山东费县秋冬型恙虫病临床流行病学与病原学研究

STUDIES ON CLINICAL EPIDEMIOLOGY AND ETIOLOGY OF SCRUB TYPHUS OF AUTUMN-WINIER TYPE IN FEI COUNTY,SHANDONG PROVINCE

为了解山东地区姜虫病流行情况，对费县部分重疫区姜虫病患者进行了个案调查及病原学分离。结果表明，费县姜虫病具有典型的四大特征，即溃疡或焦痂９１．０１％（１７２／１８９）、皮疹９５．７７％（１８１／１８９）、发烧９８．９４％（１８７／１８９）、淋巴结肿大８４．６６％（１６０／１８９）；以农民为主，流行高峰在１０月中下旬。对恙虫病人分布的概率模式分析，表明当地恙虫病分布在时间、空间上均有聚集性。患者早期血清抗体阳性率７５．４２％。床边接种小鼠３２组，其中１２组分离到恙虫病立克次体（Ｒｔ）。小白鼠一般接种后５～１０天发病，解剖可见肝脾明显肿大。血清学鉴定，除部分毒株未定型外，其余均与Ｒｔ标准株Ｇｉｌｉａｍ型呈阳性反应，这与当地恙虫病人血清抗体型别一致。

To understand the epidemic state of scrub typhus in Shandong province, we carried out researches of 194 cases in Fei county, a heavy focus of scrub typhus, and isolation of Rickettsia tsutsugamushi(Rt). The results showed that the cases in Fei county had four typical characteristics of scrub typhus. Among 189 cases, typical eschars or ulcers appeared in 172 cases(91.01%),98.94% had high fever, skin rashes observed in 181 cases (95.77%), and enlargement of lymph glands occurred in 160 cases(84.66%).84.02% of cases were peasants. The cases only appeared in September to December with a peak at mid and late October. Analysis of possibility model of case distribution indicated that the cases distributed collectively in time and space. The positive rate of antibody in former sera of cases was 75.42%.Isolation of Rt was carried out from 32 cases,12 isolates were obtained. After inoculation of isolates, the mice were illed in 5 to 10 days, enlargement of liver and spleen was observed in all mice inoculated with isolates. Serologicel identification of isolates (except 2 strains) revealed positive reaction with Rt(Gilliam strain). The serotype of the isolates was identical with that of the cases there.