15例片形吸虫病患者临床资料分析
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摘要
目的分析片形吸虫病的一般情况、临床表现、辅助资料、治疗及预后。方法收集2017年7月至2018年3月大理大学第一附属医院住院治疗的15例片形吸虫病患者的临床资料,总结并分析其一般情况、临床表现、治疗及预后等。结果 15例片形吸虫病病例呈散在分布,分别来自普洱市(3例)、大理市(6例)、临沧市(5例)、丽江市(1例)。男性4例,女性11例。临床首发症状主要为腹痛(11例)、发热(8例)、腹胀(5例)、乏力(3例)、体质量下降(4例)、纳差(2例)、恶心(2例)、呕吐(2例)等。病程在1 d至2年不等。秋季就诊患者为8例、冬季4例、夏季2例、春季1例。15例行血常规检查, 12例嗜酸粒细胞百分比升高,9例中性粒细胞百分比降低, 7例淋巴细胞百分比降低, 7例血小板升高, 6例白细胞升高。15例行肝功能检查,10例碱性磷酸酶升高, 10例γ-谷氨酰转肽酶升高。12例行C反应蛋白检测, 6例升高,最高为154 mg/L。12例行血沉检测, 11例升高,最高为120 mm/h。2例患者粪便中找到片形吸虫卵。15例患者ELISA检测血清片形吸虫抗体均为阳性。上腹部CT表现为肝弥漫多发结节灶、斑片状病变,病变不强化或周边轻度强化。腹部超声提示肝不均质回声包块声像。2例患者肝穿刺组织病理检查可见大量嗜酸粒细胞浸润、淋巴细胞、嗜酸性脓肿和局部坏死。1例患者皮肤组织病理检查可见大量嗜酸粒细胞浸润,局部小血管壁内膜增厚。15例患者中有11例辗转至云南多家医院诊治,被误诊为肝脓肿(2例)、肝占位性病变(2例)、胆管癌(2例)、肝癌(1例)、肠炎(1例)、结缔组织病(1例)、嗜酸细菌性肺炎(1例)、腹腔结核(1例)。确诊后15例患者均给予三氯苯达唑10 mg/(kg·d)×2 d治疗,治疗后症状明显改善。出院后电话随访6个月, 10例未失访患者预后良好。结论大理及周边地区仍存在人片形吸虫感染,且为散发,以秋冬季多见,患者临床表现无特异性,三氯苯达唑治疗片形吸虫病可取得较好的疗效,为首选治疗药物。
Objective To analyze the general clinical features and manifestations, treatment and prognosis of fascioliasis. Methods The data of 15 patients diagnosed as fascioliasis and hospitalized at the First Affiliated Hospital of Dali University from July 2017 to March 2018 were collected. The general clinical features including manifestations, treatment and prognosis were analyzed. Results Total 15 patients were diagnosed as fascioliasis from July 2017 to March 2018. The patients came from different areas of Yunnan Province including 3 from Pu 'er, 6 from Dali, 5 from Lincang and 1 from Lijiang. Four of them were males and 11 females. The first clinical symptoms were mainly abdominal pain(11 cases), fever(8 cases), abdominal bloating(5 cases), fatigue(3 cases),weight loss(4 cases), loss of appetite(2 cases), nausea(2 cases), vomiting(2 cases), etc.. The course of disease ranged from 1 d to 2 years with 8 cases happened in autumn, 4 cases in winter, 2 cases in summer, and 1 case in spring. Blood examination showed an increase in the percentage of eosinophils in 12 of 15 cases, 9 cases with decreased percentage of neutrophils, 7 cases with decreased lymphocyte count, 7 cases with increased platelet count and 6 cases with increased white blood cells count. In liver function tests, 10 cases showed an increase in alkaline phosphatase activity; 10 cases with increased γ-glutamyl transpeptidase. C-reactive protein was detected in 6 of 12 cases with the highest value of 154 mg/L. Most of the cases(11/12) had the elevated erythrocyte sedimentation rate with the highest of 120 mm/h. The eggs of Fasciola spp. were only found in the feces of 2 patients, however, all patients showed antibody positive in the ELISA test against Fasciola antigen. CT examination showed the diffuse multiple nodules and patchy lesions in the liver. Abdominal ultrasound showed liver heterogeneous echo mass.Histopathological examination of liver biopsy in 2 patients showed serious eosinophil infiltration, lymphocyte and eosinophilic abscess and local necrosis. Skin biopsy in one patient showed a large amount of eosinophil infiltration.Total 11 of 15 patients were misdiagnosed as liver abscess(2 cases), liver occupying lesions(2 cases), cholangio-carcinoma(2 cases), liver cancer(1 case), enteritis(1 case), connective tissue disease(1 case), acidophilic bacterial pneumonia(1 case), abdominal tuberculosis(1 case) in other hospitals. After being diagnosed as fascioliasis all 15 patients were treated with triclabendazole 10 mg/(kg·d) for successive two days. Symptoms improved significantly after treatment. The patients were followed up by telephone for 6 months, 10 patients with response showed good prognosis. Conclusion There still are cases of human infection with Fasciola spp. sporadically around Dali areas.More cases were seen in autumn and winter seasons. The clinical manifestations of fascioliasis are not specific and the infection is easily misdiagnosed. The immunological test with positive antibody is important for the diagnosis of fascioliasis. Triclabendazole is the first line of therapeutic drugs for fascioliasis.
