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    30 December 2022, Volume 40 Issue 6
    EXPERT VIEWPOINT
    Research on zoonosis surveillance and early warning system under climate change based on the concept of One Health
    WANG Chen-xi, CHEN Fu-min, XIU Le-shan, HU Qin-qin, ZHOU Xiao-nong, GUO Xiao-kui, YIN Kun
    2022, 40(6):  691-700.  doi:10.12140/j.issn.1000-7423.2022.06.001
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    Zoonosis is a major public health problem in the world. In recent years, zoonosis occurs frequently around the world, which is a serious threat to human health and ecological security. As one of the largest challenges to humans in the 21st century, climate change is an important factor driving the emergence of zoonosis. It is expected that the global average temperature will rise by 2-5 ℃ in the future, accompanied by more frequent and intense extreme weather events. Temperature, humidity and other climatic conditions will affect the survival, reproduction, abundance and distribution of zoonosis hosts, vectors and pathogens, and the dynamic interaction among humans, animals, and the ecological environment also increase the risk of zoonosis outbreaks. This paper discusses the relationship between climate change and zoonosis, explores how to construct an efficient early warning system for zoonosis risk under the influence of climate change, and applies the concept of One Health to the early warning of the spillover, spread and outbreak of zoonosis, in order to achieve efficient prevention and control of zoonosis.

    ORIGINAL ARTICLES
    The effect of SjGPR89 protein on the growth and development of Schistosoma japonicum
    WANG Xiao-ling, ZHANG Wei, YI Cun, CHEN Xiang-yu, YANG Wen-bin, XU Bin, HU Wei
    2022, 40(6):  701-707.  doi:10.12140/j.issn.1000-7423.2022.06.002
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    Objective To preliminarily explore the role of G protein coupled receptors (SjGPR89) in the growth and development of Schistosoma japonicum. Methods The protein structure and transmembrane structure of SjGPR89 were predicted using the SMART website and TMHMM website. Forty femal Kunming mice at 6-8 week old of specific pathogen free (SPF) type were infected with S. japonicum cercariae 200 ± 10 per mouse through abdominal skin, and the schistosomes were collected on the 14, 16, 18, 20, 22, 24, 26, 28, and 30 days post-infection (dpi), respectively. The worm RNA was extracted and reverse transcribed into cDNA, and the relative expression level of SjGPR89 mRNA was determined by qRT-PCR. Twelve SPF Kunming mice were infected with (60 ± 2) cercariae each, and then randomly assigned into SjGPR89 double-stranded RNA (dsRNA) group (interference group) and a green fluorescent protein (GFP) control group at even. To each of the interference group mice, 10 μg SjGPR89 dsRNA was injected through the tail vein on 1, 6, 10, 14, 18, 22, and 26 dpi. On day 30, the worm RNA was extracted from 5 male and 5 female worms and reverse transcribed into cDNA, and the relative expression level of SjGPR89 mRNA was determined by qRT-PCR. The males and females separately manually were fixed using acetate formalin alcohol (AFA) to measure the worm body length using Image J software and to count the worm burden; the male and femal were stained with carmine to observe the developmental changes of gonads with fluorescence microscope. Additional 12 femal SPF Kunming mice of 6-8 week old were infected with 40 ± 2 cercariae each mouse, and then randomly assigned evenly into the interference group and control group; to each of the interference group mice, 10 μg dsRNA was injected through the tail vein, on the 26 30, 34 and 38 dpi, and on day 42 for collection of liver tissue to determine the relative transcription levels of collagen Ⅰ, collagen Ⅲ, and α-smooth muscle actin (α-SMA) mRNA by qRT-PCR. The liver tissues were digested with 5% NaOH to count the eggs and calculate the egg number/g tissue; liver sections were prepared and stained with Masson to observe the status of fibrosis. Results The TMHMM website predicted that SjGPR89 is a conserved nine-times transmembrane G protein-coupled receptor, and the SMART website predicted that SjGPR89 protein has four transmembrane regions, one GPHR_structure domain, one low complexity region, and one abscisic acid GPCR domain. SjGPR89 transcription in female and male S. japonicum at different developmental stages (14-30 days) in mice were found at a relatively stable level detected by qRT-PCR; continuous interference with tail vein injection of SjGPR89-dsRNA showed that the relative mRNA expression of SjGPR89 in interferece females (307.70 ± 58.21) and males and (97.88 ± 11.38) were significantly lower than the GFP control group (767.10 ± 142.79) and (182.02 ± 7.42) (t = 5.96, 12.39; P < 0.01), with knockdown levels of 59.89% and 46.23%, respectively. Image J measurement showed that the lengths of the female (12.13 ± 2.67) and male (10.00 ± 1.72) in the interference group were significantly shorter than that of the control group (13.67 ± 1.74), (11.48 ± 1.94) (t = 4.10, 5.09; P < 0.01), the female and male parasites were 11.22% and 12.93% shorter, respectively. The number of parasite loads of the female and male parasites in the interference group (23.00 ± 1.83), (23.75 ± 2.99) was less than that of the control group (26.75 ± 0.96), (31.00 ± 3.56) (t = 3.64, 3.12; P < 0.05) significantly, and the degree of reduction of male and female parasite loads were 14.02% and 23.39%. The results of the carmine staining revealed that the gonads of the females in the interference group were delayed in development, the coloring of the ovaries and vitelline glands was lighter, and the area of the ovaries was significantly less than that of the control group; the male gonads were immature and smaller than those of the control group. The number of eggs per gram liver tissue in the interference group (2 777.33 ± 197.94) was significantly less than that in the control group (5 871.32 ± 875.25) (t = 5.97, P < 0.01), with a reduction of 52.70%, and the degree of liver fibrosis in the interference group was further observed to be significantly less than that in control group using Masson staining. qRT-PCR detected the relative expressions of Collagen Ⅰ, Collagen Ⅲ, and α-SMA in the liver tissues of the interference group (530.20 ± 246.81), (825.26 ± 139.82), (551.59 ± 189.94) were significantly lower than those of the control group (t = 3.81, 2.50, 4.72; P < 0.05). Conclusion S. japonicum development, viability, and egg production were impacted by interference with the SjGPR89 protein. Additionally, the host’s liver is far less likely to sustain pathological damages.

