宠物与肝包虫病

棘球绦虫寄生于犬科动物的小肠内,其幼虫棘球蚴寄生在动物和人的肝脏,该病严重危害人类和动物健康,对公共卫生造成了严重威胁。本文对包虫病的类型、危害、流行情况以及防治进行综述,希望有助于社会对该病正确的认识、深入的研究和对疾病的防治工作。     

Selective Angiography in the Diagnosis of Hydatid Disease of the Liver

Six cases of cystic hydatid disease of the liver studied by selective angiography are described. In three of these a very characteristic triad of signs was demonstrated. In the fourth case, where the cysts were relatively small and restricted to the left lobe of the liver, no angiographic abnormality and could be found although the diagnosis was strongly suspected clinically. In the fifth case, where the cyst had virtually extruded itself from the liver and had undergone chronic leakage, the findings were atypical. The sixth patient had an old heavily calcified, non-symptomatic cyst, and here the angiographic findings were unremarkable. We believe that these cases illustrate the great value of selective angiography in this condition and some of its limitations.     

Population-Based Surveillance for Invasive Pneumococcal Disease in Homeless Adults in Toronto

Background

Identification of high-risk populations for serious infection due to S. pneumoniae will permit appropriately targeted prevention programs.

Methods

We conducted prospective, population-based surveillance for invasive pneumococcal disease and laboratory confirmed pneumococcal pneumonia in homeless adults in Toronto, a Canadian city with a total population of 2.5 M, from January 1, 2002 to December 31, 2006.

Results

We identified 69 cases of invasive pneumococcal disease and 27 cases of laboratory confirmed pneumococcal pneumonia in an estimated population of 5050 homeless adults. The incidence of invasive pneumococcal disease in homeless adults was 273 infections per 100,000 persons per year, compared to 9 per 100,000 persons per year in the general adult population. Homeless persons with invasive pneumococcal disease were younger than other adults (median age 46 years vs 67 years, P<.001), and more likely than other adults to be smokers (95% vs. 31%, P<.001), to abuse alcohol (62% vs 15%, P<.001), and to use intravenous drugs (42% vs 4%, P<.001). Relative to age matched controls, they were more likely to have underlying lung disease (12/69, 17% vs 17/272, 6%, P = .006), but not more likely to be HIV infected (17/69, 25% vs 58/282, 21%, P = .73). The proportion of patients with recurrent disease was five fold higher for homeless than other adults (7/58, 12% vs. 24/943, 2.5%, P<.001). In homeless adults, 28 (32%) of pneumococcal isolates were of serotypes included in the 7-valent conjugate vaccine, 42 (48%) of serotypes included in the 13-valent conjugate vaccine, and 72 (83%) of serotypes included in the 23-valent polysaccharide vaccine. Although no outbreaks of disease were identified in shelters, there was evidence of clustering of serotypes suggestive of transmission of pathogenic strains within the homeless population.

Conclusions

Homeless persons are at high risk of serious pneumococcal infection. Vaccination, physical structure changes or other program to reduce transmission in shelters, harm reduction programs to reduce rates of smoking, alcohol abuse and infection with bloodborne pathogens, and improved treatment programs for HIV infection may all be effective in reducing the risk.     

A Pilot Study for Control of Hyperendemic Cystic Hydatid Disease in China

Background

Cystic hydatid disease (CHD) is a global parasitic zoonosis caused by the dog tapeworm, Echinococcus granulosus. The disease is hyperendemic in western China because of poor economic development; limited community knowledge of CHD; widespread, small-scale household animal production; home killing of livestock; and the feeding of dogs with uncooked offal.

Methodology/Principal Findings

A control program focusing on monthly praziquantel (PZQ) treatment of all registered dogs and culling unwanted and stray dogs has been designed to control CHD in hyperendemic areas in China. A pilot field control project in two counties (Hutubi and Wensu) in Xinjiang, China showed that after 4 years of treatment, the prevalence of dogs with E. granulosus was reduced from 14.7% and 18.6%, respectively, to 0%, and this caused a 90%–100% decrease of CHD in sheep born after commencement of the control program.

Conclusions/Significance

The strategy aimed at preventing eggs being released from dogs into the environment by treating animals before adult tapeworms are patent can decrease E. granulosus transmission and considerably reduce hyperendemic CHD. Monthly treatment of dogs with PZQ and culling unwanted and stray dogs have been shown to be an efficient, highly cost-effective and practicable measure for implementation in rural communities. As a result, the Chinese Ministry of Health has launched an extensive CHD control program in 117 counties in western China using this control strategy.     

Incidence of Heart Disease in Children in the City of Toronto

A special registry of children with heart disease in the City of Toronto was set up (a) to provide for follow-up of all children with heart disease in that community, (b) to remove the “cardiac” label from children with functional murmurs, (c) to acquaint parents with facilities available for the management of children with heart disease, and (d) to record useful data regarding heart disease in children.The 1961-62 Cardiac Registry showed that 542 of 156,775 pre-school and school children had evidence of heart disease; 464 were congenital and 68 rheumatic in origin: 121 children with congenital heart defects had been treated surgically. Congenital cardiac disease ranked fifth in frequency among the causes of death in children. There was a diminution of acute rheumatic fever and rheumatic heart disease in children in 1961-62 when compared with data for previous years. Seventy-eight per cent of children in this series with a history of rheumatic fever were receiving continuous prophylaxis.     

Clinical and Demographic Characteristics of Patients with Urinary Tract Hydatid Disease

Background

Human cystic echinococcosis (CE) is caused by flatworm larvae of Echinococcus granulosus and is endemic in many parts of the world. In humans, CE cysts primarily affect the liver and pulmonary system, but can also affect the renal system. However, the clinical manifestations of renal CE can be subtle, so healthcare professionals often overlook renal CE in differential diagnosis. In this study, we examined the clinical and demographic characteristics of patients with urinary tract CE and analyzed the diagnosis and treatment procedures for this disease.

Methods

The records of 19 consecutive renal CE patients who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 1983 to April 2011 were retrospectively reviewed. In all cases, CE of the urinary tract was confirmed by pathological examination and visual inspection during surgery.

Results

Fifteen patients were males and 4 were females. The most common symptoms were non-specific lower back pain and percussion tenderness on the kidney region. All patients were followed up for 9–180 months after surgery. None of the patients experienced a recurrence of renal CE, but 4 patients experienced non-renal recurrence of hydatid disease.

Conclusions

Hydatid cysts from E. granulosus are structurally similar in the liver and urinary tract. Thus, the treatment regimen for liver CE developed by the World Health Organization/Informal Working Group on Echinococcosis (WHO/IWGE) could also be used for urinary tract CE. In our patients, the use of ultrasound, computed tomography, serology, and clinical characteristics provided a diagnostic accuracy of 66.7% to 92.3%.