福建省2例输入性埃及血吸虫病诊治分析

Diagnosis and treatment of two imported cases with schistosomiasis haematobia in Fujian Province

目的分析2例输入性埃及血吸虫病诊治过程,为提高输入性埃及血吸虫病诊治水平及避免误诊、误治提供参考。方法收集2例病例病史和流行病学调查资料,分别采用Kato-Katz法和离心沉淀后直接涂片法检测患者粪便和尿液样本中的血吸虫虫卵,应用免疫学技术检测患者血清抗血吸虫抗体。患者确诊后,予以吡喹酮治疗。结果患者1为非洲马达加斯加国籍,在境外感染回中国待产时出现间歇性无痛性终末血尿症状,就诊于多家医院,多次检查与治疗后未见明显好转;2017年1月,血清抗血吸虫抗体检测阳性、粪便检测阴性、尿液检查发现埃及血吸虫虫卵且孵化出毛蚴,确诊为埃及血吸虫病。患者2在非洲马拉维共和国工作多年,回国后于2018年10月开始出现间歇性、无痛性终末血尿症状,就诊于多家医院均未得到明确诊断和有效治疗;2019年3月,病理检查示:膀胱肿物间质见虫卵数枚,伴大量嗜酸粒细胞浸润,符合血吸虫病膀胱炎;2019年4月,血清抗血吸虫抗体检测阳性、粪检阴性、尿液中检出埃及血吸虫虫卵且孵化出毛蚴,确诊为埃及血吸虫病。两位患者予以60 mg/kg吡喹酮治疗后症状消失。结论境外输入性埃及血吸虫病容易误诊;应加强临床医务人员血吸虫病防治知识培训,避免误诊、误治。

Objective To analyze the diagnosis and treatment of two imported cases with schistosomiasis haematobia,so as to provide insights into improving the diagnosis and treatment and avoiding misdiagnosis and mistreatment of imported schistosomiasis haematobia.Methods The medical records and epidemiological data pertaining to the two cases were collected.The stool and urine samples were collected for identification of Schistosoma eggs using the Kato-Katz technique and direct smear method after centrifugal precipitation,and blood samples were collected for detection of anti-Schistosoma antibody.Following definitive diagnosis,the patients were given praziquantel therapy.Results The patient 1,a Malagasy,was infected in Madagascar and returned to China for delivery.The case presented intermittent painless terminal hematuria symptoms,and showed no remarkable improvements following multiple-round treatments in several hospitals.In January 2017,she was found to be positive for antiSchistosoma antibody,negative for feces test,and positive for S.haematobium eggs in urine test,and miracidia were hatched from eggs.Then,the case was diagnosed as schistosomiasis haematobia.Patient 2 worked in Republic of Malawi for many years,and presented intermittent painless terminal hematuria since October 2018;however,no definite diagnosis or effective treatment was received after admission to multiple hospitals.In March 2019,pathological examinations showed a number of eggs in the interstitium of the bladder mass,accompanied by a large number of eosinophils,which was consistent with schistosomiasis cystitis.In April 2019,he was tested positive for serum anti-Schistosoma antibody,negative for the fecal test,and had S.haematobium eggs in urine samples,with miracidia hatched from eggs.Then,the case was diagnosed as schistosomiasis haematobia.Following treatment with praziquantel at a dose of 60 mg/kg,all symptoms disappeared.Conclusions Overseas imported schistosomiasis haematobia is likely to be misdiagnosed.The training pertaining to schistosomiasis control knowledge requires to be improved among clinical professionals,in order to avoid misdiagnosis and mistreatment.