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    30 April 2021, Volume 39 Issue 2
    FROM ENDEMIC TO PRELIMINARY CONTROL--SPECIAL REPORTS ON ECHINOCOCCOSIS IN SICHUAN PROVINCE
    From epidemic to preliminary control: retrospective review of echinococcosis prevention and control in the past 40 years
    WANG Qian, ZHANG Guang-jia, YU Wen-jie, LIAO Sha, HE Wei, HUANG Yan, LI Rui-rui, YANG Liu, WANG Qi, YAO Ren-xin, ZHANG Zhong-shuang, LIU Yang, ZHONG Bo
    2021, 39(2):  133-138.  doi:10.12140/j.issn.1000-7423.2021.02.001
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    The preliminary goal of echinococcosis control in the national 13th five-year plan is to reduce the human prevalence to < 1% and dog infection rate to < 5% in 70% of all endemic counties by 2020. By 2019, 83% of the counties in Sichuan Province had reached the goal, overfulling the national control plan. The control of echinococcosis in Sichuan Province has gone through four stages: the key investigation and research stage, the pilot stage carried out mainly by the health department, the preliminary stage for coordinated control by related departments, and the stage of achieving preliminary control led by the government. Great achievements have been gained in echinococcosis control, from prevalence to preliminary control, demonstrating the significant effectiveness of the comprehensive control strategy of “controling the source of infection as the main strategy, intermediate host control combining with patient screen and treatment”. The success of echinococcosis control in Sichuan Province can be attributed to the strategy of “cooperation of party and government, and population-based mobilization”, the cooperation among departments, scientific control measures, and the support from professional teams; to the continuous exploration of new strategies and measures, such as seasonal strengthening of dog deworming, rodent control in settlements, as well as the innovation of patient screening and management, health education, and monitoring of transmitting hosts. In the future, we should keep exercising the strategies and measures that proved effective in practice, and optimize strategies and measures in response to new epidemic situations timely to achieve accurate control and further control of echinococcosis transmission.

    Epidemiology of echinococcosis at the disease surveillance spots in Sichuan Province from 2016 to 2019
    LIAO Sha, WANG Qi, HE Wei, ZHANG Guang-jia, YU Wen-jie, YANG Liu, YAO Ren-xin, LI Rui-rui, HUANG Yan, LIU Yang, ZHONG Bo, WANG Qian
    2021, 39(2):  139-144.  doi:10.12140/j.issn.1000-7423.2021.02.002
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    Objective To understand the dynamic changes of echinococcosis endemic in Sichuan Province from 2016 to 2019, in order to provide reference for further prevention and control. Methods In 2016—2019, ultrasonographic examination was carried out to detect echinococcosis in the permanent residents aged over 2 years within the surveillance sites of Sichuan Province. Feces of domestic dogs and stray dogs were collected for detection of Echinococcus coproantigen, and internal organs of livestock and rodents in the surveillance counties were examined by palpation and necropsy to identify hydatid infection. Results Population surveillance at 35 sites showed that the detection rate of new cases of echinococcosis showed a trend of decrease from 0.15% (72/48 976) in 2016 to 0.02% (13/81 725) in 2019 (P < 0.05). A total of 115 new patients were detected, of them 80.87% (93/115) were from Garze Tibetan Autonomous Prefecture. Among the new cases, 59.13% (68/115) were of alveolar echinococcosis (AE), 38.26% (44/115) cystic echinococcosis (CE), and 2.61% (3/115) were found to be extrahepatic echinococcosis. The positive rates of Echinococcus coproantigen in domestic dogs from 2016 to 2019 were 1.19% (28/2 348), 2.35% (52/2 212), 3.43% (69/2 010) and 0.95% (35/3 668), and in stray dogs 2.87%(13/453), 2.00% (8/400), 4.69% (15/320) and 0.80% (5/624), respectively, with significant difference between the years (P < 0.05), and these rates in 2019 decreased by 20% and 72% compared to 2016. During 2016—2019, the prevalence in livestock were 4.45% (146/3 283), 1.53% (50/3 273), 2.93% (75/2 564) and 2.18% (89/4 078), and the prevalence in rodents were 1.71% (123/7 204), 2.48% (185/7 470), 1.19% (67/5 613) and 1.47% (154/10 477), respectively, with significant difference between the years (P < 0.05), and the prevalence in 2019 decreased by 51% and 14% compared to that in 2016. Conclusion The detection rate of new echinococcosis cases, the positive rate of dog coproantigen, the infection rate in intermediate hosts showed a overall decreasing trend from 2016 to 2019 in Sichuan Province, but the positive rate of dog coproantigen and infection rate in intermediate hosts were fluctuated.

    Exploration of a health education model and evaluation of its effect on echinococcosis control among students in Tibetan community, Sichuan Province
    ZHANG Guang-jia, WANG Qian, LIU Yang, ZHONG Bo, DANBA Ze-li, LUORONG Chu-mu, JIANGYANG Qv-zhen, LAN Zhi-qiang, HUANG Yan, YU Wen-jie
    2021, 39(2):  145-149.  doi:10.12140/j.issn.1000-7423.2021.02.003
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    Objective To explore the intervention effects of targeted health education on the knowledge of echinococcosis prevention and treatment and the practice rate of healthy behavior among students, and provide reference for implementation of health education of echinococcosis on classified base. Methods All students in the central primary schools in Bamei and Longdeng Townships in Daofu County, were assigned as the intervention group, and all students in the central primary school Qimei and Xianshui Townships were assigned as the control group. From 2016 to 2020, students in the control group were provided with conventional echinococcosis health education, and students in the intervention group were provided with additional special interventions. In each year, 150 students randomly selected from each grade of grades 3-6 in each school were surveyed. A questionnaire was used to assess the awareness rate of knowledge of echinococcosis control and the formation rate of health behavior among the students. Results In 2016, before the intervention, the awareness rates of knowledge of echinococcosis control in the intervention and control groups were 77.0% and 74.3%, respectively, and the formation rates of health behavior were 68.5% and 70.6%, respectively, with no significant difference between the two groups (P > 0.05). After the intervention, the awareness rate and behavior formation rate of students in both groups increased from 82.8% and 71.9% in 2017 to 93.1% and 85.5% in 2020, respectively (P < 0.05), and the intervention effect was better in the intervention group compared with the control group. The difference in the knowledge awareness rate between the two groups began to be significant in the first year after the intervention (82.8% and 77.4% in 2017) (P < 0.05), while the difference in the behavior formation rate began to be significant in the second year (78.5% and 75.1% in 2018) (P < 0.05), with a significant lagging response in behavior formation. In the control group, the awareness rate and behavior formation rate did not show significant difference between different years (P > 0.05), while in the intervention group, the awareness rate and behavior formation rate showed significant differences during 2016—2019 and 2017—2019, respectively (P < 0.05). Meanwhile, the awareness rate and behavior formation rate of students in the intervention group did not show significant difference between 2019 and 2020 (P > 0.05), indicating the intervention had gained steady achievements. The stratified analysis on the results demonstrated that after 4 year-consecutive health education, the difference in awareness rate between the intervention group and the control group was statistically significant in both boys and girls in 2020 (P < 0.05). The difference in awareness rate between the intervention group and the control group was statistically significant in all grades from 3 to 6 (P < 0.05). The difference in awareness rate between the intervention and the control groups was statistically significant in both Han Chinese and Tibetans (P < 0.05). There was no significant difference between the two groups in other ethnicities (P > 0.05). In addition, there was a significant difference in behavior formation rate between the intervention group and the control group in girls (P < 0.05). There was a significant difference in behavior formation rate between the intervention group and the control group in grades 4-6 (P < 0.05). Statistically significant differences in the behavior formation rate between the intervention and control groups were found in Tibetan and Han Chinese (P < 0.05). There was no significant difference between the two groups in male students, at grade 3, or in other ethnic groups (P > 0.05). Conclusion The health education pertinent to students can help improving their awareness of echinococcosis knowledge and forming health behavioral habits.

