Background Naegleria fowleri , a pathogenic free-living amoeba, causes primary amoebic meningoencephalitis (PAM), a rare but devastating disease with acute onset, rapid progression, and > 95% mortality. Despite its rarity, the catastrophic outcomes associated with this infection underscore the critical importance of prevention. In this report, we present a rare pediatric fatality caused by PAM in China, highlighting the challenges of diagnosis and treatment. Case presentation A 6-year-old child from Lushan County, Henan Province, developed persistent high fever, headache, vomiting, and altered mental status on December 5, 2024. After receiving ineffective local treatment, the child was transferred to the Eastern District of Henan Children’s Hospital on December 7 for further evaluation and management. Upon admission, cerebrospinal fluid was collected for laboratory analysis, and antimicrobial therapy, including amphotericin B, fluconazole, and rifampicin, was promptly initiated. Despite these interventions, the patient’s condition deteriorated rapidly, and the child succumbed to the infection on December 9. Conclusions Clinical and laboratory findings strongly suggest that the child was infected with N. fowleri , resulting in PAM. Epidemiological investigation suggests possible exposure at a public bathhouse. Given the survival characteristics of the N. fowleri and potential habitat expansion due to global warming, this sporadic case underscores PAM's lethal potential. With mortality exceeding 95%, early recognition and prompt intervention are crucial. Clinicians should maintain high suspicion for PAM in patients with compatible symptoms, especially in regions with warm freshwater exposure.

BACKGROUND:Malaria, which is transmitted by Anopheles mosquitoes (Diptera: Culicidae), remains a critical global public health problem. Vector control interventions, particularly insecticide-based strategies, are pivotal for malaria control and elimination, as the efficacy of these interventions is heavily dependent on the high susceptibility of Anopheles mosquitoes to insecticides. However, insecticide resistance in mosquito vectors poses a considerable threat to the sustainability of these control efforts. Notably, no synthesis data on insecticide resistance have been reported in China in recent decades. METHODS:This systematic review and meta-analysis aimed to assess the mortality rates and frequency of knockdown resistance (kdr) and acetylcholinesterase-1 (ace-1) mutations in Anopheles mosquitoes. The Chinese National Knowledge Infrastructure, Wan Fang, PubMed, Embase, and Web of Science databases were searched from 2000 to 2024 to identify relevant articles. Meta-analysis was performed using R and Stata software. RESULTS:Thirty articles reporting 30,065 An. sinensis were included. The pooled mortality rate for insecticide resistance was 61% [95% confidence interval (CI): 53-68]. The mortality rates of various insecticides were as follows: dichlorodiphenyltrichloroethane (DDT), 49%; deltamethrin, 47%; malathion, 81%; propoxur, 69%; permethrin, 61%; beta-cyfluthrin, 28%; fenitrothion, 82%; beta-cypermethrin, 48%; cyfluthrin, 59%; and lambda-cyhalothrin, 56%. Moreover, the frequency of knockdown resistance (kdr) to insecticides was 36%, whereas the frequency of acetylcholinesterase-1 (ace-1) resistance was 78%. Kdr genotype analysis revealed that 13% of the reported mosquitoes were homozygote resistant, 13% were heterozygote resistant, and 74% were zygote susceptible. Ace-1 genotype analysis revealed that 42% of the reported mosquitoes were homozygote resistant, 25% were heterozygote resistant, and 33% were zygote susceptible. CONCLUSIONS:Of An. sinensis, 36% had kdr mutations, and 78% had ace-1 mutations. These vectors were resistant to pyrethroid, organochlorine, carbamate, and organophosphate insecticides. To prevent the development of resistance to alternative insecticides, it is critical to target Anopheles mosquitoes with novel chemical insecticides or biocontrol approaches.

Sulfadoxine-pyrimethamine (SP) is a key drug recommended by the World Health Organization for the chemoprevention of malaria. However, the strategy is affected by the parasite resistance to SP. This study evaluated Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes, associated with SP resistance, from 508 P. falciparum isolates imported from West African countries to Henan Province, China, during 2012-2022. High mutant prevalence of the genes Pfdhfr (94.7%) and Pfdhps (96.8%) was observed. The mutants Pfdhfr N51I, C59R, S108N, and Pfdhps A437G were at high frequency in all countries analyzed. The overall prevalence of the mutant Pfdhps K540E was low (3.4%), but with a high frequency in Liberia (24.3%). The frequency of mutants Pfdhps I431V, A581G, and A613S was 11.7%, 9.8%, and 16.2%, respectively, all of which had the highest mutant prevalence in Nigeria. The mutant Pfdhps A581G and A613S were identified in the absence of K540E. The partially resistant haplotype (I51R59N108 - G437) was the most common (72.6%), and the fully resistant haplotype (I51R59N108 - G437E540) had a low prevalence of 3.4% and mainly occurred in Liberia. No super resistant haplotype was identified. The mutant Pfdhps I431V and the octuple mutant haplotype I51R59N108 - V431A436G437G581S613 deserve more attention. In areas of high SP resistance, the intervention still reduces low birthweight and maternal anaemia. SP should continue to be used in areas of high SP resistance until more effective alternatives for malaria chemoprevention are found. It is important to continuously monitor the molecular markers associated with SP resistance to better implement intermittent preventive treatment policies in pregnancy (IPTp) and infants (IPTi).

