蚤传立克次体病的表现与防治。

IF 3.1 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Maria A Caravedo Martinez, Alejandro Ramírez-Hernández, Lucas S Blanton
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引用次数: 7

摘要

鼠斑疹伤寒和蚤传斑点热分别是由斑疹伤寒立克次体和猫立克次体引起的未分化发热性疾病。这些微生物是小的专性细胞内细菌,通过跳蚤传播给人类。鼠型斑疹伤寒是热带和亚热带沿海地区(特别是港口城市)的地方性疾病,大鼠是主要哺乳动物宿主,鼠蚤(非洲鼠爪蚤)是病媒。在美国,一个涉及负鼠和猫蚤(猫头蚤)的传播循环分别是假定的宿主和媒介。鼠斑疹伤寒的发病率和分布在美国的流行地区似乎正在增加。猫立克次体在世界各地也有报道,并且在无处不在的猫跳蚤中被发现。跳蚤传播的立克次体病表现为一种未分化的发热性疾病。头痛、不适和肌痛是伴随发烧的常见症状。皮疹的发生率是可变的,因此没有皮疹不应阻止临床医生将立克次体病作为鉴别诊断的一部分。出现皮疹时,通常为黄斑或丘疹。虽然不是鼠斑疹伤寒的特征,但在12%的跳蚤传播的斑疹热患者中发现了焦痂。确诊的实验室诊断通常通过血清学获得;间接免疫荧光试验是血清学试验的选择。在发病的最初几天,抗体很少出现。因此,诊断需要急性期和恢复期标本来证明血清转化或抗体滴度增加四倍。由于实验室诊断通常是回顾性的,当考虑到跳蚤传播的立克次体病时,应开始经验性治疗。儿童和成人的治疗选择都是强力霉素,其结果是迅速有效的反应。现就蚤源性立克次体病的临床、流行病学、生态学、诊断和治疗等方面进行综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Manifestations and Management of Flea-Borne Rickettsioses.

Murine typhus and flea-borne spotted fever are undifferentiated febrile illnesses caused by Rickettsia typhi and Rickettsia felis, respectively. These organisms are small obligately intracellular bacteria and are transmitted to humans by fleas. Murine typhus is endemic to coastal areas of the tropics and subtropics (especially port cities), where rats are the primary mammalian host and rat fleas (Xenopsylla cheopis) are the vector. In the United States, a cycle of transmission involving opossums and cat fleas (Ctenocephalides felis) are the presumed reservoir and vector, respectively. The incidence and distribution of murine typhus appear to be increasing in endemic areas of the US. Rickettsia felis has also been reported throughout the world and is found within the ubiquitous cat flea. Flea-borne rickettsioses manifest as an undifferentiated febrile illness. Headache, malaise, and myalgia are frequent symptoms that accompany fever. The incidence of rash is variable, so its absence should not dissuade the clinician to consider a rickettsial illness as part of the differential diagnosis. When present, the rash is usually macular or papular. Although not a feature of murine typhus, eschar has been found in 12% of those with flea-borne spotted fever. Confirmatory laboratory diagnosis is usually obtained by serology; the indirect immunofluorescence assay is the serologic test of choice. Antibodies are seldom present during the first few days of illness. Thus, the diagnosis requires acute- and convalescent-phase specimens to document seroconversion or a four-fold increase in antibody titer. Since laboratory diagnosis is usually retrospective, when a flea-borne rickettsiosis is considered, empiric treatment should be initiated. The treatment of choice for both children and adults is doxycycline, which results in a swift and effective response. The following review is aimed to summarize the key clinical, epidemiological, ecological, diagnostic, and treatment aspects of flea-borne rickettsioses.

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Research and Reports in Tropical Medicine
Research and Reports in Tropical Medicine MEDICINE, RESEARCH & EXPERIMENTAL-
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