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目的分析斑点热立克次体病病例特征,为制定防控措施提供依据。方法采用中国疾病预防控制中心《立克次体病诊断与处置手册》(2008版)的诊断标准和现场流行病学个案调查方法,收集并分析2014年安吉县5例病例的临床资料,现场流行病学调查资料和病原学检测结果。结果 5例病例分别来自杭垓、上墅两个乡镇的5个山村,发病前均无外出史,但发病前两周内均有上山作业史,其中4例自诉上山后有不明昆虫叮咬史。临床表现主要为发热(5例)、寒战(5例)、皮疹(5例)和焦痂(2例)。血常规及生化检测结果显示,白细胞计数正常(4例)、血小板计数正常(5例),但所有病例血沉、超敏C反应蛋白、铁蛋白和相关酶谱均有不同程度的增高。血清学诊断显示,5例病例恢复期血清斑点热立克次体Ig G抗体滴度均较急性期有4倍以上升高。结论安吉县5例病例发病前两周内有作业史的山区可能存在斑点热立克次体疫源地,该地居民存在感染风险,需加强蜱媒传染病监测、健康教育和对上山作业者的个人防护。
Objective To analyze the case characteristics of hot spot rickety fever and provide basis for making prevention and control measures. Methods According to diagnostic criteria of Rickettsial Disease Diagnosis and Treatment Manual (2008 Edition) and case investigation of field epidemiology in China CDC, the clinical data of 5 cases in Anji County in 2014 were collected and analyzed. Surveillance data and etiological test results. Results The five cases were from 5 villages in two villages of Hangli and Shangsuo. Before the onset of disease, they all had no history of going abroad. However, both of them had a history of going uphill within two weeks before the onset of illness. The main clinical manifestations were fever (5 cases), chills (5 cases), rash (5 cases) and eschar (2 cases). Blood tests and biochemical tests showed normal white blood cell count (n = 4) and normal platelet count (n = 5), but all cases showed elevated erythrocyte sedimentation rate, high sensitivity C-reactive protein, ferritin and related enzymes. Serological diagnosis showed that 5 cases of convalescent serovar Typhimurium Ig G antibody titers were more than 4 times higher than the acute phase. Conclusion There may be epidemic spots in the mountainous areas with operating history in the five weeks before the onset of disease in five cases of Anji County. The residents of this county may be at risk of infection. Monitoring of tick-borne infectious diseases, health education, Personal protection