2009-2012年河北鼠型斑疹伤寒流行概况及实验室调查分析

发布时间：2018-04-21 14:26

本文选题：鼠型斑疹伤寒 + 莫氏立克次体　；参考：《中国人兽共患病学报》2015年06期

【摘要】：目的对2009-2012年河北省斑疹伤寒高发地区临床报告病例进行实验室调查分析。方法按我国卫生部《流行性和地方性斑疹伤寒诊断标准》(WS 215-2008)在临床可疑病例高发地区设立哨点监测医院并收集病例。临床病例进行个案登记并进行发病急性期及恢复期血液标本的收集。实验室检测按WHO推荐的立克次体血清学诊断方法-间接免疫荧光法检测病人血清IgM和IgG特异抗体。以急性期血液DNA为模板,采用巢氏PCR扩增斑疹伤寒群立克次体热休克蛋白基因groEL基因并测序。通过NCBI Blast平台同源比较序列并使用DNASTAR软件进行遗传进化分析。结果本次调查在辛集市、定州市和迁安市共收集877例临床报告病例,2009年报告病例数最多(441例),迁安市病例数最多(510例)。急性期血清莫氏立克次体IgM抗体阳性率为72.8%(73/101),IgG阳性率为78.2%(79/101)。12人通过血清IgG抗体4倍升高或降低明确诊断。PCR扩增阳性率为21.7%(22/101),成功测序的17人groEL(209bp)基因100%同源,与其他地区序列存在较大变异,与标准株R.typhi Wilmington(AY191590)核苷酸97.0%,氨基酸只有93.9%同源,进化分析与其他菌株遗传关系较远。结论河北省辛集、定州和迁安地区存在鼠型斑疹伤寒流行。进一步调查传播媒介及宿主对该病的预防控制具有重要公共卫生意义。加强该病临床诊断及鉴别诊断十分必要。
[Abstract]:Objective to investigate and analyze the clinical reported cases of typhus fever in Hebei Province from 2009 to 2012. Methods according to the diagnostic criteria of epidemic and endemic typhus fever in China Ministry of Health WS215-2008 set up sentinel surveillance hospitals and collected cases in the areas with high incidence of suspected clinical cases. Clinical cases were registered and blood samples were collected in acute and convalescent stages. Specific antibodies to IgM and IgG were detected by indirect immunofluorescence assay, which was recommended by WHO as a serological diagnostic method for Rickettsiella. The nucleotide sequence of heat shock protein gene (groEL) gene of typhus typhus group Rickettsiae was amplified by nested PCR using acute blood DNA as template. Genetic evolution analysis was carried out by using NCBI Blast platform homology comparison sequence and DNASTAR software. Results A total of 877 clinical cases were collected in Xinji, Dingzhou and Qianan cities. In 2009, 441 cases were reported and 510 cases were reported in Qianan city. In the acute phase, the positive rate of IgM antibody against Rickettsiella mohlich was 72.8% and 78.2% / 101% respectively. The positive rate of serum IgG antibody was 4 times higher or lower. The positive rate of IgG amplification was 21. 7% 22 / 101%. The homology of groEL209bpgene was 100% among 17 successfully sequenced individuals. There was significant variation with other regions, and the nucleotide sequence was 97.0% homology with the standard strain R.typhi Wilmington AY191590. The amino acid sequence was only 93.9% homology, and the genetic relationship between the phylogenetic analysis and other strains was far away. Conclusion Mouse typhus is prevalent in Xinji, Dingzhou and Qian'an areas of Hebei Province. It is of great public health significance to further investigate the prevention and control of the disease by the media and the host. It is necessary to strengthen the clinical diagnosis and differential diagnosis of the disease.
【作者单位】：河北省疾病预防控制中心;中国疾病预防控制中心传染病预防控制所;哈尔滨医科大学公共卫生学院;新疆石河子大学动物科技学院;
【基金】：国家973计划基础研究项目(No.2010CB530206) “十二五”传染病重大专项课题(No.2008ZX10004-008;No.2012ZX10004215)联合资助~~
【分类号】：R516.3

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