上海市某医院艾滋病合并梅毒病例特征分析及影响因素探讨

为了解近年来上海市艾滋病合并梅毒患者的特征及变化趋势,探讨艾滋病患者合并梅毒的影响因素,本研究收集了2013—2019年上海市(复旦大学附属)公共卫生临床中心(简称临床中心)诊断为艾滋病合并梅毒的病例作为研究对象。经详细查询研究对象的住院登记资料和病史,本文整理出用于研究的资料,并将研究对象分为艾滋病合并梅毒组和艾滋病不合并梅毒组。结果显示,临床中心艾滋病患者中有10.55%合并梅毒;2013—2019年临床中心艾滋病合并梅毒感染率总体呈上升趋势(χ2＝17.640,P<0.05),每年7—8月份为收治高峰期。患者主要来源于本地居民(占55.49%),男女性别比为14∶1,平均年龄为38±12岁。通过Logistic回归分析发现,影响艾滋病合并梅毒的因素有性别、年龄、病例来源和CD4^＋T细胞计数,其中本地来源、年龄在21～40岁、男性和CD4^＋T细胞计数≤500 /μL是艾滋病患者合并梅毒感染的高危因素。研究提示,上海市艾滋病合并梅毒感染病例数呈上升趋势,重点防控人群是上海市青壮年男性居民,应提高对此类人群的主动监测能力,加大筛查力度,做好健康教育;重点防控时间是每年7、8月份,应精准防控以期取得明显效果。本研究为上海市此类疾病防控提供了一定的科学依据。     

我国法定的传染病及报告制度

中华人民共和国成立后,经国务院批准,卫生部于1955年7月5日公布的“传染病管理办法”把应管理的传染病定为二类十八种。同年9月6日卫生部又增加7种,共计25种,介绍如下: 甲类传染病:鼠疫、霍乱和天花等。乙类传染病:流行性乙型脑炎、白喉、斑疹伤寒、回归热、痢疾(杆菌性痢与阿米巴痢)、伤寒及副伤寒、猩红热、流行性脑脊髓膜炎、麻疹、     

第三世界的主要疾病

疾病名称急性呼吸道感染循环系统疾病腹泻麻疹估计年死亡人数1000万疾病名称狂犬病估计年死亡人数艾滋病痛症疟疾结核病乙型肝炎百日咳伤寒脑(脊)膜炎1 70万1 50万90万80万60万60万35万蛔虫病贾第鞭虫病脊翻灰质炎麻风血吸虫病梅毒变形虫病20万20万7万利什受病3.5万人感染(常致死)非洲南撒哈拉以及南亚和东南亚有800万人感染10亿人感染.相似文献   

鸡西市1957-2003 年法定传染病流行病学分析

目的：分析鸡西市1957-2003年传染病流行趋势和演变规律,为控制和消除传染病制订防治对策提供依据。方法：采用描述流行病学,对鸡西市1957-2003年法定报告传染病发病和死亡情况进行分析。结果：47年共报告传染病22种（328896例）,年平均发病率690．08／10万,死亡率4．90／10万,病死率0,71％。发病率居前5位的为菌痢、麻疹、病毒性肝炎、肺结核和流感;发病率下降幅度较大的有麻疹、百日咳、白喉、脊灰,近10余年相对稳定的主要有病毒性肝炎、菌痢和流行性出血热,呈上升趋势的主要有肺结核、淋病和梅毒。结论：今后应重点加强对病毒性肝炎、菌痢、流行性出血热、肺结核、淋病和梅毒等传染病防治。     

未来的疫苗

<正> 在人类发展的历史中,从来没有产生过一种比免疫更有效、更廉价的方法来预防疾病(G.Edsall,1963)。这项报告反映了疫苗在预防天花、脊髓灰质炎、麻疹、狂犬病、黄热病、白喉和破伤风疾病上的成功;它们在控制这些疾病中起了重要作用。但是,这些成功不应使我们看不清传染病仍然是世界性的主要健康问题。     

大连市2011年疟疾疫情调查

目的 了解大连市疟疾疫情流行现状,为制定科学防治措施提供依据.方法 以2011年度大连市疾病预防控制中心疟疾疫情报告资料为基础,描述和分析大连市疟疾疫情概况.结果 大连市疟疾病例均为输入性病例,其中非洲输入性病例为14例,占全部病例的93.33％(14/15);大部分疟疾病例居住在瓦房店、普兰店、庄河市、长海县等农村地区,占全部病例的73.33％(11/15);他们的文化程度较低,初中以下学历占73.33％(11/15).结论 大连市以输入性疟疾病例为主,非洲为输入性病例主要疫源地.应加强疟疾培训,强化医务人员及时发现和有效处理疟疾的技能培训,普及疟疾防治知识.     