Objective To analyze the general clinical features and manifestations, treatment and prognosis of fascioliasis. Methods The data of 15 patients diagnosed as fascioliasis and hospitalized at the First Affiliated Hospital of Dali University from July 2017 to March 2018 were collected. The general clinical features including manifestations, treatment and prognosis were analyzed. Results Total 15 patients were diagnosed as fascioliasis from July 2017 to March 2018. The patients came from different areas of Yunnan Province including 3 from Pu 'er, 6 from Dali, 5 from Lincang and 1 from Lijiang. Four of them were males and 11 females. The first clinical symptoms were mainly abdominal pain(11 cases), fever(8 cases), abdominal bloating(5 cases), fatigue(3 cases),weight loss(4 cases), loss of appetite(2 cases), nausea(2 cases), vomiting(2 cases), etc.. The course of disease ranged from 1 d to 2 years with 8 cases happened in autumn, 4 cases in winter, 2 cases in summer, and 1 case in spring. Blood examination showed an increase in the percentage of eosinophils in 12 of 15 cases, 9 cases with decreased percentage of neutrophils, 7 cases with decreased lymphocyte count, 7 cases with increased platelet count and 6 cases with increased white blood cells count. In liver function tests, 10 cases showed an increase in alkaline phosphatase activity; 10 cases with increased γ-glutamyl transpeptidase. C-reactive protein was detected in 6 of 12 cases with the highest value of 154 mg/L. Most of the cases(11/12) had the elevated erythrocyte sedimentation rate with the highest of 120 mm/h. The eggs of Fasciola spp. were only found in the feces of 2 patients, however, all patients showed antibody positive in the ELISA test against Fasciola antigen. CT examination showed the diffuse multiple nodules and patchy lesions in the liver. Abdominal ultrasound showed liver heterogeneous echo mass.Histopathological examination of liver biopsy in 2 patients showed serious eosinophil infiltration, lymphocyte and eosinophilic abscess and local necrosis. Skin biopsy in one patient showed a large amount of eosinophil infiltration.Total 11 of 15 patients were misdiagnosed as liver abscess(2 cases), liver occupying lesions(2 cases), cholangio-carcinoma(2 cases), liver cancer(1 case), enteritis(1 case), connective tissue disease(1 case), acidophilic bacterial pneumonia(1 case), abdominal tuberculosis(1 case) in other hospitals. After being diagnosed as fascioliasis all 15 patients were treated with triclabendazole 10 mg/(kg·d) for successive two days. Symptoms improved significantly after treatment. The patients were followed up by telephone for 6 months, 10 patients with response showed good prognosis. Conclusion There still are cases of human infection with Fasciola spp. sporadically around Dali areas.More cases were seen in autumn and winter seasons. The clinical manifestations of fascioliasis are not specific and the infection is easily misdiagnosed. The immunological test with positive antibody is important for the diagnosis of fascioliasis. Triclabendazole is the first line of therapeutic drugs for fascioliasis.
