浙江省温州市1例儿童内脏利什曼病流行病学调查

Epidemiological investigation of a child visceral leishmaniasis case in Wenzhou, Zhejiang Province

收集患者门诊和住院病历,采用描述性流行病学方法对浙江省温州市1例儿童内脏利什曼病病例的基本情况、发病诊疗经过、密切接触人员、生活习惯和环境、愈后转归等进行调查。患者,丽水市青田县人,2018年1月17日出现发热、呕吐症状,期间体温反复升高。入院后查体,全身浅表淋巴结未及肿大,面色苍白,扁桃体二度肿大,黏膜发白,脾肋下2 cm。血常规检查白细胞、红细胞、血小板计数均降低,铁蛋白升高,自然杀伤(NK)细胞活性下降。血清学检测EB (epstein-barr)病毒抗体阳性。骨髓涂片检查可见巨噬细胞吞噬血细胞现象。诊断为"EB病毒感染相关性嗜血细胞综合征",给予更昔洛韦抗病毒并加依托泊苷(VP16)、环孢素(CSA)治疗,病情好转, 2月5日出院,门诊随访。2月19日为继续完成VP16、 CSA化疗,再次入院。3月21日骨髓血涂片查到利什曼原虫无鞭毛体,确诊为内脏利什曼病。PCR检测扩增出120 bp的利什曼原虫动基体小环DNA特异性条带。葡萄糖酸锑钠(五价锑600 mg/d×6 d,静脉注射;停药2 d,五价锑300 mg/d×12 d)治疗后,患者症状好转。流行病学调查结果显示,该病例为输入性内脏利什曼病病例,在其西班牙的住所附近公园内被白蛉叮咬而感染的可能性最大。

A child case of visceral leishmaniasis was diagnosed in Wenzhou, Zhejiang Province and the epidemiological investigation was performed on this case to identify the cause of infection, clinical manifestation, treat-ment and prognosis in order to provide a reference for better prevention and control of kala-azar. A patient with 8 years old originally from Qingtian County of Lishui Municipality was hospitalized with symptoms of fever and vomiting started on January 17, 2018. The physical examination found the swollen tonsil, but did not find enlargement of lymph node around the body. Lips were pale. The spleen could be touched 2 cm below the rib. Blood test showed decreased number of white blood cells, red blood cells and platelet, increased ferritin. The activity of natural killer(NK) cells was decreased. Bone marrow smear demonstrated phagocytosis of red blood cells by macrophages. Serolog-ical test showed epstein-barr(EB) virus antibody positive, so diagnosed as 'EB virus infection-related hemophilic syndrome '. After being treated with VP16, CSA and ganciclovir, the patient got improved in symptoms and discharged from hospital on February 5. The patient was hospitalized on February 19 for the second chemotherapy with VP16 and CSA. The amastigotes of Leishmania donovani was identified in bone marrow hematopoietic smear on March 21. A 120 bp fragment of Leishmania kinetoplast DNA was amplified by PCR. The diagnosis of kala-azar was confirmed. After being treated with standard anti-Leishmania antimony gluconate(intravenous injection of pentavalent antimony 600 mg/day for 6 days, paused for 2 days, followed by pentavalent antimony 300 mg/day for additional 12 days), the symptoms of the patient were improved. It has been confirmed that it was a case of imported kala-azar,most likely infected by the bite of infected sandflies in the park near his home in Spain.