    Changes of ST2+ T cell subset function and their immune checkpoint molecule expression in the peritoneal cavity of mice infected with Echinococcus multilocularis
    HOU Xin-ling, LI De-wei, SHI Yang, WANG Mao-lin, ZIBIGU Rousu, ABIDAN Ainiwaer, ZHENG Xu-ran, KANG Xue-jiao, WANG Hui, LI Jing, ZHANG Chuan-shan
    2022, 40(6):  708-716.  doi:10.12140/j.issn.1000-7423.2022.06.003
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    Objective To investigate the effect of Echinococcus multilocularis infection on the function of ST2+ T cell subsets and the expression of immune checkpoint molecules in the abdominal cavity of mice. Methods Eleven BALB/c mice were randomly divided into the infection group (5) and control group (6). Each mouse in the infection group was inoculated with 4 000 E. multilocularis protoscoleces via the hepatic portal vein, and the control group was injected with the same amount of normal saline. After 24 weeks of infection, RPMI 1640 was injected intraperitoneally into the mice to collect the intraperitoneal fluid, which was centrifuged to harvest lymphocytes. Flow cytometry was used to screen different T cell subsets in mouse abdominal cavity, detect the expression change of growth stimulating gene 2 protein (ST2), compare different ST2+ T cell subsets’ functions and the proportion and the absolute number of cells which express molecular killer cell agglutinin like receptor G1 (KLRG1), lymphocyte activating gene 3 (LAG3) and programmed death receptor 1 (PD-1), and the cells which secrete cytokines interferon-γ (IFN-γ), interleukin-4 (IL-4) and IL-17A. SPSS 25.0 software was used for statistical analysis, and independent sample t-test was used. Results At 24 weeks after infection, cystic or solid lesions were found in the abdominal cavity of mice in the infection group, and the absolute number of ST2+CD4+ T cells was (5.06 ± 3.06) × 104, the absolute number of memory ST2+CD4+ T cells is (4.66 ± 3.18) × 104, higher than that of the control group (3.31 ± 2.77) × 103 and (3.27 ± 2.77) × 103 (t = 3.442, 3.035; P < 0.05). The percentage of ST2+CD4+ T cells in the abdominal cavity of the infected mice was (22.78 ± 6.05)%, and the absolute number was (4.66 ± 3.18) × 104, both higher than the proportion and the absolute number of non-memory ST2+CD4+ T cells[(6.68 ± 1.25)% and (3.88 ± 5.20) × 103 ] (t = 5.830, 2.962; P < 0.01, 0.05). The percentage of ST2+CD8+ T cells in the abdominal cavity of infected mice was (7.03 ± 1.09)%, higher than that of non-memory ST2+CD8+ T cells (4.10 ± 1.57)% (t = 3.417, P < 0.01). The absolute number of memory ST2+CD4+ T cells expressing KLRG1, LAG3 and PD-1 in the infection group was (2.77 ± 1.41) × 103, (5.52 ± 3.95) × 103, (6.59 ± 3.75) × 103, higher than that of the control group (3.66 ± 6.42) × 102, (1.67 ± 0.72) × 102, (1.69 ± 1.49) × 103 (t = 3.760, 3.356, 2.956; P < 0.01, 0.05, 0.05). IFN-γ is secreted by ST2+CD4+ T and ST2+CD8+ T cells in the abdominal cavity of mice in the infection group. The proportion was (5.48 ± 1.33)% and (16.24 ± 4.08)%, lower than (14.82 ± 3.04)% and (44.70 ± 5.31)% in the control group (t = -6.325, -9.786; P < 0.01). The proportion of memory ST2+CD8+ T cells secreting IL-4 in infected mice was (13.10 ± 3.60)%, higher than that in control mice (4.59 ± 0.36)% (t = 5.264, P < 0.01). Conclusion The expression of ST2 on the surface of peritoneal T cells and memory T cells was up-regulated in E. multilocularis-infected mice, and the percentage of KLRG1, LAG3 and PD-1 molecules were upregulated on memory ST2+ T cells with a concomitant decrease in IFN-γ secretion capacity, suggesting the memory ST2+ T cells showing immune function exhaustion.

    Echinococcus multilocularis infection in dogs and other wild hosts in endemic area of Ningxia in 2021
    WU Xiang-lin, YAN Fang, DUAN Hong-ju, QI Rong-ting, MA Tian-bo, GAO Jian-wei
    2022, 40(6):  717-722.  doi:10.12140/j.issn.1000-7423.2022.06.004
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    Objective To understand the infection of dogs and wild animal hosts in alveolar echinococcosis endemic areas in Ningxia. Methods In 2021, 16 villages were randomly selected as investigation sites from Xiji County, Yuanzhou District and Haiyuan County, respectively, in the endemic area of alveolar echinococcosis. Feces of stray dogs were collected within 100 meters radius of the garbage drop points in the survey villages, meantime, domestic dogs were also collected from the villages. Feces from wild definitive hosts such as foxes and wolves were collected around the natural forest farm in each county. ELISA was used to detect Echinococcus antigens in the fecal samples of domestic dogs, stray dogs, foxes and wolves. Wild rats were captured within an area statting from the households outside the village, extending outwards for 1 km radius. Domestic rats were captured indoors in the households of the survey villages. After identification, the rats were dissected to examine the suspected lesions, including cysts, masses or nodules in the liver, lung, abdominal cavity and other organs, and tissue sections of suspected lesions were prepared to identify the protoscoleces microscopically after staining with hematoxylin-eosin. The infection rate of rats was calculated. SPSS19.0 software was used for statistical analysis, and the difference between the fecal antigen-positive rate and infection rate was compared by χ2 examination. Results A total of 1 554 stray dogs and 2 567 domestic dogs were investigated in Xiji County, Yuanzhou District and Haiyuan County, and the positive rates of Echinococcus coproantigen were 4.76% (74/1 554) and 0.97% (25/2 567), respectively. The difference was statistically significant (χ2 = 59.23, P < 0.05). The positive rates of Echinococcus coproantigen in stray dogs from Xiji County, Haiyuan County and Yuanzhou District were 6.51% (31/507), 3.48% (18/517) and 4.34% (23/530), respectively; which were higher than that of domestic dogs [1.30% (11/843), 0.70% (6/859) and 0.92% (2/217)] (χ2 = 27.17, 14.58, 17.62; all P < 0.05). A total of 649 rodents were captured, which belong to 7 species. The infection rate of E. multilocularis cyst was 0.62% (4/649). The four rodents infected with E. multilocularis were all Spermophilcus alashanicus. The infection rate of E. multilocularis cyst in Sp. alashanicus was 1.09% (4/366). The infection rate of E. multilocularis cyst was 2.31% (3/130) in Xiji County and 0.86% (1/116) in Yuanzhou District, with no significant difference between the two counties (χ2 = 0.77, P > 0.05). No positive rodents were found in Haiyuan County. The density of Sp. alashanicus of the survey sites were 3.02-11.48 individual/hm2 (1 hm2 = 10 000 m2). A total of 252 faecal samples from wild definitive hosts, including foxes and wolves, were detected in 3 counties (districts). The positive rate was 1.19% (3/252). All the antigen-positive faeces were from foxes, and the positive rate of fox feces was 2.61% (3/115). The positive rate of fox fecal samples was 3.92% (2/51) in Xiji County and 2.78% (1/36) in Yuanzhou District, with no significant difference between the two counties (χ2 = 0.08, P > 0.05). No positive fecal samples were found in Haiyuan County. Conclusion The positive rate of E. multilocularis coproantigen remained considerably in stray dogs and foxes in Ningxia. The intermediate host, Sp. alashanicus, was found infected with E. multilocularis, indicating that its transmission chain still exists. It is necessary to strengthen investigation, management and deworming in stray dogs and other wild animal hosts.

