收稿日期: 2023-06-26
修回日期: 2023-07-26
网络出版日期: 2023-11-06
A case of Capillaria hepatica infection
Received date: 2023-06-26
Revised date: 2023-07-26
Online published: 2023-11-06
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。
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 . DOI: 10.12140/j.issn.1000-7423.2023.05.021
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
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