对1例蓝氏贾第鞭毛虫感染者进行虫种分子鉴定并分析其感染来源.收集患儿与其父母、保姆的新鲜粪样,碘液染色后镜检,提取粪样DNA,采用巢式PCR扩增贾第虫磷酸丙糖异构酶(tpi)、谷氨酸脱氢酶(gdhi)、β-贾第素(bg)基因并测序,通过BLAST、ChromasPro和MEGA 11.0等软件对基因序列进行系统进化分析并判断其集聚体类型.结果显示,镜下可见患儿粪样中有贾第虫滋养体和包囊.巢式PCR均扩增出约500 bp的条带,与贾第虫属tpi、gdh、bg基因片段一致,确认该患儿为贾第虫感染;患儿父母和保姆均无腹泻症状,但在其父亲粪样中发现贾第虫包囊,结合巢式PCR与测序结果分析,其父为贾第虫带虫者.基因比对分析结果显示,患儿父子二人粪样扩增出的tpi、gdh、bg基因序列一致性分别为99.8％、100％和98.5％,其中tpi基因序列与贾第虫集聚体AⅡ型(GenBank登录号:LC183963)的序列一致性分别为100％、99.8％,gdh基因序列与贾第虫集聚体AⅡ型(GenBank登录号:KF843931)的序列一致性分别为99.6％、100％,患儿bg基因序列与集聚体AⅢ型(GenBank登录号:LC183968)的序列一致性为99.2％,患儿父亲bg基因序列与集聚体AⅡ型(GenBank登录号:LC183975)的序列一致性为100％.系统进化树分析结果显示,患儿与其父亲所感染的贾第虫均与集聚体A型虫株聚在一支,且以tpi和gdh为靶基因进行亚型分析均与贾第虫集聚体AⅡ型聚在一支.由此判断患儿为贾第虫集聚体AⅡ型感染,且可能为家庭内部传播导致的家庭聚集性感染.

Visceral leishmaniasis (VL) was widely prevalent in Henan Province in the 1950s. Through active efforts by the government, there were no local cases reported from 1984 to 2015. In 2016, local VL cases reoccurred, and there was an increasing trend of VL cases in Henan Province. To provide a scientific control of VL, an investigation was conducted in Henan Province from 2016 to 2021. The data from VL cases were obtained from the Disease Surveillance Reporting System of the Chinese Center for Disease Control and Prevention. The rK39 immunochromatographic test (ICT) and PCR assay were performed among high-risk residents and all dogs in the patients’ village. ITS1 was amplified, sequenced, and subjected to phylogenetic analyses. A total of 47 VL cases were reported in Henan Province during 2016–2021. Of the cases, 35 were local, and they were distributed in Zhengzhou, Luoyang, and Anyang. The annual average incidence was 0.008/100,000, showing an upward trend year by year (χ2 = 3.987, p = 0.046). Their ages ranged from 7 months to 71 years, with 44.68% (21/47) in the age group of 0–3 years and 46.81% (22/47) in the age group ≥15 years. The cases occurred throughout the year. The high-risk populations were infants and young children (age ≤3), accounting for 51.06% (24/47), followed by farmers at 36.17% (17/47). The ratio of males to females was 2.13:1. The positive rates of rK39 ICT and PCR were 0.35% (4/1130) and 0.21% (1/468) in the residents. The positive rates of rK39 ICT and PCR were 18.79% (440/2342) and 14.92% (139/929) in the dogs. The ITS1 amplification products in the patients and positive dogs were sequenced. The homology between the target sequence and Leishmania infantum was more than 98%. The phylogenetic analysis indicated that the patients and the positive dogs were infected by the same type of Leishmania, which was consistent with the strains in the hilly endemic areas in China. This paper showed that patients and domestic dogs were infected by the same type of L. infantum and that the positive rate in dogs was relatively high in Henan Province. Because the measures of patient treatment and culling of infected dogs were not effective in reducing VL incidence in Henan Province, it is urgent to develop new approaches for the control of VL, such as wearing insecticide-impregnated collars on dogs, treating the positive dogs, spraying insecticide for sandflies control, and improving residents’ self-protection awareness to prevent the further spread of VL in Henan Province.