2019年辽宁省3例输入性三日疟基因型别实验室诊治与分析

对辽宁省2019年的3例境外输入性三日疟疟疾病例进行了实验室检测与诊断分析。 收集并进行流行病学调查与资料汇总。根据疟疾实验室现有最新执行诊断标准《疟疾的诊断》（WS259-2015）的要求，对临床诊断的疑似三日疟患者采集抗凝血制作血涂片镜检、进行疟疾快速诊断检测（RDT），上送全血到辽宁省疾病预防控制中心进行病例复核，巢氏PCR检测并进行测序比对。3份病例患者外周血血涂片镜检薄厚血膜，虫体分期主要为环状体期、大滋养体期、配子体期和成熟裂殖体期，其中大滋养体期中疟色素呈深棕色、较大、沿边缘分布，发现寄生的红细胞通常不胀大甚至会缩小，配子体小而圆，根据镜下特点初步判定为三日疟原虫；RDT结果提示为感染除恶性疟以外的其他3种疟疾（三日疟、卵形疟、间日疟）的单一感染，省级参比实验室对于上送全血利用巢氏PCR检测技术进行复核检测；将扩增出的三日疟的目的片段产物序列送至上海维基基因测序公司进行序列分析比对，基因序列同源性达到了100%。 同时使用血涂片镜检、进行疟疾快速诊断检测（RDT）和PCR进行检测，实验结果均鉴定为三日疟，根据病例的流行病学调查和临床表现确定为境外输入性三日疟病例。     

广州首起输入性基孔肯雅热的调查分析

广州网络报告的疑似"登革热"患者经广州市疾病预防控制中心流行病学调查、血清学检测、病原学分离培养等做出的诊断为首例输入性基孔肯雅热。又经中国疾病预防控制中心和广东省疾病预防控制中心对疑似基孔肯雅热患者作进一步基孔肯雅病毒抗体和核酸等检测,并对扩增出的基孔肯雅病毒特异性片段进行了序列测定和分析。核苷酸同源性比较显示,E2区(336nt)和NS1区(314nt)的核苷酸序列与意大利基孔肯雅病毒分离株ITA07-RA1及多株印度的基孔肯雅病毒分离株的序列高度同源(98%以上)。根据现场流行病学和实验流行病学的调查结果,可以确认这例疑似境外感染的输入性登革热实为基孔肯雅热病例,也是中国首例输入性基孔肯雅热病例。     

日照市2005—2011年麻疹监测分析

目的分析日照市2005—2011年麻疹流行病学特征,为制定消除麻疹策略及措施提供依据。方法对日照市2005—2011年麻疹监测系统资料进行描述流行病学分析。结果日照市2005—2011年共报告麻疹病例193例,其中2011年无病例报告,年平均报告发病率0.97/100 000。麻疹病例分布各区县,但不同区县之间存在差异,发病高峰在3—6月,以15岁以上大年龄组发病为主;散发和暴发并存,散发以本土病例为主,共暴发疫情3起,均为输入性病例。结论日照市消除麻疹已取得显著进展,应继续保持和巩固高水平儿童基础免疫接种率,高质量地完成MV SIA,加强监测和风险评估,做好暴发疫情的预警与控制工作,实现消除麻疹。     

慈溪市输入性登革热的临床特征分析

2004年9月浙江省慈溪市逍林镇发生多例不明原因的发热病例。根据流行病学调查及实验室检测结果,确定是一起由输入性病例引起的登革热爆发疫情。现将本院收治的34例登革热从临床特征进行回顾性分析。     

Enhanced passive surveillance dengue infection among febrile children: Prevalence,co-infections and associated factors in Cameroon

