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广州管圆线虫(Angiostrongylus cantonensis)是一种人兽共患食源性寄生虫病——广州管圆线虫病(Angiostrongyliasis cantonensis)的病原,隶属于线虫目,后圆线虫科,后圆线虫亚科,管圆线虫属[1],广泛分布于热带及亚热带地区,引起重大的公共卫生问题[1-2]。由于其适宜在25~30 ℃的潮湿环境中发育,因此在我国主要分布于浙江、福建、江西、湖南、海南、云南、广西和广东等地[2]。A. cantonensis生活史较复杂,鼠类是A. cantonensis的终末宿主,中间宿主包括陆生和水生软体动物。保虫宿主可以是淡水鱼、虾、蟹、蟾蜍、青蛙,也可以是包括人、猫、犬在内的几十种哺乳动物[3-5]。人作为其非适宜宿主,主要通过摄入感染性幼虫污染的食物而发生感染,引起嗜酸性粒细胞增多性脑膜炎(eosinophilic meningitis, EM)。广州管圆线虫病相对罕见,但随着人们生活方式与饮食习惯的改变,广州管圆线虫病患者越来越多,如今世界累计报告病例已超过3000例。世界卫生组织(WHO)已将广州管圆线虫病列为21世纪新出现的全球威胁性传染病之一。在医疗上通常根据食用软体动物史、临床特征及实验室检查做出推定诊断,但目前已开发出的针对广州管圆线虫病的血清学检测的多种诊断方法的灵敏度及特异性仍有待提高。增加对广州管圆线虫病的认识将有助于快速诊断并改善临床结果,为此,笔者重点对广州管圆线虫的病原生物学、流行病学、发病机理、免疫机制及诊断技术的研究进展进行了概述。
Advances in epidemiology, immune regulation and diagnosis of Angiostrongylus cantonensis
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摘要: 对广州管圆线虫的病原生物学、流行病学、发病机理、免疫机制及诊断技术的研究进展进行了概述。广州管圆线虫(Angiostrongylus cantonensis, A. cantonensis)是一种食源性人兽共患寄生虫,在热带及亚热带地区的许多国家引起重大的公共卫生问题。人作为其非适宜宿主,通过摄入感染性幼虫污染的食物而发生感染,引起嗜酸性粒细胞增多性脑膜炎(eosinophilic meningitis, EM)。广州管圆线虫病的范围正在不断扩大,以前认为无A. cantonensis的地区也出现了感染病例。我国广州管圆线虫病流行情况显示我国广州管圆线虫病相对罕见,但2022年最新流行病学数据显示广州管圆线虫中间宿主的感染率相对较高。通常根据食用软体动物史、临床特征及实验室检查做出推定诊断。目前已开发出多种针对广州管圆线虫病的血清学检测方法,但许多诊断方法的灵敏度及特异性仍有待提高。增加对广州管圆线虫病的认识将有助于快速诊断并改善临床结果。Abstract: Angiostrongylus cantonensis is a zoonotic food-borne parasite, which has caused considerable public health problems in many countries in tropical and subtropical regions of the world. Humans, as unsuitable hosts, are infected by ingesting food contaminated by infective larvae of A. cantonensis, which cause eosinophilic meningitis. Angiostrongyliasis caused by A. cantonensis is expanding, and its cases have occurred in areas previously thought to be free of A. cantonensis. The prevalence of angiostrongyliasis showed that it is relatively rare in China, but the latest epidemiological data in 2022 showed that the infection rate of the intermediate hosts is relatively high. A presumptive diagnosis is usually made based on mollusk consumption history, clinical features, and laboratory examination. A variety of serological detection methods of angiostrongyliasis have been developed, but the sensitivity and specificity of many diagnostic methods remain to be improved. Increasing awareness of angiostrongyliasis will contribute to rapid diagnosis and improved clinical outcomes. A review was made of the researches in parasite biology, epidemiology, pathogenesis, immune mechanism, diagnosis, treatment and prevention of A. cantonensis.
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