Background Historically, malaria due to Plasmodium vivax has been epidemic in Henan Province, China, with Anopheles sinensis as the main vector. The most effective measures to prevent malaria transmission are based on vector control through the use of insecticides. However, insecticides exert a strong selective pressure on mosquito populations for insecticide resistance. The aim of this study was to investigate the susceptibility profile and population genetic characteristics of An. sinensis to provide basic data and scientific guidance for the study of resistance mechanisms and the control of An. sinensis in Henan Province. Methods Adult Anopheles mosquitoes were collected at sites near local farmers' sheepfolds, pigsties and/or cowsheds located in Pingqiao, Xiangfu, Xiangcheng and Tanghe counties/districts of Henan Province during July–September 2021 for insecticide susceptibility testing. Molecular identification of collected mosquitoes as belonging to genus Anopheles was by PCR, and the frequencies of mutations in the knockdown resistance gene ( kdr ) and acetylcholinesterase-1 gene ( ace-1 ) were detected using gene amplification. The mitochondrial DNA cytochrome oxidase subunit I (COI) gene was amplified in deltamethrin-resistant and deltamethrin-sensitive mosquitoes to analyze the genetic evolutionary relationship. Results A total of 1409 Anopheles mosquitoes were identified by molecular identification, of which 1334 (94.68%) were An. sinensis , 28 (1.99%) were An. yatsushiroensis , 43 (3.05%) were An. anthropophagus and four (0.28%) were An. belenrae . The 24-h mortality rates of An. sinensis in Pingqiao, Tanghe, Xiangcheng and Xiangfu counties/districts exposed to deltamethrin were 85.85%, 25.38%, 29.73% and 7.66%, respectively; to beta-cyfluthrin, 36.24%, 70.91%, 34.33% and 3.28%, respectively; to propoxur, 68.39%, 80.60%, 37.62% and 9.29%, respectively; and to malathion, 97.43%, 97.67%, 99.21% and 64.23%, respectively. One mutation, G119S, was detected in the ace-1 gene. The frequencies of the main genotypes were 84.21% of specimens collected in Xiangfu (G/S), 90.63% of speciments collected in Xiangcheng (G/G) and 2.44% of speciments collected in Tanghe (S/S). Significantly higher G119S allele frequencies were observed in both propoxur- and malathion-resistant mosquitoes than in their sensitive counterparts in the Tanghe population ( P < 0.05). Three mutations, L1014F (41.38%), L1014C (9.15%) and L1014W (0.12%), were detected in the kdr gene. The genotypes with the highest frequency in the populations of An. sinensis in Xiangfu and Tanghe were the mutant TTT (F/F) and wild-type TTG (L/L), at 67.86% (57/84) and 74.29% (52/70), respectively. In Pingqiao and Xiangfu, higher frequencies of the L1014F allele and lower frequencies of the L1014C allele were observed in mosquitoes resistant for beta-cyfluthrin than in those which were sensitive for this insecticide ( P < 0.05). The results of Tajima's D and of Fu and Li's D and F were not significantly negative ( P > 0.10), and each haplotype was interlaced and did not form two distinct branches. Conclusions High resistance to pyrethroids and propoxur was observed at four sites, but the resistance to malathion varied according to the location. Anopheles belenrae and the L1014W (TGG) mutation in An. sinensis were first discovered in Henan Province. The deltamethrin-resistant and deltamethrin-sensitive mosquito populations showed no genetic differentiation. The generation of resistance might be the result of the combination of multiple factors. Graphical Abstract

