摘要
目的云南省地处我国西南部,与缅甸、老挝、泰国等接壤,属亚热带地区,素有植物王国之称,特有地理特征及气候条件易于各种媒介滋生,是各种媒介源传染病高发地区,尤其是立克次体病。以往资料显示该地区存在有恙虫病、斑疹伤寒、斑点热以及Q热等立克次体病,然而缺乏系统的流行病学资料,特别是新发立克次体病如无形体病和埃立克体病的资料十分有限。值得注意的是,近年来,当地临床及疾控部门报告每到夏秋季节,不明原因发热病人聚增,临床医生高度怀疑立克次体病,因为多数病人非特异的外斐实验阳性(OX19≥1∶160或OX2≥1∶160或OXK≥1∶160),且临床应用抗立克次体药物有效。为了解当地人群及家畜动物立克次体感染状况,2009年3-5月,中国疾病预防控制中心传染病预防控制所立克次体研究室与云南省疾病预防控制中心联合进行了现场血清流行病学调查。方法实验设计按地理位置,选择东北寻甸回族彝族自治县、西北玉龙纳西族自治县以及南部思茅地区3个调查点,分别代表山区半山区、丘陵、林区等地貌。按卫生部下发《人粒细胞无形体病预防控制技术指南(试行)的通知》问卷,按注册户口单、双号随机开展以家庭为单位的问卷调查。调查包括年龄、职业、居住地区、是否接触动物、是否被蜱叮咬等。每名调查对象抽取3mL静脉血分离血清,-20℃当地保存,然后72h航空运送至中国疾病预防控制中心传染病预防控制所立克次体研究室进行实验室检测。按WHO推荐的间接免疫荧光(IFA)法检测8种常见立克次体包括莫氏立克次体、黑龙江立克次体、恙虫病东方体Karp型、贝氏苛克斯体、横赛巴尔通体、Hainan1斑点热群立克次体、查菲埃立克体及人粒细胞无形体。Excel录入数据,SAS9.1软件统计分析不同地区人群、不同年龄组及性别间抗体阳性率以及不同地区不同种类家畜抗体阳性率。具体方法使用χ2检验,P<0.05具有统计学意义。结果寻甸、玉龙及思茅3个地区成人立克次体血清抗体检测结果发现莫氏立克次体、巴尔通体及贝氏苛克斯体血清IgG抗体阳性率较高,分别为16.5%(39/237)、6.3%(15/237)和9.3%(22/237)。同样,儿童莫氏立克次体IgG抗体阳性率最高(12.4%)。而家畜动物莫氏立克次体IgG抗体总阳性率高达61.5%。8种立克次体在不同地区分布没有统计学意义,但存在随年龄增加而增加的趋势。结论对于新发蜱传人粒细胞无形体及查菲埃立克体,尽管人群抗体阳性率很低,但家畜动物抗体流行率较高,因此,有必要进一步调查监测这类传染病的相关媒介、宿主以及发热病人。通过本次调查,我们强调加强当地临床不明原因发热病人的诊断及鉴别诊断,及时应用特效抗生素,避免病人多器官受累甚至死亡具有重要的临床及公共卫生意义。
Yunnan Province is located in the southwest of China, which neighbors Burma, Laos, Thailand, and Vietnam. The special climate and natural environment is particularly suitable for the propagation and distribution of various vectors and host animal of rickettsiosis. Although previous investigations confirmed that Yunnan Province is the epidemic area of mufine typhus, scrub typhus, spotted fever and Q fever, systemic investigation documents are limited. To investigate seroepidemiologic features of rickettsiosis in population and domestic animals in Yunnan Province, an active epidemiological study of farm residents in agrarian areas was conducted from March to May, 2009. Two hundred and thirty seven samples of sera were collected from farmers in 3 sites with different geographic characterizes, including Xundian County, Yulong County and Simao County. Also, 81 sera samples from children aged from 4 to 6 were collected from Yulong County. A total of 270 domestic animals blood samples, including 78 dogs, 132 goats and 60 cattle, were also collected. The IgM and IgG antibodies of 8 rickettsiae, including R. typhi, R. heilongjiangensis, R. sibirica, O. tsutsugamushi Karp, E. chaffeensis, A. phagocytosis, B. henselae, C. burnetii, and Hainan 1 spotted fever group rickettsia, were examined by using immunofluorescence assays （IFA）. Investigation results indicated that the IgG positive rates of R. typhi, B. henselae and C. burnetii （16.5%, 6.3 % and 9.3 %） in adult were higher than that of the other 5 rickettsiae in the same population group investigated in the study. The IgG antibody positive rates of R. typhi for children also shared the highest （12.4 %）. Similar seroepidemiologic features were also found in domestic animals. Among the 8 rickettsiae tested in the study, the positive rate of R. typhi was the highest （61.5%）. No statistical significance among these investigated sites was observed. Here we concluded that rickettsia infection of farm population and domestic animals are common in Yunnan Province. Differential diagnosis of unknown febrile patients in clinical practice and further active surveillance of rickettsiosis should be enforced in these areas.
出处
《中国人兽共患病学报》
CAS
CSCD
北大核心
2013年第7期724-729,共6页
Chinese Journal of Zoonoses
基金
Supported by the China-U.S.Collaborative Program on Emerging and Re-emerging Infectious Diseases(No.1U2GGH000018-01)
the National Basic Research Program of China(973Program)(No.2010CB530206)
the National Science and Technology Key Project on Major Infectious Disease(Nos.2008ZX10004-002,2008ZX10004-008,2009ZX10004-203,2012ZX10004-215)~~
