切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 60 -64. doi: 10.3877/cma.j.issn.1674-1358.2022.01.009

病例报告

北京地区输入性人粒细胞无形体病患者一例
王鹤1, 胡岚1, 方媚1, 栗绍刚2,(), 王超1, 齐文杰1   
  1. 1. 100050 北京,首都医科大学附属北京友谊医院感染内科
    2. 首都医科大学附属北京友谊医院北京热带医学研究所热带病防治研究北京市重点实验室
  • 收稿日期:2021-02-27 出版日期:2022-02-15
  • 通信作者: 栗绍刚
  • 基金资助:
    首都卫生发展科研专项(No.首发2016-3-2023)

A case report of imported human granulocytic anaplasmosis in Beijing

He Wang1, Lan Hu1, Mei Fang1, Shaogang Li2,(), Chao Wang1, Wenjie Qi1   

  1. 1. Department of Infection Medicine, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
    2. Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
  • Received:2021-02-27 Published:2022-02-15
  • Corresponding author: Shaogang Li
引用本文:

王鹤, 胡岚, 方媚, 栗绍刚, 王超, 齐文杰. 北京地区输入性人粒细胞无形体病患者一例[J]. 中华实验和临床感染病杂志(电子版), 2022, 16(01): 60-64.

He Wang, Lan Hu, Mei Fang, Shaogang Li, Chao Wang, Wenjie Qi. A case report of imported human granulocytic anaplasmosis in Beijing[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(01): 60-64.

目的

探讨人粒细胞无形体病(HGA)的临床特征、实验室检查及治疗方法。

方法

回顾性分析首都医科大学附属北京友谊医院感染内科2020年11月收治的1例输入性HGA患者的临床资料及诊疗过程。

结果

患者系一名考古学家,长期于野外作业,入院前从青海都兰古墓考古回京,随后出现发热、口渴、血尿、尿潴留同时伴有白细胞、血小板计数进行性下降,于外院治疗效果不佳转至本院,血二代测序(NGS)结果为阴性,骨髓涂片可见粒细胞包涵体,高度可疑HGA,及时给予米诺环素1天余体温正常,2周后症状消失出院,出院2周后患者再次出发考古并于四川当地门诊复查血液各项指标均正常,未再出现发热。

结论

HGA病情进展迅速,严重者可引起多脏器损害,甚至死亡,而引起一过性尿潴留较为罕见,本病例首次报告HGA并发尿潴留症状,但HGA与尿潴留是否直接相关有待进一步研究。同时野外作业是HGA的高危因素。NGS对HGA诊断价值有限,及时行血涂片或骨髓涂片,以及经验性治疗是挽救生命的关键。

Objective

To investigate the clinical features, laboratory indexes, and treatment of human granulocytic anaplasmosis (HGA).

Methods

Data of a patient with imported HGA admitted to the Department of Infectious Medicine, Beijing Friendship Hospital, Capital Medical University in November 2020 was reviewed.

Results

The patient was an archaeologist who worked in the field for a long time. Before admission, he returned to Beijing from the ancient tomb of Dulan, Qinghai. He subsequently developed fever, thirst, hematuria, and urinary retention, accompanied by a progressive decline in white blood cell and platelet counts. The treatment effect in the other hospital was poor, he was transferred to our hospital. The next-generation sequencing (NGS) of blood was negative. The bone marrow smear showed granulocyte inclusion bodies and highly suspicious HGA. Minocycline was given in time for one day and the body temperature returned normal. After two weeks, the symptoms disappeared and the patient was discharged. During the archaeology, he took re-examination in the local outpatient clinic in Sichuan, all blood indicators were normal, and fever did not reappear.

Conclusions

HGA progresses rapidly. For severe cases, it can cause multiple organ damage and even death. This case is the first to report HGA complicating urinary retention. However, whether HGA is directly related to urinary retention needs further study. At the same time, field work is a high risk factor for HGA. NGS was of limited value in the diagnosis of HGA, and timely blood smear or bone marrow smear and empirical treatment are the keys to saving lives.