    Evaluation of the comprehensive control effects on echinococcosis in Ganzi Prefecture,Sichuan Province from 2016 to 2019
    KANG Dian-ju, ZHANG Jun-jie, SILANG Gema, DANBA Zeli, LIAO Sha, LIAO Ru-jun, ZHANG Meng-yuan, ZHONG Bo
    2021, 39(2):  150-155.  doi:10.12140/j.issn.1000-7423.2021.02.004
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    Objective To evaluate the comprehensive control effects on echinococcosis in Ganzi Prefecture , Sichuan Province, from 2016 to 2019. Methods From 2016 to 2019, comprehensive prevention and control measures, including screening for echinococcosis, deworming and monitoring of infection in dogs, and surveillance of cattle serum antibody, were carried out in 18 counties of Ganzi Prefecture. Ultrasound examination was performed in more than 90% of the residents (aged over 2 years in residence for at least 6 months) to screen for echinococcosis. To investigate the infection rate in dog feces, 4-6 townships were randomly selected from each county in each year of 2016—2019, and no less than 50 samples of dog feces were randomly collected from each township using ELISA for Echinococcus coproantigen. Meanwhile, 4-6 townships were randomly selected from each county in each year of 2016, 2017 and 2019, and 50 yak blood samples were collected from each township for ELISA analysis of serum anti-metacestode antibody. In 2018, no less than 30 sets of slaughtered yak organs including liver, lungs were randomly collected in each county, and tissue samples with lesions of hydatid cysts, masses or nodules were collected to be used for PCR amplification of mitochondrial cytochrome c oxidase subunit 1 (cox1) of Echinococcus spp. The yaks with positive PCR results were considered to have hydatid disease. Questionnaire was conducted to survey the awareness rate of echinococcosis knowledge in students, 50 students aged 6-12 years were randomly selected from each township every year. The survey data in 2016—2019 were analyzed including the positive rate in residents, the positive rate of Echinococcus coproantigen in domestic dogs, the positive rate of serum antibody or prevalence in cattle, and the changes of awareness rate of echinococcosis knowledge among students aged 6-12 years. Results From 2016 to 2019, the detection rates of new echinococcosis cases in the residents were 1.58‰ (693/439 091), 0.44‰ (204/460 165), 0.56‰ (244/436 473) and 0.18‰ (51/285 747), respectively, showing a trend of decrease (χ 2 = 617.21, P < 0.05). The detection rates in children aged 6-12 years were 0.35‰ (693/439 091), 0.44‰ (204/460 165), 0.56‰ (244/436 473) and 0.18‰ (51/285 747), respectively, showing a trend of decrease (χ 2 = 19.38, P < 0.05). The positive rate of Echinococcus coproantigen in domestic dogs were 16.50% (1241/7 519), 7.75% (501/6 464), 3.58% (63/1 758) and 3.32% (193/5 813), respectively, showing a trend of decrease (χ 2 = 797.96, P < 0.05). The positive rates of serum antibody or prevalence in cattle were 10.27% (572/5 569), 10.05%(511/5 087), 4.07% (20/492), and 5.22% (141/2 700) in 2016, 2017, 2019, respectively, showing a trend of decrease (χ 2 = 79.58, P < 0.05). In 2018, 492 sets of slaughtered yak organs were inspected,, of which 20 were positive, and the prevalence in cattle was 4.07%. The eligibility rates of the disease knowledge among students aged 6-12 were 89.20% (15 925/17 854), 93.90% (17 740/18 892), 94.92% (18 685/19 686), and 96.05% (23 564/24 532), showing an trend of increase (χ 2 = 902.34, P < 0.05). Conclusion There have been great achievements by comprehensive control of echinococcosis in Ganzi Prefecture. The positive rate in redidents, the positive rate of dog Echinococcus coproantigen and the positive rate of serum antibody in cattle all decreased year by year, while the awareness rate of echinococcosis knowledge among students aged 6-12 years revealed a trend of increase.

    The impact of reducing stray dog density on the prevalence of Echinococcus spp. in small mammals
    YANG Liu, HE Wei, WANG Qi, YU Wen-jie, ZHONG Bo, LIU Yang, XIAO Tong-guang, XIE Fei, YAO Ren-xin, HUANG Yan, LI Rui-rui, LIAO Sha, ZHANG Guang-jia, WANG Qian
    2021, 39(2):  156-160.  doi:10.12140/j.issn.1000-7423.2021.02.005
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    Objective To investigate the impact of reducing stray dog population on the prevalence of Echinococcus spp. in small mammals. Methods From April 2016 to June 2020, stray dogs were captured and euthanized by professional dog catchers or by the public service department, in Shiqu County of Ganzi Tibetan Autonomous Prefecture throughout the year. During 2015 to 2020, investigators drove along the highway from State-owned livestock farm to Niga Township (130.5 km) in Shiqu County, and recorded the number of stray dogs within the sight distance on both sides of the highway. The density of stray dogs in Shiqu County was calculated by dividing the number of stray dogs by the driving distance. Small mammals were captured in Edoma, Wenbo, Yiniu, Xiazha, Niga, Mengyi and Gemeng Townships of Shiqu County and dissected on-site in July 2016 and July-August 2020. Organs of small mammals were stored in 95% ethanol and transferred back to laboratory. Hydatid lesion-like tissues were sampled from the organs for extraction of genomic DNA for PCR to amplify cytochrome c oxidase subunit 1 (cox1). The amplified products of PCR were sequenced and then compared with the known sequences in GenBank through BLAST to determine the species of Echinococcus. The infection rate of Echinococcus in small mammals was calculated according to the sequencing and alignment results. The 95% confidence interval of the rate was calculated using the Clopper & Pearson exact method. The difference in the prevalence of Echinococcus in small mammals was analyzed by chi-square test or Fisher exact test. Results From April 2016 to June 2020, 41 446 stray dogs were captured and euthanized in Shiqu County, including 26 570, 4 377, 5 656, 4 100, and 743 in each year, respectively. The density of stray dogs in Shiqu from 2015 to 2020 was 0.80, 0.04, 0.06, 0.04, 0.05 and 0.05 per kilometer, respectively. In July 2016, a total of 261 small mammals were captured, including 192 pikas (Lagomorpha : Ochotonidae) and 69 voles (Rodentia : Cricetidae). There were 14 small mammals infected with Echinococcus, of which 8 were voles and 6 pikas. The infection rate of E. multilocularis metacestodes in voles in 2016 was 11.6% (8/69, 95% CI: 5.1%-21.6%). The infection rate of E. multilocularis metacestodes and E. shiquicus metacestodes in pikas in 2016 were both 1.6% (3/192, 95% CI: 0.3%-4.5%). From July to August of 2020, a total of 270 small mammals were captured, of which 223 were voles and 47 pikas. The infection rate of E. multilocularis metacestodes in voles in 2020 was 0.5% (1/223, 95%CI: 0-2.5%). No pikas were found to be infected with Echinococcus spp.. The prevalence of E. multilocularis metacestodes in voles in 2020 was significantly reduced compared with that in 2016 (P < 0.01). The infection rate of E. multilocularis metacestodes and E. shiquicus metacestodes in pikas in 2020 were both lower than that in 2016, but the difference was not statistically significant (P > 0.05). Conclusion In endemic areas where stray dogs play an important role in the transmission of E. multilocularis, measures to reduce the density of stray dogs can significantly lower the infection rate of E. multilocularis metacestodes in voles.