目的 了解河南省信阳地区家畜寄生蜱感染巴贝虫的情况.方法 2022年6-8月在河南省信阳市光山县和商城县采集家畜动物体表寄生蜱,采用形态学和PCR扩增蜱虫16S rDNA鉴定蜱虫种类.提取蜱虫基因组DNA,采用巢式PCR扩增巴贝虫18S rRNA基因.目的条带经测序后,进行BLAST比对分析,采用邻接法构建系统进化树,采用MEGA7.0软件进行同源性分析.结果 共采集335只蜱,形态学和PCR扩增鉴定结果显示,长角血蜱49只、微小扇头蜱208只、褐黄血蜱1只、具环扇头蜱34只、刻点血蜱43只.PCR扩增结果显示,335份蜱虫样品中有2份样品扩增出巴贝虫400 bp大小的目的条带,蜱虫巴贝虫总阳性率为0.6％.BLAST比对分析结果显示,1份样品扩增出的18S rRNA序列与GenBank中来自美国(MK609547)、泰国(MG199181)、中国(KU204794)的田鼠巴贝虫序列相似性均达99.26％;另1份样品扩增出的18S rRNA序列与GenBank中来自美国(MH620203)、印度(MN161136)和中国(KP666166)的吉氏巴贝虫序列相似性均达100％.系统进化树分析结果显示,田鼠巴贝虫阳性样品与来自俄罗斯(KX987864)、中国(KU204794)、泰国(MG199179)等地的田鼠巴贝虫聚在同一分支上,同源性较高;吉氏巴贝虫阳性样品与来自中国(FJ769386)、美国(MH620203)和印度(KF606884)等地的吉氏巴贝虫聚在同一分支上,同源性较高.结论 河南省信阳地区家畜寄生蜱存在田鼠巴贝虫和吉氏巴贝虫感染,可能对人和家畜有一定的致病风险.

To understand the resistance of Anopheles sinensis to insecticides,An.sinensis were captured near sheepfolds,pigstys or cowsheds in four counties （districts）,including Pingqiao District of Xinyang City,Xiangfu District of Kaifeng City,Xiangcheng District of Xuchang City,and Tanghe County of Nanyang City in Henan Province from July to September 2021.The An.sinesis was identified by morphology.The insecticide susceptibility test of female An.sinensis was determined by the filter-paper bioassay,which is recommended by WHO,using 0.05%deltamethrin （0.017 8 g/m~2）,0.15%beta-cyfluthrin （0.053 4 g/m~2）,0.1%propoxur （0.035 7 g/m~2）,and 5%malathion （1.78 g/m~2）.The result showed that a total of 1 334 An.sinensis were used for insecticide susceptibility test in Pingqiao District,Xiangfu District,Xiangcheng County and Tanghe County.The mosquitoes were exposed to the four insecticide films,including,beta-cyfluthrin,deltamethrin,propoxur and malathion.The longest knockdown time of the first mosquito exposed to deltamethrin was seen in mosquitoes collected from Tanghe was 25.85 min,and the shortest knockdown time of the first mosquito exposed to deltamethrin was seen in mosquitoes collected from Pingqiao,which was 2.83 min.The knockdown rate of cypermethrin against the tested mosquitoes from Pingqiao District,Xiangfu District,Xiangcheng County and Tanghe County after 60 min was 24.42%（21/86）,2.47%（2/81）,37.31%（25/67） and 45.45%（25/55）,respectively （χ~2=39.355,P＜0.05）.The knockdown rate of deltamethrin against mosquitoes from all different sites were75.86%（66/87）,2.33%（2/86）,10.81%（8/74） and 20.35%（23/113）,respectively （χ~2=142.630,P＜0.05）.The knockdown rate of propoxur against mosquitoes from all different sites were 48.28%（42/87）,22.62%（19/84）,50.50%（51/101） and 72.34%（34/47）,respectively （χ~2=32.635,P＜0.05）.The knockdown rate of malathion against mosquitoes from all different sites were 66.29%（59/89）,15.69%（16/102）,82.54%（104/126） and 91.84%（45/49）,respectively（χ~2=133.489,P＜0.05）.The mortality rate of mosquitoes from Tanghe exposed to beta-cypermethrin and propoxur for 24 h was 70.91%and 80.60%,respectively,and the mortality rate of mosquitoes from Pingqiao exposed to deltamethrin for 24 h was 85.85%,which had reached resistance.The 24 h mortality rates of mosquitoes from Pingqiao and Tanghe to malathion were 97.43%and 97.67%.The resistance levels were possible resistance;The 24 h mortality rates of mosquitoes from Xiangfu and Xiangcheng to malathion were 64.23%and 99.21%.The resistance levels were resistance and susceptible.The resistance level of An.sinensis to malathion varies from susceptible to resistance but has developed resistance to deltamethrin,beta-cyfluthrin,and propoxur in four surveillance sites of Henan Province.

