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GBZ324-2019 English PDF

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GBZ324-2019: Diagnosis of occupational lyme disease
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GBZ 324-2019	English	159	Add to Cart	3 days [Need to translate]	Diagnosis of occupational lyme disease	Valid	GBZ 324-2019

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Basic data

Standard ID	GBZ 324-2019 (GBZ324-2019)
Description (Translated English)	Diagnosis of occupational lyme disease
Sector / Industry	National Standard
Classification of Chinese Standard	C60
Word Count Estimation	8,870
Date of Issue	2019
Date of Implementation	2019-07-01
Issuing agency(ies)	State Administration for Market Regulation, China National Standardization Administration

GBZ324-2019: Diagnosis of occupational lyme disease

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Diagnosis of occupational lyme disease ICS 13.100 C 60 Diagnosis of occupational Lyme disease National Occupational Health Standards Published on.2019-01-30 2019-07-01 implementation National Health and Wellness Committee of the People's Republic of China

Foreword

Chapters 5 and 6 of this standard are mandatory and the rest are recommended. This standard is formulated in accordance with the Law of the People's Republic This standard was drafted in accordance with the rules given in GB/T 1.1-2009. This standard was drafted. Heilongjiang Provincial Second Hospital, Heilongjiang Mudanjiang Forestry Center Hospital, Liaoning Provincial Occupational Disease Prevention and Treatment Institute, Jilin Province Occupational Disease Prevention and Treatment Institute. The main drafters of this standard. Song Li, Shi Dongmei, Li Xiaojun, Li Dandan, Zheng Yuanchun, Jiang Yiwen, Wang Ji, Yin Hongnan, Xing Army, Shi Yaohui. Diagnosis of occupational Lyme disease

1 Scope

This standard specifies the principles of diagnosis and treatment of occupational Lyme disease. This standard applies to the diagnosis and treatment of occupational Lyme disease.

2 Normative references

The following documents are indispensable for the application of this document. For dated references, only dated versions apply. This document. For undated references, the latest edition (including all amendments) applies to this document. GB/T 16180 Labor ability appraisal employee injury and occupational disease disability level

3 Terms and definitions

The following terms and definitions apply to this document. 3.1 Occupational Lyme disease occupational lyme disease In the forest area and in the field, the workers are infected by the blood-sucking arthropods such as cockroaches. Epidemic disease.

4 Diagnostic principles

According to the history of biting arthropods in the habitats of cockroaches, there are many skin, nerves, heart and joints. Clinical manifestations of organ and multiple system damage, combined with specific laboratory test results, comprehensive analysis, exclusion of other causes Only after the disease can be diagnosed.

5 diagnosis

5.1 Engaged in forest areas, field operations, and the history of blood-sucking arthropod bites. 5.2 Have at least one of the following clinical manifestations. a) erythema, papules, blistering or necrosis in the central part of the erythema or bite. b) fever, headache, sore throat, muscle pain and other similar cold-like symptoms. c) central or peripheral nervous system damage such as meningitis, cranial neuritis, spinal radiculitis, encephalomyelitis; and/or room Heart damage such as ventricular block, myocarditis, pericarditis. d) bone and joint damage, such as arthritis; and/or skin sclerosis and chronic atrophic dermatitis. 5.3 Have at least one of the following laboratory results. a) High titer Borrelia burgdorferi-specific antibody IgM and serum are detected in serum or body fluids (cerebrospinal fluid, joint fluid, urine) (or) IgG. b) Two-fold serum Borrelia burgdorferi-specific antibody IgM and/or IgG titers increased by a factor of 2 or more. c) Direct detection of damaged sections of the damaged tissue or Borrelia burgdorferi in blood and body fluid smears. d) PCR positive for DNA detection in Borrelia burgdorferi in tissues or body fluids. 5.4 The diagnosis of occupational Lyme disease needs to meet the requirements of 5.1, 5.2 and 5.3 at the same time.

