甘肃省天水市首例人粒细胞无形体病的确认和调查

Confirmation and investigation of the first suspected case of human granulocytic anaplasmosis in Tianshui,Gansu Province

目的调查甘肃省天水市首例人粒细胞无形体病病例特征,为该病预防控制提供科学依据。方法2022年7—8月对甘肃省天水市1例疑似人粒细胞无形体病病例及其居住环境、家畜养殖和蜱虫孳生情况进行流行病学调查,用实时荧光定量PCR(qPCR)法检测病例血液和捕获蜱中的无形体抗原。结果患者发热、乏力、头痛;实验室检测白细胞(1.00×10^(9)/L)和血小板(46×10^(9)/L)均减少,转氨酶数值升高;患者体表捕获寄生蜱和病例全血的嗜吞噬细胞无形体核酸阳性,大别班达病毒和立克次体核酸阴性;常规对症用药效果不佳,喹诺酮类(左氧氟沙星)治疗后痊愈。结论天水市该患者为蜱传人粒细胞无形体感染病例,需在天水市进一步开展蜱传无形体的自然疫源地调查工作,同时加强基层医疗机构病媒生物病原学检测和监测能力。

Objective To investigate the characteristics of the first case of human granulocytic anaplasmosis in Tianshui,Gansu Province,China,so as to provide a scientific basis for the prevention and control of human granulocytic anaplasmosis.Methods From July to August 2022,an epidemiological survey was performed on a suspected case of human granulocytic anaplasmosis in Tianshui and the case's living environment,livestock,and tick infestations.Quantitative real-time PCR was used to detect Anaplasma phagocytophilum antigens in the blood and ticks collected from the case and the living environment.Results The case had fever,fatigue,and headache,with a decreased white blood cell count(1.00×10^(9)/L),a decreased platelet count(46×10^(9)/L),and increased levels of aminotransferases.The tick and whole blood from the patient were positive for the nucleic acid of A.phagocytophilum and negative for the nucleic acids of Dabie bandavirus and rickettsiae.The patient was not sensitive to conventional symptomatic medications,but was cured after treatment with quinolones(levofloxacin).Conclusions This case was confirmed as tick-borne human granulocytic anaplasmosis.It is necessary to further carry out investigations of natural foci of tick-borne Anaplasma and strengthen the capabilities of detecting and monitoring vector-borne pathogens at primary medical institutions in Tianshui.