Dengue virus (DENV) causes a spectrum of diseases ranging from asymptomatic, mild febrile to a life-threatening illness: dengue hemorrhagic fever. The main clinical symptom of dengue is fever, similar to that of malaria. The prevalence of dengue virus infection, alone or in association with other endemic infectious diseases in children in Cameroon is unknown. The aim of this study was to determine the prevalence of dengue, malaria and HIV in children presenting with fever and associated risk factors.Dengue overall prevalence was 20.2%, Malaria cases were 52.7% and HIV cases represented 12.6%. The prevalence of dengue-HIV co-infection was 6.0% and that of Malaria-dengue co-infection was 19.5%. Triple infection prevalence was 4.3%. Dengue virus infection is present in children and HIV-Dengue or Dengue- Malaria co-infections are common. Dengue peak prevalence was between August and October. Sex and age were not associated with dengue and dengue co-infections. However, malaria as well as HIV were significantly associated with dengue (P = 0.001 and 0.028 respectively). The diagnosis of dengue and Malaria should be carried out routinely for better management of fever.     

感染性疾病内皮活化/功能障碍的生物标记物的研究进展

内皮功能障碍在脓毒症、重症疟疾及登革出血热等多种感染性疾病发病机制中起着重要作用。由于内皮活化常先于内皮功能障碍,血清或/血浆中相应内皮生物标记物常较传统疾病标记物更早被检测到,故可作为评估全身感染性疾病严重程度或预后的指标。本文主要介绍了内皮细胞功能介质(血管生成素-1和血管生成素-2)和可溶性细胞表面黏附分子(可溶性E-选择素、sICAM-1和sVCAM-1)在脓毒症、疟疾及登革出血热等疾病中的表达及临床意义。     

Imported Malaria in the United Kingdom

Over 2,000 cases of imported malaria have been confirmed by blood examination. Ninety percent. of cases from tropical Africa were infected with P. falciparum. Most of the patients were Caucasians and had primary infections. All developed fever within a month after arrival and most of them within two weeks of arrival. In some patients malaria parasites were seen in routine blood films.Developing forms of P. falciparum were always present in the peripheral blood of patients suffering from a primary attack which was not diagnosed or treated until a week or more after the onset of fever.All deaths investigated were caused by P. falciparum and were primary infections.In not one of the P. falciparum infections did the victim continue taking prophylactic drugs for more than a few days after leaving the endemic area. Had drugs been continued for one month probably not a single overt case of P. falciparum would have occurred.A primary attack of P. falciparum malaria is seldom, if ever, classical in that the fever is never tertian and may resemble clinically many other diseases.Children in boarding-schools returning from the tropics should be supplied with prophylactic tablets and instructions to the matron. If there is an epidemic of a fever any students who have recently returned from the tropics should have a blood film examined for malaria.The risk of contracting malaria among drug addicts is considerable, especially with P. falciparum.     

Perspectives in the control of infectious diseases by transgenic mosquitoes in the post-genomic era--a review

Arthropod-borne diseases caused by a variety of microorganisms such as dengue virus and malaria parasites afflict billions of people worldwide imposing major economic and social burdens. Despite many efforts, vaccines against diseases transmitted by mosquitoes, with the exception of yellow fever, are not available. Control of such infectious pathogens is mainly performed by vector management and treatment of affected individuals with drugs. However, the numbers of insecticide-resistant insects and drug-resistant parasites are increasing. Therefore, inspired in recent years by a lot of new data produced by genomics and post-genomics research, several scientific groups have been working on different strategies to control infectious arthropod-borne diseases. This review focuses on recent advances and perspectives towards construction of transgenic mosquitoes refractory to malaria parasites and dengue virus transmission.     

Malaria epidemic expected in Mozambique

Health experts fear epidemics of several infectious diseases in Mozambique as floods recede and mosquitoes begin breeding. According to Pierre Kahozi of WHO, malaria is already endemic in the region but there are fears that a much greater outbreak might occur. Scores of suspected cases of cholera were reported and more are expected, along with cases of other diarrheal conditions. Neil Cameron, chief director of communicable diseases at the health department in South Africa, said that more cases are expected within a month when the breeding cycle of mosquitoes is renewed. He reported that the number of malaria cases in South Africa increased from 12,000 in 1995 to 50,000 in 1999, and a number of people had been dying from this disease. The increase could be attributed partly to climatic changes and resistance to certain drugs. DDT had been used in the past to control mosquitoes, and it?s possible that it will be used again in Mozambique. The issues involved in tackling malaria are now being considered as part of a special development initiative on infectious diseases that is being undertaken jointly by the health departments of three countries: South Africa, Mozambique, and Swaziland.     

