江西省2011—2020年并殖吸虫病病例回顾性分析

doi:10.12140/j.issn.1000-7423.2022.02.018

摘要/Abstract

摘要：

分析江西省近10年并殖吸虫病的流行病学及临床特点。收集2011年5月—2020年12月于江西省寄生病防治研究所就诊的并殖吸虫病患者的流行病学与临床资料进行回顾性分析。共收集41例患者资料,平均年龄为（29.69 ± 20.94）岁,其中18~59岁占51.2%（21/41）;男性29例,女性12例;病程10 d~5年;患者来自江西省8个设区市,其中宜春市最多,占43.9%（18/41）。发病前有饮生溪水史的患者占48.8%（20/41）,食生/半生溪蟹河虾史的占31.7%（13/41）,抓玩溪蟹史的占9.7%（4/41）,无明确食生或半生食物史的占9.7%（4/41）。混合型占39.0%（16/41）、胸肺型占26.8%（11/41）、皮肤型占14.6%（6/41）、腹肝型占12.1%（5/41）、脑型占7.3%（3/41）。41例患者的嗜酸粒细胞绝对值均升高,最高为17.74 × 10⁹/L,嗜酸粒细胞百分比最高为76.34%;21例（51.2%）患者外周血白细胞明显升高,最高为44.10 × 10⁹/L;患者血清抗并殖吸虫IgG抗体检测结果均为阳性,与多种寄生虫有交叉反应,其中与血吸虫的交叉反应率为58.5%（24/41）。电子计算机断层扫描（CT）结果显示,22例患者胸部双侧或单侧呈不同程度的胸腔积液,5例局部包裹性积液,3例合并心包积液;胸部CT平扫结果显示,9例肺内可见散在斑片状、结节状密度增高影,10例病灶内可见隧道征,1例呈肺不张;磁共振成像（MRI）检查结果显示,6例脑型并殖吸虫病患者呈出血灶、环形、类环形囊性病灶、多发结节,呈聚集、迁移状和隧道样改变;磁敏感加权成像技术（SWI）显示脑内多条短轨道样低信号影及类圆形低信号影。3例患者行皮下包块细针穿刺细胞学检查,瑞氏染色后显微镜下查见淋巴细胞、嗜酸粒细胞及梭形竹叶状夏科-雷登结晶。41例患者病原学检查均未检出并殖吸虫虫卵或虫体。41例患者经1个以上疗程治疗后均治愈。江西省并殖吸虫病呈散发,应结合流行病学史、血清抗体检测、影像学检查、嗜酸粒细胞增高等资料综合分析诊断,吡喹酮治疗预后佳。

关键词: 并殖吸虫病, 病例分析, 流行病学, 临床特点

Abstract:

To analyze the epidemiology and clinical characteristics of paragonimiasis in Jiangxi Province in recent ten years. The epidemiological and clinical data of patients with paragonimiasis who were diagnosed and treated at Jiangxi Institute of Parasitic Diseases from May 2011 to December 2020 were collected and analyzed retrospectively. A total of 41 patients’ data were collected. The average age of the 41 patients was (29.69 ± 19.94) years. Patients aged between 18-59 accounted for 51.2% (21/41). Out of all the patients, 29 cases were males, and 12 were females. The course of the disease lasts 10 days to 5 years. The patients were from 8 districts and cities in Jiangxi Province, of which Yichun had the most cases, accounting for 43.9% (18/41). Before the onset of the disease, 48.8%(20/41) of the patients drank stream water, 31.7% (13/41) ate raw/half raw shrimps and crabs, 9.7%(4/41) caught or played with crabs, 9.7% (4/41) had no clear history of eating raw or semi-raw food. The positive rate of serum anti-Paragonimus antibodies was 100%. The mixed type accounted for 39.0% (16/41), thoracopulmonary type accounted for 26.8% (11/41), subcutaneous type for 14.6% (6/41), abdominal and hepatic type for 12.1% (5/41), cerebral type for 7.3%(3/41). The eosinophils count was increased in 41 patients, the highest was 17.74 × 10⁹/L, and the highest percentage of eosinophils was 76.34%; 21 patients (51.2%) had significantly increased peripheral blood leukocyte count, the highest was 44.10 × 10⁹/L. The paragonimiasis serum IgG antibodies of the patients were all positive and had cross-reaction with various parasites, among which the positive crossover rate with serum schistosomiasis antibody was 58.5%(24/41). Computed tomography (CT) results showed that 22 cases of chest bilateral or unilateral pleural effusion of varying degrees, 5 cases of local encapsulated effusion, and 3 cases of pericardial effusion; chest CT scan results showed that 9 cases of intrapulmonary scattered patchy and nodular increased density shadows, 10 cases of tunnel sign, and 1 patient had atelectasis. Magnetic resonance imaging (MRI) showed that 6 patients with cerebral paragonimiasis had hemorrhagic foci, circular, quasi- circular cystic, multiple nodules, with aggregation, migration-like lesions and tunnel-like changes. Susceptibility-weighted imaging (SWI) showed multiple short-track-like low-intensity shadows and round-like low-intensity shadows in the brain. Three patients underwent fine-needle aspiration cytology examination of subcutaneous mass. Lymphocytes, eosinophils and fusiform bamboo leaf-shaped Charcot-Ryden crystals were found under wright staining microscopy. Eggs or parasites of Paragonimus were not found in all 41 patients by pathogenic examination. 41 patients were all cured after more than one course of treatment. The prevalence of paragonimiasis in Jiangxi Province was sporadic. Paragonimiasis should be diagnosed with a comprehensive analysis of the epidemiological history, serum antibody testing, imaging examination, eosinophilia, etc. A good prognosis is expected after praziquantel treatment.

Key words: Paragonimiasis, Case analysis, Epidemiology, Clinical feature

中图分类号:

R532.22

龚志红, 龚红卡, 徐芸, 刘俊朴, 涂永红, 谢慧群. 江西省2011—2020年并殖吸虫病病例回顾性分析[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(2): 247-251.

GONG Zhi-hong, GONG Hong-ka, XU Yun, LIU Jun-pu, TU Yong-hong, XIE Hui-qun. Retrospective analysis of paragonimiasis cases in Jiangxi Province from 2011 to 2020[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2022, 40(2): 247-251.

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