目的 对市级疟疾诊断实验室送交的样本进行复核,评价市级疟疾检测能力.方法 对2020-2021年收到的疟疾血涂片和抗凝全血样本进行复核,依据血涂片制作、染色、清洁度等指标对血涂片进行逐张评分,评价和比较各送样单位血涂片质量,计算血片制作染色合格率.采用镜检和荧光PCR对样本进行复核,分析和比较送样单位疟疾阳性符合率和虫种符合率情况.结果 2020-2021年各市级疟疾诊断实验室送交的134份血涂片、137份抗凝全血样本(存在一例病例多家单位送样),河南省疟疾诊断参比实验室复核确认疟疾病例118份,其中间日疟原虫11份,恶性疟原虫48份,三日疟原虫9份,卵型疟原虫45份,混合感染5份,阴性19份.市级疟疾诊断实验室平均阳性符合率86.13％(118/137),虫种符合率83.89％(99/118).134张血涂片制作、染色、清洁度及综合判定的合格率分别为98.50％(132/134),70.14％(94/134),69.40％(93/134)和 97.01％(130/134).市级疟疾诊断实验室血涂片镜检阳性符合率 86.56％(116/134),虫种符合率84.48％(98/116),间日疟原虫,恶性疟原虫、卵形疟原虫、三日疟原虫、混合感染的误判率分别为18.18％(2/11),4.17％(2/48),22.22％(10/45),22.22％(2/9),80.00％(4/5).结论 应持续提高血涂片染色质量,通过推进市级疟疾诊断实验室网络建设,提高疟疾检测准确率,巩固河南省消除疟疾成果.

One Health is a collaborative, multi-sectoral, trans-disciplinary approach with the goal of achieving optimal health outcomes by recognizing the interconnection between people, animals, plants, and the environment and determining how this relates to the control of infectious diseases such as malaria, schistosomiasis and so on. Malarias caused by Plasmodium that commonly infects female Anopheles mosquitoes, which feed on human blood and act as a disease vector. It has been a worldwide important public health problem from ancient times. Also, malaria is one of the infectious diseases with the longest epidemic time and the most serious harm in the history of Henan Province, China. During the past decades, the multi-sectoral, cross-regional, and multi-disciplinary One Health approach contributed to a significant reduction in malaria incidence, resulting in initiation of the Henan Malaria Elimination Action Plan. Herein, we reviewed the history of the fight against malaria in Henan Province. A full picture of malaria epidemics, prevention, and control strategies were showed, with the objective that it will help stakeholders, and policy-makers to take informed decisions on public health issues and intervention designs on malaria control towards elimination in the similar areas.

目的 分析小鼠感染肝毛细线虫后肝脏microRNA(miRNA)的表达谱,筛选差异表达miRNA,为肝毛细线虫感染致肝纤维化机制研究提供资料.方法 6只雄性BABL/c小鼠随机分为肝毛细线虫感染组和对照组,每组3只.感染组小鼠经灌胃感染肝毛细线虫感染期虫卵(20个卵/鼠),对照组灌胃等量生理盐水.感染后35 d分别取感染组和对照组小鼠的肝组织,进行组织切片、苏木精-伊红(HE)染色后,镜下观察肝组织病变情况.提取和纯化小鼠肝组织总RNA进行文库构建和miRNA高通量测序.通过生物信息学分析筛选差异表达的miRNA,预测其靶基因并进行基因本体论(GO)和京都基因与基因组百科全书(KEGG)富集分析.采用实时荧光定量PCR(qRT-PCR)对部分差异表达miRNA进行验证分析.结果 肝组织切片的HE染色结果显示,感染组小鼠肝组织呈虫卵肉芽肿性病变,伴有明显的炎性细胞浸润;对照组肝细胞形态完整,未见炎性细胞浸润、变性坏死和纤维化.通过miRNA测序,筛选出差异表达的miRNA共16条,4条表达上调,且均上调2倍以上,其中mmu-miR-129-5p上调4倍以上;12条表达下调,均下调0.5倍以下,其中mmu-miR-21a-3p下调0.1倍以下.miRNA靶基因GO功能分析显示,富集的基因主要参与了信号转导、蛋白连接、转化酶活性、G蛋白偶联受体通路、细胞凋亡的负向调控、细胞增殖的正向调控、转录调控等;KEGG通路分析显示,富集的信号通路主要有Hippo信号通路、Ras信号通路、mTOR信号通路、磷脂类信号通路、Wnt信号通路.qRT-PCR检测结果显示,感染组2个上调基因mmu-miR-21a-3p和mmu-miR-181a-1-3p的相对表达水平分别为0.70±0.30和0.68±0.27,2个下调基因mmu-miR-409-5p和mmu-miR-129-5p的相对表达水平分别为1.27±0.24和2.61±0.52,与参考基因相比表达水平均与测序结果趋势一致.结论 肝毛细线虫感染导致小鼠肝组织miRNA表达谱发生了改变,mmu-miR-409-5p和mmu-miR-129-5p等基因可能是参与肝纤维化的候选基因.

