旋毛虫病的诊断与治疗

Diagnosis and Treatment of Trichinellosis

旋毛虫病无特异性的症状和体征,临床诊断较困难,所以流行病学资料非常重要,患者常有食生或半生肉类史,在该病暴发时期,同批患者往往能追溯到聚餐史。在肠道期可出现腹痛、腹泻伴全身不适等症状。发热、眼睑或面部水肿、肌肉疼痛是急性期的主要表现,重症患者可并发心肌炎、肺炎及脑炎等。多数患者感染后2～5周外周血中嗜酸粒细胞增多。应用肌幼虫排泄-分泌(ES)抗原和合成的泰威糖(tyvelose,3,6-双脱氧己糖)抗原ELISA检测旋毛虫抗体IgG,具有较高的特异性和敏感性,是初步诊断旋毛虫感染的首选血清学方法,ELISA阳性者需经蛋白质印迹分析确认。旋毛虫病的确诊主要依靠肌肉活检发现旋毛虫幼虫。阿苯达唑是治疗旋毛虫病的首选药物,剂量为20～30mg/(kg·d),分2次口服,疗程5～7d。糖皮质激素可延长旋毛虫感染的肠道期和增加肌肉虫荷,一般仅用于重症患者且需与阿苯达唑联合应用。

Lack of specific symptoms and signs makes clinical diagnosis of trichinellosis difficult. Epidemiological information is important, such as a history of ingesting raw or undercooked meat. An outbreak can be traced to a group of people dining together. Usual manifestations include abdominal pain or diarrhea with general discomfort in the enteric stage, and fever, eyelid or facial edema, muscle pain in acute stage. Complications, such as myocarditis, pneumonia, encephalitis, may develop in severe cases. Eosinophilia appears between 2 and 5 weeks after infection. Enzyme-linked immunosorbent assay （ELISA） using the excretory-secretory （ES） antigens of the muscle larvae or synthetic tyvelose as antigen is sensitive and specific, the serological method of choice as a screening test. Western blotting is needed to confirm the positive ELISA. Definitive diagnosis depends on the finding of larvae in a muscle biopsy specimen. Albendazole is the drug of choice for its treatment, 20-30 mg/（kg.d）, two times daily for 5-7 days. Glucocorticosteroids are given only to severe cases and always be used in combination with albendazole, since they could prolong the intestinal phase of the infection and increase the muscle larval burdens.