Dengue and Chikungunya Fever among Viral Diseases in Outpatient Febrile Children in Kilosa District Hospital,Tanzania

Introduction

Viral etiologies of fever, including dengue, Chikungunya, influenza, rota and adeno viruses, cause major disease burden in tropical and subtropical countries. The lack of diagnostic facilities in developing countries leads to failure to estimate the true burden of such illnesses, and generally the diseases are underreported. These diseases may have similar symptoms with other causes of acute febrile illnesses including malaria and hence clinical diagnosis without laboratory tests can be difficult. This study aimed to identify viral etiologies as a cause of fever in children and their co-infections with malaria.

Methods

A cross sectional study was conducted for 6 months at Kilosa district hospital, Tanzania. The participants were febrile children aged 2–13 years presented at the outpatient department. Diagnostic tests such as IgM and IgG ELISA, and PCR were used.

Results

A total of 364 patients were enrolled, of these 83(22.8%) had malaria parasites, 76 (20.9%) had presumptive acute dengue infection and among those, 29(38.2%) were confirmed cases. Dengue was more likely to occur in children ≥ 5 years than in <5 years (OR 2.28, 95% CI: 1.35–3.86). Presumptive acute Chikungunya infection was identified in 17(4.7%) of patients. We observed no presenting symptoms that distinguished patients with Chikungunya infection from those with dengue infection or malaria. Co-infections between malaria and Chikungunya, malaria and dengue fever as well as Chikungunya and dengue were detected. Most patients with Chikungunya and dengue infections were treated with antibacterials. Furthermore, our results revealed that 5(5.2%) of patients had influenza virus while 5(12.8%) had rotavirus and 2(5.1%) had adenovirus.

Conclusion

Our results suggest that even though viral diseases are a major public health concern, they are not given due recognition as a cause of fever in febrile patients. Emphasis on laboratory diagnostic tests for proper diagnosis and management of febrile patients is recommended.     

Discriminating Malaria from Dengue Fever in Endemic Areas: Clinical and Biological Criteria,Prognostic Score and Utility of the C-Reactive Protein: A Retrospective Matched-Pair Study in French Guiana

Background

Dengue and malaria are two major public health concerns in tropical settings. Although the pathogeneses of these two arthropod-borne diseases differ, their clinical and biological presentations are unspecific. During dengue epidemics, several hundred patients with fever and diffuse pain are weekly admitted at the emergency room. It is difficult to discriminate them from patients presenting malaria attacks. Furthermore, it may be impossible to provide a parasitological microscopic examination for all patients. This study aimed to establish a diagnostic algorithm for communities where dengue fever and malaria occur at some frequency in adults.

Methodology/Principal Findings

A sub-study using the control groups of a case-control study in French Guiana – originally designed to compare dengue and malaria co-infected cases to single infected cases – was performed between 2004 and 2010. In brief, 208 patients with malaria matched to 208 patients with dengue fever were compared in the present study. A predictive score of malaria versus dengue was established using .632 bootstrap procedures. Multivariate analysis showed that male gender, age, tachycardia, anemia, thrombocytopenia, and CRP>5 mg/l were independently associated with malaria. The predictive score using those variables had an AUC of 0.86 (95%CI: 0.82–0.89), and the CRP was the preponderant predictive factor. The sensitivity and specificity of CRP>5 mg/L to discriminate malaria from dengue were of 0.995 (95%CI: 0.991–1) and 0.35 (95%CI 0.32–0.39), respectively.

Conclusions/Significance

The clinical and biological score performed relatively well for discriminating cases of dengue versus malaria. Moreover, using only the CRP level turned to be a useful biomarker to discriminate feverish patients at low risk of malaria in an area where both infections exist. It would avoid more than 33% of unnecessary parasitological examinations with a very low risk of missing a malaria attack.     

