台灣地區2001至2004年貓抓病疑似病例回溯性研究及淋巴結免疫組織化學染色診斷

Abstract

韓瑟勒巴通氏菌 (Bartonella henselae)是造成貓抓病 (cat scratch disease)的病原，病人於臨床上主要呈現急性局部性淋巴腺病，從2001年1月至2004年12月台灣各地區有352位疑似貓抓病通報病例共377個血清檢體，使用間接免疫螢光抗體法 (indirect fluorescence antibody assay)來進行血清學分析，有99位病患呈血清學陽性，所以貓抓病疑似病患的血清抗體盛行率為28.1%，此外也針對血清陽性病患的地理分佈、發病季節以及臨床表徵作流行病學的分析，有50.5% (50/99)的血清陽性病患居住在台灣北部地區，而有35.4% (35/99)則是於夏季感染發病。針對152名貓抓病疑似病例的回溯性研究發現，病患與接觸貓以及腋下、手肘部位的淋巴腺病等因子與血清學陽性結果高度相關。另外，由352位貓抓病疑似病患中取得16位病患的淋巴結檢體以及2位病患的皮膚檢體進行免疫組織學的研究，使用多株抗體來進行免疫化學染色 (immunohistochemistry)偵測B. henselae並與以聚合酶鏈反應 (polymerase chain reaction)的結果比較，於淋巴組織的肉芽腫病灶區內，藉由免疫化學染色觀察到位於細胞內的菌體；有10位病患的檢體呈陽性反應，其中有3位病患呈血清抗體陰性反應，而聚合酶鏈反應的結果呈現高度敏感性，有93.3% (14/15)的檢體均呈陽性反應。當無法進行血清學或分子生物學診斷時，可利用免疫化學染色針對Bartonella淋巴腺病來進行病原診斷。

Bartonella henselae is the causative agent of cat scratch diseases (CSD), which usually manifests as acute regional lymphadenopathy. From January 2001 through December 2004, 377 sera from 352 reportable CSD cases were examined by indirect fluorescence antibody assay (IFA). Ninety-nine patients were seropositive to B. henselae and which contributed to 28.1% seroprevalence in CSD suspected patients. Epidemiological features, like geographic and seasonal distribution or clinical presenting symptom were analyzed. There were 50.5% (50/99) of CSD seropositive patients were lived in north of Taiwan and 35.4% (35/99) of them were occurring in summer. The retrospective study of 152 CSD suspected cases demonstrated the seropositive results associated with cat contact, axillary and elbow lymphadenopathy. Immunohistologic studies for localization of B. henselae in collected 16 lymph nodes biopsies and 2 skin biopsies out of 352 patients were carried out by polyclonal antibody-based immunohistochemistry (IHC) and polymerase chain reaction (PCR) for comparing. IHC demonstrated the presence of the organism in intracellular location within granulomatous lesions in lymph node tissues. Ten lymph nodes from CSD suspected patients showed IHC positive and 3 of them were seronegative. The PCR results showed high sensitivity of 93.3% (14/15) cases positive. Immunohistochemistry can contribute to the etiologic diagnosis of Bartonella lymphadenopathy when serology and molecular techniques are not available.