肝毛细线虫感染1例

doi:10.12140/j.issn.1000-7423.2023.05.021

摘要/Abstract

摘要：

患者，女，45岁，农民，山东省菏泽人。2020年6—7月在河南务工期间，无明显诱因出现反复持续高热，就诊于当地医院，经验性予左氧氟沙星、哌拉西林他唑巴坦等治疗，症状无好转。影像学检查示肝脏肿大，未见明显占位，肝脏穿刺活检组织病理，疑似寄生虫感染但未能鉴定虫种。8月12日转诊至山东第一医科大学附属消化病医院。入院查体：反复持续高热（最高体温达42 ℃），精神差；血常规示嗜酸粒细胞5.49 × 10⁹/L↑，血红蛋白93 g/L↓；粪样镜检未见寄生虫虫卵。患者有饮用生水、吃剩饭剩菜的习惯。居住环境卫生条件差，常有大鼠出入。捕获大鼠并解剖，可见大鼠肝脏表面有多灶黄色小斑片状及颗粒状肝损伤，病理切片可见肝脏实质大量虫卵聚集，另见成虫横断面。取患者血样，ELISA检测血清抗体，结果示仅抗旋毛虫抗体呈弱阳性。腹部B超示肝脏肿大，密度欠均匀。调取外院肝脏穿刺组织病理切片复阅，于肝实质内查见数灶少量寄生虫卵，周围淋巴细胞及大量嗜酸粒细胞浸润，局部可见多核巨噬细胞吞噬虫卵形成的肉芽肿性炎。患者肝组织中的虫卵和大鼠肝组织中的虫卵形态相同，经鉴定均为肝毛细线虫虫卵。予口服阿苯达唑片20 mg/（kg•d），72 h后体温降至正常范围，服药7 d后，无明显不适，出院。1个月后患者回医院随访，未再出现发热症状，恢复良好。

关键词: 肝毛细线虫, 肝脏, 感染

Abstract:

The patient was a 45-year-old female peasant from Heze City of Shandong Province. While The patient was working in Henan Province, in June and July 2020, she was admitted to the local hospital due to recurrent hyperthermia without inducement. The patient was treated with levofloxacin and piperacillin-tazobactam, but the symptoms did not improve. The PET-CT results showed increased liver volume and uneven hepatic density without obvious occupation. The histopathology examination of the liver biopsy specimen was considered to be a parasitic infection, while the species was yet to be determined. On August 12th, 2020, the patient was transferred to the Affiliated Gastroenterology Hospital of Shandong First Medical University. The physical examination showed recurrent hyperthermia (About 42 ℃) and fatigue. Laboratory tests showed increased peripheral blood eosinophil count (5.49 × 10⁹/L) and decreased haemoglobin was 93 g/L. No parasite eggs were found in the stool sample. The patient had a habit of eating leftovers and drinking unboiled water. The patient had poor residential sanitation with rats. The rats in the residence were captured and dissected. The rat histopathology examination showed a large amount of eggs and cross-section of adult worms in the rat liver parenchyma. The patient blood samples was tested for serum antibodies against common human parasites by ELISA. The results showed only weak reactivities to trichinella. The B ultrasonography showed an enlarged liver with uneven density. The liver biopsy slides was reviewed and a small number of parasite eggs were found in the liver parenchyma, with lymphocytes and eosinophile infiltration and granulomatosis. The eggs in the liver tissue of the patient were the same as liver tissue of the rat, which were identified as Capillaria hepatica eggs. The patient was administrated with albendazole [20 mg/(kg·d)]. Her temperature returned to the normal range after 72 h. The patient had no obvious discomfort, and she was discharged after 7 d. One month later, the patient returned to the hospital for follow-up and recovered well.

Key words: Capillaria hepatica, Liver, Infection

中图分类号:

R383.1

张丽, 缪峰, 申艳梅. 肝毛细线虫感染1例[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(5): 650-652.

ZHANG Li, MIAO Feng, SHEN Yanmei. A case of Capillaria hepatica infection[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(5): 650-652.