6 staging

6.1 Stage (local skin damage period) Infected with Borrelia burgdorferi 3d ~ 14d around any clinical manifestation of 5.2a) or b), in line with 5.3 laboratory tests At least one. 6.2 Flood season (broadcast infection period) 5.2c) clinical manifestations of infection with Borrelia burgdorferi for weeks or months, and at least one of the 5.3 laboratory tests. 6.3 Flood season (continuous infection period) Infected with Borrelia burgdorferi for 5.2d) clinical manifestations or 5.2c) clinical manifestations for several months or 2 years, in line with 5.3 laboratory tests At least one of them.

7 Processing principles

7.1 Principles of treatment 7.1.1 Pathogen treatment. Apply sensitive antibiotics according to different stages of the disease. 7.1.2 Symptomatic treatment. Eliminate or reduce the pathological damage caused by pathogens, maintain the stability of the body environment, and alleviate the suffering of patients. 7.1.3 Supportive treatment. improve the body's resistance, give psychotherapy, rehabilitation and so on. 7.2 Other treatment If labor capacity is required, it shall be handled in accordance with GB/T 16180.

8 Instructions for the correct use of this standard

See Appendix A.

Appendix A

(informative appendix) Instructions for the correct use of this standard A.1 Epidemiological characteristics of Lyme disease A.1.1 Sources of infection and host. Rodents are the main source of infection and host of this disease. The murines reported in China include Apodemus agrarius, Dalin Apodemus, and yellow. Rat, brown rat and white-footed rat. In addition, more than 30 species of wild animals (rats, deer, rabbits, foxes, wolves, etc.), more than 40 species of birds and a variety of livestock were found. (dogs, cattle, horses, etc.) can be used as a host for this disease. A.1.2 Routes of transmission. caused by bites and bloodsucking in arthropods, between host animals, between host animals and humans. Communication, there is no report of human infection. The types of media sputum vary from region to region, and the northern forest regions of China are mainly hard rafts. The southern forest area is mainly composed of granular hard palate and two-spine blood stasis. The disease-causing spiral is mainly developed in the midgut of the sputum. When biting the host, the pathogen can pass The intestinal contents of the bacteria are spread, saliva or feces. In addition to sputum, the disease can also be caused by other arthropods or insects, such as mosquitoes and horses. And spreads such as deer flies. A.1.3 Susceptible population. The population is generally susceptible, especially for outdoor workers in infected areas. A.1.4 Incubation period. Generally, the disease-causing spiral is infected from 3d to 32d, and most of them are affected from 7d to 9d. A.1.5 Distribution A.1.5.1 Occupation. forest areas, field workers, such as lumberjacks, forest police or rangers, animal farms (beekeeping, deer, etc.) The incidence rate of workers, animal and plant inspectors, geological prospectors, and military personnel is high. A.1.5.2 Season. The time of onset varies slightly in different regions, but is related to the number of vectors and seasonal activities. In our country It can be diagnosed every year, and it is most common from April to August. A.1.5.3 Area. It is mainly in the mountainous area. The northeast and Inner Mongolia forest areas are the main high-risk areas of Lyme disease in China. A.2 About staging The disease is an inflammatory syndrome involving multiple organs and multiple systems, and the patient can be mainly affected by an organ or a certain system. Clinically According to the typical clinical manifestations, Lyme disease is divided into three phases. Generally, the symptoms of each phase can appear in sequence, and there are also overlapping overlaps. In the meantime, the symptoms in the flood season are not obvious, but directly into the flood season. Lymph disease can occur in the acute phase of the disease in group 5.2c) Chronic prolonged clinical manifestations of 5.2 c) disease may occur in the sputum stage. A.3 Laboratory examination of Lyme disease A.3.1 routine examination. the total number of white blood cells is in the normal range, occasionally elevated white blood cells with left nucleus, a small number of patients have microscopic hematuria and Mild proteinuria. ESR is often increased. Lyme disease meningitis and nervous system damage, cerebrospinal fluid lymphocytes and protein increased. heart Atrioventricular block can occur in the electrocardiogram of the injured person. A.3.2 Pathogen examination. the use of histological staining and pathogen separation techniques to detect or isolate Borrelia snails from infected tissues or clinical specimens The spine is