Potential Impact of Co-Infections and Co-Morbidities Prevalent in Africa on Influenza Severity and Frequency: A Systematic Review

Infectious diseases and underlying medical conditions common to Africa may affect influenza frequency and severity. We conducted a systematic review of published studies on influenza and the following co-infections or co-morbidities that are prevalent in Africa: dengue, malaria, measles, meningococcus, Pneumocystis jirovecii pneumonia (PCP), hemoglobinopathies, and malnutrition. Articles were identified except for influenza and PCP. Very few studies were from Africa. Sickle cell disease, dengue, and measles co-infection were found to increase the severity of influenza disease, though this is based on few studies of dengue and measles and the measles study was of low quality. The frequency of influenza was increased among patients with sickle cell disease. Influenza infection increased the frequency of meningococcal disease. Studies on malaria and malnutrition found mixed results. Age-adjusted morbidity and mortality from influenza may be more common in Africa because infections and diseases common in the region lead to more severe outcomes and increase the influenza burden. However, gaps exist in our knowledge about these interactions.     

P. vivax Malaria and Dengue Fever Co-infection: A Cross-Sectional Study in the Brazilian Amazon

Background

Malaria and dengue are the most prevalent vector-borne diseases worldwide and represent major public health problems. Both are endemic in tropical regions, propitiating co-infection. Only few co-infection cases have been reported around the world, with insufficient data so far to enhance the understanding of the effects of co-infection in the clinical presentation and severity.

Methodology/Principal Findings

A cross-sectional study was conducted (2009 to 2011) in hospitalized patients with acute febrile syndrome in the Brazilian Amazon. All patients were submitted to thick blood smear and PCR for Plasmodium sp. detection, ELISA, PCR and NS1 tests for dengue, viral hepatitis, HIV and leptospirosis. In total, 1,578 patients were recruited. Among them, 176 (11.1%) presented P. vivax malaria mono-infection, 584 (37%) dengue fever mono-infection, and 44 (2.8%) were co-infected. Co-infected patients had a higher chance of presenting severe disease (vs. dengue mono-infected), deep bleeding (vs. P. vivax mono-infected), hepatomegaly, and jaundice (vs. dengue mono-infected).

Conclusions/Significance

In endemic areas for dengue and malaria, jaundice (in dengue patients) and spontaneous bleeding (in malaria patients) should raise the suspicion of co-infection. Besides, whenever co-infection is confirmed, we recommend careful monitoring for bleeding and hepatic complications, which may result in a higher chance of severity, despite of the fact that no increased fatality rate was seen in this group.     

Therapy of uncomplicated falciparum malaria in Europe: MALTHER - a prospective observational multicentre study

ABSTRACT: BACKGROUND: Malaria continues to be amongst the most frequent infectious diseases imported to Europe. Whilst European treatment guidelines are based on data from studies carried out in endemic areas, there is a paucity of original prospective treatment data. The objective was to summarize data on treatments to harmonize and optimize treatment for uncomplicated malaria in Europe. METHODS: A prospective observational multicentre study was conducted, assessing tolerance and efficacy of treatment regimens for imported uncomplicated falciparum malaria in adults amongst European centres of tropical and travel medicine. RESULTS: Between December 2003 and 2009, 504 patients were included in 16 centres from five European countries. Eighteen treatment regimens were reported,, the top three being atovaquone-proguanil, mefloquine, and artemether-lumefantrine. Treatments significantly differed with respect to the occurrence of treatment changes (p=0.005) and adverse events (p=0.001), parasite and fever clearance times (p<0.001), and hospitalization rates (p=0.0066) and durations (p=0.001). Four recrudescences and two progressions to severe disease were observed. Compared to other regimens, quinine alone was associated with more frequent switches to second line treatment, more adverse events and longer inpatient stays. Parasite and fever clearance times were shortest with artemether-mefloquine combination treatment. Vomiting was the most frequent cause of treatment change, occurring in 5.5% of all patients but 9% of the atovaquone-proguanil group. CONCLUSIONS: This study highlights the heterogeneity of standards of care within Europe. A consensus discussion at European level is desirable to foster a standardized management of imported falciparum malaria.