引文
[1] Robinson MW, Dalton JP. Zoonotic helminth infections with particular emphasis on fasciolosis and other trematodiases[J].Philos Trans R Soc Lond B Biol Sci, 2009, 364(1530):2763-2776.
[2]顾伟,苏慧勇,邹静,等.云南省首次暴发巨片形吸虫感染的临床诊治分析[J].中国寄生虫学与寄生虫病杂志, 2012,30(6):455-459.
[3]谢玉兰,李丽,韩大康,等.人肝片形吸虫病1例报告[J].临床肝胆病杂志, 2014, 30(2):166-167.
[4]姜建强,李谦,陈忠清,等.肝片形吸虫感染一例[J].中华传染病杂志, 2014, 32(2):123.
[5]范洪波,蒋艳,刘玉芬,等.经内镜逆行性胰胆管造影术中发现肝脏片形吸虫病一例[J].中华消化杂志, 2017, 37(11):780-781.
[6]马桂洋,杨冬梅. 2016年云南3例就诊片形吸虫病例报告[J].寄生虫病与感染性疾病, 2017, 15(3):65-66.
[7]李彦,邓银,孙黎.肝外肝片形吸虫病例报告[J].寄生虫病与感染性疾病, 2017, 15(2):119-120.
[8]中华人民共和国国家卫生和计划生育委员会. WS/T 566-2017片型吸虫病诊断[S].北京:中国标准出版社, 2017.
[9]蒋国喜,蒋国成,刘焕凤.肝片形吸虫病的防控[J].畜牧与饲料科学, 2010, 31(11):196-197.
[10]周岩,熊彦红,许学年.《片形吸虫病诊断》标准解读[J].中国寄生虫学与寄生虫病杂志, 2018, 36(4):425-428.
[11]刘倩,程娜,周岩,等.片形吸虫病研究进展[J].中国寄生虫学与寄生虫病杂志, 2013, 31(3):229-234.
[12]杜伟,张靓,顾伟,等.肝脏巨片形吸虫感染的CT和MRI表现[J].实用放射学杂志, 2014, 30(5):804-807.
[13] Villegas F, Angles R, Barrientos R, et al. Administration of triclabendazole is safe and effective in controlling fascioliasis in an endemic community of the Bolivian Altiplano[J]. PLoS Negl Trop Dis, 2012, 6(8):e1720.
[14] Tavil B, Okbozkaya I, Tezer H, et al. Severe iron deficiency anemia and marked eosinophilia in adolescent girls with the diagnosis of human fascioliasis[J]. Turkish J Pediatr, 2014,56(56):307-309.
[15] Aroonroch R, Worawichawong S, Nitiyanant P, et al. Hepatic fascioliasis due to Fasciola hepatica:a two-case report[J].Chotmaihet thangphaet, 2006, 89(10):1770-1774.
[16]张国丽,苏慧勇,周俊,等.云南省宾川县28例大片形吸虫病患者的临床分析[J].中华实验和临床感染病杂志(电子版), 2014, 8(5):667-670.
[17]汤林华,许隆祺,陈颖丹.中国寄生虫病防治与研究[M].北京:北京科学技术出版社, 2012.
[18]张莉莉,王会珍,刘钢.云南肝片吸虫病首例报告[J].中国寄生虫病防治杂志, 2005, 18(5):30.
[19] Teichmann D, Grobusch MP, G bels K, et al. Acute fascioliasis with multiple liver abscesses[J]. Scand J Infect Dis,2000, 32(5):558-560.
[20]杜晓冬,廖琳,马莹,等.肝片形吸虫病误诊1例[J].预防医学情报杂志, 2011, 27(1):73-74.
[21]王淑真,蔡清源,杨金镇.急性肝片形吸虫病误诊肝癌1例[J].中国寄生虫病防治杂志, 1997, 10(1):38.
[22]杨振平.肝片吸虫病误诊1例[J].中西医结合肝病杂志,2006, 16(5):289.
[23]张学妹,常正山,张永年,等.肝片吸虫病误诊一例报告[J].中国寄生虫学与寄生虫病杂志, 2002, 20(2):47.
