内脏利什曼病治疗后64年复发1例

doi:10.12140/j.issn.1000-7423.2022.02.022

摘要/Abstract

摘要：

患者,74岁,日照莒县人,1957年在山东省莒县当地医院诊断为内脏利什曼病,予以五价锑治疗6 d后好转。1964年移居安徽省马鞍山市,2014年10月回日照莒县省亲半个月后返回马鞍山市,2020年7月移居安徽省亳州市,期间均否认白岭叮咬,家中无养犬,无内脏利什曼病患者及病犬接触史。2020年7月出现不明原因的消瘦、乏力,2021年4月出现头晕症状,2021年6月无明显诱因突发高热,乏力及头晕加重。患者骨髓涂片查见利什曼原虫无鞭毛体;骨髓病原微生物高通量基因检测,检出利什曼原虫属序列30 366条,其中杜氏利什曼原虫种序列128条;血清rk39免疫层析试条检测结果阳性。结合流行病学史和实验室检测结果,确诊患者为内脏利什曼病复发。予五价锑（0.6 g/d,肌内注射,总量6 g,疗程10 d）治疗后好转出院。出院后电话随访,患者无发热症状,但未遵医嘱到医院复查。

关键词: 内脏利什曼病, 利什曼原虫, 复发感染

Abstract:

A 74-year-old patient from Juxian County, Rizhao, Shandong Province was diagnosed with visceral leishmaniasis and treated with pentavalent antimony for 6 d in the local hospital of Juxian in 1957. In 1964, the patient migrated to Ma’anshan City, Anhui Province. In October 2014, He travelled back to Juxian County for two weeks before returning to Ma’anshan City. In July 2020, he migrated to Bozhou City, Anhui Province. The patient denied any history of being bitten by sandfly, living with a dog at home during this period. The patient had no contact history of visceral leishmaniasis patients or Leishmannia infected dogs. The patient presented unexplained emaciation and fatigue from July 2020, and dizziness from April 2021. The patient had a sudden high fever without obvious inducement and aggravated fatigue and dizziness in June 2021. Bone marrow smear examination revealed Leishmania parasite flagellate body. The metagenomic analysis of the bone marrow pathogenic microorganisms revealed 30 366 sequences of the Leishmania genus, including 128 sequences of Leishmania donovani. Serum rk39 immunochromatographic strip showed a positive result. Combining the epidemiological history and labortory test results, a recurrent visceral leishmaniasis diagnosis was made. The patient was discharged after treatment with pentavalent antimony (0.6 g/d, intramuscular injection, 6 g, one course of 10 days). The patient was followed up by telephone after discharge, and showed no fever but did not go to the hospital for review.

Key words: Visceral leishmaniasis, Leishmania, Recurrent infection

中图分类号:

R531.6

张爱平, 梁曼曼, 朱玲玲, 盛皓宇, 杨江华. 内脏利什曼病治疗后64年复发1例[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(2): 266-268.

ZHANG Ai-ping, LIANG Man-man, ZHU Ling-ling, SHENG Hao-yu, YANG Jiang-hua. Relapse of visceral leishmaniasis in a cured case after 64 years[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2022, 40(2): 266-268.