BackgroundFor the past few years, only a few monovalent EV71 vaccines have been developed, while other enterovirus vaccines are in short supply. We conducted a quantitative meta-analysis to explore the epidemiological characteristics, routine laboratory diagnosis, clinical signs and risk factors for hand, foot and mouth disease (HFMD). MethodsPubMed, Embase and the Web of Science were searched for eligible reports published before April 16, 2021, with no publication time or language restrictions. The primary outcome was the odds ratio of the epidemiological characteristics, routine laboratory diagnosis, and clinical signs associated with HFMD severity and death. ResultsAfter screening 10522 records, we included 32 articles comprising 781903 cases of hand, foot and mouth disease. Patients with severe illness developed some clinical signs (hypersomnia (OR = 21.97, 95% CI: 4.13 to 116.74), convulsion (OR = 16.18, 95% CI: 5.30 to 49.39), limb shaking (OR = 47.96, 95% CI: 15.17 to 151.67), and breathlessness (OR = 7.48, 95% CI: 1.90 to 29.40)) and had some changes in laboratory parameters (interleukin-6 levels standardized mean difference (SMD) = 1.57, 95%CI: 0.55 to 2.60), an increased neutrophils ratio (SMD = 0.55, 95%CI: 0.17 to 0.93), cluster of differentiation 4 (CD4+) (SMD = -1.38, 95%CI: -2.33 to -0.43) and a reduced lymphocytes ratio (SMD = -0.48, 95%CI: -0.93 to -0.33)) compared with patients with mild illness. The risk factors for death included cyanosis (OR = 5.82, 95% CI: 2.29 to 14.81), a fast heart rate (OR = 3.22, 95% CI: 1.65 to 6.30), vomiting (OR = 2.70, 95% CI: 1.33 to 5.49) and an increased WBC count (SMD = 0.60, 95% CI: 0.27 to 0.93). ConclusionsChina has the highest incidence of HFMD. Our meta-analyses revealed important risk factors that are associated with the severity and mortality of HFMD.

Abstract Background Plasmodium falciparum malaria is recognized as a major global public health problem. The malaria vaccine was important because the case fatality rate of falciparum malaria was high. Plasmodium falciparum circumsporozoite protein (PfCSP) is one of the potential vaccine candidates, but the genetic polymorphism of PfCSP raises concerns regarding the efficacy of the vaccine. This study aimed to investigate the genetic polymorphism of PfCSP and provide data for the improvement of PfCSP-based vaccine (RTS,S malaria vaccine). Methods Blood samples were collected from 287 Chinese migrant workers who were infected with P. falciparum and returning from Africa to Henan Province during 2016–2018. The Pfcsp genes were analysed to estimate the genetic diversity of this parasite. Results The results showed that there were two mutations at the N-terminus of imported Pfcsp in Henan Province, including insertion amino acids (58.71%, 118/201) and A → G (38.81%, 78/201). The number of repeats of tetrapeptide motifs (NANP/NVDP/NPNP/NVDA) in the central repeat region ranged mainly from 39 to 42 (97.51%, 196/201). A total of 14 nonsynonymous amino acid changes were found at the C-terminus. The average nucleotide difference (K) of imported Pfcsp in Henan Province was 5.719, and the haplotype diversity (Hd) was 0.964 ± 0.004. The estimated value of dN-dS was 0.047, indicating that the region may be affected by positive natural selection. The minimum number of recombination events (Rm) of imported Pfcsp in Henan Province was close to that in Africa. The analysis of genetic differentiation showed that there may be moderate differentiation between East Africa and North Africa (Fst = 0.06484), and the levels of differentiation in the other regions were very small (Fst < 0.05). Conclusions The N-terminus of Pfcsp was relatively conserved, and the central repeat region and the Th2R and Th3R regions of the C-terminus were highly polymorphic. The gene polymorphism pattern among Chinese migrant workers returning from Africa to Henan Province was consistent with that in Africa. The geographical pattern of population differentiation and the evidence of natural selection and gene recombination suggested that the effect of polymorphism on the efficacy of PfCSP-based vaccines should be considered.

