雷州半岛地区44例类鼻疽病的临床特征分析

Analysis of clinical feature and epidemiology investigation of melioidosis in Leizhou peninsula of Guangdong

目的分析雷州半岛地区类鼻疽病的临床特征。方法对1990年至2005年入院诊疗的有寒战高热的7786例患者进行类鼻疽伯霍尔德菌血培养和其中的1775例患者进行血清学检测,确诊的类鼻疽病患者进行临床观察、实验室检查和病案调查。结果39例细菌培养阳性患者,阳性率为0．501%,22例血清学诊断阳性(其中细菌学阳性17例、阴性5例),阳性率为1．239%,共检出类鼻疽病患者44例,分布湛江、茂名两市11个县(区、市)19个镇44个自然村；临床以外伤或皮肤溃疡或治疗原基础疾病时受凉起病；以寒战、高热、肺炎、败血症以及脏器组织损害和细菌毒素引起的全身反应为主要表现；肺部病变按叶段浸润后形成空洞；发现12种供治疗的敏感药物,死亡25例(56．8%)。结论雷州半岛为类鼻疽病的地方性流行疫区,其临床特征是受损的皮肤黏膜与稻田水接触感染,当机体免疫力低下时发病；可造成多器官损害,症状复杂多样化,病死率极高。早期使用敏感的β内酰胺酶药物治疗可降低病死率。

Objective To investigate clinical feature and endemic epidemiology investigation of melioidosis in Leizhou peninsula of Guangdong. Methods In 1990-2005, 7786 patients with chills and fever in our hospital were examined by blood culture of melioidosis pseudomonas, and 1775 patients were examined by serology investigation. These patients with final diagnosis as melioidosis were investigated with clinical observation, laboratory examination and epidemiological survey. Results Among the 7786 patients, positive blood culture were detected in 39 cases, accounted for 0. 501%, positive antibody were detected in 22 cases（positive blood culture were detected in 17 cases）, accounted for 1. 239%. These patients with final diagnosis as melioidosis were 44 cases（25 patients died, mortality rate 56.8% ）, and were youth, middle-age and old people who have already work on the agricultural land with barefoot and lived in 44 natural village, 19 town, 11 county of Zhanjiang and Maoming cities. No close contact happenned between human and bird/livestock. There were cases in every month in a year. Disease onseted with trauma, cutaneous ulcer, catch cold as treatment of basic diseases. The main clinical manifestations of the diseases were chill, hyperpyrexia, pneumonia and septemia. Twelve drug were found being sensitive for this diseases. Conclusions The epidemiology feature of melioidosis in Leizhou peninsula were scatter distribution perennial with high fatality rate. Contact infection occurred as damage skin/mucosa and water/soil in paddy fields. It is easy to onset as human with low immunity. It is cured with sensitive drug at the earlier period.