[24]董振英,任秋兰,陈述英,等.肝片吸虫病误诊一例[J].中华儿科杂志, 2001, 29(2):87.
[2]顾伟,苏慧勇,邹静,等.云南省首次暴发巨片形吸虫感染的临床诊治分析[J].中国寄生虫学与寄生虫病杂志, 2012,30(6):455-459.
[3]谢玉兰,李丽,韩大康,等.人肝片形吸虫病1例报告[J].临床肝胆病杂志, 2014, 30(2):166-167.
[4]姜建强,李谦,陈忠清,等.肝片形吸虫感染一例[J].中华传染病杂志, 2014, 32(2):123.
[5]范洪波,蒋艳,刘玉芬,等.经内镜逆行性胰胆管造影术中发现肝脏片形吸虫病一例[J].中华消化杂志, 2017, 37(11):780-781.
[6]马桂洋,杨冬梅. 2016年云南3例就诊片形吸虫病例报告[J].寄生虫病与感染性疾病, 2017, 15(3):65-66.
[7]李彦,邓银,孙黎.肝外肝片形吸虫病例报告[J].寄生虫病与感染性疾病, 2017, 15(2):119-120.
[8]中华人民共和国国家卫生和计划生育委员会. WS/T 566-2017片型吸虫病诊断[S].北京:中国标准出版社, 2017.
[9]蒋国喜,蒋国成,刘焕凤.肝片形吸虫病的防控[J].畜牧与饲料科学, 2010, 31(11):196-197.
[10]周岩,熊彦红,许学年.《片形吸虫病诊断》标准解读[J].中国寄生虫学与寄生虫病杂志, 2018, 36(4):425-428.
[11]刘倩,程娜,周岩,等.片形吸虫病研究进展[J].中国寄生虫学与寄生虫病杂志, 2013, 31(3):229-234.
[12]杜伟,张靓,顾伟,等.肝脏巨片形吸虫感染的CT和MRI表现[J].实用放射学杂志, 2014, 30(5):804-807.
[13] Villegas F, Angles R, Barrientos R, et al. Administration of triclabendazole is safe and effective in controlling fascioliasis in an endemic community of the Bolivian Altiplano[J]. PLoS Negl Trop Dis, 2012, 6(8):e1720.
[14] Tavil B, Okbozkaya I, Tezer H, et al. Severe iron deficiency anemia and marked eosinophilia in adolescent girls with the diagnosis of human fascioliasis[J]. Turkish J Pediatr, 2014,56(56):307-309.
[15] Aroonroch R, Worawichawong S, Nitiyanant P, et al. Hepatic fascioliasis due to Fasciola hepatica:a two-case report[J].Chotmaihet thangphaet, 2006, 89(10):1770-1774.
[16]张国丽,苏慧勇,周俊,等.云南省宾川县28例大片形吸虫病患者的临床分析[J].中华实验和临床感染病杂志(电子版), 2014, 8(5):667-670.
[17]汤林华,许隆祺,陈颖丹.中国寄生虫病防治与研究[M].北京:北京科学技术出版社, 2012.
[18]张莉莉,王会珍,刘钢.云南肝片吸虫病首例报告[J].中国寄生虫病防治杂志, 2005, 18(5):30.
[19] Teichmann D, Grobusch MP, G bels K, et al. Acute fascioliasis with multiple liver abscesses[J]. Scand J Infect Dis,2000, 32(5):558-560.
[20]杜晓冬,廖琳,马莹,等.肝片形吸虫病误诊1例[J].预防医学情报杂志, 2011, 27(1):73-74.
[21]王淑真,蔡清源,杨金镇.急性肝片形吸虫病误诊肝癌1例[J].中国寄生虫病防治杂志, 1997, 10(1):38.
[22]杨振平.肝片吸虫病误诊1例[J].中西医结合肝病杂志,2006, 16(5):289.
[23]张学妹,常正山,张永年,等.肝片吸虫病误诊一例报告[J].中国寄生虫学与寄生虫病杂志, 2002, 20(2):47.
[24]董振英,任秋兰,陈述英,等.肝片吸虫病误诊一例[J].中华儿科杂志, 2001, 29(2):87.