    Awareness and influencing factors of knowledge on echinococcosis prevention and control among adults in Qinghai Province
    LIU Yu-ying, ZHANG Tian-tian, MA Xiao, LEI Wen, MA Bing-cun, LIU Shou
    2022, 40(6):  723-729.  doi:10.12140/j.issn.1000-7423.2022.06.005
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    Objective To understand the awareness of echinococcosis prevention and control knowledge among adults in Qinghai Province, and provide the basis for precise prevention and control. Methods From March to August 2021, adults aged 18 to 80 were selected from 34 counties (districts) in 8 cities (prefectures) of Qinghai Province to conduct a survey on the awareness of echinococcosis prevention and control knowledge. The questionnaire include 9 questions about the source of infection, transmission route, susceptible population, main symptoms and national preferential policies of echinococcosis. 1 correct answer counted as 1 point, and more than 6 correct answers were judged as qualified. At the same time, the participant’s demographic data were collected, including age, gender, nationality, education level, occupation, monthly family income, type of residential region, and participation in health education on echinococcosis. The awareness rate and pass rate of echinococcosis prevention and control knowledge were calculated, and the influencing factors of the pass rate of echinococcosis prevention and control knowledge were analysed by single-factor and multi-factor analysis. SPSS 23.0 was used for statistical analysis. Results A total of 37 400 questionnaires were distributed in this survey, and 33 359 valid questionnaires were recovered, with a recovery rate of 89.2%. The total awareness rate of echinococcosis prevention and control knowledge was 64.2%, and the pass rate was 57.2% (19 076/33 359). The top three areas with the highest awareness rate are Xining City (70.5%), Haixi Prefecture (68.9%) and Guoluo Prefecture (68.0%) respectively; these are also the top three areas with the highest pass rate are Xining City (68.8%, 2 617/3 803), Guoluo Prefecture (67.4%, 1 844/2 734) and Haixi Prefecture (65.4%, 2 811/4 299). Haidong City had the lowest awareness rate (58.3%) and qualified rate (46.6%, 2 525/5 422). The results of the univariate analysis showed that there was a significant difference between age, nationality, education level, occupation, monthly family income, regional type, participation in health education on echinococcosis knowledge and the pass rate of adult echinococcosis prevention and control knowledge in Qinghai Province (χ2 = 7.15, 35.30, 251.00, 676.29, 179.30, 10.86, 2 704.80; P < 0.05). The results of the multifactor analysis showed that the main factors influencing the pass rate of adult hydatid disease prevention and control knowledge in Qinghai Province were: ethnic group (with Han as the control, Tibetan OR = 0.87, 95% CI: 0.82-0.93; Hui OR = 0.84, 95% CI: 0.77-0.91), an education level (with primary school and below groups as the control, Junior/Senior high school OR = 1.16, 95% CI: 1.10-1.23; university and above OR = 1.39, 95% CI: 1.27-1.53), Occupation (compared with unemployed, OR = 1.38 for farmers, 95% CI: 1.27-1.49; OR = 1.67 for herdsmen, 95% CI: 1.53-1.82; OR = 2.28 for officials/institutions, 95% CI: 2.01-2.59), monthly family income (compared with ≤ 1 000 yuan, OR = 1.10 for 1 001-3 000 yuan, 95% CI: 1.04-1.17; OR = 1.15 for > 5 000 yuan, 95% CI: 1.04-1.26), Regional type (agricultural area as a control, animal husbandry area OR = 1.12, 95% CI: 1.05-1.19) and participation in health education on hydatid disease related knowledge (compared with not, yes OR = 3.41, 95% CI: 3.25-3.58). Conclusion The awareness level of adult echinococcosis prevention and control knowledge in Qinghai Province is not high. The main factors affecting the pass rate are nationality, education level, occupation, family monthly income, regional type and participation in health education on echinococcosis knowledge.

    Analysis of surveillance on soil-transmitted nematode infections in Jiangsu Province from 2017 to 2021
    NI Bi-xian, XU Xiang-zhen, JIN Xiao-lin, DING Xin, ZHANG Qiang, MAO Fan-zhen, DAI Yang
    2022, 40(6):  730-736.  doi:10.12140/j.issn.1000-7423.2022.06.006
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    Objective To understand the current status of soil-transmitted nematode infections in Jiangsu Province from 2017 to 2021, and provide the basis for the formulating scientific prevention and control strategies. Methods From 2017 to 2021, eight counties (cities, districts) in Jiangsu Province were selected as surveillance sites each year (one fixed site, and seven ambulatory sites changed on yearly base). The surveillance sites were randomly selected from five geographical sections in the east, west, south, north and centre, from each of which one township (town) was selected to set up surveillance site therein one administrative village. No less than 200 permanent residents over the age of 3 in each administrative village were selected for surveillance. About 30 g of fecal sample was collected from each participant for examining nematode eggs using the modified Kato-Katz thick smear method (two slide-reading each sample), to calculate infection rate and intensity of different species.. Hookworm-positive fecal samples were used to identify parasite species by test tube-filter paper culture method. Children aged 3 to 9 years old were additionally examined for Enterobius vermicularis infection by adhesive cellophane swabs method. Five households were randomly selected from each village at fixed surveillance site to collect soil sample (≥ 400 g) from vegetable garden or field of each household, of which 350 g were used for detection of hookworm eggs, and 50 g for Ascaris lumbricoides eggs. Infection rates were compared between groups using the chi-square test. Results From 2017 to 2021, a total of 41 753 people were examined in Jiangsu Province surveillance sites, and found the overall infection rate of soil-transmitted nematodes at 0.30% (124/41 753). The infection rates of A. lumbricoides, hookworm, Trichuris trichura and Enterubius vermicularis were 0.13% (56/41 753), 0.06% (24/41 753), 0.02% (10/41 753) and 0.08% (34/41 753) respectively, and all soil-transmitted nematode infections were of mild type. The infection rate of soil-transmitted nematodes at fixed monitoring site was 0.37% (21/5 699), while that at mobile monitoring sites were 0.29% (103/36 054). There was no significant difference between different sites (χ2 = 0.19, P > 0.05)。From 2017 to 2021, the five-year infection rates of soil-transmitted nematodes were 0.26% (22/8 549), 0.54% (46/8 452), 0.22% (19/8 454), 0.37% (30/8 189) and 0.09% (7/8 109), respectively, with statistically significant differences in infection rates between years (χ2 = 32.88, P < 0.01). The highest infection rate of soil-transmitted nematodes was seen in Lianyungang (1.17%, 48/4 119), followed by Suqian (0.38%, 21/5 487) and Huai’an (0.36%, 11/304), with statistically significant differences among the different cities (χ2 = 137.52, P < 0.01). The infection rate was 0.26% (52/19 773) in males and 0.33% (72/21 980) in females (χ2 = 1.47, P > 0.05). For differences in age groups, the highest infection rate was found in the 3-9 years age group (0.86%, 35/4 093), with statistically significant differences among the different age groups (χ2 = 53.24, P < 0.01). For differences in occupations, the highest infection rate was found among children in kindergarten (1.21%, 22/1 811), with statistically significant differences among different occupational groups (χ2 = 45.56, P < 0.01). For education levels, the highest infection rate was found among preschool children (1.24%, 25/2 020), with statistically significant differences among people with different levels of education (χ2 = 54.96, P < 0.01). A total of 125 soil samples from fields or vegetable gardens were tested from 2017 to 2021, and one hook larva was detected (identified as duodenal hook larva by microscopic examination), with a positive rate of 0.8% for hookworm larva in soil samples, and no eggs of A. lumbricoides were detected. Conclusion The prevalence of soil-transmitted nematode infection in Jiangsu Province has been at a very low level since 2017. In the future, more attention should be paid to the key groups of children and the elderly in the northern part of Jiangsu Provinces.

