3例输入性黑热病的临床资料分析

The clinical data of 3 imported kala-azar patients

目的 分析湖北省宜昌市3例输入性黑热病患者的临床资料,为早期诊治提供依据。方法 收集并分析2014年1月-2023年12月在宜昌市中心人民医院确诊的3例黑热病患者的流行病学资料及临床资料。结果 3例黑热病患者均为男性,均有至黑热病流行区域务工的流行病学史,潜伏期时长分别为2、10和20个月;起病时3例患者均出现畏寒发热;2例患者伴有全身肌肉或关节酸痛,2例患者伴有纳差,1例患者伴有头痛,1例患者伴有咳嗽咳痰;3例患者均出现脾大,其中2例行脾脏手术切除并行脾脏病检,只有1例出现淋巴结肿大并行淋巴结切除活检。3例患者均出现不同程度的血细胞下降,2例患者出现白细胞减低及中性粒细胞减少,2例患者表现不同程度贫血,2例患者出现血小板减少;3例患者均出现低蛋白血症,1例患者有明显的球蛋白增加;1例患者出现严重的纤维蛋白原下降;3例患者均出现血清铁蛋白异常升高。3例患者骨髓涂片镜检利杜体及PCR测序确认利什曼原虫种属均为阳性,且经两性霉素B治疗后均达病原学治愈。结论 非疫区医务人员在接诊反复发热伴脾大及血细胞减少的患者时,尤其是有长江以北旅居史的患者应考虑黑热病可能,尽早诊断和治疗。

Objective To analyze the clinical data of 3 imported kala-azar patients in Yichang city of Hubei province, and provide basis for early diagnosis and treatment. Method The epidemiological and clinical data of 3 patients diagnosed with kala-azar in the Yichang Central People ' s Hospital from January 2014 to December 2023 were collected and analyzed.Results All the 3 patients were male and had an epidemiological history of working in the endemic areas of kala-azar;the incubation period was 2,10 and 20 months, respectively. At the onset of the disease, 3 patients had chills and fever, 2patients had muscle or joint pain, 2 patients had poor appetite, and 1 patient had headache, 1 patient had cough and expectoration, 3 patients had splenomegaly, and 2 patients underwent splenectomy and splenic biopsy, only one case had lymphadenopathy and lymph node biopsy. All 3 patients had blood cell decrease in different degree, 2 patients had leukopenia and neutrophil,2 patients had anemia of different degrees, 2 patients had thrombocytopenia, and 3 patients had hypoproteinemia, 1 patient had marked increase of globulin, 1 patient had severe decrease of fibrinogen, and 3 patients had abnormal increase of serum ferritin. All the 3 patients were positive for Leishmania species confirmed by bone marrow smear microscopy and PCR sequencing, and all of them were cured by amphotericin B treatment. Conclusion Medical staff in non-epidemic areas should consider the possibility of kala-fever, and make early diagnosis and treatment when receiving patients with recurrent fever, splenomegaly and cytopenia, especially those with a history of travel and residence north of the Yangtze River.