    Analysis of hospitalization expenses and subsidies for echinococcosis patients in Sichuan Province during 2016—2020
    YAO Ren-xin, ZHONG Bo, WANG Qian, ZHANG Yu, LIU Jun, LI Yong-zhong, ZHOU Guo, ZHAO Jun-bin, DANBA Ze-li, ZHU Run-mao, ZHANG Ge-ji, LIU Yang, HUANG Yan, YU Wen-jie, HE Wei, LIAO Sha, ZHANG Guang-jia, WANG Qi, YANG Liu, LI Rui-rui
    2021, 39(2):  161-165.  doi:10.12140/j.issn.1000-7423.2021.02.006
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    Objective To evaluate the impact of the echinococcosis prevention and treatment project on the treatment cost for echinococcosis patients in Sichuan Province, in order to provide a scientific basis for the formulation of subsidy policy. Methods Data of surgical treatment of echinococcosis patients in four 3A grade hospitals in Sichuan Province from 2016 to 2020 were collected, including the basic information, lesion type, hospitalization days and expenses, medical insurance subsidies, state project subsidies, etc. SPSS 18.0 statistical software was used for statistical analysis. Results A total of 504 cases were collected, with a male-to-female ratio of 1 ∶ 1.2. The ratio of cystic echinococcosis granulose(114 cases) to alveolar echinococcosis (175 cases) was 1 ∶ 1.5, and the average age was (38.6 ± 14.5) years. The main surgical site was in liver (90%, 414/460). The major operative strategy was partial hepatectomy (24.7%, 90/365). Eighty-two cases received combined surgery and 33 cases received liver transplantation. The median length of hospitalization was 15 days. From 2016 to 2020, the median of total cost of hospitalization showed a trend of yearly increase. Significant factors that influence the hospitalization expense included different hospitals, year of admission, the age upon operation, length stay in hospital, type of echinococcosis and operation method (P < 0.05). Of the 237 patients with complete subsidy data, the total cost of hospitalization was 16 833 040 yuan, with a median cost of 51 172 yuan. The total amount of the national echinococcosis subsidy project was 4 645 709 yuan, with a median of 22 000 yuan. Most of the patients received a subsidy of > 20 000 yuan (51.9%). After compensated by medical insurance and echinococcosis subsidy, 192 patients need to pay for their own cost. The total amount of self-payment was 2 710 793 yuan, with a median of 5 888 yuan. Most of the patients paid 0-5000 yuan (58.2%), with 47 patients paying no cost. Conclusion The government echinococcosis subsidy program has greatly reduced the burden of patients for medical cost.

    Analysis of echinococcosis cases reported in non-endemic counties of Sichuan Province
    YAO Ren-xin, WANG Qian, LIAO Sha, ZHANG Guang-jia, HUANG Yan, YU Wen-jie, HE Wei, WANG Qi, LI Rui-rui, YANG Liu
    2021, 39(2):  166-170.  doi:10.12140/j.issn.1000-7423.2021.02.007
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    Objective To understand the epidemic distribution and epidemiological characteristics of reported cases in non-endemic counties of Sichuan Province. Methods The basic information, disease type and epidemiological history of the reported cases in non-endemic counties (cities/districts) of Sichuan Province from 2015 to 2019 were collected. WPS Excel 2019 software was used to establish a database, and the prevalence was analyzed. Results A total of 165 cases of echinococcosis were reported from 148 non-endemic counties in Sichuan Province from 2015 to 2019, which were distributed in 57 counties (districts) of 14 cities (prefectures). The number of cases was highest in 2016 (40 cases), and decreased thereafter. The number of reported cases in Chengdu was the highest (61 cases, 37.0%). There were 114 cases (69.1%) from villages and towns. The cases were reported in all age groups, with the highest proportion(52.7%) in the 41-60 years group (87/165). There were 103 males and 62 females, with a male-to-female ratio of 1.7 ∶ 1. The occupation distribution showed that the number of cases was higher in farmers and workers (58 and 28 cases), accounting for 52.1% (86/165). The numbers of cases of cystic and alveolar echinococcosis was 55 and 34, respectively, and the type of 76 cases was not classified. Of the 119 cases traced, 62.2% (74/119) had visited endemic areas of echinococcosis. Among them, 29 cases had visited endemic counties in Sichuan Province, and the most visited endemic areas outside Sichuan Province were Xinjiang (20 cases) and Tibet (15 cases). Conclusion The cases reported in the non-endemic counties of Sichuan Province from 2015 to 2019 were mostly from Chengdu City, townships, males, age group 41-60 years, and farmers, and most of them had visited the endemic areas of echinococcosis in Xinjiang and Tibet.

    Efficacy of alternative and combined use of albendazole plus praziquantel in the treatment of echinococcosis for Tibetan herdsmen
    HUANG Yan, YU Wen-jie, SHANG Jing-ye, HE Wei, ZHANG Guang-jia, WANG Qi, YANG Liu, LIAO Sha, LI Rui-rui, YAO Ren-xin, ZENG Ming-cai, ZHANG Fu-bing, LI Shu-cheng, LIU Yang, ZHONG Bo, WANG Qian
    2021, 39(2):  171-177.  doi:10.12140/j.issn.1000-7423.2021.02.008
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    Objective To observe the efficacy and side-effect of alternative and combined use of albendazole (ABZ) and praziquantel (PQT) in the treatment of human echinococcosis in Tibetan herdsmen. Methods Patients with liver echinococcosis were diagnosed by abdominal B ultrasound and sero-antibody detection in Ruo Ergai and Rangtang counties, Sichuan Province. The patients were randomly divided into two groups and were alternatively administered with oral ABZ and PQT (ABZ+PQT treatment group) or ABZ alone (ABZ control group). The ABZ+PQT group patients were given with 15 mg/kg ABZ daily dosed in 2 times for consecutive 25 days, followed by an alternative single dose of 40 mg/kg PQT for 5 days. The treatment was continued with the two regimes alternatively, a 3-month dosing was defined as a treatment course, with no intervals between courses. For the ABZ group, patients were given with ABZ at a total daily dose of 15 mg/kg dispensed in two times for 3 months, followed by a new treatment course after an one-week intermittence. All the patients were treated for 2 years. During the treatment courses, all patients received B ultrasound examination, serum test for IgG antibody against Echinococcus metacestode and liver function monitoring, every 6 months. To understand the adverse effects of the drugs on liver function, questionnaire survey was performed. Results A total of 97 clinically diagnosed echinococcosis cases were for treatment and following up in this study, having 55 cases in the ABZ+PQT group, of them, 31 were cystic echinococcosis (CE) and 24 alveolar echinococcosis (AE) cases. In the ABZ control group, 47 patients (22 CE, 20 AE) were included. In the ABZ+PQT group, the cure rate and effective rate were 19.4% (6/31) and 58.1% (18/31) for CE cases; and 12.5% (3/24) and 50.0% (12/24) for AE cases, respectively. In the ABZ group, the cure rate and effective rate were 9.1% (2/22) and 18.2% (4/22) for CE cases; and 5.0% (1/20) and 20.0% (4/20) for AE cases, respectively. The serum anti-Echinococcus IgG antibody titer in the two groups during treatment courses did not show statistical changes. The serum anti-Echinococcus antibody A450 value was 0.39 ± 0.06 in the ABZ+PQT group before treatment, and elevated to 0.45 ± 0.05 after 3 months of treatment, but reduced to 0.39 ± 0.07 after 12 months of treatment and stayed stable afterwards. The antibody change profile in the ABZ group was similar to that in the ABZ+PQT group. The antibody A450 value was 0.41 ± 0.07 before treatment, elevated to 0.43 ± 0.08 after 3 months of treatment and turned down to 0.39 ± 0.07 after 12 months of treatment. The A450 values of sero-antibody varied significantly at different time points of the treatment course. The general side effects occurred in 23.7% (23/97) of patients, among them, 8 (34.8%) cases were from the ABZ+PQT group, while the other 15 cases (65.2%) were from the ABZ group, displaying largely as mild side effect of gastrointestinal discomfory; severe effects occurred as impairment of liver function. In 3 months of treatment, 6 cases (1 case in the ABZ+PQT group, 5 in the ABZ group) showed elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which then reduced to normal level upon following up period. Conclusion The effective rate of ABZ+PQT group regime for CE and AE was higher than that of ABZ group; adverse effects occurred in the ABZ+PQT treatment group significantly less frequently than in the ABZ treatment group; the changes of serum IgG antibody can not reflect the actual lesion progression.

