| 摘要: | 人體犬蛔蟲症(human toxocariasis)為全球常見「被忽略的人畜共通傳染病(Neglected zoonotic diseases)」之一。由於犬蛔蟲幼蟲無法在人體發育為成蟲，會以幼蟲的型態移行於人體各臟器間，造成內臟幼蟲移行症 (Visceral larva migrans, VLM) ，引發感染之慢性發炎。從最新的研究文獻已證實動物模式中，犬蛔蟲會藉由母鼠的垂直感染(vertical transmission)、或透過乳汁傳染(transmammary infection) ，造成子代先天感染(congenital transmission )，並可在幼鼠的腦部組織中回收到幼蟲，可能引起幼鼠之腦部慢性病症。南非洲史瓦濟蘭王國(Kingdom of Swaziland, Southern Africa) ，位在南非與莫三比克間，由於醫療資源貧乏、城鄉發展及公共衛生條件不良，學童的犬蛔蟲陽性感染率高達88.6%，對於一般成人 (尤其是婦女)的感染情形至今仍未知。本研究針對於史國婦女感染犬蛔蟲症疫情與相關危險因子進行探究，使用Western blot篩檢史國婦女之抗犬蛔蟲抗體發現陽性率高達75.7% (399/527)；而問卷結果以Logistic regression model分析，以居住於城鄉地區 (ORs =0.24, 95% CIs=0.13 – 0.44, p<0.0001)與感染犬蛔蟲最具顯著相關。史國婦女主要生育期為小於30歲之年齡層，其犬蛔蟲感染陽性率高達80.4% (148/184) ，與31-50歲之年齡層婦女相比有顯著較高的感染風險 (ORs=0.52, 95% CIs =0.27-0.99, p=0.047) ；儘管與婦女流產情形無統計之相關性 (ORs=0.82, 95% CIs =0.45-1.52, p=0.534) ，並無法顯示婦女感染犬蛔蟲對於懷孕胎兒之影響，因此，懷孕期間若母體受到犬蛔蟲感染，是否可能藉由母體感染給胎兒或幼兒，造成早期感染，仍需進一步針對懷孕婦女及新生兒的犬蛔蟲感染情況進行後續的追蹤，以避免先天性犬蛔蟲症感染之發生。
Human toxocariasis is one of neglected zoonotic diseases worldwide, predominantly caused by Toxocara canis (T. canis) infection. Kingdom of Swaziland is located between South Africa and Mozambique. Because of poor hygiene and sanitation, the seroprevalence of T. canis infection among schoolchildren was reportedly high, reaching 88.6%. According to murine studies, larvae entrapped various tissues in the body were able to cause chronic inflammation and were capable of transmitting into the fetus via placenta or mammary route. We intended to investigate the status of T. canis infection among adult women in Swaziland by employing western blot analysis based on excretory - secretory antigen derived from T. canis larvae (TcES). The overall seroprevalence was quite high as 75.7% (399/527). The logistic regression analysis showed that those participants who lived in suburban areas seemed to be more susceptible to T. canis infection as compared to those who lived in urban areas (ORs = 0.24, 95% CIs = 0.13 – 0.44, p<0.0001). The age group of less than 30 years old, who are the major childbearing age population in Swaziland, had higher opportunity in acquisition of T. canis infection (80.4% ;148/184), than those in the age group of 31-50 years (ORs= 0.52, 95% CIs =0.27-0.99, p=0.047). Although there was no significant association between T. canis infection and history of abortion among adult women (ORs=0.82, 95% CIs =0.45-1.52, p=0.534), it remained serious concerns to further investigate on whether congenital toxocaral transmission may occur to pregnant women in Swaziland in the future. |