    Surveillance on soil-transmitted helminth infection in residents in Qinghai Province during 2016—2020
    ZHANG Jing-xiao, SHI Ke-mei, LIU Yu-fang, ZHAO Cun-zhe, ZHAN Pei-zhen, WANG Wei, LIU Jia, LIU Na, LEI Wen, ZHANG Qing, ZHANG Xiong-ying, MA Xiao, CAI Hui-xia, MA Jun-ying
    2022, 40(6):  737-741.  doi:10.12140/j.issn.1000-7423.2022.06.007
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    Objective To understand the infection status of soil-transmitted helminth (STH) at national surveillance sites in Qinghai Province from 2016 to 2020 to provide a scientific basis for formulating prevention and control strategies. Methods National surveillance sites were set up in 29 counties (cities, districts) in Qinghai Province during 2016—2020, comprising 2 fixed surveillance sites and 5-6 mobile sites every year. Each surveillance site was divided into 5 areas as geographically at east, west, south, north and centre. In each area, one administrative village was randomly selected from one township for cluster sampling of no less than 200 permanent residents over 3 years old. Fecal samples of residents were collected and examined for STH eggs with the modified Kato-Katz thick smear method (two slide-reading for each sample). At the same time, children aged 3-9 years were examined for Enterobius vermicularis eggs using cellophane anal swab method. The infection rates and infection intensity were calculated. The distribution of gender, age, ethnic group, occupation and region of the infected population were analyzed. The Chi-square test was used to compare the infection rate between different groups. Results A total of 37 724 residents were examined during 2016—2020. The overall infection rate of STH was 0.86% (323/37 724), with Ascaris lumbricoides is the main pspecies, accounting for 99.69% (322/323) of the total infected. The infection rate of A. lumbricoides was 0.85% (322/37 724), including 87.89% (283/322) mild infection and 12.11% (39/322) moderate infection. The infection rate of En. vermicularis was 0.02% (1/4 069) in children aged 3-9 years. The infection rates of STH in males and females were 0.80% (148/18 550) and 0.91% (175/19 174), respectively, with no statistically significant difference(χ2 = 1.611, P > 0.05). The 3-10 years old group had the highest infection rate of STH (1.42%, 90/6 351), with statistically significant in different age groups (χ2 = 43.516, P < 0.01). The Han ethnic group had the highest infection rate of STH (1.66%, 276/16 622), with statistically significant differences in different ethnic groups (χ2 = 242.302, P < 0.01). Migrant workers had the highest infection rate of 2.82% (5/177), with statistically significant differences among different occupations (χ2 = 178.710, P < 0.01). From 2016 to 2020, the infection rate of STH in Pin’an County was 1.21% (24/1 086), 3.37% (39/1 157), 1.70% (17/1 000), 1.19% (13/1 091) and 0.89% (9/1 003), the differences between years were statistically significant (χ2 = 25.239, P < 0.01). The infection rate of STH in Huzhu County was 1.81% (18/994), 2.47% (24/971), 2.28% (23/1 007), 3.01%(30/998) and 2.37% (24/1 012), showing a fluctuated changes, with no significant difference among them (χ2 = 3.132, P > 0.05). From 2016 to 2020, 103 residents with STH infection were found in 27 mobile surveillance sites, of which 99 infected residents (96.12%) were found in the Qilian Mountains and Hehuang Valley. No infected resident was found in the Caidamu Basin. The difference in infection rates among different regions was statistically significant (χ2 = 378.856, P < 0.01). Conclusion The infection rate of STH was considerably low in surveillance sites in Qinghai Province, mainly with A. lumbricoides infection. Children aged 3-10 years old and migrant workers are the key groups for prevention and control in the future.