目的 了解焦作市消除疟疾后传疟媒介种群及密度情况,为消除疟疾后传疟媒介的控制和输入性疟疾再传播风险评估提供科学依据.方法 2020—2021年选择焦作市共7个县(市、区)作为传疟媒介监测点,使用诱蚊灯法及人帐诱法开展种群及密度监测,挑选大中型水体环境共20处,采用勺捕法开展蚊虫孳生地调查.结果 7个县(市、区)中除解放区外均捕获有中华按蚊.2020年媒介种群监测共捕获蚊虫8116只,其中中华按蚊构成比为21.76％,修武县捕获中华按蚊数量最多(1262只),沁阳市捕获中华按蚊构成比最高(40.39％);室内环境中中华按蚊数量多,而室外环境中中华按蚊构成比高;密度监测共捕捉蚊虫802只,平均密度为30.55只/人·小时,其中中华按蚊136只,平均密度为5.18只/人·小时;在稻田环境中捕获按蚊孑孓126条,其余水体未发现.2021年种群监测捕捉蚊虫10852只,中华按蚊构成比为1.67％,修武县捕获中华按蚊数量最多(179只),构成比最高(1.99％);室内环境捕获中华按蚊数量及构成比均高于室外环境;密度监测共捕获蚊虫3662只,平均密度为130.79只/人·小时,其中中华按蚊108只,平均密度为3.86只/人·小时;在稻田环境中捕获按蚊孑孓3条,其余水体未发现.结论 中华按蚊是焦作市主要传疟媒介,分布较广,密度较高.消除疟疾后,输入性间日疟再传播的风险仍然存在.

目的:探索与发热伴血小板减少综合征(SFTS)患者病情相关联的影响因素.方法:选取2019年5月、6月河南省信阳市后勤保障部队第九九〇医院在感染科确诊的SFTS的患者69例.采集SFTS患者血清,同时收集病例的临床诊断资料和流行病学资料.根据患者病情将病例分为轻症(n=43)、重症(n=15)及危重症(n=11)3个等级,比较3组间实验室检测指标的差异.结果:3组患者血小板(PLT)、天门冬氨酸氨基转移酶(AST)、谷丙转氨酶(ALT)、肌酸激酶(CK)、血清乳酸脱氢酶(LDH)、新布尼亚病毒(SFTSV)载量的组间差异有统计学意义(P<0.05).与患者疾病严重程度相关联的因素有年龄、SFTSV载量、PLT、白细胞(WBC)、AST、ALT、LDH和CK(P<0.05),其中PLT、WBC与严重程度呈负相关,其余变量均与严重程度呈正相关.与患者SFTSV载量相关联的因素有PLT、WBC、LDH、AST、ALT、CK、年龄及淋巴结肿大面积.结论:PLT、WBC、LDH、AST、ALT、CK及年龄与患者疾病严重程度和病毒载量存在关联,可作为患者病情分级及预测患者预后的重要指标.

目的 分析2011-2020年河南省间日疟流行病学特征,为制定消除疟疾后防止再传播策略和措施提供数据支撑.方法 收集2011-2020年河南省间日疟疫情数据及相关病例资料,对疫情概况、地区分布、感染来源及复发情况等进行统计分析.结果 2011-2020年河南省共报告间日疟病例317例,占报告疟疾病例总数的16.60％(317/1 910).其中本地感染间日疟病例171例,输入间日疟病例146例.自2012年起,全省无本地感染疟疾病例报告.输入间日疟病例以境外输入为主,占95.21％,来源国由2011年的8个扩展到24个.2011-2020年,9例间日疟病例出现复发,复发时间均小于1年,其中2例病例出现二次复发.对全省159个县(市/区)进行再传播风险分层,20个有间日疟再传播风险,139个有潜在间日疟再传播风险.结论 2012年以来河南省已连续9年无本地疟疾病例,但输入性间日疟再传播风险持续存在.应做好监测和疫点处置工作,评估输入性间日疟传播风险,巩固消除疟疾成果.

Background Severe fever with thrombocytopenia syndrome (SFTS) is a serious infectious disease with a fatality of up to 30%. To identify the severity of SFTS precisely and quickly is important in clinical practice. Methods From June to July 2020, 71 patients admitted to the Infectious Department of Joint Logistics Support Force No. 990 Hospital were enrolled in this study. The most frequently observed symptoms and laboratory parameters on admission were collected by investigating patients' electronic records. Decision trees were built to identify the severity of SFTS. Accuracy and Youden's index were calculated to evaluate the identification capacity of the models. Results Clinical characteristics, including body temperature (p = 0.011), the size of the lymphadenectasis (p = 0.021), and cough (p = 0.017), and neurologic symptoms, including lassitude (p<0.001), limb tremor (p<0.001), hypersomnia (p = 0.009), coma (p = 0.018) and dysphoria (p = 0.008), were significantly different between the mild and severe groups. As for laboratory parameters, PLT (p = 0.006), AST (p<0.001), LDH (p<0.001), and CK (p = 0.003) were significantly different between the mild and severe groups of SFTS patients. A decision tree based on laboratory parameters and one based on demographic and clinical characteristics were built. Comparing with the decision tree based on demographic and clinical characteristics, the decision tree based on laboratory parameters had a stronger prediction capacity because of its higher accuracy and Youden's index. Conclusion Decision trees can be applied to predict the severity of SFTS.

