2000-2020年海口市类鼻疽病的流行病学和临床特征分析

Epidemiological and clinical characteristics of melioidosis in Haikou City in 2000-2020

目的了解海口市类鼻疽病的流行病学和临床特征,以提高对类鼻疽病的认识和提出有针对性的防治措施。方法收集2000年1月至2020年9月海口市4家三甲医院收治的254例类鼻疽病患者的临床资料,回顾性分析其流行病学特征、临床表现、感染部位、疾病预后、药物敏感性等情况。结果254例类鼻疽病患者中,男性226例(88.98%),女性28例(11.02%),男女性别比为8.07∶1.00;职业以农民为主,占37.80%(96/254);年龄中位数为53岁,以41~80岁为主,占83.46%(212/254);民族以汉族为主,占89.76%(228/254)。发病季节主要集中在夏秋季,8-10月为发病高峰(117例)。患者主要分布在沿海地区,其中海口市最多(49例),东方(46例)、儋州(23例)、文昌市(21例)次之。伴有基础疾病的患者有196例(77.17%),其中糖尿病最为常见(162例)。入院以发热症状为主(211例),其次为咳嗽(108例)、咳痰(88例)。感染部位主要为血液104例(40.94%),肺部60例(23.62%),肝脾32例(12.60%)。195例患者经敏感抗生素治疗,出院时治愈37例(18.97%),好转129例(66.15%),未愈18例(9.23%),死亡7例(3.59%),主动出院4例(2.05%)。2010-2020年药物敏感性试验显示,亚胺培南(142例)、美罗培南(16例)、头孢他啶(141例)治疗敏感率均为100.00%,多西环素(25例)和复方磺胺甲噁唑(142例)治疗敏感率分别为92.00%(23/25)、99.30%(141/142)。结论男性、农民、中老年人及伴糖尿病等基础疾病人群是海口市类鼻疽病的高发人群;夏秋季为发病高峰。发热、肺部感染、肝脾脓肿等为海口市类鼻疽病的常见临床表现,亚胺培南、美罗培南、头孢他啶有较高的治疗敏感率。

Objective To understand the epidemiological and clinical characteristics of melioidosis in Haikou City,to rise the people's awareness of melioidosis and to provide basis for prevention and control of the disease.Methods The clinical data of 254 patients with melioidosis treated in 4 Class A tertiary hospitals in Haikou City from January 2000 to September 2020 were collected,and the epidemiological characteristics,clinical manifestations,infection site,prognosis and drug sensitivity were retrospectively analyzed.Results Among 254 patients with melioidosis,226 males(88.98%)and 28 females(11.02%),and the gender ratio was 8.07∶1.00.Farmers were the main occupation,accounting for 37.80%(96/254).The median age was 53 years old,mainly in 41-80 years old,accounting for 83.46%(212/254).Han nationality was the most,accounting for 89.76%(228/254).The onset season was mainly in summer and autumn,and the peak was from August to October(117 cases).Patients were mainly distributed in coastal areas,among which Haikou City(49 cases)was the most,followed by Dongfang City(46 cases),Danzhou City(23 cases)and Wenchang City(21 cases).Totally 196 cases(77.17%)had basic diseases,diabetes was the most common(162 cases).The main symptoms of admission were fever(211 cases),followed by cough(108 cases)and expectoration(88 cases).The infection sites were mainly blood(104 cases,40.94%),lung(60 cases,23.62%),liver and spleen(32 cases,12.60%).Totally 195 patients were treated with sensitive antibiotics,at discharge,37 cases(18.97%)were cured,129 cases(66.15%)improved,18 cases(9.23%)did not heal,7 cases(3.59%)died and 4 cases(2.05%)were discharged voluntarily.Results of drug sensitivity tests from 2010 to 2020 showed that the sensitivity rates of Burkholderia pseudomallei to imipenem(142 cases),meropenem(16 cases)and ceftazidime(141 cases)were all 100.00%,and the sensitivity rates of doxycycline(25 cases)and compound sulfamethoxazole(142 cases)were 92.00%(23/25)and 99.30%(141/142),respectively.Conclusions Males,farmers,middle-aged and elderly people and people with diabetes and other basic diseases are the high incidence population of melioidosis in Haikou City.The incidence peak is in summer and autumn.The common clinical manifestations are fever,pulmonary infection,abscess of liver and spleen,etc.In the treatment,Burkholderia pseudomallei is more sensitive to imipenem,meropenem and ceftazidime.