    Observation on the behavioral activities of the wild animals as intermediate hosts for Echinococcus spp. by infrared-triggered cameras in Shiqu County of Sichuan Province
    WANG Qi, WANG Qian, CHEN Shun-de, HE Wei, YU Wen-jie, YANG Liu, ZHANG Guang-jia, LIAO Sha, LI Rui-rui, HUANG Yan, YAO Ren-xin, LIU Yang, ZHONG Bo
    2021, 39(2):  178-184.  doi:10.12140/j.issn.1000-7423.2021.02.009
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    Objective To understand the behavioral activities of the different wild animals as intermediate hosts for Echinococcus spp. in Shiqu County, and to explore their exposure risk in the transmission of Echinococcus spp., in order to provide scientific basis for prevention and control. Methods During 2018—2020, 12 observation sites were set up within a radius of 1 km from the settlements of Niga Town and Odoma Township in Shiqu County, at varied months, and in each observation site infrared-triggered cameras were used to record the ground activity of the intermediate host animals of Echinococcus spp. within the range of 6 m. The infrared cameras were installed on a telephone pole or fence at about 100 cm high for over 3 days to record a 10-s or 25-s video after each triggering. Animal samples were captured within the range of camera-recorded, identified for species, and underwent PCR amplification of cytochrome b gene (Cyt b) followed by double-stranded DNA sequencing. The sequences were compared by BLASTN in GenBank to identify the species. Results Video records were obtained from all 12 observation sites, with a total length of 743 minutes, and 59 small mammals were captured, of which those from 6 observation sites were identified to be Ochotona curzoniae of the order Lagomorpha, with sequence homology of > 99% to the Cyt b gene of O. curzoniae in the GenBank database (Accession No. FJ227464); animals from the other 6 observation sites were identified to be Neodon fuscus, with sequence homology of > 99% to the Cyt b gene of N. fuscus in the GenBank database (Accession No. KU214680, KU214681). At the 6 observation sites of O. curzoniae, the daytime ground activity started at 6 ∶ 46 and ended at 20 ∶ 41 with an activity peak at 9 ∶ 00, 12 ∶ 00, and 17 ∶ 00, the highest at 17 ∶ 00; the activities on the ground included grazing, running, watching, and burrowing, accounting for 45.8% (546/1 192), 33.6% (400/1 192), 16.9% (201/1 192), 2.9% (34/1 192), and 0.9% (11/1 192), respectively. At the 6 observation sites for N. fuscus, the ground activity started at 7 ∶ 18 and ended at 20 ∶ 14 with an activity peak at 9 ∶ 00, 12 ∶ 00, 14 ∶ 00 and 17 ∶ 00, the highest at 9 ∶ 00; the activities on the ground included running, grazing, watching, burrowing, playing, cleaning body, and collecting hay, accounting for 34.2% (131/383), 32.9% (126/383), 19.6% (75/383), 6.3% (24/383), 4.2% (16/383), 1.6% (6/383), and 1.3% (5/383), respectively. Conclusion There are certain differences in the daytime activity of different intermediate host animals of Echinococcus spp. The activity start time, ending time, activity frequency and activity status are different between O. curzoniae and N. fuscus. The O. curzoniae activity started earlier and ended later than N. fuscus. The O. curzoniae animals are more active throughout the day. The N. fuscus animals are more active in the morning than in the afternoon, while the O. curzoniae animals are more active in the afternoon. The N. fuscus animals are more vigilant toward outside than the O. curzoniae animals, which indicated that the O. curzoniae showed higher risk to expose into the predation range of the definitive hosts.

    Trend prediction on the detection rate of newly discovered echinococcosis patients in Sichuan Province based on ARMA and GM (1,1) models
    HE Wei, WANG Qi, YU Wen-jie, HUANG Yan, ZHANG Guang-jia, LIAO Sha, YANG Liu, YAO Ren-xin, LI Rui-rui, LIU Yang, ZHONG Bo, WANG Qian
    2021, 39(2):  185-190.  doi:10.12140/j.issn.1000-7423.2021.02.010
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    Objective To explore a model suitable for predicting the detection rate of newly discovered echinococcosis patients in Sichuan Province, and to provide scientific basis for formulating prevention and control strategies for echinococcosis. Methods The detection rate data of newly discovered echinococcosis patients in Sichuan Province from 2007 to 2020 were collected, and ARMA and GM (1,1) models were established respectively to predict the detection rate from 2021 to 2023. Meanwhile, the fitting and prediction effects of the two models were compared using the coefficient of determination, mean absolute error and mean-square error. Results The ARMA model was established, and the errors between fitting and actual values of detection rate in 2017—2020 were 12.44, 26.04 and 33.30, respectively. The predicted detection rates in 2021, 2022 and 2023 using this model were 50.14/100 000, 50.04/100 000 and 49.99/100 000, respectively. Uing the GM(1,1) model, the errors between fitting and actual values of detection rate in 2017—2020 were 6.51, 2.94 and -1.20, respectively, and the predicted detection rates in 2021, 2022 and 2023 were 20.55/100 000, 17.65/100 000 and 15.77/100 000, respectively. Evaluation of fitting effects showed that the GM(1,1) had better prediction performance than the ARMA model. Conclusion The GM (1,1) model can predict the detection rate of newly discovered echinococcosis patients in Sichuan Province. Although the predicted detection rate show a trend of decrease, new cases are continuously being detected. Therefore, measures should be taken to strength prevention and control of echinococcosis and consolidate the achievements of disease control.

    An information system designed for population screening of hydatid disease and patient management in Sichuan Province
    YU Wen-jie, WANG Qian, ZHANG Guang-jia, HUANG Yan, LIAO Sha, HE Wei, WANG Qi, YAO Ren-xin, YANG Liu, LI Rui-rui
    2021, 39(2):  191-194.  doi:10.12140/j.issn.1000-7423.2021.02.011
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    To improve the quality of echinococcosis mass screening and patient management, a information system for human echinococcosis screening and patient management was designed in Sichuan Province based on the server/ueser model based on the facial biological recognition technology, comprising four modules: the screening, first diagnosis, follow-up and remote consultation. Through the human facial recognition technology, this system enables patient information consolidation, remote ultrasound consultation, quick data entering, simple query statistics and effective information management. The development of this system met the need for echinococcosis screening and patient information management for health department. It also made possible for experts to provide remote technical guidance and auxiliary diagnosis of echinococcosis to primary medical staff.

    SPECIAL REPORT
    Malaria epidemiology in China in 2020
    ZHANG Li, FENG Jun, TU Hong, YIN Jian-hai, XIA Zhi-gui
    2021, 39(2):  195-199.  doi:10.12140/j.issn.1000-7423.2021.02.012
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    Malaria epidemic data in 31 Provinces/Municipalities/Autonomous regions (Taiwan region, Hong Kong and Macao excluded) of China in 2020 were collected and sorted through the Information System for Parasitic Disease Prevention and Control. The epidemiological characteristic of malaria was analyzed. In 2020, a total of 1 086 malaria cases were reported in China, which declined by 59.4% compared to that in 2019 (2 674). Of these cases, 1 085 imported cases and 1 long incubation case infected with Plasmodium malaria were identified. None of them were indigenous cases. In addition, 1 051 cases were of Chinese nationality (96.8%, 1 051/1 086) and 35 cases were of foreign nationality (3.2%, 35/1 086). Most of the cases were within the age range of 30-49 years (57.5%, 624/1 086), with a male-to-female ratio of 13.7 ∶ 1. The reported cases included 234 cases of P. vivax infection (21.5%, 234/1 086), 610 cases of P. falciparum infection (56.2%, 610/1 086), 23 cases of P. malariae infection (2.1%, 23/1 086), 204 cases of P. ovale infection (18.8%, 204/1 086) and 15 cases with mixed-infection (1.4%, 15/1 086). The cases were reported from 29 Provinces/Municipalities/Autonomous regions, with the top 5 being Guangdong, Yunnan, Jiangsu, Sichuan and Shandong provinces, from which 570 cases (52.5%, 570/1 086) were reported. Totally 6 deaths (0.6%, 6/1 086) were reported from Guangdong (3 cases), Fujian (2 cases) and Hubei (1 case) provinces, which was decreased by 68.4% compared to the 19 deaths in 2019. Noticeably, there has been no report of indigenous cases since the last four years. Nevertheless, it is imperative to continuously strengthen the surveillance on imported malaria and the cases in border area, prevent from re-transmission of imported malaria, reduce the death risk and consolidate the achievements of malaria elimination in China.

