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| 中国人粒细胞无形体病的院内传播感染 |
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| Nosocomial transmission of human granulocytic anaplasmosis in China |
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| Zhang L., Liu Y., Ni D., Li Q., Yu Y., Yu X.-J., Wan K., Li D., Liang G., Jiang X., Jing H., Run J., Luan M., Fu X., Zhang J., Yang W., Wang Y., Dumler J.S., Feng Z., Ren J., Xu J. 2009/5/29 18:39:20 |
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JAMA - Journal of the American Medical Association, 2008, Volume 300, Issue 19
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| Context: Human granulocytic anaplasmosis (HGA) is an emerging tick-borne disease in China. A cluster of cases among health care workers and family members following exposure to a patient with fulminant disease consistent with HGA prompted investigation. Objective: To investigate the origin and transmission of apparent nosocomial cases of febrile illness in the Anhui Province. Design, Setting, and Patients: After exposure to an index patient whose fatal illness was characterized by fever and hemorrhage at a primary care hospital and regional tertiary care hospital's isolation ward, secondary cases with febrile illness who were suspected of being exposed were tested for antibodies against Anaplasma phagocytophilum and by polymerase chain reaction (PCR) and DNA sequencing for A phagocytophilum DNA. Potential sources of exposure were investigated. Main Outcome Measure: Cases with serological or PCR evidence of HGA were compared with uninfected contacts to define the attack rate, relative risk of illness, and potential risks for exposure during the provision of care to the index patient. Results: In a regional hospital of Anhui Province, China, between November 9 and 17, 2006, a cluster of 9 febrile patients with leukopenia, thrombocytopenia, and elevated serum aminotransferase levels were diagnosed with HGA by PCR for A phagocytophilum DNA in peripheral blood and by seroconversion to A phagocytophilum. No patients had tick bites. All 9 patients had contact with the index patient within 12 hours of her death from suspected fatal HGA while she experienced extensive hemorrhage and underwent endotracheal intubation. The attack rate was 32.1% vs 0% (P=.04) among contacts exposed at 50 cm or closer, 45% vs 0% (P = .001) among those exposed for more than 2 hours, 75% vs 0% (P<.001) among those reporting contact with blood secretions, and 87.5% vs 0% (P=.004) among those reporting contact with respiratory secretions from the index patient. Conclusion: We report the identification of HGA in China and likely nosocomial transmission of HGA from direct contact with blood or respiratory secretions. ©2008 American Medical Association. All rights reserved. |
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| Correspondence Address: Ren, J.; Anhui Center for Disease Control and Prevention, He Fei, Anhui Province, 230061, China; email: rj@ahcdc.com.ch |
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 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
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