湖南老年医院首例恙虫病多器官受累病例实验室分析

Laboratory investigation of the first scrub typhus case with multiorgan dysfunction in Hunnan Geriatric Hospital

目的对湖南老年医院首例恙虫病可疑病例进行实验室快速诊断及病原分子流行病学分析。方法病人急性期及恢复期血清恙虫病IgM、IgG抗体进行胶体金快速定性及ELISA定量。环介导等温扩增(LAMP)病人血液及焦痂恙虫病东方体56KD基因及巢氏PCR扩增热休克蛋白基因(groEL)并分析groEL遗传进化关系。结果病人发热期(发病24天)及恢复期(发病32天)血清IgM、IgG抗体定性试验均为阳性,ELISA定量试验双份血清IgM、IgG抗体滴度均达1∶2 560。急性期血液及焦痂DNA样本LAMP检测及巢氏PCR扩增groE阳性。结论本报道为湖南老年医院首例恙虫病病例报道。应加强立克次体病诊断及鉴别诊断。

To laboratory confirm of a clinical suspected scrub typhus with multiorgan failure in Hunnan Geriatrichospital and understand the molecular epidemiological characterizes of the pathogen tested in the study. Paired sera from the acute（24 days after onset of illness）and convalescence （32 days after illness）were tested for IgM and IgG antibodies against Orientia tsut- sugarnushi by a gold conjugate-based rapid diagnostic test （RDT）and enzyme-linked immunosorbent assay（ELISA）, respective- ly. The loop-mediated isothermal amplification （LAMP） targeting the 56KD protein gene of O, tsutsugamushiand the nested PCR targeting the groEL gene were performed respectively as the blood DNAs and the eschar DNA as temples. The IgM and IgG against O. tsutsugamushi for sera from acute and convalescence stages were positive by RDT and the highest titer of IgM and IgGwere detected in 1 ： 2 560 for both of acute and convalescence stages sera. LAMP and nested PCR proved to be positive for theDNAs from acute stage blood and eschar tissue respectively.