春县和上杭县高危人群,家畜的全血,采用巢式PCR扩增无形体16S rRNA片段, PCR产物纯化测序并与序列比对分析.结果 永春县牛的无形体感染率最高为53.85%,羊,狗无形体感染率分别为24.71%和12.50%.上杭县羊的无形体感染率为53.06%,高危人群的无形体感染率为8.33%.无形体基因序列与相应的参考序列同源性均达97%~100%.结论 福建省人和动物存在嗜吞噬细胞无形体感染.     

Habitat factors influencing distributions of Anaplasma phagocytophilum and Ehrlichia chaffeensis in the Mississippi Alluvial Valley

Human monocytotropic ehrlichiosis (HME), caused by the bacterium Ehrlichia chaffeensis, and human granulocytic anaplasmosis (HGA), caused by the bacterium Anaplasma phagocytophilum, are two emerging tick-borne zoonoses of concern. Factors influencing geographic distributions of these pathogens are not fully understood, especially at varying spatial extents (regional versus landscape) and resolutions (counties versus smaller land units). We used logistic regression to compare influences of physical environment, land cover composition, and landscape heterogeneity on distributions of A. phagocytophilum and E. chaffeensis at multiple spatial extents. Pathogen presence or absence was determined from white-tailed deer (Odocoileus virginianus) serum samples collected from 1981 to 2005. Ecological predictor variables were derived from spatial datasets that represented deer density, elevation, land cover, normalized difference vegetation index (NDVI), hydrology, and soil moisture. We used three strategies (a priori, exploratory, and spatial extent) to develop models. Best fitting models were applied within a geographic information system to create predictive probability surfaces for each bacterium. Ecological predictor variables generally resulted in better fitting models for E. chaffeensis than A. phagocytophilum (90.5% and 68% sensitivity, respectively), possibly as a result of differences in the natural histories of tick vectors. Although alternative model development strategies produced different models, in all cases bacteria presence or absence was affected by a combination of soil moisture or flooding variables (thought to affect primarily tick vectors) and forest cover or NDVI variables (thought to affect primarily mammalian hosts). This research demonstrates the potential for modeling the distributions of microscopic tick-borne pathogens using coarse regional datasets and emphasizes the importance of forest cover and flooding as environmental constraints, as well as the importance of considering ecological variables at multiple spatial extents.     

云南省曲靖市啮齿动物的立克次体血清学和分子流行病学调查

目的调查云南省曲靖市啮齿动物感染立克次体状况。方法用鼠笼法捕鼠,采集鼠血清和脾脏。用间接免疫荧光试验(IFA)检测鼠血清中7种常见立克次体的IgG抗体;用巢氏PCR方法检测鼠脾中嗜单核细胞埃立克体和嗜吞噬细胞无形体16SrRNA基因片段部份序列。结果 2012年7-9月在曲靖市捕获啮齿动物3种592只,褐家鼠(Rattus norvegicus)和黄胸鼠(Rattus flavipectus)构成比分别为61.49%和35.47%。鼠血清中贝氏柯克斯体(Coxiella burentii)、莫氏立克次体(Rickettsia typhi)、恙虫病东方体(Orientia tsutsugamushi)、西伯利亚立克次体(Rickettsia sibirica)、嗜吞噬细胞无形体(Anaplasma phagocytophilum)和嗜单核细胞埃立克体(Ehrlichia chaffeensis)的抗体阳性率依次为21.45%、7.60%、7.09%、3.38%、1.18%和0.51%;未检测到猫立克次体(Rickettsia felis)抗体。从5份褐家鼠脾脏标本中检测到16SrRNA基因序列,同源性和进化分析表明,1株为嗜吞噬细胞无形体,4株为莫氏立克次体。结论曲靖市啮齿动物中存在莫氏立克次体和人粒细胞无形体流行,褐家鼠可能是主要宿主;同时还存在恙虫病东方体、贝氏柯克斯体、斑点热立克次体和埃立克体的感染。当地疾控和医疗机构应加强立克次体病的监测。     

Identification of Ehrlichia chaffeensis,Anaplasma phagocytophilum,and A. bovis in Haemaphysalis longicornis and Ixodes persulcatus ticks from Korea

A total of 1,467 tick (1,463 of Haemaphysalis longicornis, three of Ixodes persulcatus and one of I. turdus) collected from nine provinces of Korea were examined by TaqMan real-time PCR for the presence of Ehrlichia and Anaplasma species. One set of primers and a probe were designed for detection of all of the Ehrlichia and Anaplasma species. Template DNAs (total 803) were prepared either from pools of larvae, nymphs, adult males and females, or from the salivary gland and midgut of adult ticks. Only DNAs positive in TaqMan PCR were examined for A. phagocytophilum with nested PCR and for E. chaffeensis with PCR. Four A. phagocytophilum 16S rRNA gene PCR products were sequenced for comparison with sequences previously reported. Amplification of a 16S rRNA gene fragment of Ehrlichia and Anaplasma species was observed in 364 tick DNAs (45.3% of the total). Of these 364 positive ticks, species-specific PCRs confirmed that 35 H. longicornis and one I. persulcatus were positive for A. phagocytophilum and one I. persulcatus was positive in E. chaffeensis. Except for one (AB-GGHL, GenBank accession number [GAN] AF470698), three of the four 16S rRNA gene fragment sequences of the A. phagocytophilum-positive samples were similar or identical to the sequences of variants of A. phagocytophilum deposited in GenBank. The 16S rRNA gene fragment sequence of AB-GGHL was similar to that of Anaplasma (Ehrlichia) bovis 16S rRNA (GAN U03775). The identities of the Anaplasmataceae genus and species DNA in the 327 ticks that could not be confirmed infected with either E. chaffeensis, A. phagocytophilum, or A. bovis are not known. This study is the first to demonstrate the presence of E. chaffeensis, A. phagocytophilum and A. bovis in Korean ticks.     

新疆部分地区鼠类无形体和埃立克体的调查及16srRNA序列分析

目的 调查新疆部分地区鼠类携带无形体和埃立克体的状况.方法 对新疆博乐、石河子、乌鲁木齐3个地区捕获的鼠类(沙鼠、褐家鼠、田鼠)401份,采集肺脏、脾脏提取总DNA,通过巢式PCR扩增无形体和埃立克体16SrRNA片段并与GenBank中相应基因序列进行比对分析.结果 在沙鼠样本中扩增到无形体和埃立克体16SrRNA片段,而在其它两种鼠类未扩增到目的片段,扩增片段经测序、比对后确定为Anaplasma phagocytophilum和Erhlichia chaffeenisis.在312份沙鼠检测样本中,检出无形体17份,占5.45％;埃立克体48份,占15.38％;无形体和埃立克体均检出12份,占3.84％.结论新疆地区存在无形体和埃立克体病原,其主要存在与荒漠和半荒漠地带生存的沙鼠中,新疆存在这两种病原的自然疫源地,而且两种病原可以共同存在于同一宿主动物.