    Analysis of surveillance on soil-transmitted helminth infection in Henan Province from 2016 to 2020
    JIANG Tian-tian, JI Peng-hui, HE Zhi-quan, CHEN Wei-qi, ZHANG Ya-lan, DENG Yan, WANG Dan, ZHOU Rui-min, LIU Ying, ZHANG Hong-wei
    2022, 40(6):  742-747.  doi:10.12140/j.issn.1000-7423.2022.06.008
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    Objective To understand the current status of soil-transmitted helminth (STH) infection and control effect in Henan Province, for providing basis for formulating prevention and control countermeasures. Methods From 2016 to 2020, surveillance sites were set up in selected counties in Henan Province, according to the National Surveillance Program for Liver Fluke Diseases and Soil-transmitted Nematodes (Pilot). The surveillance counties were selected from five areas (east, west, south, north and central) of the province. From each of the areas, a township was randomly selected, and then an administrative village was selected from each township as the surveillance site. Over 200 permanent residents above 3 years old were cluster sampled from each administrative village and no less than 1 000 residents were included in each surveillance county. Fecal samples were collected from the participants for examining and counting STH eggs using modified Kato-Katz thick smear method to calculate infection rate. Hookworm egg positive samples were further identified for species by test tube-filter paper culture method. The infection rate between groups was compared by the Chi-square test. Results A total of 101 254 participants were enrolled in the surveillance from 98 surveillance sites, of them, 139 were found STH positive, with an overall infection rate of 0.1% in Henan Province. The total infection rate of STH in each year was below 1.0% (0.08%-0.19%), and the difference was statistically significant (χ2 = 9.797, P < 0.05). The linear trend test showed that the total infection rate of STH has no significant difference (χ2 = 1.304, P > 0.05). Among the 18 cities and 6 counties, the top infection rates were seen in Luohe (0.46%, 19/4 097), Nanyang (0.31%, 32/10 280) and Jiyuan Demonstration Zone (0.28%, 3/1 073), and no infection was found in 7 cities (counties). The infection rates of STH in males and females were 0.14% (65/47 795) and 0.14% (73/53 459). There were no significant differences in hookworm, Ascaris lumbricoides, Trichuris trichiura and total infection rates among different genders (male: 0.07%, 0.05%, 0.02%, 0.14%; female: 0.07%, 0.05%, 0.01%, 0.14%) (χ2 = 0.117, 0.001, 0.526, 0.001; P > 0.05). The infection occurred in all age groups, with the highest infection rate in the group aged ≥ 71 years of 0.4% (27/6 603). The hookworm infection rate was the highest among the ≥ 71 years age group, at 0.24% (16/6 603). The infection rates of soil-borne nematodes, hookworm, A. lumbricoides, T. trichiura among different age groups were statistically significant (χ2 = 83.585, 69.061, 16.269 and 26.559; P < 0.01 or P < 0.05). Among different occupation groups, farmers had the highest infection rate at 0.2% (104/52 276). Among different education groups, the illiteracy or semiilliteracy group had the highest infection rate at 0.14% (10/6 939). There were significant differences in the infection rate among different ages, occupations and educational background (χ2 = 83.585, 32.330, 20.014; P < 0.01). There were significant differences in hookworm infection rates among people of different occupations and cultures (χ2 = 31.103 and 16.605, P < 0.01), but there were no significant differences in A. lumbricoides, T. trichiura infection rates among the groups (χ2 = 6.383, 4.658, 2.819, 9.366; P > 0.05). Conclusion From 2016 to 2020, the infection rate of STH in Henan Province decreased significantly and remained at a considerably low level, showing sporadic distribution. Residents at age 61 and above, farmers, people with the education of primary or middle school, illiterate or semiilliterate are the main targets of control program.

    Appraisal of diagnosis capacity of malaria reference laboratories in Henan Province during 2015—2019
    LI Su-hua, JI Peng-hui, ZHOU Rui-min, HE Zhi-quan, QIAN Dan, YANG Cheng-yun, LIU Ying, LU De-ling, WANG Hao, ZHANG Hong-wei, ZHAO Yu-ling
    2022, 40(6):  748-753.  doi:10.12140/j.issn.1000-7423.2022.06.009
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    Objective To analyze the rechecking results of the reference laboratory for malaria diagnosis in Henan Province on malaria blood samples submitted by malaria diagnosis institutions at all levels and evaluate the malaria detection capacity of malaria diagnosis institutions in Henan Province. Methods Blood smears and whole blood samples, and the diagnosis institute information, diagnosis results and other information on the malaria cases and suspected malaria cases were collected in Henan Province from 2015 to 2019. The provincial malaria reference laboratory rechecked and tested the blood samples through three methods, including microscopy, rapid diagnostic test (RDT) and PCR, and analyzed the detection results, the misjudgment of worm species, and the positive coincidence and misjudgment of worm species in diagnostic institutions at all levels. The positive coincidence rate and misdiagnosis rate of different diagnostic institutions were analyzed by χ2 test. Results From 2015 to 2019, the Malaria Diagnostic Reference Laboratory of Henan Province received a total of 1 194 malaria samples, of which 1 078 samples (90.3%) were confirmed positive, and 116 negative (9.7%) by using the three testing methods. The positive coincidence rate by PCR, RDT and microscopy was 98.7% (1 064/1 078), 96.9% (1 045/1 078) and 89.1% (960/1 078), respectively. A total of 934 samples had the same results between microscopy and PCR, among them, 711 were falciparum malaria, 58 vivax malaria, 32 quartan malaria and 133 ovale malaria. From 2015 to 2019, the rate of species misidentification showed a decreasing trend, which were 12.4% (25/202), 12.2% (28/230), 7.3% (15/206), 11.3% (27/239), and 5.4% (17/317), respectively. The misdiagnosis rates of Plasmodium falciparum, P. vivax, P. ovale, P. malariae, mixed infection and P. knowlesi were 3.7% (30/820), 23.4% (15/64), 39.9% (59/148), 34.3% (12/35), 9/10 and 1/1, respectively. The malaria cases diagnosed by disease prevention and control institutions (CDC), medical institutions and other institutions accounted for 23.7% (283/1 194), 74.5% (890/1 194) and 1.8% (21/1 194) respectively. Among the 283 cases diagnosed by disease control institutions, the positive coincidence rates of provincial, municipal and county (district) level disease control institutions were 9/9, 93.2% (69/674) and 91% (182/200), respectively, with no significant difference (χ2 = 0.438, P > 0.05). The error rate of Plasmodium species was 1/9, 20.3% (14/69) and 11.5% (21/182) respectively, with no significant difference (χ2 = 3.271, P < 0.05). Among 890 cases diagnosed by medical institutions, the positive coincidence rates of provincial, municipal, county (district) and township (town) medical institutions were 81.0% (17/21), 91.7% (742/809), 92.2% (47/51) and 6/9 respectively, with a statistically significant difference (χ2 = 55.392, P < 0.05); the misdiagnosis rate of Plasmodium species was 7/17, 10.9% (81/742), 10.6% (5/47) and 1/6 respectively, with statistical significance (χ2 = 11.978, P < 0.05). Conclusion The local settings for diagnosis units of malaria cases in Henan Province are mainly medical institutions, and the detection capacity of malaria laboratories at all levels is generally high. It is imperative to continuously strengthen. The training for malaria diagnosis professionals in medical institutions to maintain the higher capacity of malaria diagnosis.