图/表 3

参考文献 15

[1]	Hong IH, Kang SY, Kim JH, et al. Histopathological findings in wild Nutrias (Myocastor coypus) with Capillaria hepatica infection[J]. J Vet Med Sci, 2017, 78(12): 1887-1891. doi: 10.1292/jvms.16-0174
[2]	Yang YQ, Zhang CW, Wu JT, et al. Observations on the histology of capillaria hepatica and pathologic changes of the liver caused by ova and worms[J]. ADS Notification, 1989(3): 20-24, 86. (in Chinese)
	(杨元清, 张超威, 吴嘉彤, 等. 肝毛细线虫的组织学及其引起的肝脏病理变化的观察[J]. 地方病通报, 1989(3): 20-24, 86.)
[3]	Li CD, Yang HL, Wang Y. Capillaria hepatica in China[J]. World J Gastroenterol, 2010, 16(6): 698-702. doi: 10.3748/wjg.v16.i6.698
[4]	Sawamura R, Fernandes MI, Peres LC, et al. Hepatic capillariasis in children: report of 3 cases in Brazil[J]. Am J Trop Med Hyg, 1999, 61(4): 642-647. doi: 10.4269/ajtmh.1999.61.642
[5]	Choe G, Lee HS, Seo JK, et al. Hepatic capillariasis: first case report in the Republic of Korea[J]. Am J Trop Med Hyg, 1993, 48(5): 610-625. doi: 10.4269/ajtmh.1993.48.610
[6]	Terrier P, Hack I, Hatz C, et al. Hepatic capillariasis in a 2-year-old boy[J]. J Pediatr Gastroenterol Nutr, 1999, 28(3): 338-340. doi: 10.1097/00005176-199903000-00026
[7]	Berger T, Degrémont A, Gebbers JO, et al. Hepatic capillariasis in a 1-year-old child[J]. Eur J Pediatr, 1990, 149(5): 333-336. pmid: 2178935
[8]	Manor U, Doviner V, Kolodziejek J, et al. Capillaria hepatica (syn. Calodium hepaticum) as a cause of asymptomatic liver mass[J]. Am J Trop Med Hyg, 2021, 105(1): 204-206. doi: 10.4269/ajtmh.21-0120
[9]	Fuehrer HP, Igel P, Auer H. Capillaria hepatica in man: an overview of hepatic capillariosis and spurious infections[J]. Parasitol Res, 2011, 109(4): 969-979. doi: 10.1007/s00436-011-2494-1
[10]	Wang ZQ, Cui J, Wang Y. Persistent febrile hepatomegaly with eosinophilia due to hepatic capillariasis in Central China[J]. Ann Trop Med Parasitol, 2011, 105(6): 469-472. doi: 10.1179/1364859411Y.0000000035
[11]	Lin XM, Li H, Zhao XD, et al. A case report of hepatic capillariasis[J]. Chin J Parasit Dis Control, 2004, 17(4): 222, 230. (in Chinese)
	(蔺西萌, 李辉, 赵旭东, 等. 人肝毛细线虫病1例[J]. 中国寄生虫病防治杂志, 2004, 17(4): 222, 230.)
[12]	Huang JN, Lin JX. Pathological diagnosis of the first human infection of Capillaria hepatica in Fujian Province[J]. J Chin Zoonoses, 2004, 20(6): 556. (in Chinese)
	(黄佳宁, 林金祥. 福建省首例肝毛细线虫人体感染的病理诊断[J]. 中国人兽共患病杂志, 2004, 20(6): 556.)
[13]	Wang ZQ, Lin XM, Wang Y, et al. The emerging but neglected hepatic capillariasis in China[J]. Asian Pac J Trop Biomed, 2013, 3(2): 146-147. doi: 10.1016/S2221-1691(13)60039-8
[14]	Wang L, Zhang YL, Deng Y, et al. Clinical and laboratory characterizations of hepatic capillariasis[J]. Acta Trop, 2019, 193: 206-210. doi: S0001-706X(18)30866-0 pmid: 30710532
[15]	Guo YM, Hu JJ, Yang YF, et al. Research of Capillaria hepatica and hepatica capillariasis[J]. Chin J Zoonoses, 2014, 30(6): 651-654, 662. (in Chinese)
	(郭艳梅, 胡俊杰, 杨艳芬, 等. 肝毛细线虫及肝毛细线虫病的研究概况[J]. 中国人兽共患病学报, 2014, 30(6): 651-654, 662.)