图1 患者骨髓涂片(瑞-吉染色、×1 000)注:箭头所示中性粒细胞胞浆中可见蓝色深染包涵体,高度怀疑为嗜吞噬细胞无形体感染
[1]
Dumler JS. Anaplasma and Ehrlichia infection [J]. Ann NY Acad Sci,2005,1063(1):361-373.
[2]
张宏泽,尹家祥. 中国人粒细胞无形体病流行现状及其影响因素[J]. 中国人兽共患病学报,2018,34(5):478-481.
[3]
陶律延,梁张,宝福凯. 中国人粒细胞无形体病的研究进展[J]. 中国热带医学,2017,17(2): 193-197.
[4]
Chen SM, Dumler JS, Bakken JS, et al. Identification of a granulocytotropic Ehrlichia species as the etiologic agent of human disease[J]. J Clin Microbiol,1994,32(3):589-595.
[5]
中华人民共和国卫生部办公厅. 人粒细胞无形体病预防控制技术指南(试行)[J/CD]. 中华实验和临床感染病杂志(电子版),2010,4(3):350-365.
[6]
赵清,逯军,潘翔. 人感染立克次体致病研究现状[J]. 中国热带医学,2020,20(6):583-588.
[7]
Naimi WA, Green RS, Cockburn CL, et al. Differential susceptibility of male versus female laboratory mice to anaplasma phagocytophilum infection[J]. Trop Med Infect Dis,2018,3(3):78.
[8]
孙荣同,高海娥,王明义, 等. 人粒细胞无形体病的实验室诊断进展[J]. 中华传染病杂志,2012,30(1):58-59.
[9]
汤丽,高子厚,杜春红. 无形体属立克次体宿主动物和传播媒介的研究进展[J]. 中国热带医学,2017,17(8):838-841, 845.
[10]
Tate CM, Howerth EW, Mead DG, et al. Anaplasmaodocoilei sp. Nov. (family Anaplasmataceae) from white-tailed deer (Odocoileusvirginianus)[J]. Ticks Tick Borne Dis,2013,4(1-2):110-119.
[11]
Zobba R, Anfossi AG, Visco S, et al. Cell tropism and molecular epiddemiolog of Anaplasma platys-like strain in cats[J]. Ticks Tick Borne Dis,2015,6(3):272-280.
[12]
张文娟,杜春红,高子厚. 人粒细胞无形体宿主动物和媒介流行病学研究进展[J]. 实用预防医学,2015,22(7):892-895.
[13]
Mareedu N, Schotthoefer AM, Tompkins J, et al. Risk factors for severe infection, hospitalization, and prolonged antimicrobial therapy in patients with babesiosis[J]. Am J Trop Med Hyg,2017,97(4): 1218.
[14]
Diuk-Wasser MA, Vannier E, Krause PJ, et al. Coinfection by ixodestick-borne pathogens: ecological, epidemiological, and clinical consequences[J]. Trends Parasitol,2016,32(1):30-42.
[15]
Dahlgren FS, Heitman KN, Drexler NA, et al. Human granulocytic anaplasmosis in the United States from 2008 to 2012: a summary of national surveillance data[J]. Am J Trop Med Hyg,2015,93(1):66-72.
[16]
Li H, Zhou Y, Wang W, et al. The clinical characteristics and outcomes of patients with human granulocytic anaplasmosis in China[J]. Int J Infect Dis,2011,15(12):e859-e866.
[17]
刘增加,郑龙,张爱勤, 等. 人粒细胞无形体病临床流行病学与防治研究现状[J]. 中华卫生杀虫药械,2018,24(5):417-422.
[18]
Won KS, Choon-Mee K, Dong-Min K, et al. Manifestation of anaplasmosis as cerebral infarction: a case report[J]. BMC Infect Dis,2018,18(1):409.
[19]
陈施华,王峰,孙乐, 等. 中国大陆人群嗜吞噬细胞无形体血清阳性率的Meta分析[J]. 昆明医科大学学报,2020,41(4): 31-38.
[20]
张丽娟. 我国人畜共患无形体病防治面临的挑战--诊断与经验治疗[J]. 热带病与寄生虫学,2016,14(1):1-2, 31.
[21]
Bakken JS, Dumler JS. Clinical diagnosis and treatment of human granulocytotropic anaplasmosis[J]. Ann NY Acad Sci,2006,1078(10):236- 247.
[22]
叶翩,揭盛华. 人粒细胞无形体病的治疗进展[J]. 医药导报,2010,29(4):456-460.
[23]
王鹤,齐文杰. 北京地区人巴贝虫感染者一例[J/CD]. 中华实验和临床感染病杂志(电子版),2019,13(6):519-523.
[1] 杜秀藩, 潘富文, 沈宁江, 方业汉, 熊小龙, 黄晖, 黄春行, 王广积. 脊柱麻醉下股骨头置换术后尿液潴留发病率及风险因素[J]. 中华关节外科杂志(电子版), 2019, 13(05): 541-546.
[2] 陈有荣, 文鹏飞, 郭万首, 王卫国, 刘朝晖, 张启栋, 丁冉. 初次髋膝关节置换术中不留置尿管的可行性和安全性研究[J]. 中华关节外科杂志(电子版), 2018, 12(03): 350-355.
[3] 朱丽丽, 李冰, 薛静, 于慧, 李淑红. 椎管内分娩镇痛对经阴道分娩初产妇产后早期盆底功能的影响[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(04): 484-491.
[4] 王鹤, 齐文杰. 北京地区人巴贝虫感染者一例[J]. 中华实验和临床感染病杂志(电子版), 2019, 13(06): 519-523.
[5] 韩景钊, 脱红芳, 王泽普, 彭彦辉. 腹股沟疝修补术后尿潴留影响因素和防治策略[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 400-404.
[6] 姚翠, 王丹. 结肠癌术后24小时内拔除留置尿管对尿潴留的影响[J]. 中华结直肠疾病电子杂志, 2017, 06(06): 522-524.
[7] 王涛, 罗曼, 陈硕, 李玉玮. 阴部神经阻滞用于混合痔术后镇痛的临床观察[J]. 中华结直肠疾病电子杂志, 2014, 03(02): 99-101.
[8] 邸禄芹, 李天华, 陈彩真, 于静静, 王晓彦, 张娇, 丁俊琴. 骨科术后早期拔尿管患者尿潴留发生情况及影响因素分析[J]. 中华老年骨科与康复电子杂志, 2022, 08(02): 104-108.
[9] 朱琳华, 张园园, 陈晓青. 葱白穴位贴敷联合艾灸预防人工关节置换术后尿潴留的效果观察[J]. 中华老年骨科与康复电子杂志, 2018, 04(06): 331-335.
[10] 郭彤彤, 孙畅, 党海波, 陈祥芳. 针灸治疗中风后尿潴留的研究进展[J]. 中华针灸电子杂志, 2022, 11(02): 58-60.
阅读次数
全文


摘要