    INFORMATION REPORT
    Quality evaluation on the preparation of the malaria blood smears at the national level in 2019
    LI Mei, ZHOU He-jun, XIA Zhi-gui, ZHANG Li, TU Hong, YIN Jian-hai
    2022, 40(6):  754-759.  doi:10.12140/j.issn.1000-7423.2022.06.010
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    To understand and evaluate the quality of malaria blood smears in all provinces of China, provide data support for guiding the quality control of malaria microscopic examination during post-malaria elimination, and explore the standard model of evaluating the capability of preparing malaria blood smears. One blood smear of the first malaria case in a month in each province(direct-administered municipalities and autonomous regions) was collected, with a total of 5 cases or more in 2019. Provinces without malaria cases were provided with negative blood smears during malaria screening. Ten experts with WHO external assessment level 1 or level 2 certificates of malaria microscopy capability were organized to form two quality assessment teams. Fifteen assessment criteria (①-) were determined. All blood smears were divided into two groups for each province and sent to two teams of experts for double-blind reading evaluation. The single blood smear score and the qualified rate of blood smear in different provinces (15 points for each blood smear, 13 points for qualified) were calculated. The level of blood smear preparation in each province was graded (the qualification rate ≥ 90%, 80%-90%, 70%-80%, < 70% were A, B, C and D, respectively). The institutes that prepared the blood smears at different provinces were divided into provincial laboratories and non-provincial laboratories, and the differences of average single blood smear scores and preparation grades among different laboratories were compared. The average score rates of all blood smears were calculated and compared according to each evaluation standard. The average scores of blood smears between different laboratories were compared by t-test, and the levels of blood smears were compared by Person chi-square test or Fisher exact probability method. A total of 285 blood smears were collected from 28 provinces. The national average single blood smear score is (13.3 ± 1.5) with the highest score being 14.8 points, the lowest being 8.9 points, and the median being 13.6 points. The total rate of satisfied blood smears was 72.6% (207/285). The highest satisfaction rate in all provinces was 100%, and the lowest was 20%. The number of provinces categorized into A, B, C and D levels were 11, 3, 2 and 12, respectively. The average score in provincial laboratories was (14.2 ± 0.2), higher than that in non-provincial laboratories [(13.0 ± 0.4)] (t = 2.3, P < 0.05). Among the 15 provinces in which blood smears were prepared by non-provincial laboratories, 4 were marked as level A, 2 were marked as level B and 9 were marked as level D. Among the 9 provinces in which blood smears were prepared by provincial laboratories 6 were marked as level A, 1 was marked as level B, 1 was marked as level C, and 1 marked as level D. The level of preparing blood smears in the provincial laboratories was higher than that in the non-provincial laboratories (Fisher exact probability method, P < 0.05). The coefficient of variation of the average single blood smear score among different provinces (municipalities, autonomous regions) was 11.2%, and the coefficient of variation of the qualification rate was 37.5%. Nationally, the scoring rate of blood smear in items ②, ③, ⑧, ⑨, and of the evaluation criteria is low (74.8%-85.3%), which was mainly due to the unsatisfied thick blood smears. The main deducted points in provincial laboratories marked as level C are and, which mainly show that there are many contaminants in the blood smears after staining, and the staining is poor. The deducted points in the provincial laboratory marked as level D were ⑩, and. The main reason is that no red blood cells are observed in the thin films, and the protozoal morphology has changed. The levels of preparing blood smears varied in different provinces. The levels of preparing blood smears in provincial laboratories were higher than those in non-provincial laboratories. Normalized operation in preparing blood smears in basic units should be strengthened.

    REVEEWS
    Research progress on co-infection of Enterocytozoon bieneusi with HIV/AIDS
    QIN Yuan, LIU Hua, SHEN Yu-juan
    2022, 40(6):  760-766.  doi:10.12140/j.issn.1000-7423.2022.06.011
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    Enterocytozoon bieneusi is an emerging pathogen causing opportunistic infections. E. bieneusi coinfection in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients can causes chronic persistent diarrhea, even death. The co-infection of E. bieneusi has attracted increasing attention in recent years. This paper reviewed the coinfection of E. bieneusi in HIV/AIDS patients, and provided reference for the prevention and control of E. bieneusi infection in HIV/AIDS patients.

    Application of mitochondrial genes in the molecular taxonomic identification and phylogenetic analysis of Taeniidae
    CHEN Qi-lu, WANG Xu, LI Chun-yang, GUAN Ya-yi
    2022, 40(6):  767-773.  doi:10.12140/j.issn.1000-7423.2022.06.012
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    Echinococcosis or cysticercosis caused by the Taeniidae species is a zoonotic parasitic disease that has a significant impact on the social economy and public health. Accurate identification of the relevant species is helpful for the prevention, control, and even eliminate of the diseases. Currently, mitochondrial genes used in molecular classification and phylogenetic studies of Taeniidae are mainly cytochrome C oxidase subunit 1 gene, cytochrome B gene, and NADH dehydrogenase subunit 1 gene. This paper reviews the current advances of molecular classification and phylogenetic analysis of the Taenia and Echinococcus in the family Taeniidae, mainly from the perspective of mitochondrial genes.

    Research progress of immune regulation protein B7 family on immune regulation during Schistosoma japonicum infection
    CHEN Guo, ZHU Dan-dan, DUAN Yi-nong
    2022, 40(6):  774-779.  doi:10.12140/j.issn.1000-7423.2022.06.013
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    Schistosomiasis japonica is one of the most serious zoonotic diseases in the world. After schistosome infection, Th1 cells secrete interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), and CD8+ T cells exert cellular immunity at the early stage. Th2 cells secrete a large amount of interleukin-4 (IL-4), interleukin-13 (IL-13) and interleukin-12 (IL-12), and the function of Th1 cells is inhibited in the later stage, thus prompting the host to produce an adaptive immune response dominated by humoral immunity. The B7 family is a secondary signal of T cell activation and plays a crucial role in regulating T cell immune responses. Further studies demonstrate that B7 family contains B7-1, B7-2, B7 homologue1 (B7-H1), B7 dendritic cell molecule (B7-DC), B7-H2, B7-H3, B7-H4, B7-H5, B7-H6 and B7-H7, which have costimulatory or coinhibitory effects on T cells. Some of them play an important role in immune regulation in schistosomiasis and the research progress of the B7 family in the immune regulation during schistosome infection is summarised in this paper.

    Research progress on the role of pyroptosis in human parasitic diseases
    NIE Ru, LI Wen-deng, YE Geng-bo, YIN Feng-jiao, PANG Ming-quan, WANG Zhi-xin, FAN Hai-ning
    2022, 40(6):  780-785.  doi:10.12140/j.issn.1000-7423.2022.06.014
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    Pyroptosis is a new type of death mode found in recent years, which depends on caspase. Activated caspase breaks the cell membrane by cutting gasdermin protein, and at the same time, it releases pro-inflammatory cytokines and their contents, eventually leading to cell death. Its occurrence, morphological characteristics and regulatory mechanism are different from cell death modes such as apoptosis, necrosis, autophagy and iron death. Pyroptosis signal pathways include classical pathway, non-classical pathway and other pathways. At present, many studies have confirmed that pyroptosis is involved in the development of parasitic diseases. This article reviews the definition of pyroptosis, different pathways and mechanisms, and their roles in various Human parasitic diseases, hoping to provide a basis for developing the research between pyroptosis and parasitic diseases.