the direct basis for the diagnosis of Lyme disease. A.3.2.1 Direct detection of pathogens. take a damaged tissue section of the patient or blood, cerebrospinal fluid, joint fluid, urine smear, using a dark field microscope Direct microscopy at.200x or 400x dark field, or with various histological stains, can be detected in Borrelia burgdorferi, but the detection rate is low. A.3.2.2 Isolation and cultivation of pathogens. The skin around the erythema can be taken for culture, and it needs 1m~2m. Positive blood culture can be used for early diagnosis of the disease Broken, but the positive rate is low. A.3.2.3 Polymerase chain reaction (PCR). This method is used to detect the skin tissue, urine, blood, Borrelia burgdorferi DNA in cerebrospinal fluid, synovial fluid and other tissue specimens. This method is sensitive and specific and is suitable for early diagnosis. A.3.3 Serological examination A.3.3.1 Indirect immunofluorescence (IFA) and enzyme-linked immunosorbent assay (enzyme linked Immunosorbent assay (ELISA). for the detection of specific IgM and/or in serum, cerebrospinal fluid, joint fluid and other specimens IgG antibody. Usually, specific IgM antibodies appear 2w ~ 4w after the occurrence of migratory erythema, 6w ~ 8w peak, more than 4m ~ 6m down to positive Often level; specific IgG antibodies began to increase in the onset of 6w ~ 8w, peaked 4m ~ 6m. Early serological findings of Lyme disease may be Negative, early antibiotic treatment may affect the body's response to specific antibodies, which may result in serological tests that continue to be negative. A.3.3.2 Western blot (WB). its sensitivity and specificity are better than the above serological test method, suitable for upper The results of the two serological methods are suspicious patients. A.3.3.3 Serological examination methods include mutated fluorescent antibody test, enzyme-linked fluorescent test, immunochromatography and the like. A.3.3.4 The increase of the serum-specific antibody titer of 4 times and above collected at a general interval of 4w to 6w is also the basis for determining the diagnosis of the case. However, in the clinical diagnosis and treatment process, it is difficult to collect duplicate serum from 4w to 6w, and the specific antibody titer reaches 4 in actual work. The increase above the fold is almost non-existent; in addition, after treatment with antibiotics, the trend of antibody titer is different from the natural course of the disease, so As long as the double serum is increased by a factor of 2 or more, a clear history of exposure and typical clinical manifestations can be confirmed. A.4 Differential diagnosis Mainly with syphilis rash, rat bite fever, forest encephalitis, viral encephalitis, meningitis, rheumatism and rheumatoid arthritis, cardiomyopathy, Identification of tsutsugamushi disease, acute mononucleosis, and skin fungal infections. A.5 Diagnostic naming of occupational Lyme disease Occupational Lyme Disease (Phase X) A.6 on the principle of treatment A.6.1 Isolation period. Lyme disease does not require isolation. A.6.2 Pathogen treatment. early treatment with oral sensitive antibiotics can cause typical migratory erythema to disappear quickly and prevent The main complications (meningitis or recurrent arthritis) appear later. Antibiotics sensitive to Borrelia burgdorferi are tetracycline, ampicillin Xilin, ceftriaxone, imipenem, penicillin G, etc. Oral administration of doxycycline or erythromycin is usually used in the menopause; penicillin can be administered intravenously during the flood season. G; sputum. patients with severe nerve, heart or joint damage, intravenous injection of penicillin G or ceftriaxone. A.6.3 Symptomatic treatment. patients should rest in bed, pay attention to add enough liquid. For those who have fever or skin lesions, it may be appropriate Apply antipyretic analgesics. Glucocorticoids can be given to patients with high fever and systemic symptoms. For those with joint damage, intra-articular injection should be avoided. A.6.4 Prognosis. Early detection of the disease, in the flood season, flood season, timely anti-pathogenic treatment, the prognosis is generally good. Treatment in the flood season, large Most can alleviate, occasionally recurrence of arthritis; there may also be Lyme disease syndrome, that is, after the patient is treated with anti-pathogenic agents, the spirochete is dead. Retaining cells causes dermatitis and autoimmune reactions. Those with severe damage to the central nervous system may have sequelae. A.6.5 Prevention. The prevention of this disease is to do personal protection, wear appropriate protective clothing, hats, apply sputum and remove sputum drugs to prevent Locust bites.

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