    ORIGINAL ARTICLES
    Effect of praziquantel on impaired renal function in mice with acute infection of Schistosoma japonicum
    ZHAO Cheng-si, QIN Min, TAN Ming-juan, MIAO Ting-ting, SHAO Tian-ye, LIU Xin-jian, WANG Yong
    2021, 39(2):  200-209.  doi:10.12140/j.issn.1000-7423.2021.02.013
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    Objective To investigate the occurrence and development of renal inflammation in mice with acute infection of Schistosoma japonicum and evaluate the therapeutic effect of praziquantel on the impairment of renal function in the infected mice. Methods Fifty-five female C57BL/6J mice were randomly divided into 5 groups including the health control group (20), health control with praziquantel-treatment group (5), infection group (20), infection with praziquantel-treatment group(5) and praziquantel treatment group (5). Mice in the latter 3 groups were infected with 14 ± 2 cercariae of S. japonicum. Praziquantel treatment was given from the 6th week after infection. In the health control with praziquantel-treatment group and the infection with praziquantel-treatment group, praziquantel was given at a dosage of 300 mg/kg every 12 h for two consecutive weeks, and the praziquantel dosage in the praziquantel treatment group was 250 mg/kg for 3 consecutive days. Five mice in each of the health control group and the infection group were dissected at weeks 1, 3, 6 and 8 after infection. Five mice in each of the health control with praziquantel-treatment group, the infection with praziquantel-treatment group and the praziquantel treatment group were dissected at week 8 after infection. Urine and blood samples were collected to detect the levels of urinary protein and serum creatinine to evaluate renal function of the mice. The histopathological changes of kidney in each group were observed by HE staining. The infiltration of macrophages in the kidneys of mice was assessed by F4/80 immunohistochemical staining. Quantitative real-time PCR (qRT-PCR) and Western blotting were used to detect the relative transcription and protein expression level of mRNA of inflammatory cytokines (TNF-α, TGF-β, IL-1β and IL-6) and macrophage chemokine CCL2. Results At weeks 1, 3, 6 and 8 after infection, the urine protein contents in the infection group were (1.67 ± 0.52) g/L, (2.17 ± 0.41) g/L, (3.00 ± 0.89) g/L and (4.00 ± 0. 63) g/L, respectively, all higher than those in the health control group (P < 0.01). The serum creatinine levels in the infection group were (10.01 ± 1.45)μmol/, (13.00 ± 2.12)μmol/, (14.33 ± 1.21) and (19.00 ± 2.54) μmol/L, which were higher than those in the health control group (P > 0.05 or P < 0.01). qRT-PCR results showed that in the infection group the relative transcription level of inflammatory factor TNF-α mRNA were 2.47 ± 0.51, 3.14 ± 1.43, 1.83 ± 0.31 and 7.48 ± 5.54, the relative transcription level of TGF-β mRNA were 0.94 ± 0.24, 2.80 ± 1.07, 2.72 ± 0.88 and 3.03 ± 0.36, the relative transcription level of IL-1β mRNA were 1.49 ± 0.28, 4.32 ± 1.85, 2.08 ± 0.69 and 2.81 ± 0.73, the relative transcription level of IL-6 mRNA were 1.96 ± 0.31, 1.48 ± 0.35, 2.38 ± 1.17 and 2.85 ± 1.32, respectively, which were all higher in the health control group (P < 0.05 or P < 0.01). Western blotting analysis showed that the expression of TNF-α and IL-1β in the infection group were higher than those in the health control group. The relative transcription level of macrophage chemokine CCL2 mRNA in the infection group were 1.84 ± 0.17, 3.42 ± 0.85, 3.03 ± 1.00 and 2.63 ± 0.43, respectively, which were also higher than that in the health control group (P < 0.01). HE staining of renal pathological sections showed massive inflammatory cell infiltration, glomerular enlargement, and mesangial cell proliferation. Immunohistochemical results showed that the F4/80-positive areas in the kidneys of the infection group were (1.99 ± 0.49)%, (4.27 ± 0.90)%, (6.71 ± 1.38)% and (9.83 ± 1.91)%, which were higher than those in the health control group (P < 0.01). After treatment with praziquantel for two weeks, the renal tissue impairment and glomerular mesangial cell proliferation were alleviated. Compared with the infection group, the urinary protein content [(2.67 ± 0.52) g/L], serum creatinine level [(14.17 ± 2.88) μmol/L], F4/80-positive area [(5.92 ± 1.81)%], mRNA relative transcription of TGF-β and IL-6 (0.99 ± 0.23, 1.24 ± 0.53), and the protein levels of TNF-α and IL-1β were decreased in the infection with praziquantel-treatment group (P < 0.05 or P < 0.01), but did not change significantly in the praziquantel treatment group (P > 0.05). Compared with the infection group (5.29 ± 2.98, 2.81 ± 0.73, 2.63 ± 0.43), the mRNA relative transcription of TNF-α, IL-1β and CCL2 were decreased (P < 0.05 or P < 0.01) in the infection with praziquantel-treatment group (0.98 ± 0.36, 0.95 ± 0.33, 0.80 ± 0.27) and the praziquantel treatment group (1.56 ± 0.66, 1.76 ± 0.76, 1.41 ± 0.48). Conclusion In mice infected with S. japonicum, renal inflammation may occur in the early and acute stages of infection, accompanied by infiltration of macrophages in renal tissues, and impairment in glomerular and renal functions. Treatment with praziquantel for two weeks can significantly ameliorate renal inflammation and renal function in mice infected with S. japonicum.

    Effects of pyrimethamine on folate level and immune function of macrophages
    QIN Min, SHAO Tian-ye, ZHAO Cheng-si, MIAO Ting-ting, ZHANG Rong, QIU Jing-fan, WANG Yong
    2021, 39(2):  210-217.  doi:10.12140/j.issn.1000-7423.2021.02.014
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    Objective To explore the effects of pyrimethamine, an anti-Toxoplasma gondii drug, on folate level and immune function of macrophages. Methods RAW264.7 cells were seeded in 96-well plates (1 × 104 cells/well) and treated with 0 (control), 0.01, 0.05, 0.10, 0.50, 1.00, 5.00, 10.00, 50.00, 100.00, 500.00 and 1 000.00 μmol/L pyrimethamine for 24 h, respectively, followed by CCK8 assay. RAW264.7 cells were seeded in 6-well plates (5 × 105 cells/well), and infected with T. gondii tachyzoites for 3 h, followed by treatement with 0.10, 1.00, 10.00 and 100.00 μmol/L pyrimethamine for 24 h, respectively. The expression of dihydrofolate reductase (DHFR) in T. gondii tachyzoites was detected by qRT-PCR. Total RNA of RAW264.7 cells was extracted by TRIzol reagent. The expression of DHFR and inflammatory genes in macrophages was detected by qRT-PCR, the protein abundance of DHFR was detected by Western blotting and intracellular folate levels were detected by Automated Chemiluminescence Systems. The amino acid sequences of DHFR from T. gondii tachyzoites and from RAW264.7 cells were compared by BLAST. RAW264.7 cells were cultured in folate-free medium for 48 h, and then treated with 100 μmol/L pyrimethamine for 24 h to detect the expression of inflammatory genes by qRT-PCR. The comparison between two groups was performed by t-test, and multiple comparison was performed by one-way ANOVA. Results CCK8 detection showed that the inhibition rate of pyrimethamine on cell activity was in a dose-dependent manner, which could induce slight proliferation of macrophages at 0.01-0.10 μmol/L, while inhibited cell proliferation at the concentration higher than 0.10 μmol/L. qRT-PCR showed that the mRNA expression of DHFR in T. gondii tachyzoites in the 0.10, 1.00, 10.00 and 100.00 μmol/L groups were 1.190 ± 0.054, 1.460 ± 0.206, 0.468 ± 0.077 and 0.399 ± 0.073 respectively, showing mRNA expression in the 1.00 μmol/L group being higher than that in the control group, and the level in the 10.00 and 100.00 μmol/L groups lower than that in the control group (P < 0.01). Meanwhile, the mRNA expression of DHFR in the RAW264.7 cells were 0.789 ± 0.505, 1.820 ± 0.119, 2.120 ± 0.140 and 2.080 ± 0.189 respectively, higher in the 1.00, 10.00 and 100.00 μmol/L groups than those in the control group (P < 0.05 or 0.01). Western blotting results showed that the protein abundance of DHFR in macrophages in the 100.00 μmol/L group was significantly higher than that in the control group. BLAST results showed that the homology between tachyzoite DHFR and mouse macrophage DHFR was only 37.0%. Using Automated Chemiluminescence Systems, we found that the intracellular folate level of macrophages in the 100.00 μmol/L group was (10.600 ± 2.930) nmol/L, which was much higher than that in the control group (P < 0.01). After treatment with 100 μmol/L pyrimethamine, the mRNA expression of TNF-α, iNOS, Arg-1 and IL-1β were 2.230 ± 0.100, 11.800 ± 1.350, 3.610 ± 0.256 and 7.810 ± 0.987 respectively, which were all higher than those in the control group (P < 0.05 or 0.01). After treatment with 100 μmol/L pyrimethamine, the mRNA levels of TNF-α, iNOS, Arg-1 and IL-1β in the folate-free culture group were 2.460 ± 0.026, 1.330 ± 0.091, 0.974 ± 0.141 and 0.997 ± 0.018 respectively. The mRNA levels of iNOS, Arg-1 and IL-1β in the folate-free group were much lower than those in the normal folate group (P < 0.05 or 0.01), while the opposite was found for TNF-α (P < 0.01). Conclusion Pyrimethamine could increase the intracellular folate level of macrophages by promoting the expression of DHFR in mice, which further induces the inflammatory gene expression of macrophages.

