发热伴血小板减少综合征病例中无形体病鉴别诊断与治疗

Differential diagnosis and treatment of human granulocytic anaplasmosis in patients with fever and thrombocytopenia syndrome

目的确定发热伴血小板减少综合征患者中是否存在人粒细胞无形体病(human granulocytic anaplasmosis,HGA),并进行HGA临床分析。方法将2010年收治的42例发热伴血小板减少综合征患者血液标本,送中国疾病预防控制中心(Centers for Disease Control and Prevention,CDC)进行急性期与恢复期血清IgG抗体检测,部分标本送山东省CDC进行巢式PCR扩增患者血液DNA无形体16SrRNA基因。对实验室确诊的HGA进行临床特点分析。结果经血清学实验室结果证实HGA5例,PCR结果证实2例。其中1例同时PCR检测新型布尼亚病毒抗体阳性。结论发热伴血小板减少综合征病例中存在HGA。临床应注意加强对2类疾病的鉴别并分别选择必要的抗生素治疗。

Objective To ensure whether human granulocytic anaplasmosis （HGA） occur m patients with fever and thromobo- cytopenia syndrome and to analyze the clinical data of the HGA patients. Methods Serum samples were collected from 42 patients with fever and thromobocytopenia syndrome, treated in our hospital in 2010, in acute stage and recovery stage, respectively, and sent to Chinese Centers for Disease Control and Prevention （CDC） for detection of IgG antibodies. Some DNA samples were tested by nested PCR targeting the 16S rRNA gene in Shandong Province CDC. Clinical features of the laboratory-confirmed HGA patients were analyzed. Results Diagnosis of HGA was confirmed in 5 patients through serological testing and in 2 patients by PCR, one of whom was found to be ＂new Bunia virus＂ antibody positive. Conclusions HGA may occur in the patients with fever and throm- bocytopenia syndrome. The two kinds of diseases should be distinguished and treated with proper antibiotics.