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目的对1例感染源不明的疟疾病例进行流行病学溯源调查与实验室检测,以明确其传播方式和传染源。方法收集该病例临床资料,并开展流行病学溯源调查。采集患者和疑似传染源(供血者)的血样,采用血涂片镜检、快速疟疾诊断试剂条(RDT)和巢氏PCR等3种方法进行检测。结果该患者无疟疾流行区外出史,因手术输血后,出现畏寒、发热,骨髓片和外周血涂片镜检均诊断为恶性疟原虫感染,RDT检测恶性疟原虫阳性。经溯源调查,疑似传染源的供血者为非洲务工返乡人员,在献血前曾有似疟疾样发病,自行服用抗疟药后参与无偿献血,RDT检测血站存留血样为恶性疟原虫阳性,后采集该供血者血样涂片镜检为恶性疟原虫阳性,将患者血样和供血者血样进一步进行巢式PCR检测均为恶性疟原虫阳性,2份血样的正反两段Small subunit rRNA(SSU rRNA)序列比对相似率均为100%,且均为恶性疟原虫K1型和MAD20型混合感染。结论该病例为输血性恶性疟,因输入非洲返乡人员的血液而感染恶性疟原虫。
Objective To carry out epidemiological investigation and laboratory tests on one case of malaria infection of unknown origin in order to clarify the mode of transmission and source of infection. Methods The clinical data of this case were collected and the epidemiological investigation of origin was carried out. Blood samples of patients and suspected sources of infection (blood donors) were collected and tested by blood smear microscopy, rapid malaria diagnostic reagent (RDT) and nested PCR. Results The patient did not have any history of malaria endemic. After the operation was transfused, cholera and fever were detected. Plasmodium falciparum infection was diagnosed by bone marrow smear and peripheral blood smear microscopy. The positive rate of Plasmodium falciparum was detected by RDT. After traceability investigation, the blood donors suspected to be infected were sent back to Africa as migrant workers, had similar malaria-like illness before blood donation, participated in voluntary blood donation after taking antimalarial medicine by themselves, and the RDT test blood bank blood samples were positive for P. falciparum. Blood samples collected from the donors were positive for Plasmodium falciparum. The blood samples from both donors and blood donors were further positive for nested PCR. Plasmodium falciparum was positive. Two positive and negative Small subunit rRNA (SSU rRNA) The similarity of sequence alignment was 100%, and all were mixed infection of Plasmodium falciparum K1 and MAD20. Conclusion The case was falciparum falciparum malaria, which was infected with Plasmodium falciparum because of the blood supplied to returnees in Africa.