    Ecological niche modeling-based prediction on transmission risk of visceral leishmaniasis in the extension region of Loess Plateau, China
    GONG Yan-feng, HU Xiao-kang, ZHOU Zheng-bin, ZHU Hui-hui, HAO Yu-wan, WANG Qiang, ZHANG Yi, LI Shi-zhu
    2021, 39(2):  218-225.  doi:10.12140/j.issn.1000-7423.2021.02.015
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    Objective The ecological niche ensemble model was used to analyze and predict the distribution of transmission risk area of visceral leishmaniasis in Shanxi and Henan Provinces in the extension region of the Loess Plateau. Methods The locations with reported cases of visceral leishmaniasis in Shanxi and Henan Provinces from 2015 to 2019 were selected as the distribution sites, from which nine niche models were constructed based on 12 environmental variables in 3 categories and the distribution structure of ecological areas, including generalized linear models (GLM), generalized additive models (GAM), multivariate adaptive regression splines (MARS), generalized boosted models (GBM), classification tree analysis (CTA), flexible discriminant analysis (FDA), artificial neural networks (ANN), Random Forest (RF), and maximum entropy (MaxEnt). The ensemble model was established based on the area under the curve (AUC) of Receiver Operating Characteristic and true skill statistic (TSS). The transmission risk of visceral leishmaniasis was predicted in Shanxi and Henan Provinces. Results The 9 models had statistically significant difference in performance (AUC value, H = 35.742, P < 0.05; TSS value, H = 23.620, P < 0.05), among them, the RF model (AUC = 0.950, TSS = 0.829) and GBM models (AUC = 0.943, TSS = 0.803) performed better than the other single model. The performance of the ensemble model was better than the single model. The transmission risk of visceral leishmaniasis was predicted to be distributed in the Yanshan-Taihang Mountain Deciduous Broad-leaved Forest Ecological Area and the Fen-Wei Basin Agricultural Ecological Area. The risk areas of Shanxi Province accounted for 30.30% of the province’s area, and could be categorized into low-risk (12.99%), medium-risk (13.93%), and high-risk areas (3.37%). The high-risk areas of Shanxi Province were mainly located in the central and southern part of Yangquan City, North of Changzhi City, and South of Linfen City. The risk areas in Henan Province accounted for 4.68% of the Province’s area, and can be divided into the low-risk (3.51%), medium-risk (0.94%), and high-risk areas (0.23%). The high-risk areas of Henan Province were mainly located in the West of Anyang City. Conclusion The transmission risk of visceral leishmaniasis in Shanxi and Henan provinces in the extension region of the Loess Plateau shows a overall scattering and local clustering status in recent years. The ensemble ecological niche model has the potential in analysis and prediction of the disease, being able to provide scientific basis for prevention and control in key areas of leishmaniasis.

    Autocrine osteopontin promotes the growth and metastasis of Echinococcus multilocularis via the EGFR signaling pathway
    YANG Hai-cheng, ZHANG Hong-wei, SHI Kang-jie, WEN Yu-peng, LIU Shi-wen, ZHANG Yong-guo, ZHU Zhi-qiang, ZHANG Shi-jie
    2021, 39(2):  226-232.  doi:10.12140/j.issn.1000-7423.2021.02.016
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    Objective To investigate the mechanisms underlying the role of osteopontin (OPN) in the growth, invasion, and hepatic metastasis of Echinococcus multilocularis via the epidermal growth factor receptor (EGFR) pathway. Methods The C57 mouse model with E. multilocularis infection was established. In one month after infection, 100 model mice were randomly divided into 4 groups. Mice in the Lv-EmOPN-734 group and the Lv3-NC group were injected with lentivirus Lv-EmOPN-734 and Lv3-NC (empty plasmid), respectively, while mice in the PBS group were injected with PBS. The blank control group did not receive any injection. Liver tissues of mice at 5 days after injection were collected from the Lv-EmOPN-734 groups, and were prepared as cryo-sections to observe the entry of lentivirus into the liver tissue. The body weight, liver weight, and the liver volume were recorded at 1, 2, 3 and 4 months after infection, the liver tissue infected with E. multilocularis was examined, and HE staining was performed to examine the metastasis of E. multilocularis. qRT-PCR was performed to detect the transcription level of OPN mRNA, and Western blotting performed to analyze the expression of AKT and ERK (OPN and EGFR pathway molecules). Between-group analysis was made with t-test, and multi-group comparisons were performed with ANOVA. Results As observed in the frozen slices, lentivirus was mainly located in the inflammatory belt of hepatic lesion, external capsule and mucous layer cells. At 4 months after infection (3 months after virus injection), no metastasis was found in the Lv-EmOPN-734 group, with mild lesions of E. multiloculari, while in the other 3 groups, the liver surface was enveloped by E. multiloculari tissue and showed different degrees of angiogenesis. On 2 to 4 months after infection (1 to 3 months after injection of virus), the liver wet weight and volume of the Lv3-NC group, the PBS group and the blank control group were all significantly higher than those of the Lv-EmOPN-734 group (P < 0.01). The body weight of mice in the 4 groups persistently increased during 1 to 3 months after infection, and in 4 months after infection, the body weight in the Lv-EmOPN-734 group continued to increase to (41.300 ± 1.252) g, while the remaining 3 groups showed decreased body weight (P < 0.01). HE staining showed that the lung metastasis of E. multilocularis occurred in the Lv3-NC group 4 months after infection. The qRT-PCR results showed that the relative mRNA transcription level of the Lv-EmOPN-734 group was 1.44 ± 0.54, lower than the Lv3-NC group (16.62 ± 0.61), PBS group (15.45 ± 1.11) and blank control group (16.36 ± 0.79) (P < 0.01). Western blotting results showed that the relative expression of OPN, P-EGFR, P-ERK and P-AKT in the E. multilocularis tissue of the Lv-EmOPN-734 group were (0.18 ± 0.01), (0.30 ± 0.04), (0.33 ± 0.04), and (0.25 ± 0.02), respectively, all significantly lower than those in the other 3 groups (P < 0.01), while no significant difference was found of relative expression of EGFR, ERK and AKT, compared with the other three groups (P > 0.05). Conclusion OPN may promote growth and development of E. multilocularis via the EGFR pathway. When EmOPN is knocked down, E. multilocularis grows slowly in the liver, and no distant transfer occurs, suggesting that OPN may be a potential therapeutic target for E. multilocularis.

