8例脑曼氏裂头蚴病的流行病学特点、临床特征、影像学表现与预后分析

摘要/Abstract

摘要：

目的分析脑曼氏裂头蚴病的流行病学特点、临床特征、实验室检测资料、影像学表现和预后。方法收集2013年1月至2016年12月上海市公共卫生临床中心住院治疗的8例脑曼氏裂头蚴病患者资料（经中国疾病预防控制中心寄生虫病预防控制所血清学鉴定为曼氏裂头蚴抗体阳性）,分析其流行病学特点、临床特征、实验室检测资料、影像学表现和预后。结果 8例患者均为外地输入性病例,3例曾食未熟蛙肉、蛇肉;3例经常食用街边烧烤,2例原因不详。临床首发症状主要表现为头痛5例、癫痫3例、伴有肢体无力2例、情志改变1例、智力水平下降1例。治疗前,患者1、4、5、6和7的嗜酸粒细胞偏高,治疗后下降;治疗前,患者2、3和8的嗜酸粒细胞正常,治疗后上升。头颅磁共振（MRI）增强扫描结果显示8例患者病灶呈聚集的多发小环状强化。予吡喹酮[15~20 mg/(kg·d),分2次服用]联合阿苯达唑[15~20 mg/(kg·d),分2次服用]驱虫治疗及对症支持后,5例患者强化病灶消失,均痊愈;3例青少年患者颅内病灶发生迁移,周围可见水肿带,疗效差,仍有反复发作。结论脑曼氏裂头蚴病患者口服吡喹酮联合阿苯达唑后,可以获得较好的疗效。

关键词: 脑曼氏裂头蚴病, 影像学表现, 吡喹酮, 阿苯达唑, 预后

Abstract:

Objective To analyze the epidemiological characteristics, clinical features, laboratory testing data, imaging features and prognosis of cerebral sparganosis mansoni. Methods Clinical information of 8 patients with cerebral sparganosis mansoni (as determined through detection of antibody for sparganosis mansoni in serum by the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention) admitted in Shanghai Public Health Clinical Center (SPHCC), China, from January 2013 to December 2016, was obtained. The epidemiological characteristics, clinical features, laboratory testing data, imaging features and prognosis were analyzed. Results A total of 8 patients were enrolled in this study, with the antibody for sparganosis mansoni in serum and cerebrospinal fluid. All the patients were from outside of Shanghai, and 6 of them may be infected by inadequately cooked food. The patients were found with headache (5 cases), epilepsy (3 cases), weakness (2 cases), character change (1 cases), and of decline intellecteual (1 cases). The number of eosinophils in cases 1, 4, 5, 6 and 7 was higher than normal before treatment and normal after treatment. The number of eosinophils in cases 2, 3 and 8 was normal before treatment and increased after treatment. All the cases were showed a mass lesion by brain magnetic resonance imaging (MRI). With the praziquantel [15~20 mg/(kg·d),2 times/d] plus albendazole [15~20 mg/(kg·d),2 times/d] treatment, 5 cases were found with the local foci disappeared, indicating fully recovered, 3 cases were recurrent through repeated treatment. Conclusion Praziquantel plus albendazole treatment is effective for cerebral sparganosis mansoni.

Key words: Cerebral sparganosis mansoni, Radiology, Praziquantel, Albendazole, Outcome

中图分类号:

R531.31

叶善可, 徐烈, 黄琴, 凌云. 8例脑曼氏裂头蚴病的流行病学特点、临床特征、影像学表现与预后分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(2): 144-147.

Shan-ke YE, Lie XU, Qin HUANG, Yun LING. The epidemiology,clinical feature, radiology and outcome of 8 cases with cerebral sparganosis mansoni[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2018, 36(2): 144-147.

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患者编号 Patient ID	发病年龄 Age of onset	性别 Gender	始发症状 Initial symptom	血清学检测结果 Serological test result	疗程 Times of treatment	治疗结果 Outcome of treatment
1	64	女Female	头痛Headache	无No	1	治愈Recovered
2	10	女Female	头痛,癫痫、四肢无力 Headache, epilepsy, fatigue	无No	6	未愈Not recovered
3	10	男Male	癫痫 Epilepsy	无No	3	未愈 Not recovered
4	34	女Female	头痛Headache	无No	1	治愈Recovered
5	5	男Male	头痛Headache	无No	1	治愈Recovered
6	52	男Male	腹泻Diarrhea	无No	1	治愈Recovered
7	54	女Female	腹痛Abdominal pain	华支睾吸虫 Distomatosis	1	治愈Recovered
8	11	男Male	头痛,癫痫、四肢无力 Headache, epilepsy, fatigue	囊尾蚴、棘球蚴 Cysticercus, Echinococcosis	8	未愈 Not recovered

患者编号 Patient ID
	首次治疗前Before treatment		最高值Peak value		末次治疗后After last treatment		参考值Normal range
	嗜酸粒细胞数/ × 10⁹/L No. eosinophils/ × 10⁹/L	百分比/% Percentage/%	嗜酸粒细胞数/ × 10⁹/L No. eosinophils/ × 10⁹/L	百分比/% Percentage/%	嗜酸粒细胞数/ × 10⁹/L No. eosinophils/ × 10⁹/L	百分比/% Percentage/%	嗜酸粒细胞数/ × 10⁹/L No. eosinophils/ × 10⁹/L	百分比/% Percentage/%
1	55.0	7.06	55.0	7.06	19.7	1.57	0.02~0.52	0.4~8.0
2	0.2	0.04	4.1	0.36	1.2	0.11
3	0.2	0.01	1.5	0.11	0.2	0.02
4	1.7	0.07	1.7	0.07	0.4	0.02
5	15.1	0.98	15.1	0.98	14.6	1.17
6	29.4	3.77	29.4	3.77	22.1	2.21
7	8.2	0.38	8.2	0.38	7.8	0.34
8	0.3	0.01	11.0	0.6	4.6	0.31