上海洋山口岸外籍船员耐多药肺结核病例的确诊及处置

   陆晔1，王健1，章琪1，张晓航1，顾超1，贾哲甫1，周浩2，韩晓辉1，田桢干3，方筠1

    1.上海国际旅行卫生保健中心，上海200335；2.洋山出入境检验检疫局；3.上海出入境检验检疫局

    摘要：目的确诊及处置外籍耐多药肺结核船员病例，总结和完善国境口岸传染性肺结核的排查及处置方案。方法应用分子生物技术结合痰液涂片、培养、鉴定及药物敏感试验确诊病例。结果该病例浓集法痰液涂片抗酸染色3+，液体及固体培养均为阳性，细菌鉴定为结核分枝杆菌复合群，一线抗结核药物敏感试验结果为异烟肼、利福平、链霉素、吡嗪酰胺耐药，乙胺丁醇敏感。结论胸部X线摄片、痰涂片加分子生物学检测，结合临床症状能快速有效的判断传染性肺结核，出入境交通工具工作人员患传染性肺结核后缺乏规范治疗，成为传染源。口岸检疫人员应采取相应措施，救治病人、切断传播途径、保护易感人群，做好口岸防疫工作，发挥服务码头、服务船方的作用。

    关键词 国境口岸；肺结核；快速诊断；耐多药结核病

    中图分类号：R521　文献标识码：B

    Diagnosis and disposal of foreign crew withthe resistant

    multi-drug TB at Shanghai Yangshan port

    LU Ye*， WANG Jian， ZHANG Qi，ZHANGXiao-hang，GU Chao， JIA Zhe-fu，ZHOU Hao，

    HAN Xiao-hui，TIAN Zhen-gan，FANG Yun

    *Shanghai International Travel HealthcareCenter, Shanghai 200335, China

    Abstract:   Objective  To summarize the diagnosis and disposal process of MDR-TB cases atShanghai Yangshan port, and to improve the investigation anddisposal program of infectious pulmonary tuberculosis at frontierport.  Methods   The sputum smear,culture ,identification and molecular biology were used, combined withclinical to determine infectious tuberculosis. Results   The result of sputum smear was acid-faststaining3+, liquid and solid cultures were positive, bacterialidentification was Mycobacterium TB complex group. The first-lineanti-TB drug susceptibility test results, isoniazid, rifampicin,streptomycin, pyrazinamide were resistant, and ethambutol wassensitive.  Conclusion   Chest X-ray, sputum smearand molecular biology, combined with clinical symptoms can be usedto quickly determine infectious tuberculosis. The internationaltransport staff suffering from infectious tuberculosis who lack ofstandard treatment, will become the source of infection. Inspectionand Quarantine staff based on the above results can immediatelytake appropriate measures to treat patient，cut off the route oftransmission, protect vulnerable populations, do their best toprevent infectious  diseases at frontier port.

    Key words:   Frontier port；Tuberculosis； Rapid diagnosis； MDR-TB

    《中国国境卫生检疫杂志》2012年8月刊