    Expression and activity assay of serine protease in Echinococcus granulosus
    TIAN Meng-xiao, ZANG Xiao-yan, GUO Gang, QI Wen-jing, GUO Bao-ping, REN Yuan, LI Jun, ZHANG Wen-bao
    2021, 39(2):  233-239.  doi:10.12140/j.issn.1000-7423.2021.02.017
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    Objective To compare the expression levels of Echinococcus granulosus serine protease (EgSP) in protoscoleces, germinal layer (metacestode), and adult worms, and assay of the protease activity. Methods RNA was extracted from the protoscoleces (with pepsin digestion and without pepsin digestion), germinal layer (metacestode), and adult worms using TRIzol reagent, and EgSP was amplified by PCR. The PCR products were sequenced, sequence alignment was performed using the Clustal × 2.0 software, and the phylogenetic tree was constructed by the neighbor-joining method. A gene sequence with Mr of 38 000 containing the SP reactive motif was used for prokaryotic expression. cDNA with proper open reading frame was cloned into the expression vector pET-30a, and then transformed into the E. coli BL21 strain, followed by IPTG induction of recombinant protein (rEgSP) expression in the LB medium. The proteins were purified using the Ni-IDA affinity chromatography column. A total of 5 BALB/c mice were immunized with 25 μg rEgSP emulsified with the same amount of Freund’s complete adjuvant by subcutaneous multi-site injection. The same amount of incomplete Freund’s adjuvant was used from the second immunization. The fourth booster immunization was done by injecting intraperitoneally. There was an interval of one week between each immunization. After the end of immunization, blood samples were collected from the tail vein, and the serum was separated and the level of specific antibody in serum was detected by ELISA. The relative expression of EgSP mRNA in different developmental stages was measured by qRT-PCR. The expression of EgSP in different developmental stages of E. granulosus was analyzed by Western blotting, and the protein expression abundance was analyzed with the Image Lab 6.0 software. The distribution of EgSP in the protoscoleces and germinal layer (metacestode) of E. granulosus was detected by immunohistochemistry. The protease activities of rEgSP and hydatid cyst fluid (HCF) proteins were assayed using the substrates for trypsin like serine protease and cysteinase (Z-Phe-Arg-AMC) and the substrate for Cathepsin L (Z-Arg-AMC). Data were analyzed with one-factor ANOVA using the Graphpad Prism 7 software. Results PCR produced target bands from cDNA samples from protoscoleces, germinal layer (metacestode), and adult worms, with an expected size of 1 455 bp. Sequencing of PCR products showed that the EgSP open reading frame encoded 484 amino acids with 1 455 bp bases, with a relative molecular weight (Mr) 54 870. The EgSP nucleotide and amino acid sequence showed 97.73% and 96.69% identity to E. multilocularis serine protease (EmSP), respectively. The phylogenetic tree analysis showed that the amino acid sequence identity to other tapeworm genera was 33.10%-87.19%. In particular, the identity to Taenia asiaica (GenBank accession number: VDK43949.1) was 87.19% and that to Taenia solium (GenBank accession number: VDM30859.1) was 52.89%, respectively. qRT-PCR evidenced the relative transcription levels of EgSP mRNA in protoscoleces digested with pepsin, germinal layer (hydatid cyst) and adult worms were 2.1 ± 1.2, 9.1 ± 2.1, 5.8 ± 2.3 respectively, which were higher than protoscoleces without pepsin treatment (1.0 ± 0). Western blotting results showed that the gray values of EgSP in protoscoleces, germinal layer (hydatid cyst) and adult worm tissues were 1.22 ± 0.09, 3.60 ± 0.23, and 4.00 ± 0.19 respectively. The expression of EgSP in germinal layer (hydatid cyst) and adult worms was higher than that of protoscoleces (P < 0.01). The results of immunohistochemistry showed that EgSP polyclonal antibody could specifically recognize cyst germinal layer but not protoscoleces. Examining the rEgSP and HCF protease activity in 3 different pH buffer, highest serine protease activity was detected in the pH 7.2 buffer (t = 53.79, 63.82; P < 0.01). Conclusion EgSP is highly expressed in the germinal layer (hydatid cyst) and adult worms of E. granulosus, while the expression is lower in protoscoleces. Both rEgSP and HCF proteins have strong serine protease activity.

    Clinical features of 83 cases of cerebral sparganosis
    YAN Xue-qiang, LI Xiao-long, SUN Zhen-qing, WU Jie
    2021, 39(2):  240-244.  doi:10.12140/j.issn.1000-7423.2021.02.018
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    Objective To analyze the clinical features, treatment and prognosis of cerebral sparganosis, providing reference for clinical managemet. Methods Clinical data of 83 patients with cerebral sparganosis in Guangdong 999 Brain Hospital from July 2004 to January 2020 were collected, and the general conditions, clinical manifestations, laboratory examination, imaging features, treatment and prognosis were analyzed. Statistical analysis was performed using the SPSS 19.0 software. Results The 83 patients came from different areas of China, including 46 from Guangdong Province, 12 from Hunan Province, 11 Guangxi Province, 8 Jiangxi Province and 6 other Provinces (municipalities/autonomous regions). There were 48 males and 35 females. The youngest case was 8 years old and the oldest was 71. The longest course of disease was 360 months and the shortest was 2 days. A clear history of unhygienic diet was found in 68.7% (57/83) patients. The main clinical symptoms were epilepsy (84.3%, 70/83), headache (32.5%, 27/83), mild limb hemiplegia (26.5%, 22/83), speech disorder (10.8%, 9/83), visual impairment (7.2%, 6/83), and paresthesia (6%, 5/83). All patients received Routine blood examination was provided for all patients, and found an increase of leukocyte count in 7 of 83 cases, 9 cases with increased eosinophils count, and 4 cases with increased lymphocytes. C-reactive protein detection was performed in 27 cases, and 2 cases showed elevation. Serological detection of metacercaria antibody by ELISA was performed in 80 patients, and 77 cases showed positive results. Detection of antibody against metacercaria in cerebrospinal fluid was examined by ELISA for 46 cases, of them 23 cases were found positive. Seventy patients were examined by electroencephalogram, 30 cases showed abnormal slow wave, and 17 cases had epileptiform discharge and clinical seizure. Calcification was observed on CT scan of 41 cases. Brain MRI enhancement showed tunnel sign-like changes in 75 cases and beading-like enhancement in 83 cases. Fifty-eight patients were treated with surgery, and 43 white flat cotton threadlike live worms were obtained from 42 of them. At follow-up of 3 months to 8 years, 52 cases were cured, 6 cases were still progressing or not cured; 55 patients with epilepsy who underwent surgery were followed up, of them 80% (44/55) reached the modified Engel classification class Ⅰ. Twenty-five cases were treated with praziquantel, and at follow up for 3 months to 8 years, 7 cases were cured, 18 cases were still progressing or not cured. Eleven patients with epilepsy were treated with praziquantel and followed up, and only 27.3% (3/11) reached the modified Engel class Ⅰ. Conclusion Epileptic seizures are the main clinical manifestations of cerebral sparganosis. Clinical diagnosis can be made based on serum immunological examination and imaging features. Surgery is an effective approach to remove live worms and cure the disease.

    REVIEWS
    Research progress on the structure and function of RIFIN protein of Plasmodium falciparum
    SHI Shan-mei, CHEN Jun-hu
    2021, 39(2):  249-255.  doi:10.12140/j.issn.1000-7423.2021.02.019
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    Plasmodium falciparum infection can result in severe malaria and even death. The P. falciparum-encoded repetitive interspersed families of polypeptides (RIFINs), one of the variant surface antigen families, can mediate the adhesion of infected erythrocytes and the formation of rosettes in the venous vascular system, thereby blocking blood flow and leading to severe malaria. RIFINs are expressed on the surface of infected red blood cells and are considered as an important immune target. However, due to the polygenicity and the gene polymorphism of the rif gene family, RIFINs can escape from the attack of immune system. Meanwhile, the binding of RIFINs to immune cell-surface inhibitory receptors such as leukocyte immunoglobulin-like receptor B1 (LILRB1) and leukocyte-associated immunoglobulin-like receptor 1 (LAIR1) can down-regulate the immune response and achieve the immune escape. With recent research on the molecular mechanisms of falciparum malaria, the development of effective vaccines has become the key to preventing malaria and achieving malaria elimination. In this review, we introduce the structure of P. falciparum RIFINs, and highlight their roles in severe malaria and research progress in fields related to immune and vaccine development.

    Research progress on the mechanisms underlying the impairment of host hepatocytes by Echinococcus multilocularis
    XU Kai, WANG Hai-jiu, ZHANG Li, ZHANG Yao-gang, FAN Hai-ning, REN Li, REN Bin, WANG Zhi-xin
    2021, 39(2):  256-259.  doi:10.12140/j.issn.1000-7423.2021.02.020
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    Alveolar echinococcosis is a disease caused by infection of Echinococcus multilocularis metacestode, which leads to severe clinical symptoms with high mortality. This disease develops from the host liver, damaging hepatocytes. E. multilocularis metacestode infection could affect the expression of hepatocyte collagen gene, cell cycle alteration, mediation of host immune responses, activation of signaling pathways and expression of related genes. This paper reviews the mechanisms damaging the host hepatocytes to provide useful reference information for treatment of alveolar echinococcosis.

