云南省首次暴发巨片形吸虫感染的临床诊治分析

Clinical Diagnosis and Treatment in an Outbreak of Fasciola gigantica Infection in Yunnan Province

目的分析云南省首次暴发巨片形吸虫(Fasciola gigantica)感染的临床诊治过程,为今后对该病的诊治提供参考。方法收集27例患者的发病、诊断和治疗资料。对患者及其家属和部分村民进行问卷调查,内容包括生食史和宠物饲养史等。采集各类动物粪便,使用粪便沉淀法和虫卵孵育法进行粪检。选择两户患者家饲养的牛各1头,剖检寄生虫感染情况。ELISA检测患者、患者家属和部分患者同村居民的血样。在患者居住的15个村庄附近(共选35个点)的溪流和水塘边,采集中间宿主螺类,检测感染情况。结果 27例患者,最早1例发病于2011年3月10日,最后1例发病于2012年1月10日。临床表现主要为不明原因发热、血红蛋白下降、嗜酸粒细胞增高、肝脾肿大等。粪检寄生虫卵均为阴性。先后给予抗菌、抗寄生虫治疗,均未见好转。经流行病学调查27例患者均有食生拌鱼腥草史。后经ELISA检测血清巨片形吸虫抗体,其中23例患者为阳性。2012年2月16日经反复粪检于4例患者粪便中查见巨片形吸虫卵。剖解牛的肝胆系统中查到巨片形吸虫虫卵及成虫。确诊该组病例为巨片形吸虫感染。给予三氯苯达唑[10 mg/(kg.d)×2 d]连服2 d,临床症状全部缓解,在宾川州城存在中间宿主尖膀胱螺(Physa acuta)、椭圆萝卜螺(斯氏萝卜螺)(Radix swinhoei)和小土蜗(Galba pervia)。结论人体感染巨片形吸虫较为少见,该病因无特异的临床表现而较难确诊,三氯苯达唑治疗效果良好。

Objective To carry out clinical diagnosis and treatment of Fasciola gigantica infection during an outbreak in Yunnan Province. Methods Data on epidemiololgy, diagnosis and treatment were collected from 27 patients. A questionnaire survey to the patients and partial villagers was carried out including history of raw food-eating and pet-raising. Animal feces were collected and examined by precipitation method and eggs incubation method. Cattle from two patients families were dissectd to find Fasciola infection. Serum samples from patients, family members, and villagers were detected. Possible intermediate snails were collected from the vicinity of streams and ponds in 15 villages where patients lived. Results The earliest onset of symptoms among the patients was on March 10, 2011 and the last case was on January 10, 2012. The clinical manifestations were mainly fever with unknown reason, decreasing hemoglobin, increasing eosinophils, and hepatosplenomegaly. No parasite eggs were found in feces. Antibodies against F. gigantica were positive by ELISA in 23 patients. Fasciola eggs were then found in 4 patients＇ feceson February 16, 2012. F. gigantica eggs and adults were found in the hepatobiliary system of dissected eattle. Triclabendazole [10 mg/（kg.d） x2 d] was administered orally for the patients and the clinical symptoms eased. Snails ineluding Physa aeuta, Radix swinhoei and Galba pervia were collected and eereariae were found in only one snail. Conclusion An outbreak of F. gigantica infection has been confirmed and the diagnosed cases effectively treated with triclabendazole.