    Research progress of amodiaquine as an antimalarial drug
    ZHAO Hui, XIANG Zheng, ZHOU Long-can, PAN Mao-hua, YANG Zhao-qing
    2022, 40(6):  786-791.  doi:10.12140/j.issn.1000-7423.2022.06.015
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    Malaria is a serious, life-threatening infectious disease caused by the Plasmodium parasite. The treatment and prevention of malaria mainly rely on antimalarial drugs. Amodiaquine is an important drug for the treatment and prevention of malaria. It is used in combination with artemisinin dericatives as a first-line treatment drug in many countries where malaria is endemic including Africa. This article reviews the unique antimalarial activity, treatment outcomes, molecular markers for drug resistance and safety of amodiaquine.

    Research progress on microvascular density in hepatic alveolar echinococcosis
    AN Xiu-qing, WANG Miao-miao, ZHOU Hong-qian, MENG Kai, CAI Jian-ping, LIU Guang-hui, A Ji-de, YANG Jing-yu
    2022, 40(6):  792-797. 
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    Hepatic alveolar echinococcosis (HAE) is a parasitic disease caused by the larva of Echinococcus multilocularis infection. It is challenging to achieve radical resection because its biological characteristics are similar to malignant liver tumours. Although the diagnosis and treatment of HAE have been improved continuously, lesion recurrence postoperation often occurs, and the prognosis is not optimistic. In recent years, studies have shown that microvascular occurs around HAE lesions. In order to explore the blood supply and biological activity of the lesions, the vascular distribution around the lesions and the expression of angiogenesis-related factors were reviewed in this paper.

    STANDARD INTERPRETATION
    Interpretation of Criteria for Detection of Antibody against Schistosoma japonicumEnzyme-linked Immunosorbent Assay
    YAN Xiao-lan, WEN Li-yong, XIONG Yan-hong, ZHENG Bin, ZHANG Jian-feng, WANG Tian-ping, YU Li-ling, XU Guo-zhang, LIN Dan-dan, ZHOU Xiao-nong
    2022, 40(6):  798-800.  doi:10.12140/j.issn.1000-7423.2022.06.017
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    The criteria compilation for the detection of antibodies against Schistosoma japonicum using enzyme linked immunosorbent assay was performed based on the documents of Management Measures for Health Criteria and Directives for standardization-Part 1. Rules for the structure and drafting of standardizing documents (GBT 1.1—2020). The criteria are composed of six chapters which include the range of applications, normative reference documents, terms and definitions, instruments and equipment, reagent or materials and detection steps. Two informative appendices (including preparation method of main reagent materials, and schematic diagram of detection steps and points for attention) is appended along with the criteria. The criteria was issued by the National Health Commission of the People’s Republic of China through No.11 of Chinese Health Announcement and had implemented since May 1, 2022. The criteria will further promote the standardization process of schistosomiasis detection technology and provide important technical support for achieving the goal of schistosomiasis elimination in China.

    SHORT COMMUNICA TIONS
    Analysis on epidemiological characteristics of imported quartan malaria in Henan Province from 2011 to 2021
    JI Peng-hui, JIANG Tian-tian, HE Zhi-quan, ZHOU Rui-min, LI Su-hua, YANG Cheng-yun, QIAN Dan, LIU Ying, WANG Hao, ZHANG Hong-wei
    2022, 40(6):  801-805.  doi:10.12140/j.issn.1000-7423.2022.06.018
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    The epidemiological data and information on imported quartan malaria cases in Henan Province from 2011 to 2021 were collected through the Chinese Information System for Infectious Diseases Control and Prevention and the Parasitic Diseases Information Reporting Management System (PDIRMS) of the Chinese Center for Disease Control and Prevention and analyzed using descriptive epidemiological methods. A total of 60 imported quartan malaria cases were reported in Henan Province from 2011 to 2021, of which 96.7% (58/60) were males, and 3.3% (2/60) were female. Seventy-eight cases (80.0%) were found in the 24-47 age groups. Most of the cases were farmers (53.3%). All imported cases returned from 17 African countries. The imported cases from West Africa, Central Africa, South Africa and North Africa accounted for 41.7% (25/60), 26.7% (16/60), 30.0% (18/60) and 1.7% (1/60), respectively. The countries where most imported cases returned from are Angola (25.0%, 15/60), Congo (DRC) (13.3%, 8/60), Guinea (10.0%, 6/60), Nigeria (10.0%, 6/60) and Ghana (8.3%, 5/60). The proportion of the quartan malaria cases reported in 2021 to the total number of imported malaria cases in that year was the highest (13.3%, 4/30). The 60 imported quartan malaria cases were distributed in 12 cities and 1 provincial-controlled division. The number of reported cases from Zhengzhou, Luoyang, Puyang, Xuchang and Jiaozuo, accounted for 73.3% (44/60) of the total reported cases in the province. A total of 63.3% (38/60) and 11.7% (7/60) of the imported quartan malaria cases were diagnosed by prefecture (city) level medical units and Centers for Disease Control and Prevention (CDC), respectively, and 1.7% (1/60) cases were diagnosed by township (town) hospitals. There was a statistically significant difference in the number of malaria cases diagnosed by diagnostic institutions at all levels (χ2 = 96.042, P < 0.05). The median time interval between the onset and the diagnosis was 10.5 days, the shortest was 0 days, and the longest was 142 days. The time interval from onset to diagnosis was ≤ 7 days in 38 cases (63.3%, 38/60) (23 cases ≤ 3 days, 15 cases 4-7 days), and 22 cases (36.7%, 22/60) > 7 days. It is suggested that the surveillance of imported quartan malaria should be strengthened, and the diagnostic ability should be improved to consolidate the elimination achievements in the post-elimination stage in Henan Province.