目的 基于ELISA检测技术,探讨恙虫病患者血清细胞因子水平变化,为探索其临床意义及作用机制提供科学依据.方法 收集确诊患者血清和健康人血清.利用ELISA技术检测外周血清8种细胞因子表达水平.采用SAS 9.1软件进行统计学分析.结果 病例组中IL-8、IFN-γ、MCP-1、TNF-α等4种细胞因子浓度的中位数分别为34.09pg/mL、17.58 pg/mL、181.42 pg/mL、33.49 pg/mL,表达水平较对照组有不同程度升高(P＜0.05);病例组RANTES浓度的中位数为8.69 pg/mL,较对照组低(P＜0.05);其余细胞因子表达水平在两组间差异无统计学意义(P＞0.05).重症组患者的血清IFN-γ、MCP-1、TNF-α浓度中位数分别为34.57 pg/mL、299.41 pg/mL、103.00 pg/mL,表达水平比轻症组患者明显升高(P＜0.05),但血清IL-2、IL-8、IL-10、TNF-β、RANTES水平在重症组和轻症组患者之间差异无统计学意义(P＞0.05).IL-8与TNF-β(r=0.703,P=0.001)呈现正相关性,但其余细胞因子(IL-2、IL-10、IFN-γ、MCP-1、TNF-α、RANTTES)之间无相关性.结论 恙虫病东方体感染机体会导致多种血清细胞因子水平改变.血清IFN-γ、MCP-1,TNF-α水平的含量可以反映病情严重程度,对恙虫病病情评估具有重要的临床应用价值.

目的 了解河南省基层医务人员的疟疾防治知识知晓情况和培训需求,进而提升全省疟疾防治能力,巩固消除疟疾成果.方法 采用随机数表法,确定河南省许昌市、开封市为调查地区,对2019年参加河南省许昌市、开封市疟疾培训的医务人员在培训前和培训后以匿名自填问卷的方式进行调查并统计分析.结果 本次共调查93人,男女比例为1∶1.82,平均年龄(36.78±8.20)岁,学历以专科或本科为主;单位以县级工作人员为主,占76.34％;超过90.00％的调查对象所在科室为传染病防治科和检验科.培训前,调查对象疟疾防治知识答题正确率平均为71.88％.不同单位级别、职称、学历、科室之间的答题正确率均有统计学意义(x2=6.697～20.233,P均＜0.05).培训后的答题正确率平均为80.75％,较培训前有所提高(x2=40.492,P＜0.001).77.42％的调查对象认为疟疾诊断方法和技术培训最为重要.结论 河南省市、县级医务人员对疟疾知识的掌握情况较好,但仍需要在疟疾基础知识、疟疾治疗、疟疾监测与响应等方面加强培训,以提高响应的能力.

Severe fever with thrombocytopenia syndrome (SFTS) is recognized as an emerging infectious disease. This study aimed to investigate the pathogenic mechanism of SFTS. A total of 100 subjects were randomly included in the study. Cytokine levels were detected by enzyme‐linked immunosorbent assay and the viral load was detected by micro drop digital PCR. The results showed that levels of interleukin‐6 (IL‐6), IL‐8, IL‐10, IFN‐inducible protein‐10 (IP‐10), monocyte chemoattractant protein‐1 (MCP‐1), macrophage inflammatory protein‐1α (MIP‐1α), transforming growth factor‐β1 (TGF‐β1), and regulated upon activation normal T cell expressed and secreted factor (RANTES) differed significantly among the SFTS patient group, healthy people group, and asymptomatic infection group (p < .05). Compared to the healthy people group, the patient group had increased cytokine levels (IL‐6, IL‐10, IP‐10, MCP‐1, and IFN‐γ) but reduced levels of IL‐8, TGF‐β1, and RANTES (p < .0167). IL‐6, IL‐8, IL‐10, IP‐10, MCP‐1, MIP‐1α, TGF‐β1, and the RANTES levels had different trends after the onset of the disease. IL‐6, IL‐10, IP‐10, and MCP‐1 levels in severe patients were higher than those in mild patients (p < .05). There was a positive correlation between viral load and IL‐6 and IP‐10 but a negative correlation between viral load and RANTES. SFTSV could cause a cytokine change: the cytokine levels of patients had different degrees of fluctuation after the onset of the disease. The levels of IL‐6 and IL‐8 in the asymptomatic infection group were found between the SFTS patients group and the healthy people group. The levels of IL‐6, IL‐10, IP‐10, and MCP‐1 in the serum could reflect the severity of the disease, and the levels of IL‐6, IP‐10, and RANTES were correlated with the viral load.