    Research advance and application of whole-genome sequencing of Plasmodium
    LIU Hong, LIU Yao-bao, CAO Jun
    2021, 39(2):  265-270.  doi:10.12140/j.issn.1000-7423.2021.02.021
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    Malaria is an infectious disease caused by Plasmodium infection and one of the most important public health problems in the world. With the completion of human malaria parasite genome sequence and the development of sequencing technology, the whole-genome sequencing is becoming increasingly useful in determining parasite evolution, revealing epidemic characteristics, drug resistance surveillance, and genetic tracking. This paper reviews the advances in research on and application of the whole-genome sequencing technology for studies on Plasmodium.

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    Thermal stability of diagnostic targets Plasmodium falciparum histidine rich protein Ⅱ and Plasmodium lactate dehydrogenase in rapid detection
    LI Mei, TU Hong, XIA Zhi-gui, WANG Zhen-yu, ZHOU He-jun
    2021, 39(2):  245-248.  doi:10.12140/j.issn.1000-7423.2021.02.022
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    During the COVID-19 epidemic, blood samples are usually processed at 56 ℃ to attenuate the virus before pathogen detection. 71 blood samples of malaria patients reported by Shanghai Center for Disease Control and Prevention in 2017—2019 were collected, including 38 with Plasmodium falciparum infection, 8 P. malariae, 11 P. ovale and 14 P. vivax. The effect of inactivation on the thermal stability of P. falciparum histidine rich protein Ⅱ (PfHRPⅡ) and Plasmodium lactate dehydrogenase (pLDH) in blood samples was assessed before and after incubation at 56 ℃ for 30 min using the rapid diagnostic test (RDT) kit. The results showed that among the 38 P. falciparum T1-positive (PfHRPⅡ) blood samples before heat treatment, 35 samples remained to be T1-positive (92.11%, 35/38, χ 2 = 3.123, P > 0.05) after heat treatment; while 54 blood samples (26 P. falciparum, 6 P. vivax, 10 P. ovale and 12 P. vivax) that were T2-positive (pLDH) before heat treatment turned to be T2-negative (positive rate 0, 0/54, χ 2 = 87.755, P < 0.01) after heat treatment. It was demonstrated that PfHRPⅡ is stable during incubation at 56 ℃ for 30 min, while pLDH is unstable and degraded or inactivated during the heating. Therefore, the detection results of P. falciparum will not be affected by RDT, but diagnosis of the parasites other than P. falciparum in blood samples may be missed.

    Detection of Trichomonas vaginalis by PCR and LAMP
    ZHAO Li-li, MIAO Xu, XIE Huan-fei, LIU Bi-han, YUAN Lin, LIN Lin, HUANG Shuang, JIANG Xu-gan, CHEN Sheng-xia, SHEN Yu-juan, CAO Jian-ping
    2021, 39(2):  260-264.  doi:10.12140/j.issn.1000-7423.2021.02.023
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    To establish PCR and LAMP method for detection of Trichomonas vaginalis, the primers were synthesized, and the DNA of cultured of T. vaginalis was amplified. The feasibility of the two methods in clinical application was compared by detecting 40 T. vaginalis-positive and 40 T. vaginalis-negative samples of vaginal discharge identified by clinical microscopy. The specificity of the two methods was analyzed by amplifying DNA of Mycoplasma urealytium, Giardia lamblia, Staphylococcus aureus, Candida albicans and Escherichia coli. The sensitivity of the two methods was analyzed by determining the concentration of cultured T. vaginalis DNA after serial dilution. The results showed that PCR amplification of T. vaginalis DNA resulted in a 263-bp specific band, and the LAMP method caused a change of amplification product color from red to yellow, presenting the DNA ladder on agarose gel electrophoresis. The feasibility results showed that the coincidence rate of the 40 positive and 40 negative clinical samples by PCR were 100% and 100%, while LAMP method resulted in 100% and 97.5%, respectively. The specificity results showed that the DNA of 5 other pathogens could not be amplified by the two methods. The sensitivity test showed that the lower detection limit of the PCR method was 0.5006 ng/μl and the LAMP method 0.05006 ng/μl. These results indicate that the both methods are highly specific and the LAMP is superior to PCR in sensitivity.

    Current status of Ascaris lumbricoides infection in populations in Yunan Province, 2015
    ZI Jin-rong, WANG Li-bo, YANG Ya-ming, LI Ben-fu, YAN Xin-liu, PENG Jia, CAI Xuan, WANG Zheng-qing, DU Zun-wei, WU Fang-wei
    2021, 39(2):  273-277.  doi:10.12140/j.issn.1000-7423.2021.02.024
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    To understand and analyze the infection status of Ascaris lumbricoides in Yunnan Province, a cross-sectional survey was conducted according to the National Survey Program and Implementation Details of Key Parasitic Diseases in 2015. Twenty sites of 10 counties (cities) were selected using the stratified cluster sampling method and stool samples were collected from no less than 250 permanent residents (≥ 1 year old) per site for microscopical examination using modified Kato-Katz thick smear method (two-reading/sample). A total of 5 067 participants were enrolled and 381 of them were infected with A. lumbricoides, with an overall prevalence of 7.5%. Among the 381 residents, the proportions of infection with unfertilized Ascaris eggs, fertilized Ascaris eggs and a mixture of both were 42.5%, 39.4% and 18.1%, respectively. The proportions of mild, moderate and heavy infections were 68.0%, 29.1% and 2.9%, respectively. Different detection rates were observed among different ecological regions, i.e., the eastern Tibet-western Sichuan region had the highest detection rate (16.6%, 211/1 271), in which the Gongshan County had the highest rate (26.2%, 200/762), and Ascaris infection was detected in all 10 counties of this region. There was a statistically significant difference in the detection rate among different ecological regions and counties (P < 0.01). The detection rate in females (8.2%, 218/2 645) was higher than that in males (6.7%, 163/2 422) (P > 0.05). All age groups were found with Ascaris infection, but the highest detection rate was found in children under 10 years (18.1%, 119/657) (P < 0.01). The Dulong ethnicity had the highest detection rate (48.9%, 131/268) among ethnic groups (P < 0.01). Teachers had an detection rate of (2/6), while the pre-school children had an infection rate of 21.4% (93/435). Among the examinees with different educational levels, the illiterate had the highest detection rate (13.1%, 177/1347) (P < 0.01). The detection rate of Ascaris lumbricoides in Yunnan Province showed significant differences with regard to age, ethnicity, occupation, and educational level (P < 0.01). Overall, the detection rate showed a differential distribution among regions, with particularly high rate and infection intensity in some areas.

    Molecular epidemiological investigation of Babesia infection in small mammals in the central Hengduan Mountains of Yunnan Province
    WANG Fan, BIE Shuang-shuang, ZHANG Yun, SONG Jing, DUAN Xing-de, XIONG Meng-tao, WANG Jian, JIANG Jia-fu, GAO Zi-hou, DONG Yi, DU Chun-hong
    2021, 39(2):  278-282.  doi:10.12140/j.issn.1000-7423.2021.02.025
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    To understand the situation of infection with Babesia spp. in small mammals in the middle part of mountainous area of Hengduan Mountain of Yunnan Province, small mammals were captured by trap rows and cages (in the daytime) in Jianchuan, Yunlong and Eryuan counties of the area in 2013, 2016 and 2020. The species of the captured animals was identified by morphology, and DNA was extracted from the spleen tissues. The 18S rRNA gene fragment of Babesia spp. was amplified by nested PCR. After bidirectional sequencing, the targeted bands were analyzed for homology. The phylogenetic tree was constructed by the Neighbor-Joining method. A total of 498 small mammals were captured, including 212 in Jianchuan County, 171 in Yunlong County and 115 in Eryuan county. They were morphologically identified of 27 species, belonging to 14 genera, 8 families of 4 orders. The dominant rodent species included Apodemus chevrieri, A. draco and Eothenomys miletus. The 18S rRNA gene fragment of Babesia spp. was amplified from 55 samples, with an overall positive rate of 11% (55/498). The positive rate in Jianchuan County, Yunlong County and Eryuan County was 0.5% (1/212), 31.6% (54/171) and 0 (0/115), respectively. The detection rate was relatively high in A. latronum (11/17), E. elegusis (5/10) and Soriculus leucops (2/4). The results of BLAST analysis showed that the sequences amplified in the samples were highly homologous (similarity 99.6%) and belong to the Otsu type of B. microti. There was Babesia infection in small mammals in the mid-mountainous area of Hengduan Mountain, Yunnan Province, the Babesia belonging to the Otsu type of B. microti.