    An analysis of vector population and density monitoring in elimination and post-elimination of malaria in Hebei Province
    FENG Ning-ning, TAO Wei, FENG Tong, ZHEN Su-juan, LI Jun, LIU Hong-bin
    2022, 40(6):  806-809.  doi:10.12140/j.issn.1000-7423.2022.06.019
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    To understand the population, distribution and density changes of malaria vector Anopheles in the early stage of malaria elimination (2011—2019) and the early stage of post-elimination (2019) in Hebei Province, 18 and 25 monitoring points were selected to conduct overnight mosquito trapping surveys in July September 2012 (the first survey) and 2020 (the second survey). The habitats of monitoring points were divided into 4 categories according to whether there were livestock and water sources. The first survey showed that 30 759 mosquitoes were captured and the total average density was 28.48 mosquitoes/(lamp · night), of which An. sinensis accounted for 3.48% (1 070/30 759). The average number of An. sinensis captured in each habitat was 60.43, 10.92, 0.97 and 0.62 respectively (F = 6.38, P < 0.05). An. sinensis were captured in Funing County, Qinhuangdao City, Zunhua City, Tangshan City, Huanghua City, Cangzhou City, Leting County, Tangshan City, Jizhou City, Hengshui City, Pingshan County, Shijiazhuang City, and Laiyuan County, Baoding City. And the number of An. sinensis captured in these cities was 870, 85, 47, 27, 19, 18 and 4, respectively. The highest number of Anopheles mosquitoes was found among mosquitoes captured during late August, which is 259, and the smallest in late September (97). In the second survey, 14 958 mosquitoes were captured, with a total average density of 13.91 mosquitoes/(lamp·night), of which An. sinensis accounted for 2.12% (317/14 958). An. sinensis was caught only in Class II and III habitats, with an average number of 8.49 and 1.85, respectively (F = 1.68, P > 0.05), which were distributed in Xiong County, with the highest number in September (60.88%, 193/317). The malaria vector in Hebei Province is only An. sinensis. Although the number is small, it persists, and there is still a potential risk of malaria remerging.

    CASE REPORTS
    A case of pulmonary combined infection of Strongyloides stercoralis with Nocardia otitidiscaviarum
    XIAO Chang-lin, YANG Liu-liu, FANG Yong, FENG Xi-lian
    2022, 40(6):  810-812.  doi:10.12140/j.issn.1000-7423.2022.06.020
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    On November 3, 2021, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine admitted a 67-year-old male patient with “cough and space-occupying lesions in the right lung”. The patient complained of repeated cough and expectoration for more than 50 years. The symptoms worsened half a month ago. Chest CT in the external hospital showed space-occupying lesions in the lung. He had a history of contact with cats and dogs. He had been treated elsewhere for skin pruritus and rash. After admission, active Strongyloides stercoralis was found in sputum and feces by microscopic examination. Chest enhanced CT suggest lung cancer in the dorsal segment of the lower lobe of the right lung (25 mm × 24 mm), small nodules in the upper and lower lobes of both lungs and possible metastasis cannot be excluded; the bronchoscopy showed that the right main bronchus was unobstructed, the upper lobe and lower lobe bronchus, as well as each segment and sub-segment bronchus, were unobstructed, the mucosa was congested, a small amount of white discharge was seen, and no neoplasm was found. S. stercoralis (290 sequences) and Nocardia otitidiscaviarum (102 sequences) were detected in alveolar lavage fluid next-generation sequencing. Nocardia was found in the alveolar lavage fluid culture. It was diagnosed as “pulmonary S. stercoralis complicated with N. otitidiscaviarum infection”. The patient was treated with a combination of sulfamethoxazole (0.96 g once, once per 6 h for 3 months), cefoperazone sodium and sulbactam sodium (3 g once, once per 12 h for 14 days), albendazole (400 mg twice daily for 7 days, continue 1 course after 1 month). After one week, sputum and fecal microscopic examination showed that most of the S. stercoralis died with a small amount survived. After 2 months follow-up, chest CT showed that the lesions were significantly reduced.

    Severe angiostrongyliasis in a child
    LIU Yu-ting, LI Guang-xu
    2022, 40(6):  813-816.  doi:10.12140/j.issn.1000-7423.2022.06.021
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    A 5-year-old boy, Liethnic group, was admitted to the Affiliated Haikou Hospital of Xiangya Medical College, Central South University on March 21, 2020 due to "a fever and headache for 3 weeks". The clinical manifestations were: recurrent fever (about 38.5 ℃), and severe headache with vomiting. The peripheral blood eosinophil count increased to 1.87 × 109/L. Meningeal irritation was positive, accompanied by severe pneumonia, acute respiratory failure and other complications. A "bacterial meningitis" diagnosis was made intially and was treated with antibiotics for 6 days after admission. The patient’s parents claimed that the child had a history of eating snails, shrimps and crabs raw. Combined with the imaging results (head MRI showed multiple elongated foci of brain parenchyma, chest CT showed multiple inflammatory changes in both lungs) and the cerebrospinal fluid metagenomic next-generation sequencing results (sequence number 368 suggested Angiostrongylus cantonensis), the patient was diagnosed with severe angiostrongylus cantonensis. The patient was administrated with albendazole 20 mg/(kg·d) for 10 days and dexamethasone 0.15 mg/(kg·d) for 3 days. The headache and fever symptoms were relieved post the treatment. Two weeks after discharge, the eosinophil count in the peripheral blood decreased to 0.94 × 109/L, the lesions on head MRI disappeared, the lesions on chest CT decreased, and the serum A. cantonensis specific IgG antibodies were positive by ELISA. Eight weeks after discharge, the eosinophil count in peripheral blood decreased to 0.44 × 109/L, the lesions on head MRI and chest CT disappeared. The serum antibody IgG of A. cantonensis was positive by ELISA, while the IgG antibody in the cerebrospinal fluid was negative. The patient was followed up until May 2021, and developed well without other conditions.

    A misdiagnosed case of brain sparganosis mansoni
    RONG Zhi-li, SHI Ting-ting
    2022, 40(6):  817-820.  doi:10.12140/j.issn.1000-7423.2022.06.022
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    A 16-year-old male patient, who is a student, lived in Xindu district of Chengdu. In 2017, the patient was misdiagnosed as having "cerebral hemangioma" due to epilepsy in another hospital, followed by gamma knife radiosurgery three times. The patien’s symptoms were relieved after each operation. However, the patient underwent brain surgery due to visual ghosting, unable to speak freely, gait instability and radiographic suggests brain tumour could not be excluded in July 2021. During the surgery, one white worm was found in the brain tissue. The patient was transferred to the Public health clinical centre of Chengdu due to a suspected parasitic infection. The patient had a history of consuming uncooked aquatic products, blood cell count showed eosinophil count and eosinophil percentage were normal, and serum Sparganum mansoni specific IgG antibodies were positive. MRI showed inhomogeneous flaky abnormal signal and ring strengthening after enhancements in the brainstem and left cerebellar hemisphere, and CT showed speckle and small nodule enhancement in left brainstem(pons and midbrain) and left cerebellar hemisphere. Brain histopathology showed necrotic tunnel and granulomatous inflammation. The transverse striation of the body wall, longitudinal muscle and calcareous corpuscles were found in the three parasite bodies. Therefore, the patient was diagnosed with cerebral sparganosis. Praziquantel [25 mg/(kg·d), lasted 5 days, 4 courses, each treatment interval of 1 month] was used for deworming treatment. The radiographic changes mostly disappeared and the symptoms improved after 6 months.