图/表 2

参考文献 20

[1]	Chen XY,, Yang LY,, Zhao Y, et al. A study of the clinical application values of bone marrow examination and rK39 test strip in patients with sufferer performance[J]. Labeled Immunoass Clin Med, 2017, 24(11): 1252-1253, 1268. (in Chinese)
[1]	(陈曦阳,, 杨柳莹,, 赵仪, 等. 探讨骨髓检查和rK39试纸条方法对临床黑热病表现症患者检测效果[J]. 标记免疫分析与临床, 2017, 24(11): 1252-1253, 1268.)
[2]	Editorial Board of the Chinese Journal of Infectious Diseases. Expert consensus on diagnosis and treatment of Leishmania infection in China[J]. Chin J Infect Dis, 2017, 35(9): 513-518. (in Chinese)
[2]	(《中华传染病杂志》编辑委员会. 中国利什曼原虫感染诊断和治疗专家共识[J]. 中华传染病杂志, 2017, 35(9): 513-518.)
[3]	Mondal D,, Alvar J,, Hasnain MG, et al. Efficacy and safety of single-dose liposomal amphotericin B for visceral leishmaniasis in a rural public hospital in Bangladesh: a feasibility study[J]. Lancet Glob Health, 2014, 2(1): e51-e57.
[4]	Alvar J,, Vélez ID,, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence[J]. PLoS One, 2012, 7(5): e35671.
[5]	Zhang P,, Shen ZY,, Zhang YP, et al. Research progress of clinical epidemiology, prevention and treatment on visceral leishmaniasis[J]. Med J Natl Defending Forces Northwest China, 2019, 40(11): 703-708. (in Chinese)
[5]	(张鹏,, 沈兆媛,, 张亚萍, 等. 我国内脏利什曼病临床流行病学特征与防治研究现状[J]. 西北国防医学杂志, 2019, 40(11): 703-708.)
[6]	Liao ZW,, Wang SQ. Prevalence and prevention of major tropical diseases in China, 2000-2019[J]. Chin Trop Med, 2020, 20(3): 193-201. (in Chinese)
[6]	(廖志武,, 王善青. 我国2000-2019年主要热带病的流行与防治概况[J]. 中国热带医学, 2020, 20(3): 193-201.)
[7]	Zhao RR,, Li M,, Deng YD, et al. Epidemiology and clinical characteristics of 46 patients with visceral leishmaniasis[J]. Chin J Infect Dis, 2018, 36(6): 366-369. (in Chinese)
[7]	(赵荣荣,, 李敏,, 邓永东, 等. 内脏利什曼病患者46例流行病学及临床特征分析[J]. 中华传染病杂志, 2018, 36(6): 366-369.)
[8]	Zhang LP,, Zhang FN. Epidemiological and clinical analysis of 166 kala-azar cases[J]. Parasitoses Infect Dis, 2010, 8(4): 181-186. (in Chinese)
[8]	(张丽萍,, 张富南. 黑热病166例病例流行病学与临床分析[J]. 寄生虫病与感染性疾病, 2010, 8(4): 181-186.)
[9]	Wang JY,, Gao CH. Interpretation of diagnostic criteria for kala-azar[J]. Chin J Schisto Control, 2017, 29(5): 541-543. (in Chinese)
[9]	(汪俊云,, 高春花. 《黑热病诊断标准》解读[J]. 中国血吸虫病防治杂志, 2017, 29(5): 541-543.)
[10]	Xu NN,, Zhou M,, Yin M, et al. The value of high-throughput sequencing in the pathogenic detection of sepsis[J]. Chin J Crit Care Intensive Care Med Electron Ed, 2019, 5(2): 199-202. (in Chinese)
[10]	许娜娜,, 周敏,, 尹梅, 等. 高通量测序技术在脓毒症病原微生物检测中的价值[J]. 中华重症医学电子杂志(网络版), 2019, 5(2): 199-202.)
[11]	Wang ZJ. Kala-azar[M]// Hou KJ. Historical experience of preventive medicine in Shandong Province. Jinan: Shandong Science and Technology Press, 1987: 435-436. (in Chinese)
[11]	(王兆俊. 黑热病[M]//侯克济. 山东省预防医学历史经验. 济南: 山东科学技术出版社, 1987: 435-436.)
[12]	Wang ZJ. Main achievements in the control of kala-azar in Shandong Province[J]. Shandong Med J, 1959(10): 8-13. (in Chinese)
[12]	(王兆俊. 山东省黑热病防治研究上的主要成就[J]. 山东医刊, 1959(10): 8-13.)
[13]	Wang ZJ,, Wu ZJ,, He KZ. Research progress of kala-azar control in China since 1960[J]. J Parasitol Parasit Dis, 1983, 1(2): 65-72. (in Chinese)
[13]	(王兆俊,, 吴征鉴,, 何凯增. 1960年来我国黑热病防治研究工作进展[J]. 寄生虫学与寄生虫病杂志, 1983, 1(2): 65-72.)
[14]	Xiong GH. Kala-azar in China from 1985-1988[J]. Chin J Parasitol Parasit Dis, 1989, 7(3): 161-162. (in Chinese)
[14]	(熊光华. 1985-1988年全国黑热病疫情动态[J]. 中国寄生虫学与寄生虫病杂志, 1989, 7(3): 161-162.)
[15]	Wang ZJ,, Bao Y,, Shao QF, et al. Immunological evaluation of kala-azar control measures in Shandong Province[J]. Chin J Parasit Dis Control, 1991, 4(2): 81-85. (in Chinese)
[15]	(王兆俊,, 鲍勇,, 邵其峰, 等. 山东省黑热病防治效果的免疫学评价与有关问题的探讨[J]. 中国寄生虫病防治杂志, 1991, 4(2): 81-85.)
[16]	Wan GQ,, Liu X,, Miao F, et al. Surveillance on sand-fly after kala-azar was eliminated in Shandong Province[J]. Chin J Parasit Dis Control, 2003, 16(4): 244. (in Chinese)
[16]	(万功群,, 刘新,, 缪峰, 等. 山东省消除黑热病后的白蛉监测[J]. 中国寄生虫病防治杂志, 2003, 16(4): 244.)
[17]	Zhou ZB,, Li YY,, Zhang Y, et al. Analysis of national visceral leishmaniasis epidemic in 2018[J]. Chin J Parasitol Parasit Dis, 2020, 38(2): 175-180, 187. (in Chinese)
[17]	(周正斌,, 李元元,, 张仪, 等. 2018年全国内脏利什曼病疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(2): 175-180, 187.)
[18]	Zhang ZG. A case report of kala-azar relapse 26 years later[J]. Chin J Parasitol Parasitol Dis, 1990, 8(4): 287. (in Chinese)
[18]	(张志恭. 26年后黑热病复发一例报告[J]. 中国寄生虫学与寄生虫病杂志, 1990, 8(4): 287.)
[19]	Zhang FN,, Zhang LP. Analysis on recurrence and death of leishmaniasis cases in Sichuan Province[J]. J Prev Med Inf, 2010, 26(12): 961-965. (in Chinese)
[19]	(张富南,, 张丽萍. 四川省黑热病复发和死亡原因分析[J]. 预防医学情报杂志, 2010, 26(12): 961-965.)
[20]	Xie XQ,, Jiang L,, He L, et al. Analysis of the recurrence of kala-azar in 208 children[J]. J Clin Pediatr, 1996, 14(4): 237-238. (in Chinese)
[20]	(谢孝泉,, 江霖,, 何莉, 等. 小儿黑热病208例复发原因及疗效分析[J]. 临床儿科杂志, 1996, 14(4): 237-238.)