浙江省1例输血性疟疾病例的溯源调查与诊断

Tracing Investigation and Diagnosis of One Transfusion-transmitted Malaria Case in Zhejiang Province

目的对1例感染源不明的疟疾病例进行流行病学溯源调查与实验室检测,以明确其传播方式和传染源。方法收集该病例临床资料,并开展流行病学溯源调查。采集患者和疑似传染源(供血者)的血样,采用血涂片镜检、快速疟疾诊断试剂条(RDT)和巢氏PCR等3种方法进行检测。结果该患者无疟疾流行区外出史,因手术输血后,出现畏寒、发热,骨髓片和外周血涂片镜检均诊断为恶性疟原虫感染,RDT检测恶性疟原虫阳性。经溯源调查,疑似传染源的供血者为非洲务工返乡人员,在献血前曾有似疟疾样发病,自行服用抗疟药后参与无偿献血,RDT检测血站存留血样为恶性疟原虫阳性,后采集该供血者血样涂片镜检为恶性疟原虫阳性,将患者血样和供血者血样进一步进行巢式PCR检测均为恶性疟原虫阳性,2份血样的正反两段Small subunit rRNA(SSU rRNA)序列比对相似率均为100%,且均为恶性疟原虫K1型和MAD20型混合感染。结论该病例为输血性恶性疟,因输入非洲返乡人员的血液而感染恶性疟原虫。

Objective To identify the sources of infection and the mode of transmission of a malaria case with unknown origin. Methods Clinical data of the case were collected and the epidemiological investigation was conducted. The blood samples of the patient and the suspected infection source（blood donor） were detected by microscopy, rapid di- agnostic test strip （RDT） and nested PCR. Results The patient did not visited malaria endemic areas. After a blood transfusion, the patient had chills and fever, and was confirmed as falcipamm malaria by microscopy with bone marrow and peripheral blood smears and RDT. The blood donor was a worker returned from Africa. Before blood donation she was sick like malaria carrier, and took anti-malarial drug. She was then confirmed as falciparnm malaria by RDT and microscopy. The blood samples from the patient and the blood donor were diagnosed as faleiparnm malaria by nested PCR, and the similarity of the small subunit rRNA （SSU rRNA） sequence was 100%, showing they were mix-infected with K1 and MAD20 genotypes of Plasmodium falciparum. Conclusion This patient is confirmed P. falciparum infection via blood transfusion from a donor who returned from Africa.